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R Seabra-Gomes

Publications and source records attributed to R Seabra-Gomes.

At least 19 recordsLinked to original sources
PubMed1992

[Combined infarction: angiography and electrocardiographic diagnosis].

Combined infarction can be defined as the presence of ST segment elevation simultaneously in anterior and inferior leads. Their possible anatomical and physiopathological causes are suggested. Four cases of combined infarction, three of them in previously asymptomatic patients are presented, with their electrocardiographic and angiocoronarography patterns. Acute phase and 24 hours ECG ST changes are analysed and the possibility of an indirect approach to the angiographic diagnosis, is discussed.

Adult↗
PubMed1992

[Anomalous origin of the left coronary from the pulmonary artery in adults: diagnosis with bidimensional, pulsed and color Doppler echocardiography].

Anomalous origin of the left coronary artery (LCA) from the pulmonary trunk (PT) is an uncommon but frequently lethal congenital lesion of infancy. Clinically it may be difficult to distinguish from congestive cardiomyopathy, and the diagnosis is usually made by angiography. We describe the case of a 38 years old woman, in whom identification of this anomaly was achieved by 2D-Echo, pulsed Doppler and color flow mapping. She complained of fatigue, effort dyspnea and atypical chest pain. A II/VI systolic murmur at left sternal border was heard. There was cardiac enlargement on chest X-ray and ECG was suggestive of an old anterolateral myocardial infarction. The 2D-Echo study showed a dilated, poorly contracting left ventricle. A prominent right coronary ostium was recorded, but the LCA ostium could not be visualized. There was retrograde diastolic and systolic flow in proximal PT, where an anomalous vessel was seen in continuity with it by color flow mapping. Cardiac catheterization confirmed the diagnosis. The patient underwent successful reimplantation of the anomalous LCA, from the PT to the aorta. This case demonstrates usefulness of Echocardiography in the assessment of coronary artery anomalies.

Adult↗
PubMed1990

Comparison of the effects of a controlled-release formulation of isosorbide-5-mononitrate and conventional isosorbide dinitrate on exercise performance in men with stable angina pectoris.

Thirty-three men with stable exercise-induced angina pectoris entered a randomized, double-blind, crossover study in which controlled-release isosorbide-5-mononitrate 60 mg once daily was compared with conventional isosorbide dinitrate 20 mg 3 times daily. Each drug was given for 2 weeks. Twenty-eight patients completed the study and data on exercise variables are available in 23 patients. Treatment with either drug resulted in significant antianginal effects, when measured 6 hours after a single dose and after 2 weeks of therapy compared with baseline placebo; however, there were significantly fewer signs of myocardial ischemia during treatment with isosorbide-5-mononitrate. There was no evidence of tolerance to either drug treatment but a significant attenuation of resting blood pressure (but not of exercise blood pressure) was observed with both drugs. Headache was the only clinically significant adverse event during therapy and it occurred more frequently in the isosorbide dinitrate treatment group (p less than 0.05 vs placebo); 3 such patients had to withdraw from the study because of headache. Thus, once-daily, controlled-release isosorbide-5-mononitrate appears as effective as conventional isosorbide dinitrate 3 times daily in patients with stable angina pectoris. The once-daily administration is convenient and improves patient compliance.

Angina Pectoris↗
PubMed1990

[Amiodarone and propafenone: evaluation using serial Holter recordings in patients with ventricular arrhythmia].

OBJECTIVE: To review the experience of the Arrhythmology Department in evaluating antiarrhythmic therapy for ventricular arrhythmias with serial Holter electrocardiographic recordings (ECG-H). To compare the results obtained with the most used drugs in this Department: amiodarone and propafenone (groups AMIO and PROP). DESIGN: Retrospective study. No statistically significant differences between the two groups were found in respect to age, sex, underlying disease, functional class, left ventricular function and associated therapy. SETTING: Arrythmology Department at a Cardiology Service. PATIENTS: 105 sequential patients with ventricular arrhythmias in a basal ECG-H recording, that were evaluated within 1 year with a new recording on amiodarone or propafenone, without major clinical events or therapeutic changes between the two recordings. INTERVENTIONS (daily oral doses): Amiodarone 200-600 (mean 270) mg or propafenone 300-900 (mean 602) mg. RESULTS: No statistically significant differences were found between the two groups, in either the basal ECG-H or that recorded on therapy. The two drugs were similar in the degree of suppression of ventricular premature complexes per hour (VPCH): equal or superior to 75% in 64.3% of the patients on amiodarone and in 63.9% of those on propafenone. The following reductions on therapy were statistically significant (p less than 0.001 if not specified): VPCH, from 346 +/- 480 to 86 +/- 158 on amiodarone and from 418 +/- 524 to 110 +/- 215 on propafenone; most complex arrhythmia recorded, on both drugs; number of patients with pairs, from 72.1 to 34.9% on amiodarone and from 69.4 to 33.9% on propafenone; number of patients with runs of nonsustained ventricular tachycardia (VT), from 27.9 to 2.3% on amiodarone (p less than 0.01); number of runs of VT per recording, from 3 +/- 5 to 1 on amiodarone (p less than 0.06); and maximum number of complexes per run of VT, from 8 +/- 8 to 4 on amiodarone and from 7 +/- 4 to 5 +/- 1 on propafenone (both with p less than 0.06). CONCLUSIONS: Holter recordings were useful in evaluating antiarrhythmic therapy. The effectiveness of amiodarone and propafenone in treating ventricular arrhythmias was not significantly different. The choice between one of these drugs must rely on their collateral effects profile.

Adult↗
PubMed1990

[Intervention cardiology in acute myocardial infarct].

At the time when thrombolysis in acute myocardial infarction is well established, some controversy still exists about the exact role of coronary angioplasty in this setting. The rationale for a more aggressive intervention after thrombolysis lies in the fact that in a high proportion of the patients the infarct related artery remains occluded or there is a significant residual stenosis. In the latter case this would predispose to reocclusion and recurrent infarction and, by impeding coronary flow, it would limit the extent of myocardial salvage and the rate of myocardial healing. Angioplasty (PTCA) can be performed as an early procedure or late after thrombolysis. Early PTCA can be done as a primary procedure (Direct PTCA), following successful IC or IV thrombolysis (Immediate PTCA) or following unsuccessful thrombolysis (Rescue or salvage PTCA). Late PTCA can be used as a prophylactic (Deferred PTCA) selectively for recurrent angina or positive functional provocative test for ischemia. Direct PTCA has shown to be highly successful both in totally occluded arteries and in subtotal occlusions, with reduced incidence of access site, artery intimal and intramyocardial hemorrhage, but requires a 24-hour cardiac catheterization stand-by with high costs. It is certainly indicated in patients with contra indications to thrombolysis. Immediate PTCA has been evaluated in 3 large scale multicenter randomized controlled trials (TAMI, TIMI II A and ECSG) after IV rt-PA, and although with different design, they concluded that immediate PTCA offers no advantage over a deferred strategy.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

[Effects of coronary surgery on silent ischemia].

In order to assess the effects of coronary artery bypass surgery on silent myocardial ischemia, we studied a group of 39 consecutive patients, 38 male and 1 female with a mean age of 56 + 7 years, with stable chronic angina pectoris, by 48 hours-Holter monitoring and maximal treadmill exercise test before and after operation. The reduction of angina was 92% (p less than 0.0001) and of ischemia 57% (p less than 0.0001) after operation. Silent myocardial ischemia was detected in 21 patients (54%) before operation, 13 by Holter, 4 by exercise test and 4 by the two methods. After operation 13 patients (36%) continue to have silent ischemia depicted in 7 by Holter and in 7 by exercise test. No new patient developed silent ischemia after operation. The group of patients with silent ischemia preoperatively was not significantly different from the group without silent ischemia based on clinical and angiographic characteristics, results of surgery and exercise test parameters with exception of ST segment depression. In conclusion, silent myocardial ischemia may persist after successful coronary artery bypass surgery for the relief of angina pectoris, and should be monitored by serial Holter recordings and treated medically, if its prognosis and consequences proved to be similar to manifest symptomatic ischemia.

Adult↗
PubMed1989

[Computerized precordial mapping--the Mapcard system].

A computerized Data Acquisition System conceived and built by LNETI/DEE in cooperation with Department of Cardiology of Hospital Santa Cruz, and its application to processing and representation of cardiac precordial maps (MAPCARD SYSTEM), was described. A description was made about the evolution on cardiac maps, their main areas of interest, pointing to future ways. With this economic and easy to use system, important perspectives of hospital utilization are opened, in the fields of non invasive diagnostic and clinical research technics.

Cardiology↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis.

The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.

Adolescent↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic regurgitation.

The effect of preoperative left ventricular function on eraly and late prognosis was assessed in 69 patients with aortic regurgitation who underwent homograft replacement of the aortic valve. Patients were divided into two groups: Group A (38 patients) had an ejection fraction of 0.46 or more and Group B (31 patients) had an ejection fraction of 0.45 or less. Clinical data, hemodynamic data, and operative results were compared in the two groups. In Group A there was one early death (2.6%) and there were two late deaths (5.3%) compared to two early deaths (6.5%) and seven late deaths (22.6%) in Group B during a follow-up period of 13 to 98 months (mean, 49 months). Actuarial analysis showed a 94% survival at 6 years in Group A compared to 80% in Group B. Twenty-four patients were reinvestigated by repeat cardiac catheterization and coronary angiography at a mean time of 38 months following valve replacement. Left ventricular function was assessed by computerized quantitative radial analysis of segmental wall motion. Improvement in left ventricular function occurred in eight of the 14 patients reinvestigated in Group B, and appeared to be closely related to the etiology of the initial valve lesion. Despite the higher mortality rate in patients with poor left ventricular function, most derived considerable benefit from operation.

Adolescent↗
PubMed1977

The assessment of regional abnormalities of the left ventricle by angiography.

A method of regional wall motion analysis of left ventricular cineangiograms which does not make assumptions about ventricular geometry is described. The technique measures the movement of the ventricular perimeter in relation to the geometric center of gravity of the endsystolic frame expressing movement as a change in radical length. 10 control patinets each with 3 left ventricular cineangiograms, comprise the group for definition of normal values of movement and permit estimations of reproducibility within and across patient groups. Isolated examples of abnormal wall motion are shown.

Adult↗
PubMed1976

Effect of methylprednisolone sodium succinate on hypoxic heart muscle.

The ability of 30 mg/litre methylprednisolone sodium succinate (MPSS) to modify the effects of hypoxia on isolated Langendorff-perfused rat hearts was investigated. When perfused under hypoxic conditions (pO2 less than 0.8 kPa[6 mmHg]) these hearts lose intracellular enzymes, including creatine phosphokinase (CPK) and succinic dehydrogenase (SDH). The size of the extracellular space is enhanced, the cells gain Na+ and Ca2+ and lose K+, and the endogenous stores of ATP and CP are depleted. Initially the resistance to flow in the coronary circulation falls but after 75 min of hypoxic perfusion it increases so that coronary flow is reduced. MPSS failed to prevent hypoxic muscle from either gaining Na+ and Ca2+ or losing K+. It did, however, delay the release of CPK and SDH from the hypoxic muscle, prolong the phase of increased coronary flow, and decrease the rate of depletion of the energy-rich phosphate stores. MPSS potentiated the hypoxic-induced gain in Ca2+. Whilst the effects of MPSS on coronary flow and tissue Ca2+ were probably due to the steroid part of the complex, the other changes, including the protection of the ATP and CP stores and the delayed enzyme release, were probably due to the presence of the sodium succinate.

Adenosine Triphosphate↗
PubMed1976

Left ventricular function after aortic valve replacement.

Changes in haemodynamics and in systolic time intervals, early after valve replacement, were studied in a group of 15 patients. Though all the haemodynamic measurements were within normal limits at 44 hours after operation, there was a persistent change in systolic time intervals (shortening of left ventricular ejection time and electromechanical systole, and prolongation of pre-ejection period and increase in the ratio PEP/LVET). The effect of periods of myocardial ischaemia during cardiopulmonary bypass on myocardial function is suggested as the explanation for the changes observed.

Adult↗
PubMed1976

Hemodynamic effects of verapamil and practolol in man.

The hemodynamic effects of verapamil and practolol were investigated in a group of 10 selected patients (7 with coronary artery disease) undergoing cardiac catherization. The drugs were given i.v. in a dose of 0.1 mg/kg, alone or in combination, before and after controling the heart rate by atrial pacing. Measured hemodynamic parameters included aortic and left ventricular pressure and its first derivative, cardiac output, and echocardiographically derived left ventricular dimensions. Each drug given individually caused minor hemodynamic changes, but the combination of practolol and verapamil when the heart rate was fixed by atrial pacing invaribly caused a reduction in LV dp/dt max which was independent of preload and afterload. It is concluded that both drugs have a mildly negative inotropic effect when administered at this dose intravenously to patients with normal or mildly impaired left ventricular function. The myocardial depression was more apparent when practolol preceded verpamil. Caution must be exercised when using these drugs in combination in patients with impaired myocardial function.

Adult↗