Catarina Ruivo

Progressão ultrarrápida de doença coronária ou placa instável não detetada

Coronary artery disease rarely manifests itself in the first decades of life, which explains why this population is underrepresented in clinical studies. The mechanisms and natural history of the disease seem to differ between this population and older patients. Recent studies suggest a more rapid disease progression in youth, presenting more unstable atherosclerotic plaques, although this correlation has yet to be proven. In this paper, we present the case of a 41-year-old man who presented with a non-ST elevation myocardial infarction, with percutaneous coronary intervention of the culprit lesion (70-90% lesion at bifurcation of the circumflex artery with the first marginal obtuse artery and a sub-occlusive lesion of the ramus intermedius). There was also a non-significant lesion (estimated at 30%) located in the left anterior descending coronary artery. Ten days after discharge, the patient suffered another non-ST elevation myocardial infarction. The coronary angiography revealed a surprising sub-occlusive lesion of the left anterior descending coronary artery. Regarding this case, the authors reviewed the literature on the pathophysiology of rapidly progressive coronary artery disease and the approach for non-significant lesions in patients with acute coronary syndrome, especially in the younger population.

P2518Frailty and acute coronary syndrome in the over-70 population: frailty is more than age

responding all-cause mortality was 22.6% (n=12,059) and 34.9% (n=18,631). Age-stratified analysis showed that nursing home admissions within one year were 1.9 (95% confidence interval [CI] 1.7–2.0)%, 6.1 (CI 5.8–6.5)%, and 12.9 (CI 11.9–13.9)% for patients aged 70–79, 80–89, and >90 years, respectively (Figure). One-year mortality was 15.4%, 28.0%, and 43.0% for these age groups. After three years, nursing home admission rates were 3.7 (CI 3.5–3.9)%, 10.4 (CI 10.0–10.8)%, and 18.0 (CI 16.8–19.2)% for patients aged 70–79, 80–89, and ≥90 years. Corresponding mortality rates were 25.4%, 41.8% and 55.3%, respectively. Main predictors of nursing home admissions were high age (hazard ratios [HRs] 2.72 [CI 2.45–3.02] and 5.18 [CI 4.56–5.90] for subjects 80–89 and ≥90 years compared to those aged 70–79 years), living alone (HR 1.99 [CI 1.79–2.23], and female sex (HR 1.25 [CI 1.14–1.38]), and HR increased by 1.25 (CI 1.21–1.29) with every increase in the number of comorbidities.

Gerbode defect and multivalvular dysfunction: Complex complications in adult congenital heart disease.

We report a clinical case of a 40‐year‐old male with surgically corrected congenital heart disease (CHD) 10 years earlier: closure of ostium primum, mitral annuloplasty, and aortic valve and root surgery. The patient was admitted with acute heart failure. Transesophageal echocardiography (TEE) revealed a dysmorphic and severely incompetent aortic valve, a partial tear of the mitral valve cleft repair and annuloplasty ring dehiscence. A true left ventricular‐to‐right atrial shunt confirmed a direct Gerbode defect. The authors aim to discuss the diagnostic challenge of adult CHD, namely the key role of TEE on septal defects and valve regurgitations description.

Original ArticlePredictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experiencePreditores de morte em doentes pós-paragem cardíaca submetidos a hipotermia terapêutica: experiência inicial de um centro não-terciário

Introduction and Objectives Therapeutic hypothermia (TH) is recommended for patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). There is still uncertainty about management, target temperature and duration of TH. In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality.

Predictors of death among cardiac arrest patients after therapeutic hypothermia: A non-tertiary care center's initial experience

INTRODUCTION AND OBJECTIVES Therapeutic hypothermia (TH) is recommended for patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA). There is still uncertainty about management, target temperature and duration of TH. In the present study we aim to describe the initial experience of a non-tertiary care center with TH after CA and to determine predictors of mortality. METHODS During the period 2011-2014, out of 2279 patients hospitalized in the intensive care unit, 82 had a diagnosis of CA with ROSC. We determined predictors of mortality and neurological outcome in comatose patients with ROSC after CA treated by TH. RESULTS A total of 15 patients were included, mean age 47.3±14 years, 10 (67.0%) male. CA occurred out-of-hospital (n=11; 73.3%) or in-hospital (n=4; 26.7%), in initial shockable (n=10; 66.7%) or non-shockable (n=5, 33.3%) rhythm. The mean time from CA to ROSC (CA-ROSC) was 44.7±36.5 min. All patients met the 24-hour TH target temperature of 33°C. The mean neuron-specific enolase (NSE) level was 93.7±109.0 μg/l. Seven patients (46.7%) were discharged with good cerebral performance and eight (53.3%) died. Patients who survived had lower median age (p=0.032), shorter CA-ROSC (p=0.048), lower NSE levels (p=0.020) and initial ventricular fibrillation rhythm (p=NS). CONCLUSIONS The effectiveness of TH appears to be related to younger age, shockable initial rhythm and shorter CA-ROSC time. This results indicates some lines of inquiry that should be developed in appropriate prospective studies. The role of biomarkers as predictors of prognosis is an open question, with NSE potentially playing an important role.