Dispnéia e sua quantificação ventilatória

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Prevalence, etiology, and characteristics of patients with type-2 acute myocardial infarction

AbstractBackgroundIn clinical practice, type-1 (coronary thrombosis) and type-2 (imbalance between oxygen demand and supply) acute myocardial infarction (AMI) are not clearly differentiated. The aim of this study was to evaluate the prevalence and etiology of type-2 AMI and compare its profile with that of type-1 AMI.MethodsPatients admitted with ST-segment elevation AMI (STEMI)<12hours of symptom onset, and referred for coronary angiography, from 2009 to 2013, were analyzed.ResultsThere were 1,960 patients included; 1,817 were analyzed, of whom 1,786 (98.3%) had type-1 AMI, and 31 (1.7%), type-2. All patients with type-2 AMI showed no significant coronary lesions, and 36% of the cases had apical dyskinesia. Type-2 AMI patients had, in general, a clinical and laboratory profile that was similar to those with type-1, except for the younger age, lower levels of myocardial necrosis markers, higher probability of having pre-TIMI 3 flow and higher left ventricular ejection fraction. At 30 days, mortality (3.2 vs. 9.0%; p=0.23) and the occurrence of death, reinfarction, or need for target-vessel revascularization (3.2 vs. 13.0%; p=0.09) were numerically lower in type-2 AMI.ConclusionsFew patients with STEMI were classified as type-2; they had structural abnormalities, isolated or associated with the absence of significant lesions; showed little difference regarding the clinical and laboratory profile, and similar clinical outcomes at 30 days, when compared to patients with type-1 AMI

Determinação seriada do tempo de apnéia inspiratória máximo (TAIM) no pós-operatório

Objetivo: Avaliar a medida do tempo de suspensão voluntária máximo da ventilação, pela técnica do tempo de apnéia in spiratória máximo (TAIM), como teste de função pulmonar no período pós-operatório . Delineamento: Estudo de coorte contemporâneo. Local: Unidades de cirurgia do Hospital de Clínicas de Porto Alegre da Universidade Federal do Rio Grande do Sul. Pacientes: Noventa e sete pacientes submetidos a cirurgias eletivas. Intervenção: Os pacientes foram avaliados no dia anterior da cirurgia, com a mensuraçâo do valor pré-operatório do TAIM. No período pós-operatório a avaliação foi repetida duas vezes por dia, por sete dias, exceto naqueles que saíram do estudo por a lta ou por necessidade médica . Medidas e resultados: O valor do TAIM pré-operatório (em segundos e centésimos de segundo) de um determinado paciente era considerado IOOOJo para aquele paciente. Os demais valores eram calculados em percentuais do valor pré-operatório. Considerava-se um paciente com TAIM recuperado quando ele atingia ou ultrapassava IOOOJo do valor pré-cirúrgico. Tanto os pacientes com evolução pós-operatória normal (Grupo I; n = 85), como os pacientes com intercorrências pósoperatórias (Grupo 2; n = 12) apresentaram redução significativa dos valores do TAIM na primeira determinação pós-operatória (p < 0,05). O Grupo I reduziu a níveis médios de 64,40Jo (DP = 28,5), e o Grupo 2, 26,40Jo (DP = 15,7), sendo significativa a maior redução no Grupo 2 (p < 0,001) . A recuperação do TAIM no Grupo 2 foi mais lenta e sujeita a novos declínios quando comparada à dos pacientes do grupo controle. O teste mostrou boa sensibil idade e boa especificidade em todo o período estudado. Conclusões: O teste do TAIM se mostrou de fácil execução e de boa aceitação por parte dos pacientes, mostrando-se um elemento útil para acompanhamento clínico no pós-operatório, para detecção e seguimento de complicações desse período.To evaluate the time measurement of the maximum volunta ry holding of ventilation, by the technic of the maximum rime of inspiratory apnea (MTIA), as a test of pulmonary function in the postoperative period. Design: Prospective cohort. Serring: Surgery units of the Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul. Patients: Ninety seven patients submitted to ellective surgeries . Operation: The patients were previously evaluated on the previous day o f the surgery with the preoperative mensuration value o f the MTIA . In the postoperative period, the evaluation was ~epeated twice a day, for seven days, except for the ones who left the study because of discharge or medicai prescription. Measurements and results: The MTIA preoperative v a lue (in seconds and second hundreths) of a special patient was considered to be IOOOJo for that patient. The other values were calculated in percentages of the preoperative estimation. A patient was considered recovered from MTIA when he got or exceeded IOOOJo of the preoperative estimation. The patients with the normal postoperative evolu tion (Group l; n = 85), as well as the patients with "intercurrent" postoperat ive evolutions (Group 2; n = 12) presented significant reduction in the MTIA va lues in the first postoperative determination (p < 0.05). The Group I reduced to average levei of 64.40Jo (SD = 28 .50Jo), and the Group 2, 26.40Jo (SD = 15.70Jo), being significant the biggest reduction in the Group 2 (p<O.OOI) . The recovery of MTIA in the Group 2 was slower and exposed to new decrease when compared to the ones of the patients of the control group. The test showed the good sensibil ity and specificity during lhe whole studied period . Conclusions: The MTIA test showed itself as being easy of execution and having good acceptation, a good useful tool to clinicai follow-up in the postoperative period to detect and to follow complications of this period

RIAM – Multicentre, Interoperable, Clinical Registry of Acute Myocardial Infarction

Introduction: Ischemic heart disease is the leading cause of death in the world. In Brazil, in 2013, acute myocardial infarction (AMI) was the main cause of mortality due to heart disease. A better identification of the patients will serve as a tool to improve the treatment of this pathology. Objective: To expand the database of patients with ST elevation myocardial infarction (STEMI) of the Cardiology Institute (Porto Alegre-RS, Brazil). Methods and Results: The following steps were taken: (1) data elements standardisation in accordance with standard variables, including all applicable standardized data elements published by the American Heart Association / American College of Cardiology, and Brazilian national datasets standards; (2) Development of electronic case reports (CRF) using REDCap (Research Electronic Data Capture) and in accordance with the HIPAA (Health Insurance Portability and Accountability Act) privacy rule ; And (3) expansion of registration to other referral centers. The participating institutions are distributed in the regions of Santa Maria, Passo Fundo, Caxias do Sul all of Rio Grande do Sul, as well as the regions of Santa Catarina and the Distrito Federal in Brasília. The data collected will be stored according to the Health Insurance Portability and Accountability Act. Conclusion: The enhancement and expansion of the RIAM Registry to other referral centers is generating data directly into the REDCap CRF, is a tool with results the treatment of AMI in our environment, which contributes to clinical practice, health services management and policies

Clinical profile and outcomes of primary percutaneous coronary intervention in young patients

AbstractBackgroundThe epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low

Histopathological evaluation of coronary thrombi in patients with ST-segment elevation myocardial infarction

ABSTRACTBackgroundPrimary percutaneous coronary intervention (primary PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). Manual aspiration thrombectomy has been increasingly used and enables the analysis of thrombus aspirates.MethodsConsecutive patients undergoing primary PCI were enrolled from December 2009 to June 2011. Clinical, laboratory and angiographic data were prospectively collected and entered in a dedicated database. The decision to perform thromboaspiration was left to the discretion of the operators. One hundred and twelve samples of thrombi were collected, stored in 10% formalin-fixed paraffin, stained with hematoxylin-eosin and analyzed by light microscopy. On histopathological evaluation, the thrombi were classified as recent thrombi or lysed/organized thrombi.ResultsRecent thrombi were identified in 68 patients (61%) and lysed/organized thrombi in 44 patients (39%). Patients with recent thrombi had higher red blood cell infiltration (P=0.03). There were no other statistically significant differences identified for clinical, angiographic, laboratory or clinical outcomes between the two study groups.ConclusionsIn patients with STEMI undergoing primary PCI, two-thirds of thrombus aspirates showed histopathological features of recent thrombi. There were no significant associations between these characteristics and clinical, laboratory and angiographic data in this contemporary sample representative of the real world