Ademir Batista da Cunha

Left atrial myxoma associated with obstructive coronary artery disease

We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

Intervenção nos Hábitos de Vida em Instituição Pública

BACKGROUND Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18% of the men and 35% of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. STATISTICAL ANALYSIS significant variation pre and post-intervention; paired Students t test or Wilcoxons test ; existence of a significant difference between the two groups; Students t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72% of the patients that did not follow a diet, started to do so. Physical activity: of the 55% sedentary patients, 71% started to exercise three or more times a week. Smoking: of the smokers, 60% (9% of the total) stopped smoking and 32% decreased the number of cigarettes. CONCLUSION These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0).

Monitorização ambulatorial da pressão arterial e pressão casual em hiper-reatores ao esforço

BACKGROUND Developing hypertension is likely to be at least two times greater in individual with exaggerated blood pressure response on exercise testing (ET). Few reports have evaluated the parameters of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in normotensive individuals with exaggerated blood pressure response to exercise. OBJECTIVE To evaluate the relationship among the casual blood pressure with hyper-reactive response on ET and to compare Ambulatory Blood Pressure Monitoring (ABPM) data of hyper-reactive individuals with a control group in order to detect early disorders, that allows a preventive action with prognostic implication. METHODS Casual BP measurement and parameters of ABPM of 26 adult individuals, with mean age of 41.50+/-11.78 years, normotensive at rest and hyper-reactive on ET was compared to those of 16 adult individuals, with mean age of 41.38+/-11.55 years, normotensive at rest with normal BP response on exercise. The values <140 x 90 mmHg were considered normal for casual BP. The values <220 mmHg for systolic BP and/or an increase > or = 5 mmHg diastolic BP on ET for hyper-reactive response diagnosis. RESULTS Hyper-reactive individuals presented the systolic (p=0.03) and diastolic (p=0.002) casual BP and mean systolic BP (p=0.050), systolic pressure load during the day (p=0.011), and systolic (p=0.017) pressure load higher when compared to the control group. CONCLUSION Casual high normal BP had a positive correlation with exaggerated BP response. The hyper-reactive individuals showed particular characteristics in casual BP as well as in ABPM parameters, which, although within the range of reference values, differed from those of individuals with normal response to exercise.

Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients

OBJECTIVE To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.

Avaliação funcional dos enxertos coronarianos através do ecocardiograma sob estresse farmacológico com dobutamina

OBJECTIVE To verify the sensitivity, specificity and diagnostic accuracy of dobutamine stress echocardiogram (DSE) when assessing the functional status of coronary grafts: sufficient (SUF) or insufficient (INS). METHODS We carried out a prospective, observational study which included 25 patients submitted to coronary artery bypass grafting (CABG). The DSE and the coronary angiography were performed before the CABG and three months after the CABG. The left ventricle was divided into three territories per patient according to the three major coronary arterie: the anterior descending (AD), the circumflex (CX) and the right coronary (RC). Of the 75 possible territories, 54 were revascularized: 25 were specific to the AD artery and 29 of the CX/RC arteries. INS means luminal obstruction or occlusion greater than or equal to 50%. RESULTS In 14 (26%) of the 54 revascularized territories the grafts were INS. The DSE detected ischemia in 16 (28%) territories; 10 of which had INS grafts. The DSE detected ischemia in 6 (15%) of the 40 territories whose grafts were SUF. Therefore, the DSE had a sensitivity of 71.4%, specificity of 85% and diagnostic accuracy of 81.4%. CONCLUSION The DSE is a diagnostic method with high specificity and diagnostic accuracy, and good sensitivity for the functional assessment of coronary grafts.