Alexandre Alessi

I posicionamento brasileiro em hipertensão arterial e diabetes mellitus

The association between AH and DM was first described in the 70s, observed in both sexes and at any age range. The prevalence of hypertension is two to three-fold higher in diabetics than in the general population5, and about 70% of diabetics are hypertensive3,6. A meta-analysis of 102 prospective studies and 698,782 individuals showed that the presence of DM increases by two-fold the risk of coronary artery disease (CAD), cerebrovascular accident (CVA) and CV death. According to this meta-analysis, 10% of CV deaths in developed countries can be attributed to the presence of DM7.

Fibroelastoma of the mitral valve as a cause of transient ischemic stroke

A 44-year-old woman had a transient ischemic stroke, fibroelastoma of the mitral valve being the source of the embolus. The patient evolved with neutropenia induced by ticlopidine after 10 days of treatment. We report the major clinical features, therapeutical options, and medicamentous toxicity resulting from the use of antiplatelet drugs.

I Posicionamento Brasileiro sobre Pre-Hipertensao, Hipertensao do Avental Branco e Hipertensao Mascarada: Diagnostico e Conduta

Repeated BP measurement at the office allows the diagnosis of hypertension and normotension. To better assess BP behavior, there are methods that analyze BP by using a higher number of measurements, minimizing interferences of the environment, situation and observer. Those alternatives are as follows: 24-hour ambulatory BP monitoring (ABPM); and dwelling BP measurement [home BP monitoring (HBPM) and BP self-measurement (BPSM)]. Based on those methods, two other BP classifications were adopted: white coat hypertension (WCH) and masked hypertension (MH)1,3-5 (Figure 1).

Risk stratification by accelerated high-dose dipyridamole stress echocardiography in patients over 70 years of age

BACKGROUND The non-invasive prognostic assessment of coronary artery disease in patients over 70 years old is an important goal in daily clinical practice. OBJECTIVES To retrospectively assess the feasibility, the positive and negative predictive values and the accuracy of accelerated high-dose dipyridamole stress echocardiography in patients over 70 years old. METHODS Three hundred seventy nine patients (226 women; mean age of 75.9±4.6 years) underwent dipyridamole stress echocardiography. RESULTS Follow-up data were available for 313 patients (mean follow-up duration 21±15.7 months). Overall feasibility was 97%. Positive predictive values were 30% and 40% for 6 and 12 months of follow-up, respectively. Negative predictive values were 97.7% and 96.7% for 6 and 12 months of follow-up, respectively. Accuracy values were 95.5% and 94.9% for 6 and 12 months of follow-up, respectively. Among the clinical variables, dyslipidemia (OR 5.3; CI 95% 1.3-20.9; p=0.016), coronary artery disease (OR 4.2; CI 95% 1.3-13.3; p=0.014) and a positive stress echo response (OR 9.0; CI 95% 1.7-49.1; p=0.011) were independently associated with the occurrence of a cardiovascular event. A Cox regression model showed that male gender and a positive stress echo response significantly predicted death. CONCLUSIONS Risk stratification with accelerated high-dose dipyridamole stress echocardiography is feasible in patients over 70 years old. A positive stress echo response, the presence of coronary artery disease, and dyslipidemia positively predicted the occurrence of cardiovascular events. Male gender and a positive stress echo response significantly predicted death.

Avaliação clínica e laboratorial e estratificação de risco

AVALIACAO CLINICA E LABORATORIAL OBJETIVOS Os principais objetivos da avaliacao clinica e laboratorial estao apresentados na Tabela 1. Para atingir tais objetivos e fundamental considerar os aspectos apresentados a seguir, levando-se em conta que o tempo necessario para a avaliacao inicial de um paciente com suspeita de hipertensao arterial e de, pelo menos, 30 minutos.1 AVALIACAO CLINICA Deve-se obter historia clinica completa, com especial atencao aos dados relevantes referentes ao tempo e tratamento previo de hipertensao, fatores de risco, indicios [...]

Obstruction of the left ventricular outflow tract after mitral valvuloplasty with implantation of Gregori's ring

Mitral valvuloplasty is efficient for repairing mitral valve disease with few complications. In some cases, obstruction of the left ventricular outflow tract may occur due to systolic anterior motion of the mitral valve. We report the case of a patient with this complication and a pressure gradient between the left ventricle and the aorta of 130 mm Hg after mitral valvuloplasty with implantation of a Gregoris ring. The management was clinical with suspension of the vasoactive drugs and introduction of a beta-blocker. Two years after the surgery, the patient is asymptomatic and has a normal life.