Twenty-four-hour monitoring of blood pressure and heart rate in heart transplant patients.
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Adult↗
Biomedical subjects
F Pileggi
Publications and source records attributed to F Pileggi.
The antiadrenergic effects of hypermagnesemia: an experimental study.
The circulatory effects of norepinephrine (4 micrograms/kg), isoproterenol (10 micrograms/kg) and phenylephrine (20 micrograms/kg) were determined in anesthetized dogs with normal plasma magnesium and with induced hypermagnesemia. Norepinephrine caused a 24% increase in heart rate and a 103% increase in the systemic vascular resistance index in normomagnesemic dogs, while with hypermagnesemia the variations were of 13% and 1%, respectively. Isoproterenol increased heart rate by 48% and 18% in dogs with normo- and hypermagnesemia, respectively. Phenylephrine increased the systemic vascular resistance index (74%) only in the normomagnesemic state. The effects of all the drugs were significantly different (P less than 0.01), without and with the simultaneous administration of magnesium sulfate (plasma magnesium, 1.3 +/- 0.2 mEq/l and 6.8 +/- 1.1 mEq/l, respectively). We conclude that acute induced hypermagnesemia antagonizes the circulatory effects of adrenergic stimulation, a fact that may explain its antiarrhythmic and hemodynamic effects during acute myocardial ischemia.
Animals↗
Acute effects of dobutamine and dopamine on renal and respiratory functions in patients on prolonged mechanical ventilation.
1. It is known that positive pressure mechanical ventilation (PPMV) decreases diuresis and increases extravascular water, thereby impairing pulmonary gas exchange. Sympathomimetic amines are commonly used to relieve these effects. To compare the effects of dobutamine (DT) and dopamine (DP) on renal and pulmonary function, we studied 30 patients submitted to continuous PPMV for at least 72 h. All were in stable hemodynamic conditions. Patients had pulmonary insufficiency of different etiology. The drugs were randomly administered by continuous intravenous infusion at the dose of 4 to 6 micrograms kg-1 min-1 for 3 h. An interval of 60 min was allowed to elapse between treatments. 2. A significant increase in arterial pressure and heart rate occurred with both drugs (P less than 0.05). DP increased urinary flow by 93.7% (1.6 +/- 0.1 to 3.1 +/- 0.4 ml/min; P less than 0.05) and Na excretion fraction (NaEF) by 35.5% (P less than 0.05). In contrast, DT reduced NaEF by 58.9% (P less than 0.05) and had no effect on urinary flow. Neither drug altered creatinine clearance. 3. The alveolo-arterial O2 difference (A-aO2D), which was 370 +/- 20 mmHg during the control period, increased to 394 +/- 20 mmHg after DP and decreased to 355 +/- 22 mmHg after DT, the difference being statistically significant (P less than 0.05). Pulmonary shunt (%) and the venous pO2 (mmHg) did not change during the infusion of DP or DT. 4. In conclusion, an acute increase in salt and water excretion does not necessarily lead to an immediate reduction in pulmonary "shunt".(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Use of intravenous hydralazine in treatment of hypertensive crisis].
PURPOSE: To evaluate the efficacy and safety of intravenous hydralazine in arterial hypertension. PATIENTS AND METHODS: 12 patients, mean age 45.33 +/- 15.82.8 men and 4 women all of them with systolic (S) arterial pressure (AP) greater than or equal to 180 and or diastolic (D) greater than or equal to 126 mmHg with symptoms like headache, in characteristic thoracic pain and others but without an hypertensive emergency neither acute manifestation of hypertensive encephalopathy through fundi examination were studied. The AP was taken 10 minutes after rest (initial) and 5, 15, 30 and 60 min (final) after intravenous administration of hydralazine-HCL (5 mg) which was repeated when at least 20% AP reduction was not achieved. RESULTS: The initial and final SAP, DAP and heart rate (HR) were 208 +/- 19.4 and 176 +/- 17.2 (p less than 0.0001), 133 +/- 11.3 and 112 +/- 11.5 (p less than 0.001) and 72 +/- 12.9 and 80 +/- 15.5 (NS), respectively. Side effects related to the drug were observed in 3 (25%) patients. One had symptomatic orthostatic hypotension, the second had precordial pain with ST-T changes compatible with myocardial ischemia and the third presented a thorax and abdominal cutaneous erythema, but all of them reversible. CONCLUSION: Intravenous hydralazine-HC1 is an alternative when rapid arterial pressure reduction is needed.
Adult↗
[The influence of lipoprotein (a) in thrombolysis with r-TPA for myocardial infarction].
PURPOSE: To evaluate the influence of lipoprotein (a) (Lp (a)) levels in thrombolysis with rt-PA for myocardial infarction (MI). METHODS: Thirty-eight MI patients, 28 male, mean age 51 +/- 9 years, submitted to thrombolysis with rt-PA, divided in two groups according the result of the thrombolysis: A) Successful, B) Failure. Serum fibrinogen (SF) was assessed before and 90 minutes after treatment. Lp (a) levels were determined six months later. These parameters were analyzed in both groups. RESULTS: Lp (a) levels were similar in groups A and B (p = 0.45). The SF levels were not different in the groups. CONCLUSION: Lp (a) seems to have no influence in thrombolysis with rt-PA for MI.
Administration, Oral↗
[Variability of the heart rate and silent ischemia after myocardial infarction].
PURPOSE: To show a possible relation between heart rate and silent myocardial ischemia. METHODS: Forty-nine ischemic episodes were registered in six patients during a total period of 576-hour Holter monitoring. Those patients were selected from a group of 40 asymptomatic individuals after a first uncomplicated myocardial infarction; 11 (27.5%) showed ischemia during daily activities or exercise, the six selected patients had myocardial ischemia on Holter monitoring. RESULTS: The silent episodes consisted 92% of the total ischemic burden; they lasted from 1 min 30 s to 20 min and the ST-segment depression varied from -1.1 mm to 3.3 mm. Thirty-five (72%) episodes occurred at rest or during light physical activities; nine (18.5%) occurred between 7:00 AM and 12:00 PM; eight (16.5%), between 12:00 PM and 6:00 PM; 17 (35%) between 6:00 PM and 12:00 AM and 15 (30%), between 12:00 AM and 7:00 AM. There was no significant change (more than 20%) in heart rate at the onset of ischemic episodes in relation to the heart rate 1 minute before (94.63 +/- 9.79 bpm and 99.47 +/- 10.99 bpm, respectively). Complex ventricular arrhythmias occurred in all patients and only one of them had an episode of nonsustained ventricular tachycardia related to silent ischemia. CONCLUSION: Our results suggest that there is no relation between heart rate, arrhythmias and silent ischemia.
Arrhythmias, Cardiac↗
[Ergospirometry as a method for predicting the clinical course of ischemic, Chagas and idiopathic myocardiopathy].
PURPOSE: To compare and evaluate the modifications variables obtained through spyroergometry in groups of patients with ischemic cardiomyopathy (IS), Chagas' disease (CH), and idiopathic cardiomyopathy (ID). To study tolerance to anaerobic conditions of patients from the above groups who died. METHODS: A study was carried with 50 male patients, 10 of which were found in normal conditions whereas 40 presented cardiomyopathy with compensated heart failure. We observed that from the 40 patients from the cardiomyopathy groups, nine died, subgroups OB--during the study period of 1.005 days. These were compared to subgroups NOB--the remaining 31 patients. These patients were evaluated under 4 conditions--Rest (Rep), anaerobic threshold (LA), power peak of the exercise (P) and in the fourth minute recovery (REC). The investigation was based on data collected by means of spyroergometry: oxygen consumption (MET), production of CO2-(VCO2), respiratory equivalent of oxygen (VE/VO2), oxygen pulse (VO2/FC) and the time elapsed between LA and P. RESULTS: There were significant differences when the three pathological groups (IS, CH, ID) were compared with the control groups (N). There were no significant differences when the three pathological groups compared among themselves. In relation to tolerance to anaerobic conditions significant differences were found among the patients of subgroup OB--1.33 min--who died when compared to subgroup NOB--3.26 min (time elapsed between LA and P). CONCLUSION: The authors conclude that the variables studied, obtained through spyroergometry may indicate important data towards the prognosis with heart failure.
Adult↗
[Diet with usual quantity of salt in hospital treatment of congestive heart insufficiency].
PURPOSE: To study the consequences of a diet with usual salt quantity (non salt-restricted) on hospital treatment of congestive heart failure (CHF), in behalf of a better food intake. METHODS: Thirty-two patients admitted to compensation of class III or IV CHF, randomly allowed to group I (2 g salt per day diet) or II (10 g salt). Hypertensive, renal failure or restrictive syndrome cases were excluded. Oral medication and water intake were standardized; furosemide dosage was adjusted on a daly basis, allowing the study of this drug's requirements in each group. Compensation of CHF was defined as a return to classes I or II without edema. RESULTS: Group I included 14 and group II 18 patients. There was no significant difference between groups respective to the time needed for compensation of CHF (7.5 x 6.6 days, mean) percentual weight loss (12.2 x 10.0%), cumulative furosemide dosage (568 x 599 mg), mean daily furosemide dosage per kilogram of lean weight (1.43 x 1.58 mg/kg/day), and to 24-hour urinary excretion of sodium (241 x 254 mEq) and potassium (38.8 x 53.9 mEq). Small elevations of blood urea and potassium were an uniform trend. There was no significant alteration of plasmatic sodium. Food intake was adequate. There was one death for each group, from causes not directly related to CHF. CONCLUSION: Dietary salt intake did not adversely influence in-hospital compensation of severe CHF in studied group. In selected cases, adoption of a more liberal diet in this aspect may allow the patient a better ingestion of food.
Adult↗
[Comparison of the effects of diazepam, nifedipine, propranolol and a combination of nifedipine and propranolol, by sublingual administration, in patients with hypertensive crisis].
PURPOSE: To evaluate the effects of sublingual administration of diazepam, nifedipine, propranolol and the association of nifedipine with propranolol patients with hypertensive crisis. METHODS: Eighty patients with hypertensive crisis, DAP greater than 120 mmHg, and mean age of 54 +/- 7.4 years, 33 women and 47 men, were evaluated. The AP was measured with an aneroid sphygmomanometer, in mmHg, in orthostatic position, before and after 10, 20, 30 and 60 minutes of treatment. The heart rate in one minute was also measured at the same intervals. The patients were divided randomly into four groups and treated, respectively, with 10 mg of diazepam, 10 mg of nifedipine, 40 mg of propranolol and 10 mg of nifedipine associated with 40 mg of propranolol. RESULTS: A significant and gradual reduction of SAP and DAP were observed in all groups of patients. The percentage of reduction, after 60 minutes, for SAP was, respectively, 10.1%, 12.9%, 15.4% and 16%, and for DAP 7.7%, 11.3%, 13.6% and 13% in groups I to IV. The heart rate did not change in groups I and II, but significative reduction was observed in groups III (p = 0.002) and IV (p = 0.009). CONCLUSION: The drugs used were effective for the treatment of hypertensive crisis, and the sublingual administration is an important and easy way for their administration.
Administration, Sublingual↗
[Lipoprotein (a) plasma levels in normal subjects and patients with coronary disease confirmed by coronary cineangiography].
PURPOSE: To evaluate the plasma concentration of lipoprotein (a) (Lp(a) in subjects with normal or altered coronary angiography, as a risk factor of atherosclerosis in a Brazilian population. PATIENTS AND METHOD: Lp(a) plasma levels were determined by radioimmunoassay in 31 subjects with normal angiography and in 131 subjects with atherosclerosis. Plasma cholesterol, triglycerides, apolipoprotein A, A1 and B were also determined as well as risk factors like systemic arterial hypertension, smoking habit, diabetes and physical activity. RESULTS: Subjects with coronary disease had Lp(a) plasma levels of 41.9 mg/dl, compared to 23.9 mg/dl found in the normal group. Coronary artery disease risk was increased 2.3 times in those with plasma Lp(a) levels equal or above 25 mg/dl, compared to those with levels below this boundary. As to other known risk factors, only smoking habit has shown correlation with coronary artery disease. CONCLUSION: We confirmed the value of Lp(a) as a risk factor of coronary heart disease.
Adult↗
[Mitral valve prolapse and panic disorder].
PURPOSE: To determine the incidence of mitral valve prolapse (MVP), using echocardiographic and auscultatory criteria, in cases of panic disorder (complicated or not with agoraphobia). PATIENTS AND METHODS: Sixty-five patients (37 women) with panic disorder and without known cardiac disease, mean age 39.8 years (range 19-67) were studied. MVP was diagnosed when there was a typical auscultatory click or when the echocardiographic study (echo) registered one mitral lacinea 2 mm behind the C-D line at the "M" study or a systolic billowing of mitral leaflets in two views to the two-dimensional study. RESULTS: MVP was found in 29 (44.6%) of the patients, 12 (42.7) men and 17 (49.5%) women. A click was found in 19 (24%) of the cases and the Echo was positive in 24 (39.6%) of the patients. Click and a positive Echo finding were identified in 14 patients. CONCLUSION: MVP was found in panic cases, in incidence greater than in the general population.
Adult↗
[Effect of ticlopidine and dipyridamole on platelet aggregation and count in patients with chronic stable angina pectoris].
PURPOSE: To compare the ticlopidine and dipyridamole effects on platelets count and aggregation in patients with stable coronary artery disease. PATIENTS AND METHODS: Eighty patients with stable coronary artery disease and mean of 58.3 +/- 5.8 years were studied. They were divided into two equal groups of 40 patients and each one treated with ticlopidine or dipyridamole. Platelets count and aggregation were examined before treatment and at first and fourth weeks of treatment. RESULTS: At the end of fourth week of treatment, spontaneous, induced by ADP or by adrenalin platelet aggregation inhibition was observed, respectively, in 82.5%, 72.5% e 67.5% of the patients in ticlopidine group. The spontaneous, induced by ADP or by adrenalin, platelet aggregation inhibition in the patients of dipyridamole group was, respectively, 40%, 30% e 27.5% (p less than 0.001). The platelets count did not change in both groups. CONCLUSION: The ticlopidine effect is much more evident in platelet aggregation inhibition than dipyridamole, and maybe a choice in the prevention of cardiovascular events.
Coronary Disease↗
Usefulness of high-frequency analysis of signal-averaged surface electrocardiograms in acute myocardial infarction before and after coronary thrombolysis for assessing coronary reperfusion.
The incidence of late potentials on the signal-averaged electrocardiogram before and after coronary thrombolysis was studied in 54 patients with an acute myocardial infarction of less than or equal to 5 hours' duration and with an angiographically documented total occlusion of the infarct-related coronary artery on admission. A significant (p = 0.038) 50% relative reduction in the incidence of late potentials was observed in the group of 35 patients who underwent reperfusion: from 16 of 35 (46%) before to 8 of 35 (23%) at 120 minutes after the start of thrombolytic treatment. No significant reduction was seen in the 19 patients in whom thrombolysis was unsuccessful: from 8 of 19 (42%) before to 7 of 19 (37%) afterward. Despite successful recanalization, late potentials persisted or newly developed after thrombolytic therapy in 8 of 54 patients (15%). It is concluded that successful thrombolysis reduces the incidence of late potentials on the signal-averaged electrocardiogram but that the sensitivity and specificity of this finding are not high enough to allow reliable monitoring of coronary reperfusion at the bedside.
Arrhythmias, Cardiac↗
Coronary angioplasty--unstable lesions and prolonged balloon inflation time.
One of the most important complications after percutaneous transluminal coronary angioplasty is the abrupt closure of the dilated vessel (unstable lesion). The treatment of choice for this complication is a new dilation, but unfortunately many of these cases require immediate surgery to avoid an acute myocardial infarction. Prolonged balloon inflations have been suggested to control this kind of complication. In order to discover the effect of prolonged inflations on the incidence of unstable lesions we studied 439 patients enrolled in two groups: Group I (195 patients and 207 arteries) treated with balloon inflation time less than 40 sec per session and Group II (244 patients and 265 arteries) treated with inflation time over 60 sec since the first series of inflations. As a result there was a significantly lower incidence of unstable lesions and immediate surgery in Group II without an increase in the incidence of diffuse ischemia.
Angioplasty, Balloon, Coronary↗
Infective endocarditis in the 1980s: experience at a heart hospital.
Three hundred episodes of infective endocarditis (IE) in 287 patients were studied from October 1978 to August 1986. The patients were in the age range of 0.2-78 (mean 30.76 +/- 16.06) years; 185 (68%) occurred in male patients. The etiologic agents were: Streptococci viridans group (93), enterococci (21), streptococci D group, nonenterococci (19), other streptococci (14), Staphylococcus aureus (59), Staphylococcus epidermidis (14), gram-negative bacteria (16), other gram-positive bacteria (16), fungi (4). Etiologic agents were not isolated in 52 (negative cultures). Valvular heart diseases occurred in 231 episodes, congenital heart diseases in 37, other heart diseases in 6. Sixty-nine occurred in patients with prosthetic heart valves. In 69 there was no previous heart disease. Surgical treatment was performed in 102 episodes (37 with prosthetic valve IE and 65 with native valve IE); 22 patients (21%) died, 12 with prosthetic valve and 10 with native valve IE. The in-hospital mortality (medical and surgical patients) was 26% (78 patients). Long-term follow-up of 206 patients up to 7.1 (mean 2.13 +/- 1.68) years revealed that 26 patients died. Thus, IE remains a disease with high mortality and is fatal to a third of the patients, in spite of the progress in therapeutic methods. Its morbidity and mortality continues beyond the microbiological cure.
Adolescent↗
Frequency and significance of cardiac rhythm disturbances in healthy elderly individuals.
The authors examined the prevalence and significance of cardiac rhythm disturbances in healthy elderly individuals. They selected 26 men with active lifestyles, aged 70-81 years, after clinical, routine blood tests, chest radiographs, echocardiography, resting and exercise electrocardiography, and Gated cardiac blood imaging evaluations. The men were submitted to continuous electrocardiographic monitoring during their daily routine. The recording time ranged from 838 to 1,432 min (average = 1,307 +/- 153 min). Clinical follow-up was done every six months. Sinus rhythm predominated in all subjects. The maximal, minimal, and average heart rate ranges (beats/min) were, respectively: during sleeping periods, 60-115 (85.8 +/- 13.2), 42-80 (56.6 +/- 8.7), 51-85 (64.0 +/- 8.8); and during awake periods, 85-150 (118.4 +/- 16.4), 50-85 (64.1 +/- 9.1), 61-90 (75.3 +/- 8.3). The longest sinus pauses were observed during sleep and ranged from 0.8 to 2.5 sec (1.25 +/- 0.34 sec). Atrial ectopic beats were observed in 20 individuals (76.9%). They were frequent in four (15.4%) and repetitive in nine (34.6%) of them. Short-lasting episodes of paroxysmal atrial tachycardia and paroxysmal atrial flutter were observed in one case each. Ventricular ectopic beats were recorded in 20 individuals (76.9%). They were frequent in 6 (23%) and multiform in 13 (50%) of them. Couplets were observed in 5 cases (19.2%) and episodes of nonsustained ventricular tachycardia were present in 3 individuals (11.5%). No symptoms were referred by any individual during recording. No clinical signs of heart disease or symptoms were noticed during the average 40 +/- 7.2 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Correlation between gallium-67 imaging and endomyocardial biopsy in children with severe dilated cardiomyopathy.
Fourty-four patients (aged 10 months to 15 years) were assessed in a double-blind study to observe the correlation between myocardial uptake of 67-gallium and endomyocardial biopsy in the detection of moderate to severe myocardial inflammation. The sensitivity and specificity of gallium-67 imaging were 87 and 81%, respectively. Based on these findings, immunosuppressive therapy can be assigned to children with dilated cardiomyopathy and positive myocardial uptake, since moderate and severe myocardial inflammation may be detected by this non-invasive method.
Adolescent↗
Surgical treatment of endomyocardial fibrosis: a new approach.
Endomyocardial fibrosis has been treated surgically for many years. For complete removal of fibrosis from both ventricles by the classic technique, each atrioventricular (AV) valve was removed and replaced with a prosthesis. Relapse of endomyocardial fibrosis has not been observed after surgical correction. Reoperations have been carried out because of complications of valve prostheses. A new surgical technique for removal of ventricular fibrous tissue with preservation of the mitral and tricuspid valves was used in nine consecutive patients with endomyocardial fibrosis. Initial results show a reduction of pulmonary hypertension, mean right and left atrial pressures and end-diastolic pressures in both ventricles. Tricuspid annuloplasty was performed in seven patients and mitral annuloplasty in five. No valve prosthesis was used. There was no death and New York Heart Association functional class improved from class III or IV in the preoperative period to class I or II in the postoperative period. These data suggest that resection of endocardial fibrous tissue can be indicated early in the clinical course and performed with preservation of the AV valves.
Adult↗