Influência do exercício físico aeróbico na prevenção da doença coronariana

A presente revisão enfatiza a função do EFA (Exercício Físico Aeróbico), moderado ou vigoroso, como um importante fator na profilaxia da AC (arteriosclerose coronariana), sobretudo quando associado a outras medidas profiláticas conhecidas. Esse efeito está provavelmente relacionado com o fato do EFA elevar a concentração de HDL-c. Esta, provavelmente, é a única medida a ser tomada naqueles casos onde não existe nenhum fator de risco associado, mas há forte história familiar de AC. Além do mais, o EFA regular tem importante papel no processo de reabilitação cardíaca nos pacientes portadores de DIM (doença isquêmica do miocárdio).The present review emphazises the role of aerobic physical exercise (APE), of moderate or heavy intensity, as a fundamental tool in the prevention of coronary atherosclerosis (CA). There are evidences that this effect is mediated by the increase of HDL levels. On the other hand increased APE is, in some situations, the only way to prevent CA, specially in patients with no known risk factor but with a considerable family history of CA. In the same way the authors review the importance of APE in the cardiac rehabilitation of patients after myocardiac infarction

Does left ventricular reverse remodeling influence long-term outcomes in patients with Chagas cardiomyopathy?

Background: The impact of left ventricular reverse remodeling (LVRR) on the prognosis of Chagas cardiomyopathy is unknown. The aim of this study was to determine whether the presence of LVRR can predict mortality in these patients. Methods: From January 2000 to December 2010, the medical charts of 159 patients were reviewed. LVRR was defined as an increase of left ventricular ejection fraction (LVEF) and a decrease of left ventricular end-diastolic diameter (LVDD) by two-dimensional echocardiography. No patient underwent cardiac resynchronization therapy or required mechanical ventricular assistance. Results: At baseline, median (25th–75th) LVDD was 64 mm (59–70), and median LVEF was 33.2% (26.4–40.1). LVRR was detected in 24.5% of patients in a 40-month (26–64) median follow-up. In the LVRR group, LVDD decreased from 64mm (59–68) to 60 mm (56–65; p < 0.001), and LVEF increased from 31.3% (24.1–39.0) to 42.5% (32.2–47.7; p < 0.001). However, LVRR was not associated with heart failure hospitalization, cardiogenic shock, heart transplantation, or mortality (p > 0.05 for all comparisons). The Cox proportional hazard model analysis identified only cardiogenic shock (hazard ratio [HR]: 2.41; 95% confidence interval [CI]: 1.51–3.85; p < 0.001) and serum sodium level (hazard ratio, 0.91; 95% CI: 0.86–0.96; p < 0.001) as independent predictors of all-cause mortality. Conclusions: Left ventricular reverse remodeling occurs in one quarter of patients with Chagas cardiomyopathy and have no impact on the outcome of patients with this condition

The inflammatory nitric oxide mechanism and its participation in cardiac tissue injuries

Introduction: Nitric oxide exerts an important effect on the mediation of chemical processes, on the transmitting and signaling action on the inflammatory response in different pathological disorders. It has a vasodilatory effect and modulates inflammatory or anti- inflammatory reactions, depending on the cell type and the stimulus. It has the power to produce hemodilation in the muscles (it dilates the blood vessels increasing the blood flow); by this factor, one can associate the greater blood flow with the muscular recovery, process that ends up becoming faster. Objective: Understand the mechanisms by which nitric oxide acts on cardiac lesions and the inflammatory response. Methodology: The databases of CAPES, PubMed and SciELO were used as sources of search. The articles went through a selection filter so that those of greater scientific relevance were selected, based on the selection of articles published in the last 7 years in impact journals. The keywords used in the search include: "nitric oxide" and "heart" or "heart disease" or "heart failure" and "inflammatory mechanism". Results: Since its discovery, nitric oxide has been intriguing researchers about its multiple actions in the human body, as well as in the pharmaceutical industry for its applicability to active drug components. Nitric oxide has already been associated with several functions, emphasizing its importance in vascular relaxation and signaling in inflammatory processes controlling them, being produced locally in the vessels or when inflammation occurs. In some situations, the vasodilatory effect of nitric oxide can be considered potentially beneficial when analyzed in cardiac lesions, to be included in myocardial ischemia. It is noteworthy that nitric oxide in high concentrations may exert a toxic effect, and it occurs in situations of oxidative stress, generation of oxygen intermediates and deficiency of the antioxidant system. Thus, it is clear the importance of a better understanding of nitric oxide, how it acts beneficially in some lesions, what their molecular roles are, to what extent their production leads to toxicity, as it acts in the inflammatory processes of cardiac lesions. Its role in cardiac lesions varies from protection to aggression depending on the amount present in the medium and degree of injury. The major study lesions that alter the nitric oxide balance in cardiac tissue include myocardial ischemia, acute myocardial infarction, and myocardial hypertrophy. Furthermore, plasma levels of nitric oxide are increased in mice infected with T.cruzi (experimental model of Chagas' disease).Discussion and conclusion of the results: Considering the points discussed, it is concluded that nitric oxide plays a crucial role in cardiac lesions, which has a marked influence on the prognosis and clinical evolution of the cardiac lesion. Still, it can aggravate your picture, worsening general condition, when in inadequate concentrations; or improves it when administered and controlled exogenously, providing better perfusion, and reduction in the formation of atherosclerotic plaques, reduction of ischemia among many other functions

Quality of life in medical students who act in PBL methodology

Introduction: The learning takes place, mainly, by the integration of new knowledge acquired to previously existing ones, that is, by the elaboration of new information, in any of its previously analyzed forms. In the Problem Based Learning (PBL) method, constructivism is obtained at the expense of activation of prior knowledge, elaboration of new information, establishment of goals for self-directed study, and increament in the complexity of semantic networks in the final discussion of problem solving. Quality of life (QoL) can be considered as a subject of multiple approaches, contextualizations and applicability of which is used by several areas of knowledge. All the components that make up the quality of life can be measured and evaluated using quantitative instruments, including questionnaires, the main one being the WHOQOL-Bref, developed by the WHO, for having a cross-cultural evaluation methodology that allows uniform results. Objectives: To analyze in a global way the quality of life of medical students who work in the PBL model of the University of Ribeirão Preto (UNAERP). Methodology: A total of 90 students from the UNAERP medical school, aged over 18, enrolled in the 1st, 6th and 11th stages were included in this study. After signing the TCLE approved by the local CEP, the students answered a questionnaire based on the WHOQOL-bref. Results: A total of 55.5% of the women and 44.5% of the men with a mean age varying according to the stages (20 years, 1st stage, 22 years, 6th stage and 26 years in the 11th stage) were evaluated. When analyzing the degree of satisfaction of the students with regard to the PBL methodology, a percentage of 49.1% satisfaction was observed at the beginning of the course (1st stage), followed by 65.4% in the 6th stage and 77% at the end of the course (11th stage). The student’s satisfaction with the ability to perform the activities of his day-to-day recorded that in the first stage, 21.2% can carry out their activities with adequacy; in stage 6, 34.5% and in stage 11, 69.8% feel satisfied or very satisfied in this analysis. Students also had increased satisfaction with their academic performance when compared to the beginning and end of the course; on the other hand, in the intermediate phase, a percentage decrease can be observed as can be observed in the first stage: 42.8%; 6th stage: 33.5%; 11: 77%. Discussion and conclusions of the results: In this study, we measured the quality of life of university students of medicine at UNAERP and then made them reflect on how they deal with their personal, physical, social and mental issues throughout their training course. The PBL methodology enhances the need for independent study and focuses on student-led learning and improvement, which allows the student to evolve with a progressive improvement in the ability to perform day-to-day tasks and academic performance

II Diretriz Brasileira de Transplante Cardíaco

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasIIHospital de Messejana Dr. Carlos Alberto Studart GomesUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaInstituto Dante Pazzanese de CardiologiaUniversidade Federal de Minas Gerais Hospital das ClínicasFaculdade de Medicina de São José do Rio PretoPontifícia Universidade Católica do ParanáIHospital Israelita Albert EinsteinInstituto Nacional de Cardiologia, Fundação Universitária do Rio Grande do Sul Instituto de CardiologiaReal e Benemérita Sociedade de Beneficência Portuguesa, São PauloHospital Pró-Cardíaco do Rio de JaneiroSanta Casa do Rio de JaneiroUNIFESP, EPMSciEL

III Diretriz Brasileira de Insuficiência Cardíaca Crônica

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreUniversidade de Pernambuco Faculdade de Ciências Médicas de PernambucoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de Minas Gerais Faculdade de MedicinaFaculdade de Medicina de São José do Rio PretoFundação Universitária de Cardiologia do Rio Grande do Sul Instituto de CardiologiaRede Labs D'OrUniversidade Federal FluminenseUniversidade do Estado do Rio de Janeiro Faculdade de Ciencias MédicasInstituto Dante Pazzanese de CardiologiaSanta Casa de MisericórdiaUniversidade de Pernambuco Pronto Socorro Cardiológico de PernambucoHospital Pró CardíacoHospital de MessejanaPontifícia Universidade Católica do ParanáUniversidade Federal de Goiás Faculdade de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão PretoReal e Benemerita Sociedade de Beneficência PortuguesaFaculdade de Ciências Médicas de Minas GeraisUNIFESP, EPMSciEL

Development of Anatomophysiologic Knowledge Regarding the Cardiovascular System: From Egyptians to Harvey

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation

Management of cardiovascular disease in patients with COVID-19 and chronic Chagas disease : implications to prevent a scourge still larger

Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in the general population. Because the high prevalence of COVID-19 and chronic Chagas disease (CCD) where the latter is endemic, all such diseases will likely be observed in the same patient. While COVID-19 can provoke generalized endotheliitis, which can lead to a cytokine storm and a hyper-coagulable state culminating into in-site and at a distance thrombosis. Therefore, small-vessel coronary artery disease (CAD), cerebrovascular disease, thromboembolism, and arrhythmias are prominent findings in COVID-19. In CCD, small-vessel CAD, cardioembolic stroke, pulmonary embolism, heart failure and arrhythmias are frequently observed as a result of a similar but less intense mechanism. Consequently, the association of CCD and COVID-19 will likely increase the incidence of CVD. Thus, doctors on the frontline should be on the alert for this diagnostic possibility so that the proper treatment can be given without any delay