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Biomedical subjects

L S Piegas

Publications and source records attributed to L S Piegas.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Infective endocarditis. Prospective Doppler-echocardiographic study].

PURPOSE: To study of the Doppler-echocardiographic aspects in patients with IE and its correlation with the prognosis and evolution. PATIENTS AND METHODS: One hundred and eight patients with clinical of IE were prospectively studied by Doppler-echocardiography (D-E) in order to determine whether the simple presence of vegetation, its size, mobility and place of attachment could identify high risk groups. Vegetations were classified according to its size (longest axis) into small (veg less than 5 mm), medium (5 mm less than veg less than 10 mm) and large (veg less than 10 mm); according to its kind into "sessible" or "mobile" and according to its appearence into "cotton like" or "calcified". RESULTS: Patients with (84.2%) and without (15.8%) vegetations didn't show any significant difference in the complications incidence (emboli, heart failure or death) and the same happened with its size. However, patients with aortic positioned vegetations showed ligher incidence of HF (Aortic 53.8 x Mitral 31.0% x Tricuspid 3.7%) need for surgery (Aortic 69.2% x Mitral 34.5% x Tricuspid 3.7%) and death (Aortic 30.7% x Mitral 13.7% x Tricuspid 7.4%). Emboli were observed in 81.4% of the patients with tricuspid valve vegetations. Eight patients showed IE on aortic prothesis. Five of them needed surgical treatment and 2 of them died. Among 12 patients with IE on mitral prothesis, 7 needed surgery and 3 died. Pericardial effusion were verified in 51 patients (47.2%), chordal rupture in 14 (12.8%) and valve abcess in 6 (5.5%). All patients with valve abcess were submitted to surgery. CONCLUSION: Doppler-echocardiography is an excellent method in the diagnosis of IE and its aspects may have, sometimes, a positive correlation with the prognosis and patient's evolution.

Adolescent↗
PubMed1990

[Acute myocardial infarction in patients under 40 years of age].

PURPOSE: To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. PATIENTS AND METHODS: In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded. RESULTS: Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3). CONCLUSION: Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.

Adolescent↗
PubMed1990

[Use of coronary angioplasty in acute myocardial infarction without previous use of thrombolytic agents. Analysis of 201 patients].

PURPOSE: To evaluate the experience with the use of primary PTCA in the set of acute myocardial infarction (AMI) without the previous administration of thrombolytic agents. PATIENTS AND METHODS: Two hundred and one patients with AMI, aged 35 to 86 years (mean = 57.2). There were 83.5% men. Twenty patients were older than 70 years and 48.2% had an anterior AMI. PTCA was performed early in the AMI, with a delay no longer than 12 hours. In 95%, it was done solely to the infarct related artery. Seventy percent patients were in Killip class I, 21% in class II, and 8% in classes III and IV (more than 50% of this subset of patients were in cardiogenic shock). RESULTS: Primary success was achieved in 84.5%. In hospital mortality was 5.9%, and there were 7% reinfarctions. Among the 84 patients who underwent a late cinecoronariography study, there were 19% restenosis and 8.3% reocclusions. In the long term follow up 75% were asymptomatic. Repeat PTCA was required in 10.2% of the cases, late coronary surgery was performed on 10.8% of the patients, and post-hospital cardiac mortality was 8.8% during an average follow up of 28 months (range 2-72 months). CONCLUSION: Primary PTCA is a effective way of reperfusion in the AMI, with a high primary success, low complications rate and without any major contraindications.

Adult↗
PubMed1989

Results of cardiopulmonary resuscitation in a cardiology hospital.

The authors analysed a series of 557 consecutive patients who suffered cardiorespiratory arrest at the Dante Pazzanese Institute of Cardiology (DPIC) during a period of 5 years in order to examine factors predicting successful resuscitation and long-term survival. Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients, with the following results: 284 patients (53%) died immediately, another 102 (19%) died within the first 24 h after the cardiac arrest and 150 patients (28%) survived more than 24 h. Among these, 65 (12.1%) died in the first month after cardiac arrest and other 29 (5.4%) died after that period. There were 43 late survivors (8%). Thirteen patients (2.4%) were lost to follow-up. After 9 years, the accumulative life expectancy was 8.7%. Coronary heart disease, cardiomyopathy and valvular heart disease were the most frequent underlying diseases. None of the 49 patients with cyanotic congenital heart disease survived. The heart arrest was mostly caused by heart failure (55.8%) and primary arrhythmia (17.2%) in the whole group, whereas the survivor group showed primary arrhythmia in 81.7% and heart failure in 7.3%. In those patients where the initial mechanism of cardiac arrest was ventricular fibrillation, 33.2% survived more than 1 month, while among those on ventricular asystole, only 3.4% survived more than 1 month.

Brazil↗
PubMed1989

[Use of isosorbide-5-mononitrate in acute myocardial infarction].

Isosorbide mononitrate in a dose of 20 mg t.i.d. was used in 25 patients admitted few hours after acute myocardial infarction. The following parameters were analysed: systolic and diastolic blood pressure, heart rate, clinical features, and laboratory data. Heart rate and diastolic blood pressure remained unchanged, however systolic blood pressure was slightly reduced (p less than 0.01). There was a reduction in the angina episodes post-AMI. None of the patients included in the study had clinical deterioration or showed infarction extension. There were no changes in laboratory data. After the interruption of the drug, one patient died on the 6th day with acute mitral insufficiency. In conclusion, isosorbide mononitrate can be safely used during an uncomplicated acute myocardial infarction, without the risk of haemodynamic deterioration, and helps to prevent post-infarction angina.

Adult↗
PubMed1988

Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty.

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.

Angina Pectoris↗
PubMed1988

[Shock lung].

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Animals↗