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

Edition: 26.2 - 11 Article(s)

Point of View

How we treat hypertension in children and adolescents

Como tratamos hipertensão na criança e no adolescente

Sabrina Andrade de Godoy Bezerra; Ana Luiza Saenger; Renato de Lima Azambuja; Andréa Araujo Brandão

Rev Bras Cardiol. 2013;26(2):86-89

Abstract PDF PORT

The authors emphasize the importance of diagnosing hypertension in childhood and adolescence, together with blood pressure (BP) classification and pharmacological and non-pharmacological recommendations for controlling BP in this age group. The early adoption of BP interventions is of fundamental importance for the primary prevention of cardiovascular diseases.

Keywords: Hypertension; Treatment; Child; Adolescent

Preliminary Communication

Pharmacoepidemiology and antihypertensive drugs misuse at Rio de Janeiro state

Farmacoepidemiologia e uso indevido de anti-hipertensivos no estado do Rio de Janeiro

Felipe Costa de Souza; Emiliana Barbosa Marques; Ana Amélia Rangel Ribeiro; Karoline Carvalho Coutinho; Christianne Bretas Vieira Scaramello

Rev Bras Cardiol. 2013;26(2):90-93

Abstract PDF PORT

BACKGROUND: Pharmacoepidemiology makes possible the better knowing and understanding of patients drugs use risk-benefit ratio.
OBJECTIVE: Our study aims to evaluate the use of drugs by people in productive ages that live in metropolitan area of Rio de Janeiro state. Data collection included a structured questionnaire applied after an informed consent document signature.
RESULTS: Nonsteroidal antiinflammatories (40%), drugs used in cardiovascular diseases (23%) and oral contraceptives (9%) were the most used pharmacological classes by 235 respondents. Angiotensin converting enzyme inhibitors/angiotensin receptor blockers (A, 29-33%), diuretics (D, 28%) and -blockers (B, 21-35%) were the most antihypertensives used by 186 individuals aged from 20 to 60 years.
CONCLUSIONS: The hypertension pharmacological management indicated for the studied group covers A or B monotherapy. It is inappropriate to use N; B must be avoided, such as D, especially in combination therapy because B and D promote glucose intolerance and hypertriglyceridemia. Hypertensive females in reproductive ages must avoid A and drug interaction with oral contraceptives. So the use of antihypertensive drugs is not entirely in agreement to current consensus.

Keywords: Pharmacoepidemiology; Antihypertensives; Prescription drug misuse; Working-age population

Original Article

Association among nutritional status, waist circumference and blood pressure in adolescents

Associação entre estado nutricional antropométrico, circunferência de cintura e pressão arterial em adolescentes

Everton Domingos; Veridiana Domingues; Raymundo Pires Júnior; Alexandre Schubert Caldeira; Diego Giulliano Destro Christofaro; Juliano Casonatto

Rev Bras Cardiol. 2013;26(2):94-99

Abstract PDF PORT

BACKGROUND: Heart diseases are the main cause of morbidity and mortality, with these rates rising with age. However, epidemiological studies have been indicating an increase in the prevalence of related risk factors among young people and adolescents.
OBJECTIVE: To ascertain the existence of possible associations between waist circumference and high blood pressure among children and adolescents in the government school network in Cambira, northern Paraná State, Brazil.
METHODS: This transverse study was conducted between August and November 2011, with a sample of 154 schoolchildren between 10 and 17 years old. Anthropometric analyses of body mass, height and waist circumference were undertaken, as well as measuring at-rest blood pressure. The Mann-Whitney U and Student t tests were used to analyze and compare the data. The chi-square test examined associations among blood pressure, nutritional status and waist circumference. Binary logistics regression was used to identify the magnitude of the associations, with a significance level of p<0.05.
RESULTS: There was an association between nutritional status and high blood pressure (p=0.032), as well as between waist circumference and high blood pressure (p=0.003). Subjects with abdominal obesity were 3.23 times more likely to develop high blood pressure, compared to individuals with a normal waist circumference.
CONCLUSION: Abdominal obesity is associated with an increase in high blood pressure among adolescents.

Keywords: Adolescents; Abdominal obesity; Blood pressure

Acute effects of high intensity physical exercise on post-prandial lipemiain young subjects not exercising regularly

Efeito agudo imediato de uma sessão de exercício físico sobre a lipemia pós-prandial em jovens irregularmente ativos

Jefferson Petto; Jefferson Andrade Pereira; Rubens da Purificação Britto; Cloud Kennedy de Sá; Luis Agnaldo Pereira Souza; Ana Marice Teixeira Ladeia

Rev Bras Cardiol. 2013;26(2):100-105

Abstract PDF PORT

BACKGROUND: Postprandial lipemia (PPL) is a metabolic phenomenon that is correlated with atherogenesis. Although exercise lowers the triglycerides (TG) curve resulting from LLP, its acute effect has not yet been fully clarified.
OBJECTIVE: To discover whether Short Duration High Intensity Interval Training (SDHIIT) lowers the (TG) curve resulting from LLP among young people who exercise irregularly.
METHODS: A prospective analytical study analyzed 32 individuals (14 men) with an average age of 25±3.3 years and no metabolic alterations who underwent a cardiopulmonary exercise test and two PPL tests: Basal (PPLT-B) and Exercise (PPLT-E). Blood samples were collected for TG measurements at intervals of 0 minutes (fasting) and 30 minutes, and after ingestion of a lipid compound (50 g) at 90 minutes, 210 minutes and 270 minutes. After the fasting blood collection, an SDHIIT session was completed on a treadmill for the PPLT-E at 40% VO2max.
RESULTS: The PPLT-B and PPLT-E values for fasting, 30 minutes, 90 minutes, 210 minutes and 270 minutes were respectively: 69±34 mg/dL vs. 72±34 mg/dL (p= 0.4348); 68±34 mg/dL vs. 71±34 mg/dL (p=0.4771); 78±37 mg/dL vs. 77±34 mg/dL (p=0.8457); 124±57 mg/dL vs. 124±53 mg/dL (p=0.9525); and 120±64 mg/dL vs. 124±65 mg/dL (p=0.6636), finding no significant difference.
CONCLUSION: The results show that the lipid curve resulting from PPL among young people exercising irregularly is not modified by SDHIIT.

Keywords: Hyperlipemia; Dyslipidemias; Primary prevention

An educational activity in the waiting room with heart failure patients

Atividade educativa na sala de espera com pacientes com insuficiência cardíaca

André Maurício Souza Fernandes; Viviane Sahade Souza; Igor Carmo Borges; Dafne Carvalho Andrade; Felipe Amoedo Luedy; Rodrigo Rêgo Martins; Roque Aras Júnior; Francisco José Farias Borges dos Reis

Rev Bras Cardiol. 2013;26(2):106-111

Abstract PDF PORT

BACKGROUND: Heart failure (HF) is a chronic syndrome and of complex treatment. So that, it allows health education strategies to have important impact on the management of these patients.
OBJECTIVE: To evaluate the efficacy of educational activities on the waiting room of a specialized clinic for patients with HF.
METHODS: While waiting for their appointments at the clinic, the patients took part on an educational activity with main duration of 40 minutes. They answered questionnaire (consisting of 10 questions) both before and after the lectures about HF. Sociodemographic data were collected during the questionnaire application and the clinical data during the medical appointment.
RESULTS: 187 patients answered the initial questionnaire and 114 answered both of them. There was a significant improvement of the questionnaire's results after the lectures (79.3% vs 92.8%, p<0.001).
CONCLUSIONS: Lectures performed at the waiting room of a specialized clinic represent an important educational strategy of simple execution and with a significant immediate impact on the patient's knowledge about HF.

Keywords: Heart failure; Teaching; Outpatient clinic; Learning

Long term follow up of patients undergoing valvular cardiac surgery

Seguimento pós-operatório em longo prazo de pacientes submetidos à cirurgia valvar

Fernando Fonseca França Ribeiro; Guilherme D'Andréa Saba Arruda; David Mayer Ptak; Fernando Reis Menezes; Miguel Angel Ortuno Torrico; Auristela Isabel de Oliveira Ramos

Rev Bras Cardiol. 2013;26(2):112-119

Abstract PDF PORT

BACKGROUND: The native valve may be replaced by a mechanical or biological prosthesis, with this choice often open to discussion, as it raises morbidity and mortality issues for operated patients.
OBJECTIVE: To compare the progress of patients receiving biological and mechanical prostheses.
METHODS: Retrospective study of the medical records of patients undergoing first valve replacements (aortic and/or mitral), from 1995 to 2000 at a tertiary hospital in the National Health network. Of the 303 records selected, 173 constituted the biological group and 130 the mechanical prosthesis group. The variables analyzed included gender, age when operated, comorbidities, type of surgery, ventricular ejection fraction and cardiac rhythm before and after surgery, and outcomes: death, reoperation, stroke and infective endocarditis.
RESULTS: The median follow-up time was 10 years, with delayed mortality at 3.46% (bio-prosthesis) and 5.38% (mechanical), p=0.568. There were more reoperations in the bio-prosthesis group (43.4%) than in the mechanical group (4.6%), with an OR of 15.83 (CI 95% 6.61 - 7.85; p<0.001). The stroke rate was similar (11% for bio-prosthesis vs 8.5% mechanical) p=0.561, with endocarditis at 11.6% for bio-prosthesis vs 6/2% mechanical (p=0.115).
CONCLUSIONS: The mortality, stroke and endocarditis rates were statistically similar between the groups, but with significantly more reoperations in the mitral and aortic bio-prosthesis group.

Keywords: Heart valves; Mitral valve; Aortic valve; Heart valve prosthesis

Is glycated hemoglobin a predictor for the anatomical severity and extent of coronary artery disease?

A hemoglobina glicada é preditora de extensão e gravidade anatômica da doença arterial coronariana?

Marcelo Bettega; André de Castro Linhares; Deize Caldeira; Aniele Cristine Ott Clemente; Paulo Roberto Ferreira Rossi; Mirnaluci Paulino Ribeiro Gama

Rev Bras Cardiol. 2013;26(2):120-126

Abstract PDF PORT

BACKGROUND: Elevated glycated hemoglobin (A1C) levels are associated with higher rates of adverse cardiovascular events, but its correlation with the anatomical severity of coronary artery disease (CAD) is not well established.
OBJECTIVE: To correlate A1C with the extent and severity of CAD in a Cardiology Reference Hospital in Curitiba.
METHODS: A prospective longitudinal observational study in which patients hospitalized consecutively for acute coronary syndrome were segmented into three groups: diabetics, hyperglycemics and euglycemics (control group), based on admission glycemia and fasting blood glucose. They were compared for admission glycemia, fasting blood glucose, A1C, HDL, triglycerides, CK-MB activity, abdominal circumference, ultra-sensitive C-reactive protein and blood pressure. Cardiac catheterization was performed to evaluate CAD extent and severity.
RESULTS: Of 150 patients, 38% were hyperglycemic at admission, 36% were diabetic and 26% were euglycemic. The A1C varied between 8.17±1.08 in the diabetics, 6.29±0.53 in the hyperglycemics and 6.16±0.55 for the control group, with a significant difference. Admission glycemia, fasting blood glucose and CK-MB were also significantly different. The mean significant and critical coronary obstructions were respectively 1.18 and 0.97 per patient, not correlated to A1C.
CONCLUSION: A1C is not correlated with the anatomical severity and extent of CAD in the sample studied.

Keywords: A1C; Diabetes mellitus; Coronary artery disease; Cardiac catheterization

Electrocardiograms in the acute phase of Chagas disease through oral transmission

O eletrocardiograma na fase aguda da doença de Chagas por transmissão oral

Dilma do Socorro Moraes de Souza; Adriana de Jesus Benevides de Almeida; Francisco de Assis Costa; Elenild de Goes Costa; Maria Tereza Sanches Figueiredo; Rui Manoel dos Santos Póvoa

Rev Bras Cardiol. 2013;26(2):127-130

Abstract PDF PORT

BACKGROUND: The Amazon region has always been rated as a low-risk area for Chagas disease (CD).
OBJECTIVE: To report on electrocardiographic changes observed in the acute phase of orally transmitted CD.
METHODS: ECG tracings were analyzed for 161 patients with clinical, serological and parasitological acute phase CD, all probably infected orally, between January 2009 and April 2010, seen at the Hospital das Clínicas Gaspar Viana in Belém, Pará State, Brazil.
RESULTS: The results showed basically the same classic electrocardiographic changes described for the acute phase of the disease, suggesting no significant differences between myocarditis caused by oral transmission compared to blood and vector transmission.
CONCLUSION: Electrocardiographic changes in acute phase CD are similar to those found when this disease is contracted through vectors in endemic areas.

Keywords: Chagas cardiomyopathy; Chagas disease; Electrocardiogram

Obesity and cardiovascular risk markers in women with polycystic ovary syndrome

Marcadores de obesidade e risco cardiovascular em mulheres com síndrome dos ovários policísticos

Rosângela Maria Lopes de Sousa; Maria Bethânia da Costa Chein; José Albuquerque de Figueiredo Neto; Alexsandro Ferreira dos Santos; Joyce Pinheiro Leal Costa; Samira Gracielle Pinheiro Cutrim; André do Lago Pinheiro; João Victor Leal Salgado; Luciane Maria Oliveira Brito

Rev Bras Cardiol. 2013;26(2):131-137

Abstract PDF PORT

BACKGROUND: Obesity is very frequent in women with polycystic ovary syndrome (PCOS) and is associated with the increased cardiovascular risk.
OBJECTIVE: To associate anthropometric measurements body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist hip ratio (WHR), body fat percentage (BF%) with the following cardiovascular risk factors (CVRF): high blood pressure, lipid profile and fasting glucose changes among women with PCOS.
METHODS: Cross-section study conducted with 78 women with PCOS, diagnosed according to the Rotterdam Consensus. The following were measured: total cholesterol (TC), triglycerides (TG), LDL cholesterol (LCL-c) HDL cholesterol (HDL-c), fasting glucose and blood pressure (BP) in all patients, as well as anthropometric variables.
RESULTS: The prevalence of obesity was high when assessed by BMI (34.6%) and BF% (61.5%). The lipid profile was relevant in the sample, especially the decrease in HDL-c noted in 34.6% of the women. The BMI, WC and WHtR showed significant positive correlation with all CVRF analyzed in this study.
CONCLUSIONS: The presence of cardiovascular risk factors was high in the sample studied. The anthropometric indicators used in this study showed a good correlation to cardiovascular risks among women with PCOS. This suggests the feasibility of using these indicators in clinical evaluations in order to detect cardiovascular risks among these patients.

Keywords: PCOS; Anthropometry; Cardiovascular risk factor

Cardiovascular Image

Electrocardiographic changes in patients with hypertrophic cardiomyopathy using ICD

Variações eletrocardiográficas em paciente portador de cardiomiopatia hipertrófica em uso de CDI

Maria Eulália Thebit Pfeiffer; Dirson de Castro Abreu; Lilian Stewart; Monica Celente; Washington Maciel

Rev Bras Cardiol. 2013;26(2):138-141

Abstract PDF PORT

Hypertrophic cardiomyopathy (HCM) is a relatively common and complex genetic heart disease, rated as main cause of sudden cardiac death (SCD) in young people, including athletes, accounting for 36% of these cases in young athletes in the United States (USA). IDC implants have proved highly effective for preventing such events. For diagnostic evaluations of CMH, the electrocardiogram (ECG) is a very useful tool, being altered in 75% to 95% of clinical cases. After an ICD implant, as demonstrated in this case report, variations in the ECG are noted that could explain the beneficial alteration in the pathophysiology of obstructive HCM.

Keywords: Hypertrophic cardiomyopathy; Defibrillators, implantable; Electrocardiogram

Case Report

Salmonella enteritidis pericarditis with tamponade

Pericardite com tamponamento por Salmonella enteritidis

Hugo Filipe de Mendonça Arruda Gonçalves Café; Bruno Francisco Taborda Oliveira da Silva; Ana Paula Moreira Faria; José Jorge Rodrigues Araújo

Rev Bras Cardiol. 2013;26(2):142-146

Abstract PDF PORT

Report on a 22 year old female with no relevant prior medical history who was admitted to the Emergency Department complaining of acute chest pain and progressive fatigue, mentioning abdominal complaints 72 hours previously. A medical evaluation showed moderate pericardial effusion. After admission, this developed into pericardial tamponade, requiring pericardiocentesis. Salmonella enteritidis was identified in the pericardial fluid, starting treatment with antibiotics. The prognosis was satisfactory, with complete clinical and echocardiographic recovery.

Keywords: Pericarditis; Salmonella enteritidis; Cardiac tamponade