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Biomedical subjects

M Carvalho

Publications and source records attributed to M Carvalho.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Value of the ergometric test after myocardial infarction].

Exercise stress testing (EST) after myocardial infarction helps to define the clinical subsets of patients at high and low risk. It should be performed before hospital discharge, unless a contraindication exists. In order to exclude false positives, EST must be repeated 4-6 weeks later. EST helps to recognize the presence of residual ischaemia. Significant ST segment depression during exercise, associated or not with angina, is the most important indicator of ischemia. These patients with ischaemia at distance i.e., those with ST segment changes in ECG leads without W waves, are at high risk. Some continuous exercise variables (degree of ST deviation, time of recovery and exercise duration) are related to cardiac mortality. Exercise induced complex ventricular arrhythmias seem to be related to left main or three vessels disease, and a greater likelihood of sudden death, particularly when coexist a low ejection fraction, important segmentar disturbances of contractility and ST segment depression. EST after myocardial infarction has great value to assess the results of medical therapy and/or coronary angioplasty or bypass grafting. EST also constitutes a valuable clinical tool to support a comprehensive rehabilitation programme.

Clinical Protocols↗
PubMed1990

[Maximal values of serum creatine phosphokinase and its myocardial fraction in acute myocardial infarct. Correlation with a previous history of ischemic cardiopathy].

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.

Aged↗
PubMed1990

[Rhythm profile in patients with psoriatic arthritis].

OBJECTIVE: To analyze the rhythmic profile in patients with psoriatic arthritis (PA). DESIGN: In order to evaluate the rhythmic profile of patients with PA, we have carried out ambulatory 24 hour ECG recordings in 22 patients presented consecutively to the Holter ECG laboratory. SETTING: Patients followed in a specialised rheumatology consultation, in Santa Maria Hospital. PATIENTS: We have studied 22 patients (pts), 10 male and 12 female, aged 49.8 +/- 8.4 years, presenting PA diagnosed in average 12.9 years before. A group of 36 individuals, 25 male and 11 female, aged 37 +/- 8 years and without disease, were used as control. RESULTS: All patients were in sinus rhythm with a mean heart rate of 71 +/- 6 (min - 51.5 +/- 7.0 and max - 130.3 +/- 15.0). In 8 (36.6%) there were sinus bradycardia less than 50/min and sinus tachycardia (greater than 120/min) in 15 patients (68.1%). Two patients (9%) presented supraventricular tachycardia and one had AV block. There were premature atrial systoles in 14 pts (63.6%), and ventricular arrhythmias in 9 (40.9%). In control group, there were sinus bradycardia in 16.6%, sinus tachycardia in 33.3%, premature atrial systoles in 33.3% and ventricular arrhythmias in 25% of them; in 11% there were conduction disturbances. CONCLUSIONS: a) Premature atrial systoles were the rhythm disturbance more prevalent. b) Patients with PA presented a significant higher incidence of sinus bradycardia and sinus tachycardia. c) Cardiac conduction disturbances were not frequent. d) Our results may suggest the presence of a subtle autonomic dysfunction in patients with psoriatic arthritis.

Adult↗
PubMed1989

[Silent ischemia in patients with previous myocardial infarct. Correlation of Holter and coronarography].

OBJECTIVE: Our objective was to determine the presence of silent myocardial ischemia and the degree of coronary obstructions. DESIGN: Successively patients with myocardial infarction. SETTING: Patients admitted to the coronary intensive care, later followed in a specialised out-patients consultation. PATIENTS: 62 patients with previous myocardial infarction. INTERVENTIONS: All the patients were submitted to Holter-monitoring and coronary angiography. RESULTS: Silent ischemia was present in 14 (22,6%) of the patients. Seven of these (50%) had 3 vessels disease, 2 (14,3%) had 2 vessels disease, and 5 (35,7%) had 1 vessel disease. Twelve of the patients (86%) had occlusive lesions (greater than 90%), localised in 11 (79%) in the third proximal segment of the artery. CONCLUSIONS: Our results showed that the presence of silent myocardial ischemia was predominantly associated with 3 vessels disease, and with lesions of more than 90% of occlusion, localised in the 1/3 proximal of the vessel. Patients with previous myocardial infarction and silent ischemia may belong to a subgroup with surgical indication. And so, Holter studies in these patients should be followed by angiographic studies for localization of the obstructive lesions.

Adult↗
PubMed1987

Ultrasound-guided brain abscess aspiration in neonates.

Four cases of brain abscess in neonates are described, diagnosed by ultrasonography and CT. All abscesses were confirmed surgically. One patient was operated on 5 weeks after diagnosis because of initial parental refusal. The etiology in all cases was meningitis superimposed on an hypoxic-ischemic insult. Two cases had a single abscess while the other two had multiple lesions. All cases were operated on with intraoperative ultrasound examination through the fontanelle. The case with delayed aspiration showed complete evolution from localized cerebritis to complete capsule formation with mass effect. One abscess was sterile, and in the others grew Klebsiella pneumoniae and Enterobacter aerogenes. The microorganism initially isolated from the lumbar CSF was also found in the abscess. Even after sterilization of the lumbar CSF, all abscesses were still present. Ultrasound examination and CT are compared.

Brain Abscess↗
PubMed1984

Reflex increases in heart-rate induced by perfusing the hind leg of the rat with solutions containing lactic acid.

The hypothesis that metabolic receptors in skeletal muscle influence heart-rate during exercise was tested by means of a perfused preparation of the rat's hind legs. The isolated leg was connected to the body only by nerve and bone and was perfused with tyrode solution. The humoral changes of exercise were simulated by perfusing with modified tyrode solutions in which concentration of K+, osmolality, concentrations of lactic acid, and inorganic phosphate were changed to reflect to those occurring during heavy exercise. Only perfusion with a solution enriched with lactic acid elicited a significant increase in heart-rate. The response disappeared when the nerve supply to the leg was cooled or sectioned. 20-60 s after the start of perfusion with solution of high [lactic acid] heart-rate began to increase reaching a maximum (delta HR +/- SE = 20.2 +/- 8.2, n = 7) after about 2 min. The effect on heart-rate increased when the venous concentration of lactic acid was increased the range from 3 to 10 mmol/l. In further experiments, we tried to separate the effects of pH and lactate. Heart-rate responses were induced only at low pH and at low pH the extent to which heart-rate changed increased with increases in lactate concentration.

Animals↗
PubMed1982

Persistent dysarthria with apraxia associated with a combination of lithium carbonate and haloperidol.

Reported is a 19-year-old manic-depressive patient who developed persistent dysarthria with coexisting apraxia while on a combination of high dose haloperidol and lithium carbonate. The speech disability occurred as a solitary symptom in a patient with normal serum lithium levels and no other signs or symptoms of lithium toxicity and persisted after lithium was discontinued and the neuroleptic changed. There were several factors which favored an association between the speech disability and the drug therapy. These included improvement during a drug-free trial: the absence of a prior history of a speech problem; the patient's marked psychotic state and anxiety: and the high dosage of haloperidol.

Adult↗