Blood pressure measurement

This article reviews the basis of indirect blood pressure measurement. The technical aspects, confounding factors and special situations, and the normal values supported by literature consensus are reviewed.Este artigo revisa a medição da pressão arterial através do método indireto. São discutidos a técnica de medida e fatores que interferem no método, situações especiais e os valores de referência com base nos consensos recentemente publicados

Cardiovascular examination: inspection, palpation and percussion

A importância da avaliação da inspeção e da palpação do sistema cardiovascular é ressaltada. Procurou-se demonstrar a importância da interpretação dos dados obtidos na análise do ictus cordis, da perfusão periférica e dos pulsos arteriais e venosos para as diversas cardiopatias, sempre com o objetivo de sistematização.The inspection and palpation of the physical examination of the cardiovascular system is emphatizated. The value of the analysis of the periferic perfusion and arterial and venous pulses for the systematic evaluation of the several cardiopathies is reinforced.   &nbsp

Cardiac auscultation: physiological and physiopathological mechanisms

São revistos os mecanismos básicos, determinantes dos sons cardíacos, normais e anormais, com ênfase nas suas implicações para a ausculta cardíaca à beira do leito.The physiologic and physiopathological mechanisms of normal and abnormal heart sounds are reviewed, including their implications for bedside cardiac auscultation

Equine leukoencephalomalacia: report of five cases

Relatam-se 5 casos de leucoencefalomalécia em equinos associados com a ingestão de milho mofado, ocorridos durante o inverno de 1990, provenientes de 3 propriedades no Estado de São Paulo, nos municípios de Poá, Pirassununga e Santana do Parnaíba. Os animais apresentaram sinais clínicos semelhantes como ataxia, cegueira, disfagia, andar em círculos e convulsões. Ao exame necroscópico, os cérebros encontravam-se congestos, revelando ao corte áreas de cavitação ao nível da substancia branca sub-cortical. O exame histopatológico exibiu lesões ao nível de substancia branca, caracterizadas por necrose de liquefação, hemorragias focais e infiltrados celulares nos espaços de Virchow-Robin, compostos predominantemente porpolimorfonucleares (eosinófilos e neutrófilos), associados a mononucleares. Análises microbiológicas demonstram que Fusarium moniliforme foi o fungo mais freqüente (1.9 x 10 6 UFC/g de alimento).This paper reports the occurrence of 5 cases of Equine Leukoencephalomalacia associated with the ingestion of mouldy corn during the winter of 1990 in three properties of the State of São Paulo, in the municipal districts of Poá, Pirassununga and Santana do Parnaíba. The animals showed in every case the following clinical signs: blindness, ataxia, dysphagya, tendency to circle and convulsions. The necropsy revealed congestion of brain and areas of cavitation within the hemispheres of subcortical white matter. The histopathological examination show edlesions characterized by liquefactive necrosis, multifocal haemorrhages and cellular infiltration, predominantly of polimorphonuclear (neutrophils and eosinophils) associated with mononuclear cells in the white matter. Microbiological analysis showed a mycoflora composed, predominantly, by Fusarium moniliforme (49.4%), followed by genera Aspergillus (25.8%) and Penicillum (24.8%)

Acute coronary syndromes in the emergency department

As síndromes isquêmicas miocárdicas Instáveis (SIMI) são freqüentes na Sala de Urgência (SU) e o seu não reconhecimento ou tratamento inadequado implicam em elevada morbimortalidade. A conduta, no ambiente da SU, é dependente do risco, estimado a partir de aspectos de história e exame físico, parâmetros eletrocardiográficos e da dosagem de marcadores séricos de necrose miocárdica. Os princípios terapêuticos das SIMIs com supradesnivelamento de ST ao eletrocardiograma (infarto agudo do miocárdio) e das SIMIs sem supradesnivelamento de ST (angina instável e infarto agudo sem supradesnível de ST) são revisados neste artigo.Acute Coronary Syndromes (ACS) are very frequent in the emergency department and the lack of proper diagnosis or inadequate treatment imply great morbidity and mortality. The ACS treatment is dependent on the risk, estimated by medical history and physical examination, eletrocardiographic parameters and serologic necrosis markers. The therapeutic principles for ACS with ST elevation (acute myocardial infarction) and of the ACS without ST elevation (unstable angina and acute myocardial infarction without ST elevation) are reviewed

Prospective study of ventricular function and myocardial deformation related to survival in acute Chagas disease: an experimental animal model

Chagas disease (CD) has been changing from an endemic Latino-American disease to a condition found outside endemic regions, due to migratory movements. Although often subclinical, its acute phase can be lethal. This study aimed to assess survival during the acute phase of CD and its relationship with ventricular function in an experimental model. To this end, 30 Syrian hamsters were inoculated with Trypanosoma cruzi (IG) and other 15 animals received saline solution (CG). Groups were monitored daily and submitted to echocardiography in two moments: before the challenge and 15 days post-infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of the LV were measured. The IG was divided into groups of animals with and without clinical signs of disease. ANOVA for mixed models was used to compare ventricular function parameters. Survival analysis was studied using Kaplan-Meier curves and the log-rank test. The follow-up lasted 60 days. LVEF in IG was reduced through time (53.80 to 43.55%) compared to CG (57.86 to 59.73%) (p=0.002). There was also a reduction of GLS (−18.97% to −12.44%) in the IG compared to CG (p=0.012). Twelve animals from IG died compared to one animal from CG. Eleven out of the 12 animals from the IG group died before presenting with clinical signs of infection. Survival was reduced in the IG compared to CG over time (p=0.02). The reduced survival during the acute phase of this experimental model of Chagas disease was related to the significant reduction of LV function. The mortality rate in the IG was higher in the group presenting with clinical signs of infection

SIMULAÇÃO DE PACIENTES – CURSOS DE SUPORTE DE VIDA ACLS, BLS E PALS NA FMRP - USP

The American Heart Association Life Support courses, including Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support, are spreading across the world since the introduction of international guidelines for clinical emergencies. The impact of the insertion of these courses on university institutions is unknown. The goal of this article is to describe the experience to implement these courses atthe University Hospital, Medical School of Ribeirão Preto, University of São Paulo (HCFMRP-USP), characterizing its historical evolution, impact onresearch, teaching and health care activities and also future perspectives.Os cursos de suporte de vida organizados e coordenados pela American Heart Association incluem as modalidades: Suporte Básico de Vida, Suporte Avançado de Vida em Cardiologia e Suporte de Vida Avançado em Pediatria. Esses cursos estão sendo disseminados mundialmente, especialmente após o estabelecimento de diretrizes internacionais estabelecendo consensos para o atendimento a emergências clínicas. O impacto da inserção destes cursos em instituições universitárias brasileiras ainda é desconhecido. O objetivo precípuo deste artigo é descrever a experiência de implantação de um centro de treinamento em Suporte de Vida no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), um hospital universitário público inserido no Sistema Único de Saúde. São discutidos aqui aspectos históricos, financiamento e gerenciamento, o impacto em atividades de pesquisa, ensino e de atenção à saúde tanto no contexto local, regional, nacional e internacional, bem como suas perspectivas futuras