Biomedical subjects

N da Silva

Publications and source records attributed to N da Silva.

At least 37 records · Page 2Linked to original sources

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↗

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↗

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↗

PubMed1989

[Movement of the mitral valve in patients with ischemic cardiopathy].

STUDY OBJECTIVE: 1. Determination of the clinical value of the mitral-septal angle (MSA), a new two-dimensional echocardiographic (2DE) index, in the evaluation of left ventricular function; 2. Assessment of the relation of incomplete mitral leaflet closure (IMLC) with the presence of mitral regurgitation (MR) or elevated end-diastolic left ventricular pressure (EDLVP). DESIGN: Prospective study involving subjects without heart disease and patients with coronary artery disease. SETTING: Cardiology Department of the Hospitais Civis de Lisboa--Hospital de S. Marta. PARTICIPANTS: We studied: A - 30 normal volunteers; B - 43 patients (pt) with coronary artery disease documented by coronary angiography. METHODS: Two-Dimensional Echocardiography was performed in all subjects. MSA was measured in early diastole using the apical four-chamber view. Using the same view IMLC was assessed. Echo pulsed Doppler was used to detect the presence of MR. All patients in group B were submitted to cardiac catheterization. EDLVP was measured and left ventriculography and coronary arteriography were performed. Presence of MR was assessed and ejection fraction (EF) calculated. According to EF patients were divided: Group B1 (EF greater than 50 - 23 pt); Group B2 (EF 35-50% - 11 pt); Group B3 (EF less than 35% - 9 pt). MEASUREMENTS AND MAIN RESULTS: In group A MSA was always less than 30 degrees and IMLC was never observed. In group B pt with EF greater than 50% had MSA less than 30 degrees in all but one case. Patients with EF less than 50% had MSA superior to 30 degrees in all but two cases. MSA superior to 45 degrees was found in 2 pt with EF 35-50% and in 5 pt with EF less than 35%. IMLC was detected in 11 pt. Only 2 pt had MR and 7 had EDLVP greater than 18 mmHg - 15 pt had an elevated EDLVP in the whole group. IMLC was frequent in group B3 - 7 pt. Correlation between MSA and EF was good (r = -0.81). Sensitivity and specificity of MSA in the separation of pt with EF superior and inferior to 50% was 90% and 95%, respectively: they dropped when we tried to separate pt with EF superior and inferior to 35% (sensitivity 55%, specificity 77%). CONCLUSIONS: IMLC didn't correlate with the existence of MR or elevated EDLVP; it appears, however, to be associated with poor left ventricular function (EF less than 35%). MSA is a good echocardiographic index of left ventricular in patients with coronary artery disease. It is easily measured and it can be a good alternative to mitral E point septal separation in patients in which left sternal views are difficult or impossible.

Adult↗

PubMedDate not supplied

New criteria for the diagnosis and treatment of atrioventricular node reentrant tachycardia.

The authors describe a new elecrocardiographic criterion to diagnose atrioventricular node reentrant tachycardia, review the electrocardiographic and electrophysiological diagnosis of this tachyarrhythmia and analyse the results of catheter ablation of fast versus slow pathway, selecting the fast pathway whenever the induction of atrioventricular node reentrant tachycardia is performed only after pharmacological maneuvers. The high specificity for atrioventricular node reentrant tachycardia of the criterion characterized by the absence of ST-segment depression found in left precordial leads from V4 to V6 suggests the need to include it in electrocardiographic algorithms for the differential diagnosis of tachycardias with a narrow QRS complex. The high primary and final success rates of catheter ablation obtained after a therapy stratification based on induction criteria, emphasize the use of the fast pathway ablation as a first option in selected cases and for the treatment of recurrences.

Catheter Ablation↗

PubMedDate not supplied

[Multiple thromboembolism associated with anti-thrombin III deficiency].

Congenital deficiency of antithrombin III is considered as one serious primary hypercoagulable state. The authors present a case of deficiency of antithrombin III in a 28 years old young male, with aortic valve disease and several thromboembolic events. When discussing their diagnostical and therapeutical aspects they call the attention to the need for investigation of the situations in which thrombophilia presents with recurrent venous and arterial thrombosis.

Adult↗

PubMedDate not supplied