Raquel Ferreira

Avaliação hematológica e hemogasométrica de potros nascidos de éguas com placentite ascendente

The placentitis is a major cause of premature birth, abortion and compromised foal delivery, and may result in hypoxia and sepsis. The blood gas analysis and hematology can provide important information for monitoring the foals born from mares with placentitis, with different degrees of maturity. The aim of this study was to describe the hematological and blood gas values during the first 24 hours of life in foals born from crossbreed mares with experimentally induced placentitis, presenting different degrees of maturity. Sixteen foals, born from mares with experimentally induced ascending placentitis were assigned to three groups according to degree of maturity: premature (n=8), dysmature (n=4), and full-term foals (n=4). Blood samples were collected at birth (0), at 12h and 24h, and hematological evaluation and blood gas variables were measured. In the premature group normocytic normochromic anemia was observed compared to dysmature group at 12h and 24h. The premature group showed lower count of white blood cells at 24h relative to the full-term group (p=0.01). The pH, cHCO3 and SO2 values do not differ among the groups; however the premature group showed respiratory acidosis (pH=7,28). The PCO2 was higher at 0h in the premature foals (p=0.02). In all groups, the PCO2 presented an adaptive curve with reduction between 12h and 24h. The premature foals showed lower base excess (BE) values at birth (p=0.02), confirming the respiratory acidosis in this group. We conclude that the hematological and blood gas response differs between foals with different degrees of maturity. Acidosis in the premature foals at birth, with stabilization and compensation of pH value during the first 12-24h demonstrate the necessity of sequential blood gas analysis in risk foals. This may help identify the clinical response to the process and assist in the establishment of adequate treatment and prognosis for these foals.

Brugada Pattern, Brugada Phenocopy, What to Think?

Propafenone is a class 1 anti-arrhythmic medication with beta-adrenergic and calcium channel blocker properties. B r u g a d a s y n d r o m e ( B r S ) h a s a t y p i c a l electrocardiographic pattern characterized by increased propensity for malignant ventricular arrhythmias and sudden death in patients with no structural heart disease.1 Brugada phenocopies (BrP) have electrocardiographic patterns that are identical to true type 1 and type 2 Br, despite the absence of a true congenital BrS. BrP are elicited by clinical conditions including ionic (or water and electrolyte) disturbances, myocardial ischemia and pulmonary embolism.2-5 We report a case of suicide attempt by an overdose of propafenone which yielded a type 1 Brugada pattern.

Central and peripheral blood pressure response to a single bout of an exercise session in patients with resistant hypertension

Resistant hypertension (RH) is an important public health issue that increases the risk of cardiovascular events, chronic kidney disease, and death, as well as the burden of disease [1]. Currently, the available treatment options to lower blood pressure in patients with RH, namely, antihypertensive drugs and renal sympathetic denervation, have shown limited success [1, 2]. Exercise training has been suggested as a promising therapy, as it has been shown to decrease both acute [3] and chronic [4] blood pressure in RH patients. However, evidence is lacking regarding how the central and peripheral blood pressures in these patients respond to acute aerobic exercise. Thus, this study analyzed the effects of a single session of light-intensity aerobic exercise on the central and peripheral blood pressure and the carotid-femoral pulse wave velocity (cf-PWV) in RH patients. Nineteen patients (nine women and ten men) were enrolled. To be admitted, patients were required to be between 45 and 75 years of age, have RH for more than 3 years and have regular and unchanged medication use in the previous 6 months; RH was defined as systolic blood pressure (SBP) ≥140 mmHg, despite treatment with ≥3 optimally dosed antihypertensive medications of different classes, including a diuretic, or the need for four or more drugs to achieve an SBP ≤140 mmHg [5]. The exclusion criteria were heart failure, any previous cardiovascular event, peripheral artery disease, renal failure, chronic obstructive pulmonary disease, insulin-dependent diabetes, and regular participation in exercise training programs. The hospital ethics committee approved the study. Participants provided written informed consent, and all procedures were conducted according to the Declaration of Helsinki. Determination of the cf-PWV and pulse wave analysis of the right radial artery was performed after a 10-min rest period after the exercise session using applanation tonometry (SphygmoCor, AtCor Medical, Australia) according to international guidelines [6]. Changes in central and brachial blood pressure and cf-PWV were recorded in response to a 10-min session of walking on a treadmill at 3 km/h. The speed and duration of walking were set to reproduce a reallife situation such as dog walking or picking up children from school. Paired t-tests were used to compare mean differences between variables and the magnitude of changes between central and peripheral pressures. The effect size for within-group comparisons was calculated using the Cohen d coefficient. Overall, patients were middle aged (58.7 ± 9.0 years) and mostly overweight/obese (weight: 84.4 ± 9.5 kg; height: 166.6 ± 7.4 cm; body mass index: 30.5 ± 3.7 kg/m). The number of medications used for blood pressure control ranged from three to eight pharmacological agents (mean 4.7 ± 1.9) and included diuretics (71.5%), angiotensinconverting enzyme inhibitors/angiotensin receptor antagonists (42.75%), calcium channel blockers (66.5%), betablockers (61.75%), central inhibitors (33.25%), and vasodilators (9.5%). Both the central (150.5 ± 22.8 to 156.6 ± 21.1 mmHg, p= 0.023; Cohen’s d= 0.278) and peripheral (163.1 ± 21.7 to 173.4 ± 21.2 mmHg; p= 0.002; Cohen’s d= 0.478) SBP were increased immediately after exercise, but the magnitude of the increase was significantly lower * Fernando Ribeiro fernando.ribeiro@ua.pt

Flutter auricular atípico tardio após ablação de fibrilhação auricular

Cardiac surgery for structural heart disease (often involving the left atrium) and radiofrequency catheter ablation of atrial fibrillation have led to an increased incidence of regular atrial tachycardias, often presenting as atypical flutters. This type of flutter is particularly common after pulmonary vein isolation, especially after extensive atrial ablation including linear lesions and/or defragmentation. The authors describe the case of a 51-year-old man, with no relevant medical history, referred for a cardiology consultation in 2009 for paroxysmal atrial fibrillation. After failure of antiarrhythmic therapy, he underwent catheter ablation, with criteria of acute success. Three years later he again suffered palpitations and atypical atrial flutter was documented. The electrophysiology study confirmed the diagnosis of atypical left flutter and reappearance of electrical activity in the right inferior pulmonary vein. This vein was again ablated successfully and there has been no arrhythmia recurrence to date. In an era of frequent catheter ablation it is essential to understand the mechanism of this arrhythmia and to recognize such atypical flutters.