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Arquivos Brasileiros de Cardiologia, Volume: 78, Número: 6, Publicado: 2002
  • Echocardiographic Assessment of the Pulmonary Venous Flow: An Indicator of Increased Pulmonary Flow in Congenital Cardiac Malformations Original Articles

    Rivera, Ivan Romero; Moisés, Valdir Ambrósio; Paola, Angelo Amato V. de; Carvalho, Antonio Carlos

    Resumo em Inglês:

    OBJECTIVE: To identify the left inferior pulmonary vein as an indirect marker of increased pulmonary flow in congenital heart diseases.METHODS: We carried out a prospective consecutive study on 40 patients divided into 2 groups as follows: G1 - 20 patients diagnosed with congenital heart disease and increased pulmonary flow; G2 (control group) - 20 patients who were either healthy or had congenital heart disease with decreased or normal pulmonary flow. We obtained the velocity-time integral of the left inferior pulmonary vein flow, excluding the "reverse A" wave, with pulsed Doppler echocardiography.RESULTS: In G1, 19 out of the 20 patients had well-identified dilation of the left inferior pulmonary vein. No G2 patient had dilation of the left inferior pulmonary vein. Dilation of the left inferior pulmonary vein in conditions of increased pulmonary flow had sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 95% (1 false-negative case). The integral of time and velocity of the pulmonary venous flow obtained with pulsed Doppler echocardiography was greater in the G1 patients (G1=25.0±4.6 cm versus G2=14.8±2.1 cm, p=0.0001).CONCLUSION: The identification of dilation of the left inferior pulmonary vein suggests the presence of congenital heart disease with increased pulmonary flow. This may be used as an indirect sign of increased flow, mainly in malformations of difficult diagnosis, such as atrial septal defects of the venous sinus or coronary sinus type.
  • Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit Original Articles

    Moreira, Daniel Martins; Mariante Neto, Guilherme; Oliveira, Marcelo Wierzynski; Alves, Letícia Biscaino; Adamatti, Luís Carlos Chorazje; Trotta, Eliana de Andrade; Vieira, Sílvia Regina Rios

    Resumo em Inglês:

    OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01) death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.
  • Can the Cardiopulmonary 6-Minute Walk Test Reproduce the Usual Activities of Patients with Heart Failure? Original Articles

    Guimarães, Guilherme Veiga; Bellotti, Giovanni; Bacal, Fernando; Mocelin, Amilcar; Bocchi, Edimar Alcides

    Resumo em Inglês:

    OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45±12 years, ejection fraction 23±7%, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max), cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale) (6EB), and cardiopulmonary 6-minute walk test using the usual recommendations (6RU). The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption (ml.kg-1.min-1) 15.4±1.8, 9.8±1.9 (60±10%), and 13.3±2.2 (90±10%); heart rate (bpm) 142±12, 110±13 (77±9%), and 126±11 (89±7%); distance walked (m) 733±147, 332±66, and 470±48; and respiratory exchange ratio (R) 1.13±0.06, 0.9±0.06, and 1.06±0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p<0.05). CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients.
  • Analysis of the Association Between Apolipoprotein E Polymorphism and Cardiovascular Risk Factors in an Elderly Population with Longevity Original Articles

    Schwanke, Carla Helena Augustin; Cruz, Ivana Beatrice Mânica da; Leal, Ney Furhmann; Scheibe, Rosane; Moriguchi, Yukio; Moriguchi, Emílio Hideyuki

    Resumo em Inglês:

    OBJECTIVE: To establish the allelic and genotypic frequencies related to apolipoprotein E (ApoE) polymorphism and association of the genotypes with risk factors and cardiovascular morbidity in an elderly population with longevity. METHODS: We analyzed 70 elderly patients aged 80 years or more who were part of the Projeto Veranópolis. We used the gene amplification technique through the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and cleavage with the restriction enzyme Hha I to identify the ApoE genotypes. The most frequent genotypes were compared considering biological variables and cardiovascular risks and morbidity. RESULTS: The frequencies of the E2, E3, and E4 alleles were 0.05, 0.84, and 0.11, respectively, and of the genotypes were as follows: E3E3 (0.70), E3E4 (0.22), E2E3 (0.06), and E2E2 (0.02). Individuals with the E3E4 had a mean age greater than those with the E3E3. No association was observed between the genotypes and the variables analyzed, except for obesity, which was associated with the E3E3 genotype. Individuals with the E3E4 genotype had high levels of LDL-cholesterol and fibrinogen as compared with those with the E3E3 genotype. CONCLUSION: The results suggest that the E4E4 genotype may be associated with early mortality. A balance between the protective or neutral factors and the cardiovascular risk factors may occur among the individuals with different genotypes, attenuating the negative effects of the E4 allele.
  • Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism Case Report

    Rachid, Acir; Caum, Leiber C.; Trentini, Ana Paula; Fischer, Carlos A.; Antonelli, Dênis A. J.; Hagemann, Rafael P.

    Resumo em Inglês:

    The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.
  • Primary Cardiac Angiosarcoma: A Therapeutical Dilemma Case Report

    Frota Filho, José Dario; Lucchese, Fernando A.; Leães, Paulo; Valente, Luís Antônio; Vieira, Mariana S.; Blacher, Celso

    Resumo em Inglês:

    Cardiac angiosarcomas are malignant tumors that almost invariably have a short and fatal evolution. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. Heart transplantation is an attractive option in nonresectable tumors, even though the current experience is still limited. However, in most patients, the diagnosis is still established late, and survival is only slightly altered by the proposed treatments, mainly due to previously existing and undetected metastases. We report a case that illustrates the therapeutic dilemma faced with this neoplasia, and we discuss the case based on a literature review.
  • Multiple Embolism in a Female Patient with Infective Endocarditis: Low Back Pain and Hematuria as the Initial Clinical Manifestations Case Report

    Vieira, Marcelo Luiz Campos; Schmidt, Mônica Luisa Rappi; Resende, Marcos Valério Coimbra de; André Júnior, Luis Sérgio Afonso de

    Resumo em Inglês:

    A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.
  • Consultar, Diagnosticar e Tratar Vivências Da Prática

    Tuppy, Georg
  • Febre, Convulsão e Coma em Mulher de 60 Anos Portadora de Doença Reumática Crônica Correlação Anatomoclínica

    Coutinho, Margleicia Maria Vasconcelos; Demarchi, Léa Maria Macruz Ferreira
  • Caso 6/2002 - Instituto do Coração do Hospital das Clínicas da FMUSP Correlação Clínico-Radiográfica

  • Intervenções Percutâneas em Cardiopatias Congênitas Atualização

    Costa, Francisco de Assis; Kajita, Luiz Junya; Martinez Filho, Eulógio Emílio
  • A Participação do Tecido Adiposo Visceral na Gênese da Hipertensão e Doença Cardiovascular Aterogênica: Um Conceito Emergente Atualização

    Barroso, Sergio Girão; Abreu, Virgínia Genelhu de; Francischetti, Emílio Antonio
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