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Aging is an important risk factor for the development of heart failure (HF) and half of patients with HF have preserved ejection fraction (HFpEF) which is more common in elderly women. In general, sex differences that lead to discrepancies in risk factors and to the development of cardiovascular disease (CVD) have been attributed to the reduced level of circulating estrogen during menopause. Estrogen receptors adaptively modulate fibrotic, apoptotic, inflammatory processes and calcium homeostasis, factors that are directly involved in the HFpEF. Therefore, during menopause, estrogen depletion reduces the cardioprotection. Preclinical menopause models demonstrated that several signaling pathways and organ systems are closely involved in the development of HFpEF, including dysregulation of the renin-angiotensin system (RAS), chronic inflammatory process and alteration in the sympathetic nervous system. Thus, this review explores thealterations observed in the condition of HFpEF induced by menopause and the therapeutic targets with potential to interfere with the disease progress.

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A necessidade de aplicação e registro do Processo de Enfermagem em unidade hospitalar motivou a realização do presente estudo que tem como objetivo identificar os diagnósticos de enfermagem mais prevalentes nos pacientes internados na unidade coronariana de um hospital universitário com Insuficiência Cardíaca (IC). Trata-se de uma pesquisa transversal e descritiva realizada por meio de uma análise documental retrospectiva. Os diagnósticos de enfermagem foram elaborados a partir de evidências clínicas levantadas dos registros médicos e de enfermagem contidos nos prontuários. A formulação da declaração diagnóstica foi feita com a utilização da linguagem de Classificação Internacional para a Prática de Enfermagem - CIPE® versão 2. Os diagnósticos de enfermagem identificados foram: Baixo débito cardíaco, Troca gasosa prejudicada, Risco para infecção, Volume de líquido aumentado e Ventilação prejudicada. Estes diagnósticos estão intimamente relacionados à fisiopatologia da doença e contemplam as necessidades biológicas do indivíduo; no entanto os registros contidos nos prontuários revelaram-se insuficientes para abranger a totalidade das necessidades sabidamente afetadas e apresentadas pelos pacientes.

The need forapplicationand registrationof nursing processathospitalmotivated thepresent studythataimed to identifynursing diagnosesmore prevalent inpatients withheart failure (HF)admitted to thecoronary care unitof auniversity hospital. This isa cross-sectional, descriptivestudy usingaretrospectivedocumentary analysis. The nursing diagnosesweremade fromclinical evidenceofmedical and nursingrecordscontainedin the patient's records. Toformulate thediagnosticstatementwere used thelanguageof the International ClassificationforNursing Practice-ICNP®Version 2. The nursing diagnosesidentified were:Low cardiac output, Gas exchangeimpaired, Risk of infection, Increased liquid volume andVentilation impaired. These diagnosticsare closely relatedto thepathophysiologyof the diseaseandinclude theindividual's biological needs, howeverthe recordscontainedin the patient recordswere insufficienttocover allknownaffectedneeds presented by patients.

La necesidad de laaplicación y registro delProceso de Enfermeríaen el hospitalmotivóel presente estudio quetuvo como objetivo identificarlos diagnósticos de enfermeríamásfrecuentesen los pacientescon insuficienciacardíaca (IC), ingresados enla unidad coronariade un hospitaluniversitario.Se trata deun estudio transversal, descriptivo, realizadamediante un análisisdocumentalretrospectivo.Los diagnósticos de enfermeríafueron hechos deevidencia clínica deregistros médicosy de enfermeríaidentificados que figuran en losregistros médicos.Para formular ladeclaración de diagnósticose utilizó ellenguajede la ClasificaciónInternacional para la Prácticade Enfermería -CIPE® Versión2.Los diagnósticosde enfermería identificadosfueron:Bajo gasto cardíaco, Deterioro del intercambio gaseoso, Riesgo de infección, El aumento de volumen de líquido eDeterioro de laventilación. Estos diagnósticosestán estrechamente relacionados conlafisiopatología de la enfermedade incluyenlas necesidades biológicas dela persona, sin embargolosregistros contenidos enlas historias clínicasno fueron suficientes paracubrirtodaslas necesidades conocidamente afectadas y presentadaspor los pacientes.

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Objective: To evaluate the effects of a nutritional intervention focused on the improvement of clinical status and the prognosis of heart failure patients. Methods: A 12-mo randomized controlled study in 203 heart failure (HF) patients assigned to intervention (IG, n=84) or control group (CG, n=119). Patients in the IG received a sodium (2000 to 2400 mg/d) and fluid (<1500 ml/d) restricted diet. CG received general nutritional recommendations. Body composition, clinical status, hospitalization and time of survival were evaluated. Results: At the end of follow-up, urinary sodium excretion decreased 16,4 percent in the IG vs. an 8,8 percent increase in the CG (p<0,05). Extra cellular water decreased 1,4 percent in the IG vs. a 1¡2 percent increase in the CG (p=0,03). In addition, decrease percentage of fatigue was significant and higher in the IG that in the CG, and a significant increase in the ejection fraction for the IG vs. CG (49,6 percent vs. 5,0 percent, p=0,001), among systolic HF patients was found. Amount of hospitalizations and time of survival tended to be better in the IG. Conclusion: A nutritional intervention with restriction of sodium and fluid was proved to be beneficial since had positive effects in clinical status in HF patients.

Objetivo: Evaluar el efecto de una intervención nutricional sobre el estado clínico y el pronóstico de pacientes con insuficiencia cardiaca (IC). Métodos: Doscientos tres pacientes con IC fueron aleatorizados al grupo con intervención (GI, n=84) o al control (GC, n=119) y seguidos por 12 meses. El GI recibió una dieta con restricción de sodio (2000 a 2400 mg/d) y líquidos (<1500 ml/d) y el GC recomendaciones nutricionales generales. Se evaluó la composición corporal, el estado clínico, hospitalizaciones y sobrevida. Resultados: Al término del seguimiento, la excreción urinaria de sodio disminuyó 16,4 por ciento en el GI vs. un aumento de 8,8 por ciento en el GC (p<0,05). El agua extracellular disminuyó 1,4 por ciento en el GI vs. 1,2 por ciento de aumento en el GC (p=0,03). Asimismo, el porcentaje de reducción de fatiga fue significativo para el GI, no así para el GC; también se observó, entre los pacientes con IC sistólica, un aumento significativamente mayor en la fracción de expulsión para el GI vs. CG (49,6 por ciento vs. 5,0 por ciento, p=0,001). El número de hospitalizaciones y el tiempo de sobrevida tuvieron una tendencia a ser mejor en el GI. Conclusión: Una intervención nutricional con restricción de sodio y líquidos mostró tener un impacto favorable en el estado clínico de pacientes con IC.

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Background: Diabetes mellitus is an important risk factor for cardiovascular complications among patients on hemodialysis. However, the incidence of these complications among non diabetic patients on hemodialysis is not well known. Aim: To assess the incidence of cardiovascular complications in non diabetic patients on hemodialysis. Patients and methods: Seventy five non diabetic patients aged 55.6 ± 17 years (48 males), receiving hemodialysis three times a week were evaluated with laboratory tests, echocardiogram anda carotid ultrasound. In 26 patients, interleukin 6, tumor necrosis factor alpha, and intercellular adhesión molecule (ICAM-1) were also measured. Patients were followed during two years. Results: The mean lapse of dialysis therapy was 6.5 ±5 years. The main cause of renal failure was hypertension. Sixty two percent had systolic hypertension, 86 percent had concentric left ventricular hypertrophy, 43 percent had atrial dilatation and 60 percent had calcifications in the thoracic aorta. Compared with normal controls, patients had higher levels of interleukin 6, tumor necrosis factor alpha and ICAM-1. Carotid media thickness was also higher and increased in the two years of follow up. No correlations were found between ventricular hypertrophy and dialysis lapse, packed red cell volume, calcium phosphorus product, parathormone levels or median arterial pressure. No cardiovascular events were recorded during the follow up period. Conclusions: Non diabetic patients on chronic hemodialysis have a high frequency of ventricular hypertrophy, carotid media thickening, aortic calcifications and an increase in proinflammatory cytokines.

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