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Biomedical subjects

J Quininha

Publications and source records attributed to J Quininha.

At least 55 records · Page 3Linked to original sources
PubMed1992

Coronariographic significance of heart rate variation related to ischemic episodes in patients undergoing peripheral vascular surgery.

OBJECTIVES: To evaluate the characteristics of myocardial ischemia during daily life and their coronariographic significance in a group of patients with proven coronary artery disease undergoing peripheral vascular surgery. SETTING: Department of Cardiology--Central Hospital--Lisbon. METHODS: In 14 patients undergoing peripheral vascular surgery and in whom coronariography revealed coronary significative lesions, Holter monitoring was performed during a 24-hour period. Two groups of ischemic episodes were considered: Group A constituted by 44 episodes detected in patients with left main or three vessel disease and group B by 12 episodes detected in patients with one ot two vessel disease. In each group the ischemic parameters were studied. RESULT: The incidence of myocardial ischemia was 64%. Statistically significant differences were observed between group A and B concerning the mean heart rate variation from two minutes before the onset of ST-segment depression to its onset (2.39 bpm vs 8.75 bpm; p < 0.05), from the onset of ST-segment depression to its maximal depression (4.43 bpm vs 16.67 bpm; p < 0.001) and from two minutes before St-segment depression to its maximal depression (6.82 bpm vs 25.4 bpm; p < 0.00001). No differences were found in duration and maximal ST-segment depression. CONCLUSION: Particular characteristics of heart rate variation related to the ischemic episodes seem to have a relation with the severity of coronary artery disease in patients undergoing peripheral vascular surgery.

Aged↗
PubMed1992

Functional significance of premature ventricular complex morphology evaluated during treadmill exercise stress test in patients with coronary artery disease.

OBJECTIVES: To evaluate the relation between premature ventricular complexes morphology and left ventricular myocardial systolic function in patients with proved coronary artery disease. SETTING: Department of Cardiology at General Hospital. METHODS: From 112 patients (pts) with proved coronary artery disease, thirty-three pts with premature ventricular complexes (PVC) detected during treadmill exercise stress test were selected. Two groups of pts were considered: group I-20 pts with regular contour or with a narrow notching (< 40 ms; type I PVC) and group II-13 patients with wide notching (> 40 ms; type II PVC). In each group the following parameters were studied: ejection fraction, QRS duration, duration of exercise, number of metabolic units and the prevalence of ventricular aneurysm and mitral regurgitation. RESULTS: Statistical significant differences were found between group I and II concerning the mean ejection fraction (59.2% vs 48.6%; p < 0.05). The prevalence of ventricular aneurysm and mitral regurgitation was higher in patients with type II ventricular premature complexes (10% vs 30%). CONCLUSION: Particular characteristics of premature ventricular complexes detected during treadmill exercise stress test, in patients with proved coronary artery disease, suggest the presence of left ventricular myocardial systolic dysfunction.

Coronary Disease↗
PubMed1992

[Annuloaortic ectasia: report of a case].

The authors describe a case of a patient with annuloaortic ectasia (AAE) and severe aortic regurgitation. The diagnostic was made by angiography. He was submitted to a Bentall's procedure; replacement of the ascending aorta by a conduit and of aortic valve by a mechanical prosthesis with reimplantation of coronary arteries into the conduit. The only complication was atrial fibrillation with fast ventricular response. Nowadays he is clinically well, in NYHA class I. The authors make some considerations about AAE, its surgical treatment and its results.

Aortic Diseases↗
PubMed1991

[Value of two-dimensional echocardiography in the prognosis of patients after acute myocardial infarction].

OBJECTIVES: To evaluate the prognostic importance of two-dimensional echocardiography in patients (pts) with acute myocardial infarction. SETTING: Department of Cardiology in a Central Hospital. METHODS: In 71 pts (63 men and 8 women) aged 35 to 75 years interned with a proved myocardial infarction, a score of left ventricular segmental wall motion was used on echocardiographic examination performed during the late hospital phase, to evaluate left ventricular function. Two groups of pts were considered: group A constituted by 38 pts with complication detected during follow-up that ranged 4 to 18 months; group B by 33 pts with no cardiac events for the same period. The relation of the wall motion score with each group and the location of myocardial infarction was performed. RESULTS: In group A, the mean score index was 1.67 in pts with angina, 1.08 in pts with heart failure and 0.82 in pts who died. The mean score index was 1.25, 1.57 and 1.18 respectively in pts with an anterior, inferior and antero-inferior infarction. In group B, the mean score index was 1.70 in pts with an anterior infarction, 1.85 in those with an inferior infarction and 1.33 in the patient with an antero-inferior infarction. Patients with a non-Q wave infarction had a mean score index of 2. The mean score index was significantly different between group A and B (respectively 1.33 vs 1.79; p less than 0.00001) and a mean score index of 1.53 was considered the mean risk value. CONCLUSIONS: Two-dimensional echocardiography performed during hospital predischarge permits risk stratification after acute myocardial infarction, specially for death and heart failure.

Adult↗
PubMed1991

[Exercise test parameters after acute myocardial infarction. Relationship with coronary angiography].

OBJECTIVE: To analyze the relation between characteristics of symptom-limited treadmill exercise stress test, after acute myocardial infarction (MI) and coronariographic results (number of diseased vessels). Both tests were performed before hospital discharge. DESIGN: Retrospective study with comparative analysis between variable defined groups. POPULATION AND SETTING: From 232 patients interned in the department of Cardiology of Hospital de Santa Marta with a first acute MI, a population of 112 patients submitted to exercise stress test and coronary angiography before discharge were selected (aged 29 to 69 years). METHODS: Symptom-limited treadmill exercise stress tests were performed according to Bruce protocol, with no heart-rate limitation. The following parameters were analyzed: Stress test duration (DUR); Double product variation (varDP); Metabolic equivalent units (METS); Maximal heart rate (FCmax); Percentage of the maximal reached heart rate (% FCmax); Incidence of ST segment depression (InfST); Maximal ST segment depression (Max-InfST); Onset minute of ST segment depression (MinInfST); Heart rate at the onset of ST segment depression (FCInfST); Double product at the onset of ST segment depression (DPInfST); Recovery minute of ST segment depression (MinRInfST); Onset minute of angina (MinAng); Heart rate at the onset of angina (FCAng); Double product at the onset of angina (DPAng). RESULTS: Statistical significant differences were obtained between coronariographic groups concerning the following parameters: DUR: 1-vessel/3-vessel P = 0.02; VarDP: 1-vessel/3-vessel p = 0.008, 2-vessel/3-vessel p = 0.004; METS: 1-vessel/3-vessel p = 0.01. No differences were seen between anterior and inferior myocardial infarctions regarding all the stress test parameters. However in patients with anterior MI significant differences were obtained concerning the following variables: VarDP: 1-vessel/2-vessel p = 0.02; InfraST: 1-vessel/2-vessel p = 0.006, 1-vessel/3-vessel p = 0.03; MaxInfST: 1-vessel/2-vessel p = 0.01, 1-vessel/3-vessel p = 0.0006; Angina: 1-vessel/2-vessel p = 0.0005, 1-vessel/3-vessel p = .001. In inferior myocardial infarctions only the stress duration differed between 1-vessel and 3-vessel groups (p = 0.003). CONCLUSIONS: Symptom-limited treadmill exercise stress tests, safely performed in our institution, were an important method for post MI evaluation and allowed the diagnosis of a great number of patients with residual ischemia. Statistical significant differences were found in ergometric parameters, between coronariographic groups (defined by the number of diseased vessels), emphasising the importance of stress tolerance analysis.

Adult↗
PubMed1991

Incidence, characteristics and coronariographic significance of myocardial ischemia during daily life in patients with angina pectoris.

OBJECTIVES: To evaluate the incidence, characteristics and angiographic significance of myocardial ischemia detected on Holter monitoring in a group of patients with stable angina pectoris. SETTING: Department of Cardiology of a Central Terciary Hospital. METHODS: In 24 patients (pts) with stable angina pectoris and proven coronary artery disease (11 pts with left main or three vessel disease; 13 pts with one or two vessel disease), a 24 hour Holter monitoring was performed. Two groups of ischemic episodes were considered: Group I with 65 ischemic episodes detected in pts with left main or three vessel disease and group II constituted by 17 ischemic episodes detected in pts with one or two vessel disease. RESULTS: The incidence of myocardial ischemia was 91% in pts with left main or three vessel disease and 46% in pts with one or two vessel disease. Statistically significant differences were seen between group I and II concerning the mean heart rate variation from two minutes before onset of ST-segment depression to its onset (3.5 bpm vs 7.4 bpm; p less than 0.05) and from the onset of ST-segment depression to its maximal depression (6.5 bpm vs 15 bpm; p less than 0.000001). CONCLUSIONS: The presence of myocardial ischemia and some of its characteristics on Holter monitoring seem to have a relation with the severity of coronary artery disease in patients with stable angina pectoris.

Activities of Daily Living↗
PubMed1991

[Dysrhythmic profile and clinical aspects in a population of 23 patients with hypertrophic cardiomyopathy].

OBJECTIVES: To evaluate: 1. The incidence and characteristics of ventricular arrhythmias on Holter monitoring and their relation to the clinical, functional and morphological aspects. 2. The survival and therapeutical efficiency of amiodarone in a subgroup of patients with ventricular tachycardia. SETTING: Department of Cardiology in a General Hospital. METHODS: 23 patients (pts) aged 19 to 74 years with an echocardiographic diagnosis of cardiomyopathy were studied during a four year period by 24 hours Holter monitoring. Ventricular arrhythmias were defined according the Lown classification. Patients were classified according to: obstructive or nonobstructive hypertrophy (funtional groups, 11 and 12 pts respectively), asymmetric hypertrophy of the septum or ventricular concentric hypertrophy or apical hypertrophy (morphological groups, 18, 3 and 2 pts respectively). They were also classified according medical therapy (pharmacological with B-blockers or calcium antagonists and nonpharmacological groups, 7 and 16 pts respectively). RESULTS: the incidence of severe ventricular arrhythmias was 57.1% and 62.5% in the pharmacological and nonpharmacological groups respectively. In both obstructive and nonobstructive forms, severe ventricular arrhythmias were also found (7/8 pts in each group). 12 pts with asymmetric hypertrophy of the septum and 2 pts with the concentric hypertrophic form also had severe ventricular arrhythmias. Five pts with nonsustained ventricular tachycardia have been submitted to oral amiodarone therapy in a dosage of 200 mg daily. All these pts are alive (follow-up ranged from 15 to 54 months) and in five no significant ventricular arrhythmias have been detected on serial Holter records. CONCLUSIONS: the incidence of ventricular arrhythmias was high in this patients population and no definitive relation could be found between the severity of ventricular arrhythmias and the previous described groups. Meanwhile, classic medical therapy seems not to alter the incidence and the characteristics of ventricular arrhythmias. On other hand, amiodarone therapy seems to abolish ventricular tachycardia in a large percentage of cases and no death occurred during a significant period of time (maximal 54 months).

Adult↗
PubMed1990

[Clinical and hemodynamic efficacy of enalapril in severe congestive heart failure].

OBJECTIVES: Evaluate the clinical and hemodynamic efficacy of enalapril in the treatment of severe congestive heart failure, refractory to the classic therapeutics with diuretics and digitalis. SETTING: Hospitalized patients (pts) of a cardiac department. MATERIAL AND METHODS: 10 pts with a mean age of 57.8 years in whom a Swan-Ganz catheter was placed for 72 hours to monitor the right pressures and cardiac output, with regular control of arterial blood pressure and cardiac frequency. Low doses of enalapril (2.5 mg) were utilized at the start of the treatment and this dose was readjusted depending on the clinic and hemodynamic parameters. RESULTS: the 10 pts had the following characteristics: Basal-mean pulmonary arterial pressure (PAP) 34.1 mmHg, Pulmonary wedge pressure (PWP) 21.1 mmHg, cardiac output (CO) 4.8 l/min, cardiac index (CI) 2.8 l/min/m2. After 72 hours with enalapril treatment, these measurements were: PAP-23.8 mmHg, PWP-12.6 mmHg, CO-5.2 l/min and Cl-3.0 ll/min/m2. These differences were statistically significant. With a follow-up of 18.4 months, there was also a clinical improvement; of the 4 pts in class III, 2 moved to class II and 2 to class I; the 4 pts in class IV 4 moved to class II; two pts had died. CONCLUSIONS: In severe heart failure, the addition of enalapril to the classic therapy has allowed the immediate improvement of the clinical and hemodynamic indexes and this improvement was maintained in the follow-up period.

Aged↗
PubMed1990

[Influence of recipient auricular contraction on the left ventricle filling pattern of the transplanted heart studied with pulsed Doppler echocardiography].

OBJECTIVES: to evaluate the influence of recipient atrial contraction (RAC) timing on left ventricular filling pattern (LVFP), assessed by Pulsed Doppler, in orthotopic transplant recipients (OTR). STUDY DESIGN: prospective study of OTR. SETTING: patients (pts) submitted to orthotopic heart transplantation at Hospital de Santa Marta, from April/87 to March/89, in routine evaluation. PARTICIPANTS: nine pts, aged 21 to 55 years (mean = 32 +/- 11), 0.5 to 20 (mean = 7.4 +/- 6.9) months post-operatively. METHODS: in each pt 40 to 60 (mean 52) consecutive cardiac cycles were analysed; five groups (Gr.) were considered, according to RAC (P wave) position in the cardiac cycle: Gr. I--Early systole, GR. II--late systole, Gr. III--early diastole, Gr. IV--late diastole and Gr. V--absent. The following parameters were studied: peak early diastolic mitral flow velocity (Evel), peak late diastolic mitral flow velocity (Avel), ratio Evel/Avel, (E/A) and pressure half time (PHT). RESULTS: 1) Evel and E/A were significantly higher, Avel lower, and PHT shorter, in Gr II and III; 2) Avel was higher and E/A smaller in Gr. IV; 3) no statistically significant differences were found betwenn Gr. I and V, for any of the parameters analised. CONCLUSIONS: the timing of RAC significantly influences LVFP and it must be considered on Echo-Doppler analysis of diastolic function in OTR.

Adult↗
PubMed1990

[Flow in the entry chamber of the right ventricle: diastolic function indexes in a normal population].

OBJECTIVES: To define normal values of indexes of diastolic function of right ventricle by bidimensional pulsed doppler echocardiography. STUDY DESIGN: Prospective study of normal individuals. MATERIALS AND METHODS: Thirty normal subjects by physical examination, electrocardiographic, radiological and echocardiographic criteria, aged between 22-48 (mean 31.2 +/- 6.7) were evaluated. We determined 16 different indexes and correlated them with heart rate, age and body surface; 27% of cases owing to the poor quality of records, were excluded. RESULTS: Eight indexes were heart rate dependent and for their use is necessary the respective correction; none of them correlated with age or body surface. Areas determined under the curves of flow are very time consuming and require great accuracy determination. So, we had correlated areas with other different indexes in order to obtain other parameters to give us the same information on a easier and quickly way. E/A relation correlated with all areas relations. CONCLUSIONS: The indexes determined can be considered as normal standard in order to evaluate, by a non-invasive way, right ventricle diastolic function. Nevertheless, the great proportion of records of poor quality is a limitation of the method.

Adult↗
PubMed1990

[Flow in the entry chamber of the left ventricle. Changes with age].

OBJECTIVES: To evaluate the influence of aging in the parameters of the left ventricle diastolic function, using 2D-Doppler echocardiography. STUDY DESIGN: Prospective study of normals subjects. MATERIAL AND METHODS: They were studied 38 normals subjects aged between 23-70 years divided in two groups: group A--20 subjects aged less than 45 years (34.5 +/- 6) and group B--18 subjects aged greater than 45 years (55.7 +/- 8.4); we registered the left ventricle inflow flows by 2D-pulsed Doppler Echocardiography and analyzed the following indexes: E and A Velocities, E/A ratio, relations of areas under the curves of flow, E Area/Total Area (EAr/TAr), A Area/Total Area (AAr/TAr), 33% Area/Total Area (33Ar/TAr), 50% Area/Total Area (50Ar/TAr) and A Area/E Area (AAr/EAr). RESULTS: E Vel and E/A ratio are significantly higher in the group A (p less than 0.001), both decreasing with aging, respectively r = -0.71 and r = 0.63; on the other way, the relative contribution of atrial systole to the left ventricle diastolic filling is significantly higher in the group B(ArA/ArT p less than 0.001; AAr/EAr p less than 0.001), increasing significantly with aging, r = 0.64 and r = 0.69, respectively. CONCLUSIONS: There is an increasing of atrial contribution to the left ventricular diastolic filling in the elderly, so in comparative studies it must be used control groups with the same age.

Adult↗
PubMed1990

[Non-invasive evaluation of systolic pressure of the pulmonary artery in patients with tricuspid regurgitation, using Doppler echocardiography].

STUDY OBJECTIVE: To quantify the systolic pulmonary artery pressure (SPAP) by continuous wave Doppler echocardiography and record the prevalence of tricuspid regurgitation (TR). DESIGN: Prospective analysis of 42 patients (pts), submitted to right heart catheterization (RHC). SETTING: Pts referred to the Echocardiographic Laboratory at Sta. Marta Hospital - H.C.L. PATIENTS: Sequential sample of 42 pts with several cardiac pathologies, subjected to RHC and 2D Doppler Echocardiography. INTERVENTIONS: The right ventricular and SPAP were recorded in the hemodynamic exam. We considered pulmonary hypertension (PH) if SPAP was greater than 35 mmHg or mean pressure greater than 20 mmHg. The pts were divided into two groups: I-pts without PH and II-pts with PH. The 2D Doppler echocardiography was made within 24 H of the hemodynamic one. Peak gradient (pg) of TR and the correlation with catheterization data were analysed. RESULTS: Hemodynamic--The mean SPAP in the sample was 46 +/- 21.5 mmHg (27 +/- 4.6 in group I and 55 +/- 20.2 mmHg in II). In 35 pts with TR the mean SPAP was 50.3 +/- 21.2 mmHg. Doppler--The pressure gradient was 40 +/- 18.7 mmHg. 57% pts of the group I and 96% II had TR p less than 0.001. The correlation between Doppler gradient and SPAP was r = 0.95, and no change was noted when 7 is used as a constant. CONCLUSION: Continuous wave Doppler echocardiography is a non invasive technic useful to the quantitative analysis of SPAP.

Adult↗
PubMed1990

[Infective endocarditis of pulmonary valve. Considerations apropos of a case associated with interventricular communication and aortic insufficiency ].

We report the case of a 23 year old patient in whom heart disease was detected in childhood. He began to have suddenly fever and symptoms of right side heart failure. There were signs of aortic regurgitation, a systodiastolic murmur in the left parasternal region and a diastolic murmur in the left 4th intercostal space. The bidimensional and Doppler Echocardiogram showed a saccular dilatation in the right ventricular outflow tract. He was submitted to catheterisation which confirmed aortic regurgitation and detected ventricular septal defect and pulmonary hypertension. During surgery, a subaortic ventricular septal defect was seen as well as a dilatation of the right coronary aortic cusp which prolapsed through the defect to the right ventricular outflow tract. Vegetations were seen in the pulmonary valve. The aortic valve and a pulmonary cusp were excised and a Björk Shiley aortic prosthetic valve was inserted. The septal defect was closed. The patient is still alive, symptomless, with 40 months of follow up. We discuss some problems related to this case, particularly the surgical indication and the rarity of the morphology discovered.

Adult↗
PubMed1989

[MB isoenzyme of myocardial creatino-kinase: activity curves in the blood, after ischemic cardiopathy surgery].

OBJECTIVE: To determine the curve of cardiac creatine-kinase (MB-CK) plasma activity, in patients with coronary heart disease who were submitted to Coronary Artery Bypass Graft (CABG) and/or aneurysmectomy, in order to evaluate the degree of a eventual myocardial lesion occurring during the first 72 hours after surgery. DESIGN: Assay of the plasma MB-CK activity and of the 12 lead electrocardiogram (EGC) during the first 72 hours after surgery. SETTING: Patients undergoing surgery in a Department of Cardiac Surgery. PATIENTS: 49 consecutive patients included in 2 groups: Group A: 38 pts submitted to CABG. Group B: 11 pts submitted to aneurysmectomy (6 of them with simultaneous CABG). INTERVENTIONS: Determination of plasma MB-CK activity and execution of 12 lead EGC before surgery and at 0, 6, 12, 24, 36 and 72 hours after surgery. RESULTS: Using as a reference the MB-CK values in a control group undergoing surgery for either aortic or mitral valvulopathy, the patients in group A were subdivided: Group A1: 25 pts which curves of MB-CK activity were similar to the control group; none showed sign of myocardial infarction in the EGC. Group A2: 13 pts which curves of MB-CK activity showed a increased value when compared to controls (at least, two Standard Deviation above the medium control value). In 6 of them the EGC were compatible with acute myocardial infarction. Group B patients were also divided in 2 subgroups: Group B1: 10 pts with a similar MB-CK activity to the control group. Group B2: 1 patient with MB-CK activity similar to the patients in Group A2 and whose EKG showed a pattern of "the new" myocardial infraction. CONCLUSIONS: The method used in our work allowed us to define a MB-CK activity curve that translates the expected variability after surgery in patients submitted to CABG and/or aneurysmectomy. This curve allows the distinction between myocardial lesion due to surgical aggression and a ischemic lesion. The EGC although a method with high specificity has apparently a low sensitivity for the detection of myocardial necrosis after CABG. The aneurysmectomy "per se" does not influence the MB-CK activity.

Adult↗