Angelo Amato Vincenzo de Paola

I Latin American Guidelines for the diagnosis and treatment of Chagas' heart disease: executive summary.

Much has been achieved in one century after Carlos Chagas discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. Its also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.Jadelson Pinheiro de Andrade, Jose Antonio Marin Neto, Angelo Amato Vincenzo de Paola, Fábio Vilas-Boas, Glaucia Maria Moraes Oliveira, Fernando Bacal, Edimar Alcides Bocchi, Dirceu Rodrigues Almeida, Abilio Augusto Fragata Filho, Maria da Consolação Vieira Moreira, Sergio Salles Xavier, Wilson Alves de Oliveira Junior, João Carlos Pinto Dias et al Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ Brasil

Acute atrial fibrillation during dengue hemorrhagic fever

Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

The effects of glucose on myocardial substrate utilization in acute myocardial infarction or angina pectoris

Infusion of glucose-insulin-potassium during acute myocardial infarction has favorable clinical and hemodynamic effects, presumably as a result of decreased myocardial utilization of free fatty acids. In 14 patients with coronary artery disease, hypertonic glucose (a bolus of 10 g followed by infusion of a 30% glucose solution at a constant rate of 10 mg/kg/min) was infused and arterial and coronary sinus levels of glucose, lactate and free fatty acids were measured before and after 15 and 30 minutes of infusion. Arterial glucose and lactate levels increased significantly after glucose infusion, whereas free fatty acid levels decreased significantly. Modest but significant correlations also existed between glucose arterial levels and the arterial-coronary sinus glucose difference (r = 0.53, p less than 0.001); arterial lactate and the arterial-coronary sinus lactate difference (r = 0.35, p less than 0.01); arterial free fatty acids; and the arterial-coronary sinus free fatty acid difference (r = 0.62, p less than 0.001). These results with a hypertonic glucose infusion are similar to those reported after infusion of glucose-insulin-potassium without the potential for harmful adverse effects from infusions of insulin or potassium. Therefore, infusion of hypertonic glucose may be beneficial in patients with coronary artery disease. Further work is necessary to study its effects in different subgroups of patients with coronary artery disease.

I Diretriz Latino-Americana para o diagnóstico e tratamento da cardiopatia chagásica: resumo executivo

Much has been achieved in one century after Carlos Chagas discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. Its also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.Jadelson Pinheiro de Andrade, Jose Antonio Marin Neto, Angelo Amato Vincenzo de Paola, Fábio Vilas-Boas, Glaucia Maria Moraes Oliveira, Fernando Bacal, Edimar Alcides Bocchi, Dirceu Rodrigues Almeida, Abilio Augusto Fragata Filho, Maria da Consolação Vieira Moreira, Sergio Salles Xavier, Wilson Alves de Oliveira Junior, João Carlos Pinto Dias et al Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ Brasil

Initial Energy for External Electrical Cardioversion of Atrial Fibrillation

OBJECTIVEnTo investigate the initial energy level required for electrical cardioversion of atrial fibrillation (AF).nnnMETHODSnWe studied patients undergoing electrical cardioversion in the 1st Multicenter Trial of SOCESP. Patients were divided into 2 groups according to the initial energy level of electrical cardioversion: 100J and >/=150J. We compared the efficacy of the initial and final shock of the procedure, the number of shocks administered, and the cumulative energy levels.nnnRESULTSnEight-six patients underwent electrical cardioversion. In 53 patients (62%), cardioversion was started with 100J, and in 33 patients (38%), cardioversion was started with >/=150J. Groups did not differ regarding clinical features and therapeutical interventions. A tendency existed towards greater efficacy of the initial shock in patients who received >/=150J (61% vs. 42% in the 100J group, p=0.08). The number of shocks was smaller in the >/=150J group (1.5+/-0.7 vs. 2.1+/-1.3, p=0.04). No difference existed regarding the final efficacy of electrical cardioversion and total cumulative energy levels in both groups. In the subgroup of patients with recent-onset AF (</=48h), the cumulative energy level was lower in the 100J group (240+/-227J vs. 324+/-225J, p=0.03).nnnCONCLUSIONnPatients who were given initial energy of >/=150J received fewer counter shocks with a tendency toward greater success than those patients who were given 100J; however, in patients with recent-onset AF, the average cumulative energy level was lower in the 100J group. These data suggest that electrical cardioversion should be initiated with energy levels >/=150J in patients with chronic AF.

Executive Summary of the II Brazilian Guidelines for Atrial Fibrillation

Since 2009, when the Brazilian Society of Cardiology released the Brazilian Guidelines for Atrial Fibrillation,1 important studies on the subject have been published, particularly on new oral anticoagulants (NOACs). At least three of these drugs (dabigatran, rivaroxaban and apixaban) are currently approved for clinical use in Brazil. n nIn addition to pharmacological treatment, new data related to non-pharmacological treatment, notably the radiofrequency ablation (RA) procedure, have expanded the indication of this therapeutic approach. For this reason, an update of the guidelines is justified. n nEpidemiological changes in atrial fibrillation nIn the last two decades, atrial fibrillation (AF) has become a public health problem, with high consumption of health resources. AF is the most frequent sustained arrhythmia in the clinical practice, with a prevalence of 0.5% - 1.0% in the general population. According to more recent studies, however, AF prevalence is almost two times higher than that in the last decade, ranging from 1.9% in Italy to 2.9% in Sweden, possibly associated with age increase.2 However, in addition to ageing, other potential factors may explain the increment in AF prevalence, including advances in the treatment of chronic heart diseases, leading to greater number of patients susceptible to AF. Furthermore, besides the classical risk factors for AF - hypertension, diabetes mellitus, heart valve disease, heart infarction and heart failure (HF)3,4 -new potential ones, including obstructive sleep apnea,5 obesity,6 alcohol consumption,7 physical exercise,8 family history and genetic factors,9 contribute to the increase in AF prevalence. n nThe most used AF classification in the clinical practice is based on its form of presentation. Paroxysmal AF is defined as an episode of AF that terminates spontaneously or with medical intervention within seven days of onset. The term permanent AF refers to AF episodes longer than seven days, and long-term persistent AF is used by some authors to refer to cases longer than one year. Finally, the term permanent AF is used when attempts to convert to sinus rhythm have been abandoned. n nThe prognosis of AF is related to its close association with increased risk of ischemic and hemorrhagic stroke, and mortality. Other important consequences of AF include cognitive changes and socioeconomic implications

I Directriz latinoamericana para el diagnóstico y tratamiento de la cardiopatía chagásica: resumen ejecutivo

Much has been achieved in one century after Carlos Chagas discovery. However, there is surely much to be done in the next decades. At present, we are witnessing many remarkable efforts to monitor the epidemiology of the disease, to better understand the biology of the T. cruzi and its interaction with human beings as well as the pathogenesis and pathophysiology of the complications in the chronic phase, and deal more appropriately and effectively with late cardiac and digestive manifestations. Although the vector and transfusion-derived transmission of the disease has been controlled in many countries, there remains a pressing need for sustained surveillance of the measures that led to this achievement. It is also necessary to adopt initiatives that enable appropriate management of social and medical conditions resulting from the migration of infected individuals to countries where the disease formerly did not exist. Its also necessary to standardize the most reliable methods of detection of infection with T. cruzi, not only for diagnosis purposes, but more crucially, as a cure criterion. The etiological treatment of millions of patients in the chronic stage of the disease is also to be unraveled. A renewed interest in this area is observed, including prospects of studies focusing on the association of drugs with benznidazole. We also wait for full evidence of the actual effectiveness of the etiological treatment to impact favorably on the natural history of the disease in its chronic phase. Eventually, cardiologists are primarily responsible for improving the clinical management of their patients with Chagas disease, judiciously prescribing drugs and interventions that respect, as much as possible, the peculiar pathophysiology of the disease, wasting no plausible therapeutic opportunities.Jadelson Pinheiro de Andrade, Jose Antonio Marin Neto, Angelo Amato Vincenzo de Paola, Fábio Vilas-Boas, Glaucia Maria Moraes Oliveira, Fernando Bacal, Edimar Alcides Bocchi, Dirceu Rodrigues Almeida, Abilio Augusto Fragata Filho, Maria da Consolação Vieira Moreira, Sergio Salles Xavier, Wilson Alves de Oliveira Junior, João Carlos Pinto Dias et al Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ Brasil

Miocárdio não compactado, Doença de Chagas e disfunção: relato de caso

Relatamos la asociacion entre la cardiopatia asociada al miocardio no compactado del ventriculo izquierdo (MNCVI) con la cardiopatia chagasica cronica (CCC) en paciente con clinica de insuficiencia cardiaca, accidente vascular cerebral isquemico y arritmia cardiaca. Las imagenes tipicas de MNCVI y CCC fueron documentadas por resonancia magnetica cardiaca (RMC).We report the association between heart disease associated with noncompaction of the left ventricular myocardium (NCLVM) and chronic Chagas heart disease (CCHD) in a patient with heart failure, ischemic stroke and cardiac arrhythmia. Images typical of NCLVM and CCHD were documented by cardiac magnetic resonance imaging (CMRI).Miocardio ventricular no compactado, enfermedad de Chagas, disfunción ventricular izquierda. Relatamos la asociación entre la cardiopatía asociada al miocardio no compactado del ventrículo izquierdo (MNCVI) con la cardiopatía chagásica crónica (CCC) en paciente con clínica de insuficiencia cardíaca, accidente vascular cerebral isquémico y arritmia cardíaca. Las imágenes típicas de MNCVI y CCC fueron documentadas por resonancia magnética cardíaca (RMC). Miocardio no Compactado, Enfermedad de Chagas y Disfunción Caso Clínico