Evaluation of acute myocardial infarction protocol

Existem dados na literatura nacional e internacional sugerindo que a implementação de protocolos melhora desfechos. Contudo, sabe-se que as mudanças obtidas não são mantidas a longo prazo. Nós desenvolvemos este projeto para reavaliar o Protocolo de Infarto Agudo do Miocárdio implementado no Hospital de Clínicas de Porto Alegre (HCPA). Foram utilizados indicadores de qualidade para comparar dados deste Hospital com os existentes em literatura internacional. Dados dos indicadores de qualidade assistencial foram coletados no sistema de prontuários informatizado Avaliou-se 48 pacientes atendidos na emergência com diagnóstico de infarto agudo do miocárdio (IAM).Vinte e sete do 48 pacientes tiveram IAM com supra de segmento ST. Aspirina foi prescrita em 93,8% e beta-bloqueador em 70,8% dos pacientes nas primeiras 24 horas. Na alta hospitalar, aspirina foi prescrita em 92,7% e beta-bloqueador em 85,4% dos pacientes. O inibidor da enzima de conversão (IECA) foi prescrito em 70,7% e estatina em 85,4%. Setenta e nove por cento dos pacientes foram a cateterismo cardíaco, 56,3% a angioplastia e 6,3% a revascularização miocárdica. Concluímos que os dados obtidos no HCPA são semelhantes aos descritos na literatura internacional, porém aquém do ideal.There are data in the national and international literature suggesting that implementation of pathways and guidelines result in better outcomes. Also, these data suggest that the gotten changes are not kept in long periods. We developed this project to reevaluate the Acute Myocardium Infarction (AMI) Pathway implemented in the Hospital de Clínicas de Porto Alegre (HCPA). We used quality indicators to compare our data with the existing ones in international literature; data have been collected online. Forty eight patients were admitted to the emergency room with diagnosis of AMI. Twenty seven of the 48 patients had diagnosis of AMI with ST segment elevation. Aspirin was prescribed to 93.8% and beta-blockers to 70.8% of the patients in the first 24 hours. At hospital discharge, aspirin was prescribed to 92.7% and beta-blockers to 85.4% of the patients. The angiotensin-converting enzyme inhibitors were prescribed to 70.7% and statins to 85.4% of the patients. Seventy nine per cent of patients were submitted to coronary angiography and 56.3% to angioplasty and 6.3% to coronary artery bypass grafting. We concluded that the data at HCPA are similar to the ones described in the international literature, being however below the ideal

Management of acute stroke in Hospital de Clínicas de Porto Alegre

Introdução: Acidente vascular cerebral (AVC) é a segunda causa de óbito no mundo e a terceira nos países industrializados. O objetivo deste estudo é avaliar a qualidade do atendimento prestado aos pacientes vítimas de AVC no Hospital de Clínicas de Porto Alegre (HCPA). Poucos trabalhos descrevem o modo de atendimento ideal do AVC agudo, e a ausência de padronização de condutas muitas vezes implica em retardo diagnóstico e terapêutico. Materiais e métodos: trabalho retrospectivo onde foram analisados 55 pacientes (n: 55) admitidos na emergência do HCPA com diagnóstico de AVC agudo, através de suas características demográficas (sexo e idade), tempo de internação e mortalidade geral, indicadores de atendimento inicial (glicemia capilar [GC], pressão arterial [PA], perfil lipídico, eletrocardiograma [ECG], tomografia computadorizada [TC] de crânio), avaliação complementar (ecocardiograma, ecografia com doppler de carótidas, tomografia após 48 horas) e tratamento instituído (AAS, estatina, anticoagulação, trombolítico) Resultados: dos 55 pacientes, 45 (81,8%) apresentaram diagnóstico de AVC isquêmico e 10 (18,2%) de AVC hemorrágico, sendo que a mortalidade do AVC hemorrágico foi significativamente maior (40% vs 4%). Mais de 90% obtiveram medidas de PA e ECG na chegada, e 100% dos pacientes realizaram TC de crânio nas primeiras 24 horas; medidas de GC foram feitas em 60% dos pacientes, e perfil lipídico em apenas 11%. Dos exames complementares destaca-se o ecocardiograma realizado em quase 90% dos casos (69% transtorácico e 18% transesofágico [TE]) e a ecodoppler de carótidas feita em 90%; menos de 30% dos pacientes obtiveram TC após 48 horas. Quanto ao tratamento, aproximadamente 80% receberam AAS e estatina; 20% receberam anticoagulação e nenhum recebeu trombolítico. As análises dos exames complementares e do tratamento foram realizadas apenas nos pacientes com AVC isquêmico. Discussão: a análise dos dados demográficos e a caracterização do AVC (hemorrágico X isquêmico) foram similares aos encontrados na literatura. A falha do estudo foi não ter excluído os pacientes que foram a óbito na análise do tempo de internação, desta forma subestimando o resultado principalmente do AVC hemorrágico, que obteve maior mortalidade. A avaliação complementar foi satisfatória e condizente com a descrição da literatura. Quanto ao tratamento, apesar de fortes evidências validando o uso de trombolíticos, este não foi praticado neste hospital por norma interna do serviço; a prescrição de AAS e estatina foi adequada ao recomendado na literatura.Background: Stroke is the second cause of death in the world and the third in industrialized countries. The main target of this study is to evaluate the quality of the management of stroke at the Hospital de Clínicas de Porto Alegre (HCPA). There are very few studies in the literature describing the ideal management of the acute stroke, and the lack of management pattern implies in a late diagnosis and treatment. Materials and methods: analysed 55 patients (n: 55) received at emergency room at HCPA with stroke diagnosed, patient´s demographic details (age and sex), internment time and general mortality, fist management impressions (fingerstick glucose [FSG], blood pressure [BP], lipidic profile, eletrocardiogram [ECG], head CT scan), complementary evaluation (echocardiography, carotid US Doppler, head CT scan after 48 hours) and treatment applied (aspirin, statin, anticoagulation, thrombolytic). Results: from the 55 patients, 45 (81,8%) showed ischemic stroke and 10 (18,2%) the hemorrhagic stroke, and the number of deaths from hemorrhagic was significantly higher (40% vs 4%). More than 90% of the patients got BP and ECG measurements upon arrival, and 100% of them had head CT scan on the first 24 hours; FSG measurements were made in 60% of the patients, lipidic profile in only 11%. From the complementary exhaminations the echocardiography is highlighted as the one made in almost 90% of the cases (69% transthoracic and 18% transesophagic [TE]) and the carotide US doppler in 89%; less than 30% had CT scan after 48 hours. Regarding the treatment, approximately 80% received aspirin and statin; 20% received anticoagulation and none received thrombolytic. The analysis of the complementary exhaminations and of the treatment were made only in the patients with ischemic stroke. Discussion: the analysis of the demographic data and stroke type (hemorrhagic X ischemic) was similar to the ones found in the literature. The study failure was to use the patients that died at the internation time - this fact underestimated the results (number of days at the hospital) specially in hemorragic stroke, which got more number of deaths. The complementary evaluation was satisfactory and according to the literature. Regarding to the treatment, in spite of the strong evidences of the use of trombolitics, this was not used in this hospital following internal rules; the prescription of aspirin and statins was as per as recommended in the literature

Sessão anatomoclínica HCPA : tosse produtiva e dispnéia

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Relationship of polymorphisms in the tissue inhibitor of metalloproteinase (TIMP)-1 and -2 genes with chronic heart failure

Dysregulated expression of tissue inhibitors of matrix metalloproteinases (TIMPs) is associated with systolic dysfunction and worsening heart failure (HF). However, no study has assessed the relationship between TIMP polymorphisms and chronic HF. In this study, 300 HF outpatients with reduced left ventricular ejection fraction and 304 healthy blood donors were genotyped for the 372 T > C polymorphism (Phe124Phe; rs4898) in the TIMP-1 gene and the −418 G > C polymorphism (rs8179090) in the TIMP-2 gene to investigate whether these polymorphisms are associated with HF susceptibility and prognosis. The genotype and allele frequencies of the 372 T > C polymorphism in HF patients were not significantly different from those observed among healthy subjects, and the C allele of the −418 G > C polymorphism was very rare in our population (frequency  0.05 for all comparisons). Thus, our findings do not support the hypothesis that the 372 T > C (Phe124Phe) polymorphism in the TIMP-1 gene and the −418 G > C polymorphism in the TIMP-2 gene are associated with HF susceptibility and prognosis in Southern Brazilians