Infarto agudo do miocárdio : primeira manifestação da cardiopatia isquêmica e relação com fatores de risco

Objective - To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. Methods - We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. Results - Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. Conclusion - Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels

Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels

Os recém-nascidos sentem dor quando submetidos à sondagem gástrica?

Objetivos: avaliar parâmetros fisiológicos e comportamentais para verificar se o recém-nascido sente dor durante a passagem da sonda gástrica. Métodos: 50 recém-nascidos hígidos com idade gestacional superior a 33 semanas e com peso ao nascer superior a 1.999 g foram submetidos a sondagem gástrica e, após, randomizados por sorteio simples em dois grupos: Fricção/Punção e Punção/Fricção. Os recém-nascidos eram avaliados através da escala NIPS - Neonatal Infant Pain Scale- (0-7 pontos, dor >3) por dois observadores independentes em três momentos: um minuto antes, durante e um minuto após a sondagem gástrica, punção e fricção do pé com monitorização simultânea da freqüência cardíaca, da freqüência respiratória e da saturação de oxigênio da hemoglobina. Resultados: a freqüência respiratória diminuiu somente durante a sondagem gástrica (p=0,004). A freqüência cardíaca diminuiu durante a sondagem gástrica (p=0,001), durante a punção no grupo Fricção/Punção (p=0,01) e durante a fricção no grupo Punção/ Fricção (p=0,022). A saturação de oxigênio da hemoglobina não se alterou nos três procedimentos. Em relação aos resultados obtidos com a escala NIPS em ambos os grupos, os recém-nascidos sentiram dor durante a sondagem gástrica e a punção, e não na fricção (Friedman, p3) by two independent observers in three different moments: one minute before, during, and one minute after gastric suctioning, heel lancing and foot friction, with simultaneous monitoring of heart rate, respiratory frequency, and hemoglobin oxygen saturation. Results: the respiratory frequency only decreased during gastric suctioning (P=0.004). The heart rate was lower during gastric suctioning (P<0.0001), during the heel lacing procedure in the Friction/Lancing group (P=0.01), and during friction in the Friction/ Lancing group (P=0.022). The hemoglobin oxygen saturation suffered no alterations during the three procedures. The results obtained through NIPS revealed that both groups felt pain during gastric suctioning and heel lancing, and did not feel pain during friction (P<0.0001). Conclusion: during the gastric suctioning procedure, newborns responded as if it were a painful stimulus. Physiological alterations were neither specific nor sensitive to pain assessment in newborn infants

Os recém-nascidos sentem dor quando submetidos à sondagem gástrica?

Objetivos: avaliar parâmetros fisiológicos e comportamentais para verificar se o recém-nascido sente dor durante a passagem da sonda gástrica. Métodos: 50 recém-nascidos hígidos com idade gestacional superior a 33 semanas e com peso ao nascer superior a 1.999 g foram submetidos a sondagem gástrica e, após, randomizados por sorteio simples em dois grupos: Fricção/Punção e Punção/Fricção. Os recém-nascidos eram avaliados através da escala NIPS - Neonatal Infant Pain Scale- (0-7 pontos, dor >3) por dois observadores independentes em três momentos: um minuto antes, durante e um minuto após a sondagem gástrica, punção e fricção do pé com monitorização simultânea da freqüência cardíaca, da freqüência respiratória e da saturação de oxigênio da hemoglobina. Resultados: a freqüência respiratória diminuiu somente durante a sondagem gástrica (p=0,004). A freqüência cardíaca diminuiu durante a sondagem gástrica (p=0,001), durante a punção no grupo Fricção/Punção (p=0,01) e durante a fricção no grupo Punção/ Fricção (p=0,022). A saturação de oxigênio da hemoglobina não se alterou nos três procedimentos. Em relação aos resultados obtidos com a escala NIPS em ambos os grupos, os recém-nascidos sentiram dor durante a sondagem gástrica e a punção, e não na fricção (Friedman, p3) by two independent observers in three different moments: one minute before, during, and one minute after gastric suctioning, heel lancing and foot friction, with simultaneous monitoring of heart rate, respiratory frequency, and hemoglobin oxygen saturation. Results: the respiratory frequency only decreased during gastric suctioning (P=0.004). The heart rate was lower during gastric suctioning (P<0.0001), during the heel lacing procedure in the Friction/Lancing group (P=0.01), and during friction in the Friction/ Lancing group (P=0.022). The hemoglobin oxygen saturation suffered no alterations during the three procedures. The results obtained through NIPS revealed that both groups felt pain during gastric suctioning and heel lancing, and did not feel pain during friction (P<0.0001). Conclusion: during the gastric suctioning procedure, newborns responded as if it were a painful stimulus. Physiological alterations were neither specific nor sensitive to pain assessment in newborn infants