Renal sympathetic denervation in resistant hypertension

Resistant hypertension remains a major clinical problem despite the available multidrug therapy. Over the next decades, its incidence will likely increase given that it is strongly associated with older age and obesity. Resistant hypertension patients have an increased cardiovascular risk, thus effective antihypertensive treatment will provide substantial health benefits. The crosstalk between sympathetic nervous system and kidneys plays a crucial role in hypertension. It influences several pathophysiological mechanisms such as the central sympathetic tone, the sodium balance and the systemic neurohumoral activation. In fact, studies using several animal models demonstrated that the renal denervation prevented and attenuated hypertension in multiple species. Large reductions in blood pressure were also observed in malignant hypertension patients submitted to sympathectomy surgeries. However, these approaches had an unacceptably high rates of periprocedural complications and disabling adverse events. Recently, an innovative non-pharmacological therapy that modulates sympathetic activation has been successfully developed. Renal sympathetic percutaneous denervation is an endovascular procedure that uses radiofrequency energy to destroy the autonomic renal nerves running inside the adventitia of renal arteries. This method represents a promising new approach to the strategy of inhibiting the sympathetic nervous system. The aim of this review is to examine the background knowledge that resulted in the development of this hypertension treatment and to critically appraise the available clinical evidenc

VALORIZAÇÃO DA PRESSÃO TELEDIASTÓLICA DO VENTRÍCULO ESQUERDO NO ESTUDO DE HEMODINÂMICA

O avanço significativo das tecnologias não invasivas, na última década, permitiu maior clareza e rapidez na obtenção de diagnósticos complexos, no entanto, a suboptimização dos resultados ou as características intrínsecas dos doentes revelam que a avaliação invasiva é muitas vezes indispensável, como acontece na quantificação das perturbações hemodinâmicas associadas a doenças cardiovasculares. Segundo Morton,a interpretação da curva de pressão telediastólica do ventrículo esquerdo é muitas vezes um indicativo da sua capacidade funcional. O principal objectivo deste trabalho de investigação, foi avaliar o aumento da pressão telediastólica do ventrículo esquerdo (VE) em indivíduos submetidos a cateterismo cardíaco, e identificar a sua relação com a função ventricular esquerda

Right coronary artery aneurysm

Int J Cardiol. 2007 Jan 18;114(3):e122-3. Epub 2006 Oct 16. Right coronary artery aneurysm. Luz A, Silveira J, Carvalho H, Gomes L. Abstract Coronary artery aneurysms, characterized by abnormal dilatations of a localized portion of the coronary artery, are an uncommon finding during angiography. We present a case where a giant right coronary aneurysm was detected during angiography, in a patient admitted with a inferior wall myocardial infarction. PMID: 17049395 [PubMed - indexed for MEDLINE

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

Spironolactone was likely to provide faster congestion relief. -------------------------------------------------------------------------------- Abstract Background/objectives Mineralocorticoid receptor antagonist (MRA) use in acutely decompensated chronic heart failure (ADCHF) may improve congestion through diuretic effect and prevent neurohormonal activation. We aimed to evaluate the clinical effect and safety of spironolactone in ADCHF. Methods Prospective, experimental, single-center, and single-blinded trial. Patients were treated with: standard ADCHF therapy or oral spironolactone 50–100 mg/d plus standard ADCHF therapy. Results During a 1 year period, 100 patients were enrolled, 50 included in the treatment group. Mean (SD) spironolactone dose (mg) at day 1 was 94.5 ± 23.3 and at day 3 was 62.7 ± 24.3. Worsening renal function (increase in pCr ≥ 0.3 mg/dL from day 1 to day 3) was more likely to occur in control group (20% vs. 4%; p = 0.038), serum potassium did not differ between groups, and plasma NTproBNP had a significant decrease in spironolactone group at day 3 (median [IQR], 2488 [4579] vs. 1555 [1832]; p = 0.05). Furthermore, a greater proportion of patients in the treatment group were free of congestion at day 3: less edema, rales, jugular venous pressure (JVP) and orthopnea (all, p < 0.05). In addition, a significantly higher proportion of patients were on oral furosemide at day 3 (44% vs. 82%; p < 0.001). Conclusions Our study supports the safety of high dose spironolactone in ADCHF and suggests a positive impact in the resolution of congestion. The important findings of our pilot study need to be confirmed in larger trials

High-Sensitivity Troponin T: A Biomarker for Diuretic Response in Decompensated Heart Failure Patients

Background. Patients presenting with acutely decompensated heart failure (ADHF) and positive circulating cardiac troponins were found to be a high-risk cohort. The advent of high-sensitive troponins resulted in a detection of positive troponins in a great proportion of heart failure patients. However, the pathophysiological significance of this phenomenon is not completely clear. Objectives. The aim of this study is to determine the early evolution and clinical significance of high-sensitivity troponin T (hsTnT) in ADHF. Methods. Retrospective, secondary analysis of a prospective study including 100 patients with ADHF. Results. Globally, high-sensitivity troponin T decreased from day 1 to day 3 (P = 0,039). However, in the subgroup of patients who remained decompensated no significant differences in hsTnT from day 1 to day 3 were observed (P = 0,955), whereas in successfully compensated patients a significant reduction in hsTnT levels was observed (P = 0,025). High-sensitivity troponin T decrease was correlated with NTproBNP reduction (P = 0,007). Patients with hsTnT increase had longer length of stay (P = 0,033). Conclusions. Episodes of ADHF are associated with transient increases in the blood levels of hsTnT that are reduced with effective acute episode treatment. The decrease in hsTnT can translate less myocardial damage along with favourable ADHF treatment