Nuno Marques

Implementation of a pre-hospital network favoring primary angioplasty in STEMI to reduce mortality: The Algarve Project

OBJECTIVE To analyze the impact of reperfusion by either primary percutaneous coronary intervention (PPCI) or fibrinolysis, and mortality rates of a pre-hospital fast-track network for treating patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS A pre-hospital network for STEMI patients, designated the Green Lane for Acute Myocardial Infarction (GL-AMI), has been implemented in the southern region of Portugal --the Algarve Project. We performed an observational study based on a prospective registry of 1338 patients admitted to Faro Hospital between 2004 and 2009, classified in two groups according to the method of admission: emergency department group (EDG) and GL-AMI group (GLG). More patients from GLG were reperfused (p < 0.0001). PPCI was the preferred method of reperfusion, 73.1% in GLG and 45.3% in EDG. Time delays were significantly shorter in GLG, except for pre-hospital delay: pre-hospital delay (p = 0.11); door-to-needle (p < 0.0001); door-to-balloon (p < 0.0001); and delay between symptoms and reperfusion (p < 0.0001). In-hospital mortality (4.3% vs 9.2%, p = 0.0007) and 6-month mortality (6.3% vs 13.8%, p < 0.0001) were significantly lower in GLG. CONCLUSIONS The Algarve Project significantly reduced the time delay between onset of symptoms and reperfusion, significantly increased the rate of reperfusion, and significantly reduced in-hospital and six-month mortality.

Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos?

INTRODUCTION AND OBJECTIVES The aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery. METHODS In this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow-up was conducted. RESULTS There were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00). During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one-year follow-up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05). CONCLUSION Changes to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period.

A 72-year-old woman with an uncorrected tetralogy of Fallot presenting with possible pulmonary endocarditis: a case report.

IntroductionTetralogy of Fallot is one of the most common forms of cyanotic congenital heart disease and in the absence of surgical correction it has an elevated early mortality, with most patients dying in childhood.The authors reported this case because of the unusual course of an uncorrected tetralogy of Fallot. There are only a few reports of patients with an uncorrected tetralogy of Fallot who reach an advanced age and to the best of our knowledge this is the first case report of a possible endocarditis in a patient with an uncorrected tetralogy of Fallot who is older than 70 years.Case presentationThe authors present a case of a 72-year-old Caucasian woman with uncorrected tetralogy of Fallot who was admitted with fever and heart failure to our Cardiology Department with possible infective endocarditis.ConclusionsThe longevity of this patient is probably due to the association between a large ventricular septal defect, a balanced subpulmonary stenosis and to the presence of systemic hypertension. After empiric antibiotic therapy, the patient was discharged and no surgical intervention was performed due to her previous benign evolution.

Unidade de Síncope – Experiência de um centro com base em organigramas de decisão para síncope de etiologia incerta após a avaliação inicial

INTRODUCTION AND OBJECTIVES Syncope is a common symptom that leads to 1% of admissions to hospital emergency departments, and is associated with high costs to the health system. The cardiology department of Faro Hospital has had a syncope unit since July 2007. The aim of this study is to analyze its results in terms of etiological diagnosis and treatment of syncope, using diagnostic flowcharts based on European Society of Cardiology (ESC) guidelines. METHODS We conducted a retrospective study of all patients referred to the syncope unit of Faro Hospital between July 2007 and August 2011. We analyzed demographic data, characteristics of syncopal episodes, diagnostic methods, etiology of syncope and treatment. The percentages of syncope of cardiac and uncertain etiology were compared with data from other international syncope units. Statistical analysis was performed using SPSS version 13.0. RESULTS Of the 304 patients referred to the syncope unit for loss of consciousness, 245 (80.7%) had syncope. Most had reflex syncope (52.2%), 20% had cardiac syncope, 15.6% had orthostatic hypotension, and in 12% of cases etiology remained undetermined. The percentages of cardiac and uncertain etiology were similar to data published by other syncope units. CONCLUSIONS The Faro Hospital syncope unit obtained similar results to those published by other international syncope units through application of diagnostic flowcharts for etiological diagnosis of syncope. The flowcharts presented can be of value for the proper application of ESC guidelines on syncope.

Congenital left ventricular apical aneurysm presenting as ventricular tachycardia

The authors present the case of a 34-year-old male patient seen in our department due to palpitations. On the electrocardiogram monomorphic ventricular tachycardia (VT) was documented, treated successfully with amiodarone. The subsequent study revealed a normal echocardiogram and an apical aneurysm of the left ventricle on magnetic resonance imaging, confirmed by computed tomography coronary angiography that also excluded coronary disease. He underwent an electrophysiological study to determine the origin of the VT and to perform catheter ablation using electroanatomical mapping. VT was induced and radiofrequency applications were performed in the left ventricular aneurysm area. VT was no longer inducible, with acute success. Despite this it was decided to implant a subcutaneous implantable cardioverter-defibrillator (ICD). Eight months after the ablation the patient was admitted again due to VT, treated by the ICD.

MPS 09-05 OPTIMAL BLOOD PRESSURE LEVELS AFTER AN ACUTE MYOCARDIAL INFARCTION - IS LOW ARTERIAL BLOOD PRESSURE AFTER AN ACUTE MYOCARDIAL INFARCTION HARMFUL?

Objective: Angiotensin converting enzyme inhibitors (ACEI) and beta-blockers (BB) are recommended after an acute myocardial infarction (AMI). These drugs attenuate myocardial remodeling and lower blood pressure. We pretended to assess the influence of blood pressure on readmission and mortality rate at 1-year post AMI. Design and Method: Prospective study involving 240 patients admitted to the Cardiology department due to an AMI, from the 1st January 2011 to the 30th November 2012. The basal clinical characteristics were noted and ambulatory blood pressure monitoring (ABPM) was made 1-month after the AMI. The follow-up at 1-year was made through phone call. The statistical analysis was undertaken using SPSS. Results: ABPM was performed in 240 patients, 175 men (73%). 49% had ST-segment elevation AMI. At discharge, 74% were on BB, 75% on ACEI, 6% on ARB, 10% on CCB and 22% on diuretics. In ABPM, 27% showed mean arterial systolic pressure (MASP) > 130 mmHg and 18% had MASP < 110 mmHg. 14% had mean arterial diastolic pressure (MADP) > 80 mmHg and 60% had MADP < 60 mmHg. 81% were “dippers”. There were a total of 32 patients readmitted, 24 of which due to cardiovascular (CV) causes. Nocturnal systolic pressure (NSP) > 120 mmHg (p < 0.01), nocturnal diastolic pressure (NDP) > 65 mmHg (p < 0.05), MASP > 130 mmHg (p < 0.05), MADP > 80 mmHg (p < 0.05) and a non-dipper profile (p < 0.01) were all associated with readmission due to CV causes. There were no differences in readmission or mortality among patients with diurnal SP < 110 mmHg or NSP < 100 mmhg. The only independent predictor of readmission due to CV causes was NSP > 120 mmHg. There were a total of 4 deaths (1.7%) without any correlation to ABPM data. Conclusions: In our study, hospital readmission due to CV causes was associated with elevated blood pressure values as well as a non-dipper profile. Low blood pressure appeared to be safe. High NSP was an independent predictor of readmission rate and this parameter should be taken into special account on ABPM after an AMI.

Síncope reflexa vasovagal – haverá benefício da terapêutica com pacemaker?

Reflex vasovagal syncope often affects young populations and is associated with a benign prognosis in terms of mortality. However, a minority of patients have recurrent episodes, with a considerable impact on their quality of life. Pacemaker therapy has been an option in these patients since the 1990s if a conservative strategy fails. Initially, non-randomized and open-label randomized trials showed promising results, but these studies were associated with a significant placebo effect. Recently, an approach based on the use of implantable loop recorders has shown that some patients with reflex vasovagal syncope could benefit from implantation with dual-chamber pacemakers, particularly patients aged >40 years, with recurrent syncopal episodes resulting in frequent injuries, in whom a long asystole (≥3 s asystole with syncope or ≥6 s asystole without syncope) has been documented with an implantable loop recorder. The authors present a literature review on the role of cardiac pacing in reflex vasovagal syncope and propose a diagnostic and therapeutic decision flowchart for patients with syncope of probable reflex etiology.

PW043 Predictors of outcome in takotsubo cardiomyopathy – a multicenter study

quences and detection of late gadolinium enhancement (LGE) which was used as a marker of early myocardial involvement. Results: Six (14%) patients had LGE, mainly involving apical, mid-basal inferoseptal and basal inferolateral segments. The presence of LGE was significantly higher in the group who had electrocardiographic abnormalities (29% vs. 4%, p <0.05). Of these 6 patients, 3 had regional wall motion abnormalities (2 with isolated apical dyskinesis and 1 with lateral hypokinesis). Only one patient showed oedema on STIR sequences suggestive of active inflammatory activity. With CMR as the method of reference, the ECG had a sensitivity of 83% and a negative predictive value of 96% to detect CCM. Conclusion: ECG proves to be a useful, inexpensive and globally available tool for the screening of CCM in asymptomatic patients but with proven myocardial involvement in the CRM.

Original articleImplementation of a pre-hospital network favoring primary angioplasty in STEMI to reduce mortality: The Algarve ProjectImplementação de uma rede pré-hospitalar privilegiando a angioplastia primária no enfarte agudo do miocárdio com elevação do segmento ST, para reduzir a mortalidade: O Projeto Algarve

Objective To analyze the impact of reperfusion by either primary percutaneous coronary inter-vention (PPCI) or fibrinolysis, and mortality rates of a pre-hospital fast-track network for treating patients with ST-elevation myocardial infarction (STEMI).

Imagem tubular «transversal ao septo interauricular»

Please cite this article as: Faria R, et al. Imagem tubular «transversal ao septo inter-auricular». Rev Port Cardiol 2012. doi:10.1016/j.repc.2012.01.010. ∗ Corresponding author. E-mail address: ricardofaria555@gmail.com (R. Faria). apex; the electrocardiogram showed sinus rhythm and left anterior bundle branch block. Left parasternal long-axis echocardiography revealed an anomalous tubular image in continuity with the anterior wall of the ascending aorta (Fig. 1), while in parasternal short-axis view the same tubular structure was seen encircling the aorta (Fig. 2). In apical 4-chamber view, a tubular image, 2 mm in diameter and 42 mm in length, was observed crossing the atrial septum;