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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Edition: 28.2 - 12 Article(s)

Editorial

Food may lead to benefits for the cardiovascular system: fact or fiction?

Alimentação pode levar a benefícios para o sistema cardiovascular: fato ou ficção?

Ludmila Cardozo; Denise Mafra

Int J Cardiovasc Sci. 2015;28(2):87-88

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Original Article

Effects of chocolate in the endothelial function of patients with acute coronary syndrome

Efeitos do chocolate na função endotelial de pacientes com síndrome coronariana aguda

Ana Maria Junkes Colombo; Jamil Mattar Valente Filho; Daniel Medeiros Moreira

Int J Cardiovasc Sci. 2015;28(2):89-94

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INTRODUCTION: Unsweetened chocolate improves endothelial function, but there are few data on its action in patients with coronary disease.
OBJECTIVE: To assess the endothelial function in patients with acute coronary syndrome after consumption of unsweetened chocolate and white chocolate.
METHODS: This is a randomized crossover clinical trial that evaluated 11 patients admitted with acute coronary syndrome. The patients were selected to receive unsweetened chocolate or white chocolate and crossed over to receive the other intervention after seven days. The primary outcome was the variation in flow-mediated vasodilation of the brachial artery pre and post intervention in both groups. The secondary outcomes were the values of flow-mediated vasodilation and the diameter of the brachial artery after the intervention, the levels of high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR).
RESULTS: The variation of flow-mediated vasodilation pre and post intervention was higher in the group that received the unsweetened chocolate compared with the group that received white chocolate. Both groups showed a significant increase in flow-mediated vasodilation after intervention. The flow-mediated vasodilation after intervention, however, was higher in the group receiving unsweetened chocolate (0.32±0.10) compared to white chocolate (0.21±0.11) (p=0.001). There were no significant differences in hsCRP, ESR, SBP, DBP or HR values.
CONCLUSION: The consumption of chocolate improves endothelial function in patients after acute coronary syndrome patients and this effect is more pronounced with the consumption of unsweetened chocolate.


Keywords: Acute coronary syndrome; Cacao; Endothelium, vascular

Is active search for congenital heart disease possible? Experience from eight Brazilian cities

Busca ativa por cardiopatias congênitas é factível? Experiência em oito cidades brasileiras

Sandra da Silva Mattos; Cláudio Teixeira Regis; Felipe Alves Mourato; Thamine de Paula Hatem; Carolina Paim Gomes de Freitas; Renata Grigório Silva Gomes; Vanessa Oliveira Pacífico de Souza; Lucia Roberta Didier Nunes Moser

Int J Cardiovasc Sci. 2015;28(2):95-100

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BACKGROUND: Congenital heart defects are the cause of high morbidity and mortality in pediatric patients. In developing regions, the lack of early diagnosis may lead to worsening of the condition; an active search for congenital heart diseases can assist in resolving this situation.
OBJECTIVE: To describe the key findings of an active search for heart diseases in childhood, held in eight Brazilian cities in the state of Paraíba.
METHODS: A study conducted in eight Brazilian cities in the state of Paraíba. The active search included two phases. In the first, local health centers screened children with symptoms or a history of cardiovascular diseases. In the second phase, a clinical consultation with echocardiogram to identify diseases was conducted. The frequencies were then analyzed. Categorical variables were compared using the chi-square test.
RESULTS: 440 children were assisted. Of these, 192 (43.63%) had abnormalities on echocardiogram. The presence of heart sounds and Down's syndrome showed a significant correlation (p <0.05) with the congenital heart disease. Most cases were congenital heart disease by shunt (64.1%), followed by valve defects (12.5%) and acyanogenic obstructive heart diseases (8.3%).
CONCLUSION: The active search conducted was able to identify a significant number of congenital heart diseases in childhood not previously recognized and inserting these patients in health services for appropriate treatment, thus ensuring them a better quality of life.


Keywords: Screening; Public health; Congenital heart diseases

Hemostatic risk marker associated with cardiovascular events in metabolic syndrome

Marcador de risco hemostático associado a eventos cardiovasculares em síndrome metabólica

Luiz Carlos Bodanese; Mario Wiehe; Joyce Santos Jardim; Cassiane Cardoso Bonato; Ellen Magedanz Rodrigo Bodanese;Terezinha Paz Munhoz

Int J Cardiovasc Sci. 2015;28(2):101-106

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BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in developing countries. Individuals with metabolic syndrome (MS) are at increased risk for CVD. The traditional risk factors, altogether, do not explain all cardiovascular events. The von Willebrand factor (vWF), involved in platelet aggregation and thrombosis, has been investigated in this context.
OBJECTIVE: To investigate the relationship between the vWF and CVD in patients with MS, with and without previous cardiovascular events.
METHODS: The study included 77 outpatients, >18 years, with MS, according to the criteria established by NCEP-ATP III. The plasma level of vWF was measured and the mean values were compared between the groups with prior CVD (n=30) and without documented CVD (n=47).
RESULTS: In the study population, 66.0% were female, 78.0% were white, mean age 63.7±8.9, mean weight 82.9±14.9 kg, and body mass index 32.2±4.8 kg/m2. The average plasma level of vWF was similar in patients with and without previous CVD, with values of 154.5±52.1 and 155.47±41.4, respectively. There was an association between diabetes mellitus (DM) and established CVD, which remained significant after adjusting for other variables included in the multivariate model.
CONCLUSIONS: There was no difference in the mean plasma level of vWF among patients with MS, with and without documented CVD. The presence of DM, however, was independently associated with CVD in this population.


Keywords: Cardiovascular diseases; Metabolic syndrome X; Diabetes mellitus

Evaluation of the manchester triage system in the acute coronary syndrome

Avaliação do sistema de triagem de manchester na síndrome coronariana aguda

Vivian Ellen Tácito Gouvêa; Marco Antonio Moura Reis; Gustavo Maciel Gouvêa; Helbert do Nascimento Lima; Allan Abuabara

Int J Cardiovasc Sci. 2015;28(2):107-113

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BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide. The search for safe solutions to ensure priority in the healthcare of patients with severe conditions, such as acute coronary syndrome, is a determining factor in the prognosis.
OBJECTIVE: To evaluate the healthcare of patients with acute coronary syndrome undergoing the Manchester triage system applied by nurses.
METHODS: Retrospective observational study based on the review of medical reports of patients admitted for acute coronary syndrome between October 2010 and April 2012 in a public hospital of cardiology in Joinville, Brazil. The following were assessed: health history, symptoms on admission, medical diagnosis, classification by the Manchester triage system, opening hours and procedures, information on admission, and the outcome of the case. The data were entered into an e-form and submitted to statistical analysis.
RESULTS: Of the 191 patients selected, 65.0% were men and 47.0% had a history of coronary artery disease. The Manchester triage system allowed correctly classifying 80.1% of patients. The flowchart "thorax pain" with the discriminator "chest pain" was the most used. The average waiting time for classification, medical care and first electrocardiogram were 12.2, 28.6 and 24.9 minutes, respectively.
CONCLUSION: The Manchester triage system allowed a high rate of correct classification by the nurse of patients with acute coronary syndrome.


Keywords: Triage; Acute coronary syndrome; Emergencies

Food insecurity in households of patients with hypertension and diabetes

Insegurança alimentar em domicílios de indivíduos portadores de hipertensão e/ou diabetes

Sandra Mary Lima Vasconcelos; Niedja Cristina Paciência Torres; Patrícia Maria Candido Silva; Tatiana Maria Palmeira dos Santos; Juliana Vasconcelos Lyra da Silva; Cristhiane Maria Bazílio de Omena; Alane Cabral Menezes de Oliveira

Int J Cardiovasc Sci. 2015;28(2):114-121

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BACKGROUND: People living in households with food insecurity typically have a monotonous diet, low in complex carbohydrates and rich in simple sugars and fats. Such condition associated with obesity, diabetes mellitus (DM) and hypertension (HA) compromises the quality of life and contributes to an increased risk of morbidity and mortality, especially from cardiovascular diseases.
OBJECTIVES: To evaluate cardiovascular risk factors (CVRF) in patients with HA and/or diabetes mellitus and its relationship with the socioeconomic status and the situation of food insecurity (IA) in households.
METHODS: Cross-sectional study. Patients evaluated: (In) household food security according to the Brazilian Scale of food insecurity (EBIA): Mild, moderate and severe FI; economic status and CVRF. We used the chi-square test, bivariate logistic regression, OR with 95% CI and p≤0.05.
RESULTS: The study included 225 patients: 74.0% (n=166) hypertensive (M), 18.0% (n=41) diabetic hypertensive (HD) and 8.0% (n=18) diabetic patients (D); 80.9% were women, mean age 60.3±11.19 years and 64.0% belonging to the economy class D. The patients resided in households in FI: 78.0% of H, 73.0% of HD and 78.0% of D. The frequency of CVRF among individuals in FI was high: 92.0% hypertension, 80.0% hypercholesterolemia, 79.0% hyperglycemia, 76.0% overweight/obesity, 73.0% abdominal obesity and 72.0% hypertriglyceridemia. There was a positive association between FI and hypertension (p=0.034), abdominal obesity (p=0.009) and hypertriglyceridemia (p=0.001).
CONCLUSIONS: The predominant unsafe condition in the households of the population studied represents an additional risk factor, since the difficulty of access to healthy food both in quantitative and quality terms compromises the treatment and control of these diseases.


Keywords: Food security; Hypertension; Diabetes mellitus; Risk factors; Cardiovascular diseases

A comparative study among different treatment adherence methods in hypertensive patients

Estudo comparativo entre diferentes métodos de adesão ao tratamento em pacientes hipertensos

Tania Pavão Oliveira Rocha; José Albuquerque de Figueredo Neto; Darci Ramos Fernandes; Ewaldo Eder Carvalho Santana; Jerusa Emídia Roxo Abreu; Raimundo Luís Silva Cardoso; Jorgiléia Braga de Melo

Int J Cardiovasc Sci. 2015;28(2):122-129

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BACKGROUND: Cardiovascular diseases are the leading cause of death in Brazil, and systemic hypertension is one of the main risk factors. In this sense, adherence to treatment is critical for controlling hypertension and prevention of its complications.
OBJECTIVES: To determine and compare non-adherence rates to hypertension treatment by using different methods and blood pressure control, and determine the factors associated with non-adherence of hypertensive patients in Estratégia Saúde da Família (Family Health Strategy), in the city of São Luís, state of Maranhão.
METHODS: The cross-sectional study, conducted in São Luís, State of Maranhão, with 502 users of Estratégia Saúde da Família (Family Health Strategy - FHS). In order for adherence to be assessed, we used the Morisky and Green Test (MGT), Qualiaids team's Medication Adherence Questionnaire (QAM-Q) and Haynes' Questionnaire. To check the relation between adherence to treatment and sociodemographic and clinical variables, either Fisher's exact test or Chi-Square Test was used.
RESULTS: Non-adherence prevalence rate measured by MGT, MAQ-Q and Haynes was, respectively, 29.28%, 60.16% and 13.15%. Concordance between Haynes-MAQ-Q tests (kappa=80.68%) was substantial, while those between MAQ-Q-Morisky (kappa=48.61%) and Morisky-Haynes (kappa=55.58%) were moderate. Variables such as patient's smoking habit and return to physician for a follow-up visit have been shown, in all three tests, to be associated with non-adherence to treatment.
CONCLUSIONS: Tests under evaluation have been shown to have good concordance. Non-adherence rate was high when measured by MAQ-Q, but low when measured by MGT and Haynes. Considering the control of blood pressure, MAQ-Q and Haynes presented statistical significance; MAQ-Q identified the greatest number of individuals with non-controlled blood pressure among those who do not adhere. The variables smoking and showing up to return visits were associated with non-adhesion in the three questionnaires.


Keywords: Hypertension; Medication adherence; Questionnaires

Evaluation of the impact to the treatment of heart failure in the Brazilian public health system

Avaliação do impacto do tratamento da insuficiência cardíaca em hospital do Sistema Único de Saúde

Frederico Augusto de Lima e Silva; Guilherme Emilio Ferreira; Ezequiel Aguiar Parente; Eduardo Cesar Rios Neto

Int J Cardiovasc Sci. 2015;28(2):130-138

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BACKGROUND: Heart failure (HF) is a worldwide health problem with the prospect of further increasing its prevalence due to population growth and increased life expectancy. The clinical treatment of patients with HF is the use of drugs, devices and procedures that improve cardiac performance, relieve symptoms and prolong survival.
OBJECTIVE: To evaluate the impact of treatment of heart failure in Hospital de Messejana (HM), Fortaleza, CE, Brazil.
METHODS: This is an observational, retrospective and quantitative study. In this study, 635 adult patients admitted in the Cardiac Units of HM from January 2011 to July 2013 were evaluated through the analysis of medical records. The study evaluated aspects related to mortality rates, treatment effectiveness and the number of readmissions. It also investigated the incidence of hospital infections and the percentage of patients whose treatment was heart transplantation.
RESULTS: Concerning the clinical treatment, 88.3% used anticoagulants, 80.8% used diuretics, 74.2% used beta-blockers, 48.7% used angiotensin-converting enzyme inhibitors and 19.25% used angiotensin receptor blocker. About the surgery, 11% had valvuloplasty or valve replacement, 9.3% had heart transplantation, 2.2% had pacemaker implant and 4.7%, coronary artery bypass grafting surgery.
CONCLUSION: Patients treated with HF in HM received the classic therapy recommended, including the use of surgical devices and procedures such as heart transplantation and had a satisfactory outcome in most cases, despite a high rate of in-hospital mortality.


Keywords: Treatment intention analysis; Survival analysis; Heart failure; Hospital mortality; Hospitalization

Identification of readmission predictors in elderly patients with acute coronary syndrome

Identificação dos preditores de readmissão de idosos com síndrome coronariana aguda

Jaqueline Nagatani Belitardo; Andrea Cotait Ayoub

Int J Cardiovasc Sci. 2015;28(2):139-147

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BACKGROUND: Readmission in elderly patients with acute coronary syndrome (ACS) is often associated with decreased functional capacity and quality of life, besides being an indicator of hospital care quality.
OBJECTIVES: To identify clinical and sociodemographic profile of elderly patients with ACS, the hospital readmission predictors and the time that may influence the readmission-free survival curve; to describe the most prevalent nursing diagnoses.
METHODS: Retrospective longitudinal study with purposive sample of elderly patients with ACS based on retrospective analysis of 2012 medical records, considering the following variables: date of admission, cause, time interval between readmissions and hospital length of stay. Data were expressed in frequencies and means ± standard deviation. The readmission-free survival (p <0.05) was evaluated by the Kaplan-Meier curve.
RESULTS: Seventy-five elderly patients with ACS were studied: average of 72.0±8.3 years old, 61.3% male, 89,0% with hypertension. The readmission predictors were: ACS and percutaneous procedures. The period between readmissions ranged from 7 to 60 days, where 53.5% ranged from 31 to 60 days after hospital discharge. Nursing Diagnoses (NDs): impaired tissue integrity presented 25-day readmission average (p=0.04); 77 days (p=0.01) for impaired physical mobility, and 86 days (p=0.02) for risk for constipation.
CONCLUSIONS: Clinical and sociodemographic characteristics of elderly patients with ACS under study: male, mean age of 72 years, low level of education, with multiple comorbidities. ACS and percutaneous procedures were the most frequent readmission predictors. NDs indicating possibility for readmission: impaired tissue integrity, risk for constipation and impaired physical mobility.


Keywords: Patient readmission; Quality indicators in health care; Elderly Patients; Acute coronary syndrome; Nursing care

Preliminary Communication

Clinical examination and pulse oximetry to detect congenital heart defects

Exame físico e oximetria de pulso para detectar cardiopatias congênitas

Fernanda Cruz de Lira Albuquerque; Elizabeth Trigueiro Maia; Vanda Lúcia de Figueiredo; Felipe Alves Mourato; Sandra da Silva Mattos

Int J Cardiovasc Sci. 2015;28(2):148-151

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BACKGROUND: Many studies have shown that arterial-pulse oximetry is an effective tool for screening congenital heart defects (CHD), and most of these studies have been carried out in developed countries.
OBJECTIVE: Analyze primary data from the CHD screening performed through clinical examination and arterial-pulse oximetry in a maternity hospital, in the Brazilian Northeast.
METHODS: Neonates born after 34 weeks of pregnancy and in good clinical conditions were screened for CHD through clinical examination (CE) and arterial-pulse oximetry (APO) after 24 hours of life and before hospital discharge.
RESULTS: Screening techniques increased the detection of CHD at the maternity hospital. However, most cases were detected through clinical examination. Underperformance of arterial-pulse oximetry.
CONCLUSION: The combination of arterial-pulse oximetry and clinical examination is crucial in the detection of congenital heart defects. Arterial-pulse oximetry alone, although useful to detect critical cases, has underperformed against clinical examination.


Keywords: Mass screening; Heart defects, congenital; Oximetry

Update Article

Coronary microvascular dysfunction

Disfunção coronariana microvascular

Leonardo Silva Roever Borges; Elmiro Santos Resende

Int J Cardiovasc Sci. 2015;28(2):152-159

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In the last two decades, a number of studies reported that abnormalities in the coronary microcirculation function and structure may occur in patients without obstructive atherosclerosis, in patients with risk factors, with myocardial diseases, as well as in obstructive atherosclerosis. Coronary microvascular coronary dysfunction may be iatrogenic and is an important risk marker, contributing to the pathogenesis of cardiovascular and myocardial diseases. Due to its importance, it becomes a therapeutic target. This article presents an update on the clinical relevance of coronary microvascular dysfunction in different clinical situations.


Keywords: Myocardial infarction; Coronary angiography; Atherosclerosis

Point of View

Medical therapy of stable multivessel coronary artery disease. Less is more?

Tratamento clínico da doença coronariana multiarterial estável. Menos é mais?

Antônio Sérgio Cordeiro da Rocha

Int J Cardiovasc Sci. 2015;28(2):160-162

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Despite the advances of all forms of treatment of coronary artery disease (CAD), there is still considerable controversy about the benefits of myocardial revascularization surgery compared to medical therapy (MT). In multivessel CAD, randomized clinical trials have demonstrated that revascularization techniques did not reduce the incidence of hard outcomes, such as death and nonfatal acute myocardial infarction. Thus, these studies suggest that the MT, a lower treatment cost, may be applied as an initial therapy for these patients.


Keywords: Coronary disease; Myocardial revascularization; Therapeutic approaches

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