Biomedical subjects
Publications and source records attributed to H Madeira.
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The management of heart failure in Europe is largely conducted by primary care physicians in out-patient clinics and by cardiologists and internists in hospitals. Several reports suggest differences among these specialists regarding knowledge and actual practice, and indicate that the application of guidelines is far from optimal. In order to look for differences between cardiologists and internists in terms of implementation of guidelines a survey was carried out among the directors of 83 hospital departments of cardiology and internal medicine in Portugal. The survey included questions about diagnostic and treatment protocols, special areas for management, and suggestions to improve the quality of heart failure patient treatment. The answers suggest that in Portuguese hospitals at least half of the patients with HF are treated by internists. Treatment protocols exist in about 25% of the cardiology departments but are virtually non-existent in internal medicine. The use and availability of echocardiography are high in cardiology but no more than reasonable in internal medicine. There are neither special in-hospital areas nor specialized nurses for the treatment of HF. Cardiologists recognize the need for greater specialization in this field--doctors, nurses and clinics--but this is not a priority for internists. An effort should be made to improve in-hospital HF treatment.
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UNLABELLED: Prospective study to evaluate the influence of 2 different iodine contrasts (used in coronariography) on the electrocardiographic changes recorded after intra-coronary injection. MATERIAL AND METHODS: Sixty-six patients (pts) - 50 men and 16 women - 59 +/- 4 years underwent coronariography to confirm and/or evaluate coronary artery disease (CAD). Group I (33 pts) received a hyperosmolar contrast; group II received a low osmolarity contrast. The electrocardiograms were recorded during and until 20 seconds after intra-coronary injection, in standard leads and V5. Tracings were analysed regarding the development of: arhythmias, mean axis deviation and QRS enlargement - type A abnormalities; ventricular repolarization (ST/T) changes - type B abnormalities. ECG changes were compared with: 1. contrast used; 2. presence (or absence) of CAD; 3. correlation between type B abnormalities and the arteries affected. RESULTS: 1. a) Twenty nine pts (88%) of group I had A and/or B electrocardiographic changes, compared with 16 (48%) of group II (p < 0.01). b) There were type A changes in 13 pts of group I (39%) versus 3 pts (9%) of group II (p < 0.01). c) Type B changes were present in 25 pts (76%) of group I and in 20 pts (60%) of group II (p-NS). 2. a) Type A abnormalities were recorded in 13 of 48 pts with CAD (27%) against 3 of 18 (17%) cases with normal coronariography (p-NS). b) Type B abnormalities were present in 30 of 48 pts (63%) with CAD and in 10 of 18 cases (56%) of people with normal coronariography (p-NS). 3. In 21 pts with isolated right (or left) CAD, contrast injection in the right coronary artery induced type B ECG changes on the homo-lateral supplied territory in 14 cases, no change at all in 4 cases and changes in the contra-lateral area in only 3 pts. Injections in the left coronary artery produced similar results. CONCLUSIONS: 1. Hyperosmolar contrast produced significantly more electrocardiographic abnormalities, mainly type A, than low osmolarity contrast. This one may be, therefore, preferable. 2. Both types of electrocardiographic changes were equally recorded in pts with CAD and in people with normal coronariography. 3. Type B changes seem to be related with the location of the injection, irrespective of the presence or absence of coronary artery disease.
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The authors describe a case of Whipple's disease, characterized by arthralgias, chronic diarrhea and weight loss. The diagnosis was established on clinical, laboratorial and radiological grounds and confirmed histologically, through a duodenal biopsy. Rapid improvement occurred, soon after the beginning of antibiotic therapy.
It is unusual the association between hypertrophic cardiomyopathy and atrial septal defect. We present in this paper the results of the tests done to one patient with these two diseases and profit to make an update of the bibliography on this subject.
OBJECTIVE: To evaluate the importance of preinfarction angina as a determinant of infarct size. DESIGN: Retrospective study of patients (pts) with acute myocardial infarction (AMI). SETTING: Patients admitted to an Intensive Care Unit of a University Hospital. PATIENTS: The study concerns 224 pts, 161 men women, aged 63.09 +/- 11.92 years, who did not receive thrombolytic or intravenous beta-blocking therapy and in whom it was possible to establish the presence or absence, of previous ischemic heart disease. METHODS: Patients, were divided in 2 groups: A (1st AMI, 172 dts - 123 M, 49 F) and B (2nd AMI, 52 dts - 38 M, 14 F). These groups were subdivided according the presence of preinfarction angina (A1, B1) or its absence (A2, B2). The infarct size was evaluated by peak values of CK/CKMB. RESULTS: Group A: CK/CKMB--959/101; Group B: CK/CKMB--742/77 (p-NS). Subgroups--A1: CK/CKMB--1143/118; A2: CK/CKMB--725/78 (p less than 0.001); B1: CK/CKMB--635/59; B2: CK/CKMB--818/88 (p-NS). The analysis of CK/CKMB values distribution, according to the affected cardiac wall, has shown an identical correlation. CONCLUSION: 1--The larger infarct size in subgroup A1 (1st AMI without angina) suggests a protective effect by collateral circulation in subgroup A2 (1st AMI with angina). 2--The larger infarction (although not significantly) in group A (1st AMI), correlates with less viable muscle in group B (2nd AMI). 3--The higher values of CK/CKMB in group B2 (2nd AMI with angina) can be expected given the presence of residual ischemia. 4--The absence of the protective role by collateral circulation in patients of subgroup A1 (1st AMI without angina) suggests for them a stronger indication for thrombolytic therapy.
Echocardiography (Echo) is the best non-invasive technique to study aortic regurgitation (AR). The authors (AA) start reviewing the place of M-Mode (MM) and two-dimensional (2D) Echo on the identification of AR and its cause, as well as on the assessment of left ventricular function. Secondly, the AA study the role of Doppler (Dp) techniques--pulsed (PDp), continuous (CDp) and colour coded (CCDp)--analysing their relative advantages and complementarity. They conclude that AR is best identified by PDp and MM Echo, its cause may be recognized by MM and 2D Echo, and its importance is correctly judged by CDp and CCDp Echo. Left ventricular function is best appreciated by 2D Echo, helped by CDp and CCDp Echo. The AA also state that, in AR, an haemodynamic study is injustifiable, unless Echo is technically incomplete, there is pluri-valvular disease insufficiently clarified, or coronarography is necessary.
Forty patients, 30 men and 10 women with an average age of 38.47 +/- 11.07 years, suffering from ankylosing spondylitis and attending a Rheumatology Outpatient Clinic, were evaluated for cardiovascular involvement. The evaluation was based on patients' clinical observation, electrocardiography, echocardiography, and chest x-ray. More than a simple review, this study was undertaken with the aim of arriving at a better clinical definition of the cardiovascular manifestations found in ankylosing spondylitis. In fact, of the 40 patients, 8 (20%) had systemic hypertension for which an explanation could not be found, 4 of whom were less than forty-five years old; the echocardiogram showed mitral valve prolapse in 4 patients (10%), 2 of them with a systolic murmur and other 2 with a protosystolic click on auscultation. More significant than the changes in conduction was the finding of a sinus bradycardia in 9 patients (22.5%), and a PR interval below 120 msec in 3 patients (7.5%). The authors conclude that the extension of cardiovascular changes in ankylosing spondylitis is more vast than usually acknowledged.
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The dramatic clinical recuperation of a thirty years old, Caucasian female, with peripartum cardiomyopathy, treated with azathioprine and prednisolone, is described. The maintenance of the same degree of ventricular dilatation and fractional shortening (14%) on serial echocardiograms inspite of complete regression of cardiac congestion was the most intriguing feature of this clinical case.