Remo Holanda de Mendonça Furtado

Endocardite por Coxiella burnetii (febre Q): doença rara ou pouco diagnosticada? Relato de caso

Q fever is a zoonosis of worldwide distribution that is caused by Coxiella burnetii. However, reports of this disease in Brazil are rare. Seroepidemiological studies have shown relatively high frequencies of antibodies against Coxiella burnetii in populations with occupational exposure. In humans, it can be manifested clinically as acute or chronic disease. Endocarditis is the most frequent chronic form of Q fever and the form with the greatest morbidity and mortality. We report a severe case of endocarditis due to Coxiella burnetii acquired in Brazil that had a fatal outcome, despite specific antibiotic therapy and valve surgery treatment.

Stem-cell therapy in ST-segment elevation myocardial infarction with reduced ejection fraction: A multicenter, double-blind randomized trial

Left ventricular ejection fraction (LVEF) is a major determinant of long‐term prognosis after ST‐segment elevation myocardial infarction (STEMI). STEMI patients with reduced LVEF have a poor prognosis, despite successful reperfusion and the use of renin‐angiotensin‐aldosterone inhibitors.

DRUG INTERACTION BETWEEN CLOPIDOGREL AND RANITIDINE OR OMEPRAZOLE IN PATIENTS WITH CORONARY HEART DISEASE: A DOUBLE-BLIND, DOUBLE-DUMMY, RANDOMIZED COMPARATIVE STUDY

In patients taking dual antiplatelet therapy with acetylsalycilic acid (ASA) and clopidogrel, proton-pump inhibitors are often utilized for gastrointestinal (GI) bleeding prophylaxis. However, this class of medication has been associated with reduction of the antiplatelet potency of clopidogrel. The

For patients with acute coronary syndrome, is initial measurement of troponin alone the best we have to offer?

Myocardial infarction; coronary disease; troponin; biological markers/blood.For decades it has been known that there is good correlation between the levels of certain enzymes and the size of myocardial infarction evaluated by necropsy.As it might be expected, several publications have found highly significant correlations between the levels of these markers and the incidence of events, mainly deaths - the higher the value, the higher the mortality.On the other hand, with the emergence of new markers, basically troponins and CKMB mass (“biomarkers of myocardial necrosis”), new evidence began to emerge. For example, many patients who were categorized as having unstable angina have received a diagnosis of acute myocardial infarction without ST segment elevation, because these biomarkers are more sensitive than the enzymes previously used. On the other hand, it was also found that approximately 30% of patients with increased troponin levels have normal CKMB activity, and that these patients have a worse prognosis than those with normal troponin.This relevant study by Santos et alPor otro lado, con el surgimiento de nuevos marcadores, básicamente troponinas y CKMB masa (“biomarcadores de necrosis miocárdica”), nuevas evidencias comenzaron a surgir. Por ejemplo, muchos pacientes que serían catalogados como portadores de angina inestable comenzaron a recibir el diagnóstico de infarto agudo de miocardio sin supradesnivel del segmento ST, ya que estos biomarcadores son más sensibles que las enzimas previamente utilizadas. Por otro lado, también se demostró que aproximadamente 30% de los pacientes con aumento de troponina presentan niveles de CKMB actividad normal, y que estos pacientes presentan peor pronóstico en relación a aquellos con troponina también normal. El importante trabajo de Santos et al1 viene a contribuir a un mejor entendimiento del tema, al analizar el papel de la troponina y de la CKMB masa en una población no seleccionada de pacientes con cuadro clínico compatible con coronariopatía aguda (de cierta forma con sorprendentes 2/3 portadores de angina inestable y apenas 1/3 con IAM sin supradesnivel de ST).

Is adenosine associated with sudden death in schizophrenia?: A new framework linking the adenosine pathway to risk of sudden death

HighlightsLower Adenosine levels have been reported in Schizophrenia patients.Lower Adenosine potentialy increase the risk of Sudden Death.Adenosine relation to Sudden Death in Schizophrenia should be better researched. ABSTRACT Schizophrenia is associated with an increased mortality from cardiovascular disease. Relatively few studies have assessed the putative association of schizophrenia pathophysiology with sudden death. Low adenosine levels have been associated with schizophrenia. In cardiology, increased mortality among patients with congestive heart failure has been associated with genetic polymorphisms that potentially lead to lower adenosine levels. Thus, we hypothesize that adenosine could link schizophrenia and cardiovascular mortality, with decreased adenosine levels leading to increased vulnerability to hyperexcitability following hypoxic insults, increasing the odds of fatal arrhythmias. Low adenosine levels might also lead to a small increase in overall mortality rates and a major increase in the sudden death rate. This hypothesis paves the way for further investigation of the increased cardiac mortality associated with schizophrenia. Potentially, a better characterization of adenosine‐related mechanisms of sudden death in schizophrenia could lead to new evidence of factors leading to sudden death in the general population.

PLATELET AGGREGABILITY, COAGULATION, FIBRINOLYSIS AND INFLAMMATION IN PATIENTS WITH CORONARY ARTERY DISEASE AND PREVIOUS CEREBROVASCULAR ISCHEMIC EVENT

Background: Approximately 17% of pts with coronary artery disease (CAD) have previous ischemic stroke or transitory ischemic attack. (IS/TIA). This is a high risk subgroup for ischemic and bleeding events. The role of platelet aggregability, coagulation, endogenous fibrinolysis and inflammation in

Aos pacientes com coronariopatia aguda, apenas a dosagem inicial de troponina é o melhor que temos a oferecer?

Myocardial infarction; coronary disease; troponin; biological markers/blood.For decades it has been known that there is good correlation between the levels of certain enzymes and the size of myocardial infarction evaluated by necropsy.As it might be expected, several publications have found highly significant correlations between the levels of these markers and the incidence of events, mainly deaths - the higher the value, the higher the mortality.On the other hand, with the emergence of new markers, basically troponins and CKMB mass (“biomarkers of myocardial necrosis”), new evidence began to emerge. For example, many patients who were categorized as having unstable angina have received a diagnosis of acute myocardial infarction without ST segment elevation, because these biomarkers are more sensitive than the enzymes previously used. On the other hand, it was also found that approximately 30% of patients with increased troponin levels have normal CKMB activity, and that these patients have a worse prognosis than those with normal troponin.This relevant study by Santos et alPor otro lado, con el surgimiento de nuevos marcadores, básicamente troponinas y CKMB masa (“biomarcadores de necrosis miocárdica”), nuevas evidencias comenzaron a surgir. Por ejemplo, muchos pacientes que serían catalogados como portadores de angina inestable comenzaron a recibir el diagnóstico de infarto agudo de miocardio sin supradesnivel del segmento ST, ya que estos biomarcadores son más sensibles que las enzimas previamente utilizadas. Por otro lado, también se demostró que aproximadamente 30% de los pacientes con aumento de troponina presentan niveles de CKMB actividad normal, y que estos pacientes presentan peor pronóstico en relación a aquellos con troponina también normal. El importante trabajo de Santos et al1 viene a contribuir a un mejor entendimiento del tema, al analizar el papel de la troponina y de la CKMB masa en una población no seleccionada de pacientes con cuadro clínico compatible con coronariopatía aguda (de cierta forma con sorprendentes 2/3 portadores de angina inestable y apenas 1/3 con IAM sin supradesnivel de ST).

A los pacientes con coronariopatía aguda, ¿ Apenas el dosaje inicial de troponina es lo mejor que tenemos para ofrecerles?

Myocardial infarction; coronary disease; troponin; biological markers/blood.For decades it has been known that there is good correlation between the levels of certain enzymes and the size of myocardial infarction evaluated by necropsy.As it might be expected, several publications have found highly significant correlations between the levels of these markers and the incidence of events, mainly deaths - the higher the value, the higher the mortality.On the other hand, with the emergence of new markers, basically troponins and CKMB mass (“biomarkers of myocardial necrosis”), new evidence began to emerge. For example, many patients who were categorized as having unstable angina have received a diagnosis of acute myocardial infarction without ST segment elevation, because these biomarkers are more sensitive than the enzymes previously used. On the other hand, it was also found that approximately 30% of patients with increased troponin levels have normal CKMB activity, and that these patients have a worse prognosis than those with normal troponin.This relevant study by Santos et alPor otro lado, con el surgimiento de nuevos marcadores, básicamente troponinas y CKMB masa (“biomarcadores de necrosis miocárdica”), nuevas evidencias comenzaron a surgir. Por ejemplo, muchos pacientes que serían catalogados como portadores de angina inestable comenzaron a recibir el diagnóstico de infarto agudo de miocardio sin supradesnivel del segmento ST, ya que estos biomarcadores son más sensibles que las enzimas previamente utilizadas. Por otro lado, también se demostró que aproximadamente 30% de los pacientes con aumento de troponina presentan niveles de CKMB actividad normal, y que estos pacientes presentan peor pronóstico en relación a aquellos con troponina también normal. El importante trabajo de Santos et al1 viene a contribuir a un mejor entendimiento del tema, al analizar el papel de la troponina y de la CKMB masa en una población no seleccionada de pacientes con cuadro clínico compatible con coronariopatía aguda (de cierta forma con sorprendentes 2/3 portadores de angina inestable y apenas 1/3 con IAM sin supradesnivel de ST).

Permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease

Descrevemos um caso raro de implante de marcapasso definitivo em gestante, portadora de valvopatia mitral reumatica, previamente submetida a valvoplastia percutânea por cateter-balao. A paciente apresentava bloqueio atrioventricular de grau avancado, de causa nao-reversivel, sintomatico e manifesto no 3o trimestre da gestacao.We describe a rare case of permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease previously undergoing percutaneous balloon valvuloplasty. She presented symptomatic advanced atrioventricular block of non-reversible cause and manifest in the third trimester of gestation.

Implante de marcapasso definitivo em gestante portadora de valvopatia mitral reumática

Descrevemos um caso raro de implante de marcapasso definitivo em gestante, portadora de valvopatia mitral reumatica, previamente submetida a valvoplastia percutânea por cateter-balao. A paciente apresentava bloqueio atrioventricular de grau avancado, de causa nao-reversivel, sintomatico e manifesto no 3o trimestre da gestacao.We describe a rare case of permanent pacemaker implantation in a pregnant woman with rheumatic mitral valve disease previously undergoing percutaneous balloon valvuloplasty. She presented symptomatic advanced atrioventricular block of non-reversible cause and manifest in the third trimester of gestation.