Edgar Guimarães Victor

Avaliação ecocardiográfica em obesos graves assintomáticos

OBJECTIVE To study the systolic and diastolic function of asymptomatic patients with severe obesity using a Doppler echocardiography. METHODS Thirty candidates for bariatric surgery, with an average BMI of 49.2 +/- 8.8 kg/m2 and no previous history of heart disease were evaluated through transthoracic echocardiography. RESULTS Enlarged left chambers were observed in 42.9% of the sample, diastolic dysfunction in 54.6% and left ventricular hypertrophy in 82.1%, of which 50% of the cases presented the geometric pattern of eccentric hypertrophy. Indexation of left ventricular mass to height resulted in a significantly higher number of diagnoses for hypertrophy than indexation to body surface area (p = 0.0053), demonstrating that this index is more appropriate to determine ventricular hypertrophy in obese people. Correlations between left ventricular hypertrophy with obesity duration and pressure levels were positive as well as correlations between body mass index and diastolic dysfunction indicators. CONCLUSION This study demonstrated that echocardiograms performed on asymptomatic severely obese patients can detect alterations in the cardiac structure that are common in cases of obesity cardiomyopathy and can be associated with the development of heart failure, arrhythmias and sudden death, enabling the identification of patients with greater cardiovascular risk [corrected]

Pressão arterial em adolescentes durante teste ergométrico

OBJECTIVE Describe arterial blood pressure response in adolescents undergoing exercise stress testing. METHODS This was a cross-sectional study conducted with 218 adolescents (131 of whom were males), aged between 10 to 19 years, undergoing exercise stress testing. Maximum heart rate, total exercise time, maximum oxygen uptake, systolic blood pressure (SBP) and diastolic (DBP) at rest, during maximal physical exertion and at six minutes of recovery were measured. RESULTS At rest, SBP values were greater in males and no difference was found in DBP between genders, although both increased with age. During exercise, SBP rose and DBP fell in both genders. SBP variation was greater in men, particularly in those over 14 years of age. CONCLUSION Analysis of results showed that during physical exercise, SBP had a direct relationship with the individuals age, weight, height and body mass index, whereas DBP bore a relationship to age only.

Framingham Score for Public Transportation Drivers in the City of Teresina, Piauí

OBJECTIVE To estimate the absolute risk of the public transportation drivers in the city of Teresina, Piauí, to develop coronary heart disease over the course of ten years based on the Framingham risk score. METHODS An observational, descriptive, cross-sectional study using the Framingham score was conducted with 107 public transportation drivers in the city of Teresina, Piauí, to assess level of risk and its association with the Framingham predictors that include: age, total cholesterol, HDL cholesterol, systolic blood pressure, diastolic blood pressure, diabetes mellitus and smoking. The significance test used was Chi2. The prevalence rate was used as the association measurement. RESULTS Mean risk was 5% and the greatest majority of the participants were situated in the low risk category (85.05%). Mean values for the variables were: 42 years of age, total cholesterol 200 mg%, HDL cholesterol 49 mg%, systolic blood pressure 130 mmHg and diastolic blood pressure 85 mmHg. The associations between diabetes mellitus, smoking and HDL cholesterol with level of risk were not statistically significant; however other variables had a great influence on the level of risk obtained. CONCLUSION The mean absolute risk estimate for the public transportation drivers in the city of Teresina to develop coronary heart disease over the next ten years based on the Framingham score is low. The majority of the participants in the study (85.05%) were situated in the low risk category, that is, with a relative risk less than or equal to 10%.

Origem anômala das artérias coronárias

The anomalous origin of the coronary arteries is a potentially lethal pathology, especially in neonates and young athletes. The understanding of the pathophysiological pattern of the disease has allowed the recognition of the different forms of clinical presentation. Despite being a cause of myocardial ischemia, functional tests can be normal. Coronary angiography used to be the gold standard for the diagnosis of this pathology, but non-invasive cardiovascular imaging tests have shown better definition of the origin and course of coronary arteries. Surgical treatment should be indicated for symptomatic patients, mainly in children with the anomalous origin of the left coronary artery from the pulmonary artery. The ideal management of asymptomatic patients remains undefined.

Endomyocardial Fibrosis: Report of 6 Patients and Review of the Surgical Literature

Six patients with endomyocardial fibrosis were treated by endocardium decortication and atrioventricular valve replacement. There were 5 female patients and 1 male patient ranging from 14 to 48 years old (mean, 30 years). Four patients had involvement of the right ventricle, 1 patient had involvement of the left ventricle, and 1 patient had biventricular disease. There was 1 operative death due to low cardiac output state (the patient with biventricular endomyocardial fibrosis), and there was 1 late noncardiac death. The surgical literature, which describes 19 previously reported cases, was reviewed. On the basis of the results of this series and those of the reported cases, it is concluded that surgical treatment of endomyocardial fibrosis is feasible and provides good clinical improvement.

Ventricular septal defect following nonpenetrating trauma. Case report and review of the surgical literature

From the Institute of Diseases of the Chest of Recife. Real Hospital Português de Beneficência em Pernambuco. Av. Portugal, 163, Recife Brazil. Rupture of the interventricular septum may result from blunt trauma of the chest or from a penetrating wound of the heart. Patients with traumatic ventricular septal defect from a penetrating wound usually have symptoms and signs of cardiac tamponade or hemothorax and do not develop the typical clinical picture of an acute ventricular septal defect, due to blunt trauma, which is quite similar to those of interventricular septal ruptures following myocardial infarction. Traumatic ventricular septal defect was first described by Hewett’ in 1847. EaSt2 made the first diagnosis in life and Guilfoil and Doyle3 reported the first case proven by cardiac catheterization. The first successful repair of traumatic ventricular septal defect was performed by Lillehei in 1955. This case was reported upon by Campbell .4 Since then, at least twenty-one4-23 patients have received surgical treatment for ventricular septal defect due to indirect trauma. In the present paper a case of traumatic ventricular septal defect repaired surgically is described and the surgical literature reviewed.

Association between ankle-brachial index and carotid atherosclerotic disease

BACKGROUND The association between the ankle brachial index (ABI) and the measurement of intimal medial thickness (IMT) has not been fully studied. OBJECTIVE We aimed to evaluate whether the prevalence of carotid atherosclerosis was higher in patients with ABI < 0.9 than in those with ABI > 0.9. METHODS From January 2011 to December 2011, 118 patients (48 men and 70 women) were enrolled. ABI and IMT Measurements were performed in all patients. Patients were divided in Group 1 (ABI < 0.9) and Group 2 (ABI > 0.9) according to ABI values. Mann-Whitney, Chi-square and Fischer tests were used for comparison among the groups. Pearsons correlation was used to assess correlation between ABI and IMT. RESULTS The prevalence of ABI < 0.9 was 29.7%, whereas carotid atherosclerosis > 1.5 mm was 34.7 %. Clinical characteristics were similar between groups 1 and 2: mean age (64 ± 9 vs. 62 ± 7.2 years, p = 0.1), male gender (40% vs. 41%, p = 0.9), hypertension (74% vs. 59%, p = 0.1), diabetes mellitus (54% vs. 35%, p = 0.051), dyslipidemia (26% vs. 24%, p = 0.8), smoking (57% vs. 65%, p = 0.4). The prevalence of carotid atherosclerosis was higher in group 1 (48.6% vs. 28.9%, p = 0.04). Pearsons correlation between ABI and IMT was -0.235, with a p value = 0.01. CONCLUSION Patients with ABI < 0.9 showed a higher prevalence of carotid atherosclerosis. There was a negative correlation between ABI and IMT.

Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction.

Esta serie de casos teve o objetivo de avaliar as condutas adotadas pelos pacientes, durante a fase pre-hospitalar do infarto agudo do miocardio (IAM). Avaliaram-se 115 individuos portadores de IAM, com supradesnivelamento do segmento ST. Foi aplicado o teste qui-quadrado e o teste exato de Fisher. Os individuos que nao associaram os sintomas a doenca cardiovascular atribuiram, mais frequentemente, as seguintes origens: gastrointestinal (38%), osteomuscular (29,7%), intoxicacao alimentar e/ou medicamentosa (8,5%) e decorrentes do aparelho respiratorio (6,3%). A proporcao de desfechos maiores e de pacientes que chegaram a emergencia apos 12 horas foi mais elevada entre mulheres, individuos com renda mensal de ate um salario minimo, que usaram analgesicos e nao associaram os sintomas a doenca cardiovascular. Constatou-se que individuos em condicoes socio-conomicas desfavoraveis, que interpretaram os sintomas de forma incorreta, chegaram mais tardiamente a emergencia e apresentaram piores desfechos intra-hospitalares.This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fishers exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%), musculoskeletal (29.7%), food and/or medication poisoning (8.5%) and arising from the respiratory apparatus (6.3%). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.

Determining respiratory system resistance and reactance by impulse oscillometry in obese individuals

Objective: To evaluate peripheral respiratory system resistance and reactance (Rrs and Xrs, respectively) in obese individuals. Methods: We recruited 99 individuals, dividing them into four groups by body mass index (BMI): < 30.0 kg/m2 (control, n = 31); 30.0-39.9 kg/m2 (obesity, n = 13); 40.0-49.9 kg/m2 (severe obesity, n = 28); and ≥ 50.0 kg/m2 (morbid obesity, n = 13). Using impulse oscillometry, we measured total Rrs, central Rrs, and Xrs. Peripheral Rrs was calculated as the difference between total Rrs and central Rrs. All subjects also underwent spirometry. Results: Of the 99 individuals recruited, 14 were excluded because they failed to perform forced expiratory maneuvers correctly during spirometry. The individuals in the severe obesity and morbid obesity groups showed higher peripheral Rrs and lower Xrs in comparison with those in the two other groups. Conclusions: Having a BMI ≥ 40 kg/m2 was associated with a significant increase in peripheral Rrs and with a decrease in Xrs.

Hipertensão arterial sistêmica no setor de emergência: o uso de medicamentos sintomáticos como alternativa de tratamento

OBJECTIVE: Compare the therapeutic response of symptomatic, hypertensive patients to symptomatic medication or anti-hypertensive drugs at the Emergency Unit. METHODS: A randomized, blind clinical trial involving 100 (one hundred) patients assisted at the Cardiology Emergency Unit at Oswaldo Cruz University Hospital (HUOC). All patients reported symptoms associated to systolic pressure (SBP) between 180 and 200 mmHg and/or diastolic pressure (DBP) between 110 and 120 mmHg. Patients were randomized for treatment with symptomatic (dipirone or diazepan) or anti-hipertensive drug (captopril). Those reporting any associated clinical condition and in need of immediate treatment at the Emergency Unit were excluded from the study. Patients reporting no symptoms, and systolic pressure reduced to levels under 180 mmHg and diastolic pressure under 110 mmHg after the 90-minute period were considered as having met discharge criteria. RESULTS: Mean age of population studied was 54.4 years old, most commonly females. Patients were chronic hypertensive, on irregular pharmacological treatment, with low compliance to non-pharmacologic actions, and classified as overweight and obese grade I. Headache, type D (non-angina) chest pain, and dyspnea were the most frequent complaints. The number of patients treated with symptomatic drug who reached discharge criteria was similar to that of patients treated with anti-hypertensive (p=0.165). No association was found between previous high blood pressure (HBP) diagnosis (p=0.192), pharmacological treatment (p=0.687), and non-pharmacological treatment and discharge criteria. CONCLUSION: Blood pressure (BP) was reduced below levels for discharge criteria for a (non-significant) higher rate of patients treated with symptomatic drug, who were turned into asymptomatic after the observation period.