Márcio Silva Miguel Lima

Caracterização da variabilidade de freqüência cardíaca e sensibilidade do barorreflexo em indivíduos sedentários e atletas do sexo masculino

ABSTRACTCharacterization of heart rate variability and baroreflexsensitivity in sedentary individuals and male athletesIntroduction: The capacity to vary the heart rate representsimportant physiologic role in the daily life. The variations of the RRintervals is dependent of biological modulators as the autonomicnervous system. Those variations constitute the heart rate vari-ability (HRV). Methods: 10 athletes (Atl) and 10 sedentary (Sed)male individuals (20-35 age) were submitted to digital electrocar-diography, in rest, before, during and after the maneuver. The va-lues of RR were analyzed (software Matlab 6.1 ), in the time doma-in. Results: Both Sed and Atl presented mean heart rate of 73.5bpm ± 2,5 and 51 bpm ± 2,4, respectively. Related to the RR inter-vals, the group of Sed presented average of 826.58 bad ± 5.3 andthe group Atl, 1189.18 ± 6.9. The return time of sympathetic sys-tem after the maneuver was 72 ± 12 s (Sed) 37 ± 6 s (Atl). Thereturn time of parasympathetic system was 80 ± 11 s (Sed) and40 ± 8 s (Atl). The pNN50 was of 10 ± 3,3 (Sed) and 42,10 ± 6,9(Atl). The value of RR variation above the average of the wholesign was 343 ± 40 (Sed) and 175 ± 39 (Atl). The RR variation be-low the average of the whole sign was 281 ± 27 (Sed) and 425 ±26 (Atl).

Prognostic value of coronary and microvascular flow reserve in patients with nonischemic dilated cardiomyopathy.

BACKGROUND Coronary and microvascular blood flow reserve have been established as important predictors of prognosis in patients with cardiovascular disease. The aim of this study was to assess the value of coronary flow velocity reserve (CFVR) and real-time myocardial perfusion echocardiography (RTMPE) for predicting events in patients with nonischemic dilated cardiomyopathy. METHODS One hundred ninety-five patients (mean age 54 ± 12 years; 66% men) with dilated cardiomyopathy (left ventricular ejection fraction < 35% and no obstructive coronary disease on invasive angiography or multidetector computed tomography) who underwent dipyridamole stress (0.84 mg/kg over 10 min) RTMPE were prospectively studied. CFVR was calculated as the ratio of hyperemic to baseline peak diastolic velocities in the distal left anterior coronary artery. The replenishment velocity (β), plateau of acoustic intensity (A(N)), and myocardial blood flow reserve were obtained from RTMPE. RESULTS Mean CFVR was 2.07 ± 0.52, mean A(N) reserve was 1.05 ± 0.09, mean β reserve was 2.05 ± 0.39, and mean myocardial blood flow reserve (A(N) × β) was 2.15 ± 0.48. During a median follow-up period of 29 months, 45 patients had events (43 deaths and two urgent transplantations). Independent predictors of events were left atrial diameter (relative risk, 1.16; 95% confidence interval, 1.08-1.26; P < .001) and β reserve ≤ 2.0 (relative risk, 3.22; 95% confidence interval, 1.18-8.79; P < .001). After adjustment for β reserve, CFVR and myocardial blood flow reserve no longer had predictive value. Left atrial diameter added prognostic value over clinical factors and left ventricular ejection fraction (χ2 = 36.8-58.5, P < .001). Beta reserve added additional power to the model (χ2 = 70.2, P < .001). CONCLUSIONS Increased left atrial diameter and depressed β reserve were independent predictors of cardiac death and transplantation in patients with nonischemic dilated cardiomyopathy. Beta reserve by RTMPE provided incremental predictive value beyond that provided by current known prognostic clinical and echocardiographic factors.

Myocardial infarction caused by coronary artery injury after a blunt chest trauma

Relatamos el caso de un individuo del sexo masculino, de 29 anos de edad, victima de accidente automovilistico en el cual sufrio traumatismo toracico cerrado, evolucionando con insuficiencia cardiaca congestiva. El paciente presentaba buena salud previamente, sin sintomas de enfermedad cardiovascular. En la evaluacion inicial, el electrocardiograma mostro ondas Q en las derivaciones precordiales y el ecocardiograma mostro disfuncion ventricular izquierda importante. La angiografia coronaria mostro una lesion en la arteria coronaria descendente anterior izquierda (ADI), con acinesia de la pared anterior en la ventriculografia de contraste. La tomografia computada por emision de foton unico (SPECT) con Talio-201 no mostro viabilidad. El paciente fue mantenido en tratamiento clinico con buena evolucion.We report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. He had previously had a good overall health status, with no symptoms of cardiovascular disease. At the initial assessment, the electrocardiogram showed Q waves in the precordial leads and the echocardiogram disclosed severe left ventricular dysfunction. Coronary angiogram showed a proximal left anterior descending coronary artery lesion, with anterior wall akinesis on contrast-enhanced ventriculography. A Thallium-201 single photon emission computed tomography (SPECT) showed no viability. He remained on medical treatment with good evolution.

Hemoptise e hemotórax como apresentação de ruptura de aorta torácica

Thoracic aortic dissection is a disease of great mortality in its initial phase, but in some cases it can assume chronic course. We report a case of a patient with Stanford type A1 aortic dissection, admitted with mental confusion, dyspnea and event of severe hemoptysis. Electrocardiogram showed unspecific change and chest X-ray revealed opacification of the left hemithorax. Transthoracic echocardiogram did not show aortic dissection, but showed image similar to hemithorax leading to the suspicion of aortic rupture. The patient developed cardiovascular collapse and evolved to death. This case describes two unusual presentations of aortic dissection: hemothorax and severe hemoptysis.

ASSOCIATION OF PROTEIN-LOSING ENTEROPATHY CAUSED BY EOSINOPHILIC GASTROENTERITIS WITH ESSENTIAL THROMBOCYTOSIS: CASE REPORT

These diseases can be classified into 3 large groupsaccording to the protein-loss mechanism: ulcerated lesionswith protein exudation (eg, peptic ulcer, inflammatorybowel disease, and gastric carcinoma), mucosal lesionswithout ulceration, but with increased permeability (eg,Menetrier’s disease, celiac sprue, and eosinophilic gastro-enteritis), and obstructive diseases (eg, lymphoma), as wellas primary disorder of the lymphatic system (eg, intestinallymphangiectasia).One of the several causes of protein-losing enteropa-thy is eosinophilic gastroenteritis. This is a rare diseasecharacterized by infiltration of eosinophils from the mu-cosa to the serosa layer, mainly in the stomach and thesmall bowel.

Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with refractory angina: A study with speckle tracking echocardiography

Cardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA.

Rheumatic Mitral Valvopathy and Papillary Fibroelastoma An Unusual Association

Papillary fibroelastoma (PF) is the second most common primary cardiac tumor, predominantly affecting the cardiac valves and accounting for three-quarters of all cardiac valvular tumors.1 Most patients with PF are asymptomatic and the evolution of echocardiography has allowed for an earlier detection and better characterization of PF. Although rare and benign, PF may result in multiple complications, such as stroke and arterial embolisms.1

Dysfunctional Mitral Bioprosthesis Treated using Transapical Approach with Inovare Transcatheter Valve: A New Alternative to Conventional Surgery

DOI: 10.5935/2318-8219.2018004

Calcic Embolization with Acute Myocardial Infarction and Ventricular Septal Defect After Bioprosthetic Mitral Valve Implantation using the Valve-in-Valve Technique

Calcic Embolization with Acute Myocardial Infarction and Ventricular Septal Defect after Bioprosthetic Mitral Valve Implantation using the Valve-in-Valve Technique Marcelo Tadeu Blumer Peron,1 Márcio Silva Miguel Lima,1,2 Renato Garcia Lisboa Borges,1 Guilherme Sobreira Spina,1 Henrique Barbosa Ribeiro,1 Jeane Mike Tsutsui1,2 Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo;1 Fleury Medicina e Saúde,2 São Paulo, São Paulo − Brazil

Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction?

Background Estimative of left ventricular ejection fraction (LVEF) is a major indication for echocardiography. Speckle tracking echocardiography (STE) allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS) and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective This study aims to check which one has the highest correlation with LVEF. Methods Patients with normal LVEF (> 0,55) and systolic dysfunction (LVEF <0,55) were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results A total of 131 patients were included (mean age, 46 ± 14y; 43%, men). LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001), more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001). Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001); torsion (r = 0.75; r2 = 0.56; p < 0.001). Conclusion GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.