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Biomedical subjects

J T Soares-Costa

Publications and source records attributed to J T Soares-Costa.

18 recordsLinked to original sources
PubMed1999

[The variability of the heart rate in the first 24 hours after fibrinolytic therapy in acute myocardial infarct].

AIM OF THE STUDY: The role of heart rate variability changes in the appraisal of reperfusion after fibrinolytic therapy in acute myocardial infarction is still controversial. The aim of this study was to analyze the influence of reperfusion and infarct site on heart rate variability within 24 hours after infarction. PATIENTS AND METHODS: We studied 45 patients with a mean age = 56.3 +/- 12.4 years, 25 with anterior infarction and 20 with inferior infarction. The reperfusion was defined by the simultaneous presence of three classic noninvasive criteria (fast relief of pain, fast regression of ST segment elevation and early peak of CK). We studied heart rate variability parameters in time-domain and frequency-domain on a 24-hour Holter ECG started at the same time as fibrinolytic therapy. RESULTS: Thirty-three patients showed reperfusion. We did not find significant differences in the several parameters of heart rate variability between patients with reperfusion and patients without reperfusion, but the patients with anterior wall infarction showed a significant reduction in SDNN in comparison with patients with inferior wall infarction (84 +/- 28 ms vs 102 +/- 30 ms; p = 0.05). pNN50 (5.3 +/- 7.2 ms vs 10.5 +/- 9.8 ms; p = 0.04), LF (618 +/- 591 ms2 vs 1374 +/- 1761 ms2; p = 0.05) and TP (1415 +/- 1199 ms2/Hz vs 3015 +/- 4243 ms2/Hz). CONCLUSION: These data suggest a relationship between infarct severity and sympathetic activation and/or reduction of vagal modulation, but a potential beneficial effect of reperfusion on autonomic nervous system alterations was not evident in the first day of acute myocardial infarction.

Adult↗
PubMed1998

[Thrombolytic treatment of acute myocardial infarct. 1].

I-Rationale of thrombolytic therapy in acute myocardial infarction (AMI). II-Thrombolytic drugs. III-Effects of thrombolytic therapy on mortality. IV-Studies comparing the effects of various thrombolytic agents on mortality.

Clinical Trials as Topic↗
PubMed1997

[Coronary disease in the postmenopausal woman. The experience of an intensive care unit over 10 years].

OBJECTIVES: Analysis of the characteristics of acute myocardial infarction in female patients admitted to a coronary care unit during a 10 year period. DESIGN: Retrospective analysis of computerized data collected during a 10-year period in every patient with acute myocardial infarction admitted between 1986 and 1995. SETTING: A coronary care unit of a central hospital. PATIENTS AND METHODS: Data on 2439 patients were analyzed in what concerns gender, age and hospital mortality. In the restricted group of 655 patients admitted between 1993 and 1995 the prevalence of the following risk factors was assessed: arterial hypertension, dyslipidemia, smoking and diabetes mellitus. RESULTS: During a 10-year period, 1918 male (M) and 521 female (F) patients were admitted, originating a 3.5 to 1 M:F ratio. The M:F relation decreased from decade to decade from 11:1 in patients under 50 years old to 1.8:1 in patients over 70 years old. Hospital mortality was 25.9% in female patients and 12.0% in male patients (p < 0.001). Mortality was similar in males and females until 60 years of age; significant differences were found only in the seventh decade of life (25% in females vs. 12% in males, p < 0.001) and in patients over 70 years old (36% in females vs. 24% in males, p < 0.005). Hypertension was significantly move prevalent in females (66% in females vs 46% in males, p < 0.001) as well as diabetes mellitus (31% in females vs. 20% in males). Similarly, a previous history of dyslipidemia was more frequently found in females than in males, but the difference was not significant (24% vs. 19%, respectively). On the contrary, smoking was significantly less frequent in female patients (11% in female patients vs. 44% in male patients, p < 0.001). CONCLUSIONS: The probability of the occurrence of acute myocardial infarction is very low in premenopausal women. The M:F ratio decreases with aging. The risk of death progressively increases with age, and it is significantly higher in females in relation to males after the age of 60 years. Women, besides being older, have a higher prevalence of coronary artery disease risk factors, namely hypertension, diabetes mellitus and dyslipidemia.

Adult↗
PubMed1992

[Clinical case and review of the subject. Prognosis in acute myocardial infarction].

Aiming to discuss the value of the prognostic indices in the acute myocardial infarction (AMI), we present two cases of AMI, where the predictable prognosis at 48 hours of the onset of symptoms is informed by the outcome of each case. In the first one, a patient in cardiogenic shock had a good evolution because he suffered a biventricular infarction that responsed well to hydric overcharge. The other case, a Killip classe I infarction, was complicated by a late left ventricular free wall rupture. We discuss the several aspects of each case, and finally we do a critical aproach of the most common prognostic indices (Killip and Kimbal classes, Peel prognostic groups and Norris prognostic groups).

Heart Rupture, Post-Infarction↗
PubMed1991

[Influence of age on systolic and diastolic time intervals in normal individuals].

OBJECTIVE: To evaluate the influence of age (I) on the left ventricle (VE) systolic time intervals, the S2O interval, the pulse transmission time (TTP) and the relative amplitude of the a wave (Aa%) of the apexcardiogram (ACG) of normal individuals. METHODS: 202 subjects considered as normal by clinical and electrocardiographic examinations were studied. Their age (I) was 38 +/- 13 years (average +/- 1 SD), being 125 male and 77 female. The electrocardiogram (ECG), phonocardiogram, ACG and carotid arterial pulse tracing (PC) were simultaneously recorded. The following intervals were determined: Electromechanical (IEM)--from the onset of QRS complex of the ECG to the ascending branch of the great wave of the ACG (A point); mechanical systole (SM)--from the A point of the ACG to the beginning of first high frequency vibration of the aortic component of the second heart sound (S2); ejection period (FE)--from the beginning of the anacrotic branch of the PC to the nadir of its dicrotic notch (ID); isovolumic contraction time (FIS)--subtracting FE duration to the SM duration; S2O interval--since S2 to the O point (nadir) of the ACG; Aa%--relation percentage expressed between a wave amplitude and total amplitude of the ACG; pulse transmission time--since S2 to ID. Statistically significant correlations (p less than 0.05) between I (years expressed) and the previously mentioned variables were investigated. RESULTS: It was possible to verify: a) the IEM and FIS intervals were not significantly correlated with I; b) the FE had a linear, positive and significant correlation with I (r = 0.222); c) the correlations between FE and heart rate (FC) were not significantly different between the considered age groups (14-34, 35-49, 50-69 years); d) the S2O interval had a linear, negative and significant correlation with FC (r = -0.196), and a linear, positive and significant correlation with I (r = 0.392); e) multiple regression equation between S2O, I and FC was: S2O = 70 - 0.36 x FC + 0.55 x I; f) the Aa% had a linear, positive and significant correlation with I (r = 0.252); g) TTP has a linear, negative and significant correlation with I (r = -0.793). CONCLUSIONS: a) The FE increases with I related probably to the afterload increasing that follows aging process; b) the S2O interval increases with I reflecting the elongation of the relaxing time that is associated to the senescence; c) the Aa% increases with I, expressing the reduction of the compliance of the VE associated to the aging; d) the TTP decreases with I related to the increasing of velocity of the pulse wave that follows senescence and is attributed to the increasing of the aortic stiffness.

Adolescent↗
PubMed1991

[Arterial hypertension and the right heart. A hemodynamic and echocardiographic study].

OBJECTIVE: To evaluate the effects of arterial hypertension on the pulmonary circulation and the right heart. SETTING: Coronary Care Unit (UTIC Arsénio Cordeiro) Hemodynamics Laboratory and Medicine I Echocardiography Laboratory-Santa Maria Hospital. PARTICIPANTS: 38 hypertensive patients separated in two groups: 24 with thickened septum and left ventricular posterior wall (10 with hemodynamic evaluation)--Group A--and 14 without thickening--Group B; a control group of 12 healthy volunteers--Group C. RESULTS: The hypertensive patients with hemodynamic evaluation had normal pulmonary capillary wedge pressure the average pulmonary resistance (135.29 +/- 63.47 dyn.cm.5), pulmonary systolic (31.30 +/- 10.01 mmHg) and mean pressures (18.23 +/- 8.21 mmHg) were raised, but the diastolic pulmonary pressure was normal. The right ventricle systolic pressure was raised (32.10 +/- 9.12 mmHg) and there was no modification of the right atrial or ventricular telediastolic pressures. On echocardiography there was a diastolic thickening of the right ventricular free wall in both group A (7.08 +/- 1.41 mm) and B (4.07 +/- 1.00 mm) as compared to group C (3.08 +/- 0.51 mm); there were similar findings regarding systolic thickness with statistical significance in group A (p less than 0.001). The right ventricular ejection fraction was normal in both groups. There was a positive correlation between the diastolic thickness of left ventricular posterior wall and right ventricular free wall in hypertensive patients and normotensive volunteers (r = 0.7754; p less than 0.001). CONCLUSIONS: The findings suggest an anatomic an functional relationship between both ventricles regarding the cardiac repercussions of arterial hypertension.

Adult↗
PubMed1989

[Surgical treatment of variant angina. Apropos of a clinical case].

A case of a male 66 years-old patient who presented with a clinical picture of Prinzmetal's variant angina early in the evolution of an acute myocardial infarction is reported. Transient elevation of ST-segment was documented on Holter monitoring in association with angina at rest as well as asymptomatic episodes of ST-segment changes. Significant two-vessels obstructive lesions (left anterior descending and circumflex arteries) was present. As variant angina had several recurrences in spite of medical therapy with nitrates and calcium antagonists, the patient was submitted to coronary by-pass surgery associated to plexectomy. A Thallium myocardial scintigraphy suggests that a peroperative infarction had occurred. The patient was asymptomatic at six months follow-up.

Aged↗
PubMed1989

[Role of hemodynamic studies in evaluating left ventricular insufficiency in acute myocardial infarct].

Left ventricle (LV) disfunction is the main cause of death in patients suffering from acute myocardial infarction (AMI) who are admitted to Coronary Care Units. Therefore, it is easily understandable that the study of LV performance is of paramount importance in the choice and evaluation of the efficacy of therapy, as well as in the prognosis of patients with AMI. In the first section of this paper, the authors analyze the physiopathology of LV disfunction during AMI; in the second section, based upon a study of 480 patients, they value the contribution of hemodynamic examination with the Swan-Ganz catheter in the evaluation of the cardiac function and in the prognosis of patients with AMI.

Catheterization, Swan-Ganz↗
PubMedDate not supplied

[Cardiac manifestations of connective tissue diseases].

We have studied the cardiac manifestations of connective tissue diseases. In 213 files of patients with connective tissue disease of the Department of Medicina I, Hospital Santa Maria, during 21 years. Cardiac manifestations were observed in 63 (90%) SLE. Pericarditis was the most frequent manifestation and occurred in 33 patients (43%). The cardiac manifestations were observed in 40 (41%) RA. Pericarditis appeared in 11 patients, valvulopathy in 12 patients and coronaropathy in 11 patients. In 10 of PD diagnosed patients, ECG abnormalities were the only findings. Arrhythmias, conduction disturbances, cardiac failure and coronaropathy were the cardiac manifestations of PSS in 11 patients. Polyarteritis Nodosa patients had myocardial ischemia and another had a malignant hypertension diagnosis. We found pericardial effusion in one patient and angina in another one with MCTD diagnosis. We did'nt find any cardiac manifestation in AS. Cardiac manifestations are frequent in connective tissue diseases. The ECG, ECO and pathology show abnormal findings. Although there is not clinical cardiological expression of the disease we suggest the use of ECG. ECO Holter electrocardiography and isotopic myocardial perfusion scan technics in the clinical evaluation of such patients.

Adolescent↗