Rita Rodrigues

Relação entre o perfil tensional noturno e a prevalência e gravidade da retinopatia hipertensiva

INTRODUCTION Non-dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established. AIM To assess the association between the prevalence and severity of HR and nocturnal BP. METHODS We prospectively studied hypertensive patients who underwent 24-hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non-dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined. RESULTS Forty-six patients (46% male, aged 63±12 years) were analyzed, of whom 91% (n=42) were under antihypertensive treatment. Seventy percent (n=33) had uncontrolled BP. HR was diagnosed in 83% (n=38). Patients with HR had higher mean systolic nocturnal BP (151±23 vs. 130±13 mmHg), p=0.008). Patients with greater HR severity (Scheie stage ≥2) had higher nocturnal BP (153±25 vs. 140±16 mmHg, p=0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR. CONCLUSIONS The prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR.

Inferior wall acute myocardial infarction or something else

The authors present the case of an 83-year-old male with a history of hypertension, appendectomy and cervical spine surgery who presented at the emergency department with epigastric pain and dyspnea at rest for six hours. The physical examination was compatible with refractory acute pulmonary edema requiring endotracheal intubation and ventilation. The electrocardiogram showed sinus rhythm with ST-segment elevation in the inferior leads. The emergent coronary angiography revealed three-vessel disease with distal occlusion of the right coronary artery (Figure 1, Videos 1 and 2). Primary angioplasty was performed successfully (Figure 2, Video 3). During the procedure a contrast retention image was observed apparently synchronous with the cardiac/respiratory cycle (Figure 3, Video 4). The first possibility that came to mind was an aortic dissection, which was excluded by an anteroposterior projection, which showed that the image was in the midline (Figure 4, Videos 5 and 6). A chest computed tomography scan was then requested to rule out the presence of a fistula (esophageal or bronchial), which revealed that the image corresponded to retention of contrast in the medullary canal from myelography performed in the 1980s (Figure 5A and B). Myelography is still used in the study of patients with suspected atrophic or degenerative changes in the spinal cord. Current soluble contrast agents have less acute and

Hipersensibilidade à aspirina e coronariografia urgente: desafio terapêutico

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are common and five types of reactions have been defined. The prevalence of such reactions in patients with myocardial infarction is unclear, and so antiplatelet therapy in this population is a challenge. Various desensitization protocols have been developed but there are no specific guidelines for their use. The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography. Aspirin desensitization therapy is safe and successful in many patients, but more randomized trials are needed to confirm its benefits in coronary artery disease patients.

A rare case of ascending aortic stenosis

A 48-year-old woman was referred to an in-hospital cardiology evaluation after performing a transthoracic echocardiography (TTE) that indicated a severe aortic valvular stenosis. She had a cognitive delay, short stature and long-term symptoms of fatigue for moderate exertion. No history of syncope or angina. …

Estenose aórtica subvalvular associada à deleção 8p23

We report the case of a 35-year-old man admitted due to heart failure, who had had moderate cognitive deficit, craniofacial dysmorphism, epilepsy, panic attacks and congenital heart disease (subvalvular aortic stenosis) associated with chronic atrial fibrillation since childhood. In view of his facial dysmorphism and clinical presentation, karyotype analysis was performed and revealed a de novo interstitial deletion in chromosome 8 in the region p23.1-p23.2. This is a rare chromosomal anomaly (about 50 descriptions in the literature), whose most common manifestations include heart defects, cognitive retardation and behavioral disturbances. In this paper we present the first case with associated subvalvular aortic stenosis and review the literature on this chromosomal abnormality.

Padrão de Brugada em doente medicada com lamotrigina

The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern. After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed. Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern.