Vitor Engrácia Valenti

Sudden cardiac death athletes: a systematic review.

Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords sudden death, athletes and mortality. The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes evaluation helps to recognize situations that may put the athletes life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes pre-competition routine is an important way to minimize the risk of SCD.

Índices geométricos de variabilidade da frequência cardíaca na doença pulmonar obstrutiva crônica

BACKGROUNDnIt was already evidenced decreased heart rate variability (HRV) in chronic obstructive pulmonary disease (COPD) patients at rest.nnnOBJECTIVEnIn order to insert new elements in the literature regarding this issue, we evaluated geometric index of HRV in COPD subjects.nnnMETHODnWe analyzed data from 34 volunteers, divided into two groups according to spirometric values: COPD (17 volunteers, FEV1/FVC=47.3±10.2; FEV1=50.8±15.7) and control (17 volunteers, FEV1/FVC=78.8±10.8; FEV1=100.1±14.7). For analysis of HRV indexes the volunteers remained in the supine position for 30 minutes. We analyzed the following indexes: triangular index (RRtri), triangular interpolation of RR intervals (TINN) and Poincaré plot (SD1, SD2 and SD1/SD2). Student t test for unpaired samples and Mann-Whitney test were used for data analysis.nnnRESULTSnWe observed statistically significant reductions in geometric indexes in the COPD group: RRtri (0.043±0.01 vs. 0.059±0.02; p=0.018), TINN (105.88±51.82 vs. 151.47±49.9; p=0.014), SD1 (9.76±4.66 vs. 14.55±6.04; p=0.014) and SD2 (34.86±17.02 vs. 51.51±18.38; p=0.010). SD1/SD2 (0.30±0.11 vs. 0.28±0.07; p=0.605) were not significantly different between groups. Patients with COPD presented a visual analysis of Poincaré plot of lower dispersion of RR intervals both beat to beat and the long term.nnnCONCLUSIONnSubjects with COPD present reduction of geometric indexes of HRV, indicating reduced heart rate variability.

Nutritional status of pre-school children from low income families.

BackgroundWe evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers.MethodsCross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W), height (H) and body mass index (BMI) were classified according to the 2000 National Center for Health Statistics (CDC/NCHS). Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center.ResultsChildren presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively.ConclusionLow income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.

Cardiac baroreflex is already blunted in eight weeks old spontaneously hypertensive rats

Background The literature did not evidence yet with which age spontaneously hypertensive rats (SHR) start to present baroreflex reduction. We endeavored to evaluate the baroreflex function in eight-week-old SHR. Methods Male Wistar Kyoto (WKY) normotensive rats and SHR aged eight weeks were studied. Baroreflex was calculated as the variation of heart rate (HR) divided by the mean arterial pressure (MAP) variation (ΔHR/ΔMAP) tested with a depressor dose of sodium nitroprusside (SNP, 50 μg/kg) and with a pressor dose of phenylephrine (PHE, 8 μg/kg) in the right femoral venous approach through an inserted cannula in the animals. Significant differences for p < 0.05. Results Baseline MAP (p < 0.0001) and HR (p = 0.0028) was higher in SHR. Bradycardic peak was attenuated in SHR (p < 0.0001), baroreflex gain tested with PHE was also reduced in the SHR group (p = 0.0012). PHE-induced increase in MAP was increased in WKY compared to SHR (p = 0.039). Bradycardic reflex responses to intravenous PHE was decreased in SHR (p < 0.0001). Conclusion Eight weeks old SHR already presents impairment of the parasympathetic component of baroreflex.

Memantine prevents cardiomyocytes nuclear size reduction in the left ventricle of rats exposed to cold stress

OBJECTIVES Memantine is an N-methyl-d-aspartate (NMDA) glutamate receptor antagonist used to treat Alzheimer’s disease. Previous studies have suggested that receptor blockers act as neuroprotective agents; however, no study has specifically investigated the impact that these drugs have on the heart. We sought to evaluate the effects of memantine on nuclear size reduction in cardiac cells exposed to cold stress. METHOD We used male EPM-Wistar rats (n=40) divided into 4 groups: 1) Matched control (CON); 2) Memantine-treated rats (MEM); 3) Rats undergoing induced hypothermia (IH) and 4) Rats undergoing induced hypothermia that were also treated with memantine (IHM). Animals in the MEM and IHM groups were treated by oral gavage administration of 20 mg/kg/day memantine over an eight-day period. Animals in the IH and IHM groups were submitted to 4 hours of hypothermia in a controlled environment with a temperature of − 8°C on the last day of the study. RESULTS The MEM group had the largest cardiomyocyte nuclear size (151 ± 3.5 μm3 vs. CON: 142 ± 2.3 μm3; p<0.05), while the IH group had the smallest mean value of nuclear size. The nuclear size of the IHM group was preserved (125 ± 2.9 μm3) compared to the IH group (108 ± 1.7 μm3; p<0.05). CONCLUSION Memantine prevented the nuclear size reduction of cardiomyocytes in rats exposed to cold stress.

Evaluation of baroreflex function in young spontaneously hypertensive rats

FUNDAMENTO: A literatura tem descrito dados contraditorios em relacao ao inicio da diminuicao da funcao barorreflexa em ratos espontaneamente hipertensos. OBJETIVO:Este estudo foi realizado para avaliar a funcao barorreflexa em ratos jovens de 13 semanas espontaneamente hipertensos. METODOS:Foram estudados ratos machos Wistar Kyoto (WKY) (n=15) e ratos espontaneamente hipertensos (REH) de 13 semanas (n=15). Cânulas foram inseridas na arteria aorta abdominal atraves da arteria femoral direita para medir a pressao arterial media (PAM) e a frequencia cardiaca (FC). A funcao barorreflexa foi calculada como a derivada da variacao da FC em funcao da variacao da PAM (ΔFC/ΔPAM), quando submetida a teste com uma dose depressora de nitroprussiato de sodio (50µg/kg) e com uma dose pressora de fenilefrina (8µg/kg) atraves de cânula inserida na veia femoral direita em ratos espontaneamente hipertensos e WKY. Diferencas com um valor de p < 0.05 foram consideradas estatisticamente significantes. RESULTADOS:Ratos espontaneamente hipertensos: ΔPAM=43,5 mmHg±5,2, ΔFC=-59,7 ppm±17,9 e ΔFC/ΔPAM=1,3 ppm/mmHg±0,1 testados com fenilefrina; Wistar Kyoto: ΔPAM=&56mmHg±3, ΔFC=*-114,9ppm±11,3 e ΔFC /ΔPAM =#1,9ppm/mmHg±0,3 testados com fenilefrina; ratos espontaneamente hipertensos: ΔPAM=-45,6mmHg±8,1, ΔFC=40,1ppm±11,6 e ΔFC/ΔPAM=0,9ppm/mmHg±0,5 testados com nitroprussiato de sodio; Wistar Kyoto: ΔPAM=-39,8mmHg±6,2, ΔFC=51,9ppm±21,8 e ΔFC/ΔPAM=1,4ppm/mmHg±0,7 testados com nitroprussiato de sodio (*p<0,05; #p<0,01; &p<0,001). CONCLUSAO: Nossos resultados mostram que ratos espontaneamente hipertensos de 13 semanas apresentaram reducao da funcao barorreflexa quando testados com fenilefrina.BACKGROUNDnThe literature describes contradictory data regarding the onset of the baroreflex reduction in spontaneously hypertensive rats.nnnOBJECTIVEnThis investigation was undertaken to evaluate the baroreflex function in 13-week-old spontaneously hypertensive rats.nnnMETHODSnMale Wistar Kyoto (n=15) and spontaneously hypertensive rats (n=15) aged 13 weeks were studied. Cannulas were inserted in the abdominal aortic artery through the right femoral artery to measure mean arterial pressure and heart rate. Baroreflex function was calculated as the derivative of the variation of HR in function of the MAP variation (Delta heart rate/Delta mean arterial pressure) tested with a depressor dose of sodium nitroprusside (50microg/kg) and with a pressor dose of phenylephrine (8microg/kg) in the right femoral venous approach through an inserted cannula in awake spontaneously hypertensive rats and Wistar-Kyoto. Differences with p values < 0.05 were considered statistically significant.nnnRESULTSnSpontaneously hypertensive rats: Delta mean arterial pressure=43.5mmHg+/-5.2, Delta heart rate=-59.7ppm+/-17.9 and Delta heart rate/Delta mean arterial pressure=1.3ppm/mmHg+/-0.1 tested with phenylephrine; Wistar Kyoto: Delta mean arterial pressure=&56mmHg+/-3, Delta heart rate=*-114.9ppm+/-11.3 and Deltaheart rate/Delta mean arterial pressure=#1.9ppm/mmHg+/-0.3 tested with phenylephrine; spontaneously hypertensive rats: Delta mean arterial pressure=-45.6mmHg+/-8.1, Delta heart rate=40.1ppm+/-11.6 and Delta heart rate/Delta mean arterial pressure=0.9ppm/mmHg+/-0.5 tested with sodium nitroprusside; Wistar Kyoto: Delta mean arterial pressure=-39.8mmHg+/-6.2, Delta heart rate=51.9ppm+/-21.8 and Delta heart rate/Delta mean arterial pressure=1.4ppm/mmHg+/-0.7 tested with sodium nitroprusside (*p<0.05; #p<0.01; &<0.001).nnnCONCLUSIONnOur results showed that 13-week-old spontaneously hypertensive rats presented reduced baroreflex function when tested with phenylephrine.

Effects of sidestream cigarette smoke exposure on baroreflex components in spontaneously hypertensive rats

We evaluated short-term effects of sidestream cigarette smoke (SSCS) exposure on baroreflex function in spontaneously hypertensive rats (SHR) and Wistar Kyoto (WKY) normotensive rats. Rats were exposed to SSCS during three weeks, 180 min, five days per week, in a concentration of carbon monoxide (CO) between 100 and 300 ppm. We observed that SSCS exposure increased tachycardic peak and heart rate range while it attenuated bradycardic reflex in WKY. In respect to SHR, SSCS also increased tachycardic peak. Taken together, our data suggests that three weeks of exposure to SSCS affects the sympathetic and parasympathetic component of the baroreflex in normotensive WKY while it tended to affect the sympathetic component in SHR.

ATZ (3-amino-1,2,4-triazole) injected into the fourth cerebral ventricle influences the Bezold-Jarisch reflex in conscious rats

OBJECTIVES: Many studies have investigated the importance of oxidative stress on the cardiovascular system. In this study we evaluated the effects of central catalase inhibition on cardiopulmonary reflex in conscious Wistar rats. METHODS: Male Wistar rats were implanted with a stainless steel guide cannula in the fourth cerebral ventricle. The femoral artery and vein were cannulated for mean arterial pressure and heart rate measurement and for drug infusion, respectively. After basal mean arterial pressure and heart rate recordings, the cardiopulmonary reflex was tested with a dose of phenylbiguanide (PBG, 8 µg/kg, bolus). Cardiopulmonary reflex was evaluated before and µl15 minutes after 1.0 µL 3‐amino‐1,2,4‐triazole (ATZ, 0.01g/100µL)0.01 g/100 µL) injection into the fourth cerebral ventricle. Vehicle treatment did not change cardiopulmonary reflex responses. RESULTS: Central ATZ significantly increased hypotensive responses without influencing the bradycardic reflex. CONCLUSION: ATZ injected into the fourth cerebral ventricle increases sympathetic inhibition but does not change the parasympathetic component of the cardiopulmonary reflex in conscious Wistar rats.

Prevalence of overweight preschool children in public day care centers: a cross-sectional study

CONTEXT AND OBJECTIVEnBrazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age.nnnDESIGN AND SETTINGnCross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil.nnnMETHODSnWeight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex.nnnRESULTSnThe mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (± 3.5) and Z scores for: weight/height (W/H): 0.50 (± 1.22); height/age: -0.03 (± 1.07); weight/age (W/A): 0.51 (± 1.23); and BMI: 0.51(± 1.23). The prevalence of overweight children (BMI > 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66).nnnCONCLUSIONnA high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

Fluoxetine effects on mitochondrial ultrastructure of right ventricle in rats exposed to cold stress

OBJECTIVEnTo assess fluoxetine effects on mitochondrial structure of the right ventricle in rats exposed to cold stress.nnnMETHODSnThe experimental study procedures were performed in 250-300g male EPM-Wistar rats. Rats (n=40) were divided into four groups: 1) Control group (CON); 2) Fluoxetine (FLU); 3) Induced hypothermia (IH) and; 4) Induced hypothermia treated with fluoxetine (IHF). Animals of FLU group were treated by the administration of gavages containing 0.75 mg/kg/day fluoxetine during 40 days. The induced hypothermia was obtained by maintaining the groups 3 and 4 in a freezer at -8 degrees C for 4 hours. The animals were sacrificed and fragments of the right ventricle (RV) were removed and processed prior to performing electron microscopic analysis.nnnRESULTSnThe ultrastructural changes in cardiomyocytes were quantified through the number of mitochondrial cristae pattern (cristolysis). The CON (3.85%), FLU (4.47%) and IHF (8.4%) groups showed a normal cellular structure aspect with preserved cardiomyocytes cytoarchitecture and continuous sarcoplasmic membrane integrity. On the other hand, the IH (34.4%) group showed mitochondrial edema and lysis in cristae.nnnCONCLUSIONnThe ultrastructural analysis revealed that fluoxetine strongly prevents mitochondrial cristolysis in rat heart, suggesting a protector effect under cold stress condition.