Efeito da combinação de diuréticos em pacientes com insuficiência cardíaca agudamente descompensada : um ensaio clínico randomizado

Introdução: A insuficiência cardíaca agudamente descompensada (ICAD) é a principal causa de hospitalização em pacientes com 65 anos ou mais, e a maioria deles apresenta congestão. O uso de hidroclorotiazida (HCTZ) pode aumentar a resposta aos diuréticos de alça. Objetivo: Avaliar o efeito da adição de HCTZ à furosemida na congestão em pacientes com ICAD. Métodos: Ensaio clínico randomizado comparando HCTZ 50 mg e placebo por 3 dias em pacientes com ICAD e sinais de congestão. O desfecho primário foi redução de peso diário. Os desfechos secundários foram mudança na creatinina, necessidade de drogas vasoativas, mudança nos peptídeos natriuréticos, pontuação de congestão, dispneia, sede e tempo de internação. Resultados: 51 foram randomizados - 26 para o grupo HCTZ e 25 para o grupo placebo. Houve uma tendência de redução de peso adicional no grupo HCTZ (HCTZ: -1,78 ± 1,08 kg/dia; placebo: -1,05 ± 1,51 kg/dia; p = 0,062). Em análise post hoc, o grupo HCTZ demonstrou redução de peso significativa para cada 40 mg de furosemida intravenosa (HCTZ: -0,74 ± 0,47 kg / 40 mg; placebo: -0,33 ± 0,80 kg / 40 mg; p = 0,032). Houve um aumento significativo na creatinina no grupo HCTZ (HCTZ: 0,50 ± 0,37 mg/dl; placebo: 0,27 ± 0,40 mg/dl; p = 0,05), mas nenhuma diferença significativa em insuficiência renal aguda (HCTZ: 58%; placebo: 41%; p = 0,38). Nenhuma diferença foi encontrada nos demais desfechos. Conclusão: Houve tendência de maior redução de peso diária no grupo HCTZ. Na análise ajustada à dose de furosemida intravenosa, a adição de HCTZ 50 mg à furosemida resultou em um efeito sinérgico na perda de peso.Introduction: Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. Objective: To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. Methods: This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Results: Fifty-one patients were randomized — 26 to the HCTZ group and 25 to the placebo group. There was a trend towards additional weight reduction in the HCTZ group (HCTZ: -1.78 ± 1.08 kg/day vs placebo: -1.05 ± 1.51 kg/day; p=0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: -0.74 ± 0.47 kg/40 mg vs placebo: -0.33 ± 0.80 kg/40 mg; p=0.032). There was a significant increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 mg/dl vs placebo: 0.27 ± 0.40 mg/dl; p=0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p=0.38). No differences were found in the remaining outcomes. Conclusion: There was a trend towards greater daily weight reduction in the HCTZ group. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a synergistic effect on weight loss

Cardiac involvement in Erdheim-Chester disease: a case report.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis of unknown etiology characterized by proliferation of lipid-containing foamy histiocytes affecting bones and potentially every organ. There is a wide clinical spectrum of the disease, ranging from asymptomatic bone or soft-tissue lesions to life-threatening systemic involvement. Although the initial descriptions published by Jakob Erdheim and William Chester in 1930 included a patient with right atrial infiltration on autopsy, cardiovascular involvement in ECD has only gained more recognition recently. In the present report, we describe a case with cardiac involvement, presenting with symptomatic heart failure and a cardiac mass assessed with echocardiogram and cardiac magnetic resonance imaging

Cardiac involvement in Erdheim-Chester disease: a case report.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis of unknown etiology characterized by proliferation of lipid-containing foamy histiocytes affecting bones and potentially every organ. There is a wide clinical spectrum of the disease, ranging from asymptomatic bone or soft-tissue lesions to life-threatening systemic involvement. Although the initial descriptions published by Jakob Erdheim and William Chester in 1930 included a patient with right atrial infiltration on autopsy, cardiovascular involvement in ECD has only gained more recognition recently. In the present report, we describe a case with cardiac involvement, presenting with symptomatic heart failure and a cardiac mass assessed with echocardiogram and cardiac magnetic resonance imaging

ST elevation myocardial infarction with extensive coronary thrombus in a patient with sickle cell anemia myocardial infarction in patients with sickle cell

O infarto agudo do miocárdio em pacientes com anemia falciforme é, muitas vezes, subdiagnosticado em virtude de fatores de confusão (por exemplo, doença vaso-oclusiva, levando a crises dolorosas). Na maioria dos casos relatados na literatura, as artérias coronárias estavam pérvias e sem lesões. Neste relato de caso, descrevemos a presença de trombo coronariano extenso em paciente com anemia falciforme, apresentando-se sob a forma de infarto agudo do miocárdio com supradesnivelamento do segmento ST, manejado satisfatoriamente com a associação de anticoagulantes e antiplaquetários.Myocardial infarction in patients with sickle cell anemia is often underdiagnosed due to confounding factors (e.g., vaso-occlusive disease leading to painful crisis). In the majority of reported cases, the coronary arteries were pervious and without stenotic lesions. In this case report, we describe the presence of an extensive coronary thrombus in a patient with sickle cell anemia presenting with ST elevation myocardial infarction, managed satisfactorily with the association of anticoagulants and antiplatelet drugs

Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure : a randomized clinical trial

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty‑one patients were randomized—26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: − 1.78 ± 1.08 kg/day vs placebo: − 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: − 0.74 ± 0.47 kg/40 mg vs placebo: − 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss