RESUMO
Las enfermedades cardiovasculares son muy frecuentes en la población anciana (pacientes mayores de 75 años). El enfrentamiento y manejo de ellas es distinto al indicado en pacientes jóvenes. Son escasos los estudios que incluyen población mayor de 75 años, con evidencia acerca de las diferencias que existen en la respuesta terapéutica en comparación al paciente joven. El anciano tiene mayor fragilidad y múltiples comorbilidades, con reserva cardiaca disminuida, lo que obliga a un manejo integral y acucioso. Los cambios propios de la edad repercuten tanto en riñón, cerebro, hígado, musculatura y corazón, lo que los hace pacientes más proclives a presentar complicaciones de la terapia farmacológica o intervencional. El objetivo de este artículo es resumir las recomendaciones sobre el manejo de las cardiopatías más frecuentes en el anciano, incluyendo insuficiencia cardiaca crónica, cardiopatía coronaria, hipertensión arterial, estenosis aórtica valvular y fibrilación auricular no valvular.
Cardiovascular diseases are very common in the elderly population, and their management is different. There are few studies that include population older than 75 years, with little evidence about the differences in the therapeutic response compared to the young patient. The elderly have greater fragility and multiple comorbidities, with diminished cardiac reserve, which requires a comprehensive and careful management. Changes due to advanced age, in kidney, brain, liver and musculature (among others), make them more vulnerable to complications of the pharmacological or interventional treatment. The objective of this article is to summarize the recommendations on the management of the most frequent heart diseases in the elderly, including chronic heart failure, coronary heart disease, arterial hypertension, valvular aortic stenosis, and non-valvular atrial fibrillation.
Assuntos
Humanos , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Estenose da Valva Aórtica , Marca-Passo Artificial , Arritmias Cardíacas , Fibrilação Atrial , Morte Súbita Cardíaca , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Desfibriladores , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hipertensão/diagnóstico , Hipertensão/terapiaRESUMO
BACKGROUND: Hemodialysis patients (HD) display high rates of cardiac disease and mortality. The cardiovascular morbidity and mortality of HD patients is attributable in a significant proportion to endothelial dysfunction, arterial stiffness, and vascular calcifications. AIM: To measure vascular reactivity in HD subjects and compare them with healthy volunteers. MATERIAL AND METHODS: Forty eight non diabetic patients aged 58 ± 4.6 years (29 males) on hemodialysis for a mean lapse of 4.8 years were studied. Arterial stiffness was measured in the radial artery. Pulse wave velocity was measured by noninvasive peripheral arterial tonometry in carotid and femoral arteries. Endothelial function was assessed, measuring reactive hyperemia response after a 5 min period of ischemia. As a control, all values were also measured in age and gender-matched healthy volunteers. RESULTS: Arterial stiffness was significantly higher in HD patients than controls (23.9 ± 3.3 and 18.4 ± 3.4% respectively, p < 0.05). HD subjects had an increased pulse wave velocity (10.0 ± 0.8 and 7.6 ± 0.9 m/s respectively, p < 0.05). A reduction in the change in pulse amplitude pressure, as a measure of arterial dysfunction, was only observed in male patients (1.7 ± 0.4 and 2.7 ± 0.4 respectively p < 0.01). CONCLUSIONS: Noninvasive assessment of peripheral vascular function may be useful for the identification of patients at risk for late cardiac events.
Assuntos
Pressão Sanguínea/fisiologia , Artérias Carótidas/fisiopatologia , Endotélio Vascular/fisiologia , Artéria Femoral/fisiopatologia , Artéria Radial/fisiopatologia , Rigidez Vascular/fisiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Diálise Renal , Fatores de RiscoRESUMO
Background: Hemodialysis patients (HD) display high rates of cardiac disease and mortality. The cardiovascular morbidity and mortality of HD patients is attributable in a significant proportion to endothelial dysfunction, arterial stiffness, and vascular calcifications. Aim: To measure vascular reactivity in HD subjects and compare them with healthy volunteers. Material and Methods: Forty eight non diabetic patients aged 58 ± 4.6 years (29 males) on hemodialysis for a mean lapse of 4.8 years were studied. Arterial stiffness was measured in the radial artery. Pulse wave velocity was measured by noninvasive peripheral arterial tonometry in carotid and femoral arteries. Endothelial function was assessed, measuring reactive hyperemia response after a 5 min period of ischemia. As a control, all values were also measured in age and gender-matched healthy volunteers. Results: Arterial stiffness was significantly higher in HD patients than controls (23.9 ± 3.3 and 18.4 ± 3.4% respectively, p < 0.05). HD subjects had an increased pulse wave velocity (10.0 ± 0.8 and 7.6 ± 0.9 m/s respectively, p < 0.05). A reduction in the change in pulse amplitude pressure, as a measure of arterial dysfunction, was only observed in male patients (1.7± 0.4 and2.7 ± 0.4 respectively p < 0.01). Conclusions: Noninvasive assessment of peripheral vascular function may be useful for the identification of patients at risk for late cardiac events.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Sanguínea/fisiologia , Artérias Carótidas/fisiopatologia , Endotélio Vascular/fisiologia , Artéria Femoral/fisiopatologia , Artéria Radial/fisiopatologia , Rigidez Vascular/fisiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Manometria , Valor Preditivo dos Testes , Diálise Renal , Fatores de RiscoRESUMO
Summary: Heart Disease is the leading cause of death among women in Chile. It appears at younger ages than most people think and the risk increases during aging. Although mortality has declined in men in recent years, women have increased. Cardiovascular risk factors, including menopause, are critical in atherogenesis, and explained 90 percent of heart attacks in women, and greater morbimortality. Cardiovascular risk factors, differently affect men and women. In turn, mortality from cardiovascular disease increases with the number of risk factors, which increase after menopause, especially obesity, hypertension and dyslipidemia, which could be associated with metabolic factors mediated by hormonal changes. Framingham tables underestimate the risk of women classified as 90 percent of women at low risk and very few at high risk before age 70. The recommendations are appropriate management of cardiovascular risk factors to prevent atherosclerosis, with a thorough individual risk assessment to identify women at risk. Hormone replacement therapy is not indicated as cardiovascular prevention.
Assuntos
Humanos , Feminino , Aterosclerose/epidemiologia , Aterosclerose/prevenção & controle , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVES: Hemodialysis patients (HD) display high rates of cardiac diseases and mortality. In chronic kidney disease, vascular injury leads to coronary artery disease, heart failure, and stroke. Carotid intima-media thickness (CIMT) measurements are currently widely used in randomized controlled trials (RCTs) to study the efficacy of interventions. An RCT was designed for the assessment of the safety and effectiveness of spironolactone to inhibit the progression of CIMT in HD patients as a primary outcome. Secondary outcomes included measurements of plasma potassium. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: HD patients were randomly assigned to receive 50 mg spironolactone or placebo thrice weekly after dialysis. In between dialysis sessions, plasma potassium concentrations were measured every month. Ultrasonographic measurements of CIMT were done at the beginning of the study and after 2 years. RESULTS: Fifty-three age- and sex-adjusted patients (30 with drug and 23 with placebo) successfully completed the trial. There were no significant differences between the two groups in all profiles studied at baseline. Measurements of CIMT after 2 years showed a progression in the placebo group, whereas in the spironolactone group a significant decrease or even reversed CIMT was observed. Progression rates (mm/yr) were: common carotid, placebo: 0.06 +/- 0.07, spironolactone: 0.01 +/- 0.04; carotid bifurcation, placebo: 0.15 +/- 0.27, spironolactone: 0.0001 +/- 0.01; internal carotid, placebo: 0.10 +/- 0.12, spironolactone: -0.10 +/- 0.15. No episodes of hyperkalemia were observed, but a slight increase in plasma potassium was found in the spironolactone group. CONCLUSIONS: Fifty milligrams of spironolactone thrice weekly significantly reduced the progression of CIMT in HD patients.
Assuntos
Artérias Carótidas/efeitos dos fármacos , Doenças das Artérias Carótidas/tratamento farmacológico , Falência Renal Crônica/terapia , Antagonistas de Receptores de Mineralocorticoides/administração & dosagem , Diálise Renal , Espironolactona/administração & dosagem , Túnica Íntima/efeitos dos fármacos , Túnica Média/efeitos dos fármacos , Idoso , Biomarcadores/sangue , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/patologia , Chile , Progressão da Doença , Método Duplo-Cego , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Efeito Placebo , Potássio/sangue , Espironolactona/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , UltrassonografiaRESUMO
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% had concentric left ventricular hypertrophy, 43% had atrial dilatation and 60% 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.
Assuntos
Doenças Cardiovasculares/etiologia , Citocinas/sangue , Falência Renal Crônica/complicações , Diálise Renal/efeitos adversos , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/sangue , Estudos de Casos e Controles , Feminino , Humanos , Mediadores da Inflamação/sangue , Interleucina-1/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por SexoRESUMO
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.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Cardiovasculares/etiologia , Citocinas/sangue , Falência Renal Crônica/complicações , Diálise Renal/efeitos adversos , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/sangue , Estudos de Casos e Controles , Mediadores da Inflamação/sangue , Interleucina-1/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Fatores de Risco , Distribuição por SexoRESUMO
Chile la tasa de tabaquismo en individuos entre 17 y 24 años es de 55 por ciento. A medida que los estudiantes de Medicina avanzan en su carrera, el conocimiento acerca del tabaquismo como determinante de enfermedad aumenta. Sin embargo, los estudiantes de cursos superiores fuman más que aquellos de cursos iniciales. Objetivo: Determinar la prevalencia de tabaquismo y la actitud de cambio frente al hábito tabáquico en estudiantes de Medicina e Ingeniería, de primer y cuarto año de la Universidad de Chile. Material y método: Estudio descriptivo-transversal. Se utilizó un cuestionario autoadministrado, registrándose variables demográficas, conducta fumadora y actitud de cambio frente al hábito tabáquico. Resultados: La muestra estuvo constituida por490 estudiantes (28,6 por ciento mujeres). La prevalencia actual de tabaquismo fue 18,6 por ciento (17,9 por ciento en mujeres y 18,9 por ciento en hombres, pns). En Medicina la prevalencia actual de tabaquismo fue 21,4 por ciento, en Ingeniería 16,6 por ciento (p<0,01). En ambas carreras los primeros años tuvieron una tasa similar (18,2 por ciento Medicina y 16,8 por ciento Ingeniería, pns). Esta cifra se mantuvo en cuarto año de Ingeniería (16,3 por ciento), pero aumentó significativamente en cuarto año de Medicina (24,3 por ciento). Los estudiantes de Medicina tienen un comportamiento más dinámico en su conducta fumadora que los de Ingeniería. El patrón de conducta tabáquica en mujeres es potencialmente menos dañino que en hombres. Discusión: El conocimiento médico de los efectos nocivos del tabaco no desempeña un rol en disminuir las tasas de tabaquismo. Resulta necesario potenciar en las facultades de Medicina actividades preventivas relacionadas al consumo de tabaco.
Introduction: Smoking is the greatest determinant of public health problems. In Chile, the rate of smoking in individuals between 17 and 24 years is 55 per cent. As medical students advance in their studies, their knowledge of smoking as a determinant of disease increases. Nevertheless, students from more advanced class levels smoke more than those of lower levels. Objective: Determine the prevalence of smoking and the attitude towards quitting in medical and engineering students, in their first and fourth years of studies at the University of Chile. Material and method: Cross sectional descriptive study. A self-administered survey was used, recording demographic variables, smoking behavior, and attitude towards quitting. Results: The sample consisted of 490 students (28.6 percent women). The prevalence of smoking was 18.6 per cent (17.9 percent in women and 18.9 percent in men, p=ns). Among medical students, the prevalence of smoking was 21.4 percent; among engineering students it was 16.6 percent (p<0.01). In both areas the first year students had a similar rate (18.2 percent in medical students and 16.8 percent in engineering, p=ns). This rate was maintained in fourth year engineering students (16.3 percent), but increased significantly in fourth year medical students (24.3 percent). Medical students have a more dynamic attitude towards their smoking habit than engineering students. The pattern of tobacco behavior in women is potentially more harmful than in men. Discussion: Medical knowledge of the harmful effects of tobacco doesn't play a role in decreasing the rates of smoking. It is necessary to promote preventive activities related to the consumption of tobacco in medical schools.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Educação Médica , Estudantes/psicologia , Tabagismo/epidemiologia , Tabagismo/psicologia , Estudos Transversais , Chile/epidemiologia , Prevalência , Inquéritos e QuestionáriosRESUMO
In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Fatores de RiscoRESUMO
La evaluación integral de factores de riesgo cardiovascular (FR) ha permitido diseñar tablas de estratificación de riesgo cardiovascular (RCV), que puedan predecir el riesgo global de sufrir un evento cardiovascular en los próximos 10 años en personas asintomáticas. Objetivo: Evaluar la prevalencia de FR en personas aparentemente sanas, y estratificarlas según su riesgo de presentar un evento cardiovascular en la próxima década. Métodos: Se estudiaron 12.409 personas sanas (PS), de 25 comunas de Santiago, edad 47,59 +-12 años, (51,5 porciento mujeres, 48,5 porciento hombres). Se evaluó conocimiento de FR, hábito tabáquico y alimentario (consumo de colesterol) actividad física y antecedentes familiares. Se midió presión arterial (PA), índice masa corporal (IMC, circunferencia cintura (CC), colesterol total (CT), y glicemia postprandial >4 hr (Gl). Se estratificaron en niveles de riesgo cardiovascular (RCV), según tablas de evaluación de RCV europeas, que consideran RCV bajo (<5 porciento), leve ( 5-10 porciento), moderado (10-20 porciento), alto (20-40 porciento)y muy alto (>40 porciento) de presentar un evento cardiovascular en los próximos 10 años. Resultados: la prevalencia de FR fue de 21,1 porciento hipertensión sistólica; 19,9 porciento hipertensión diastólica; 53,1 porciento hipercolesterolemia; 37,8 porciento tabaquismo; 68,6 porciento sedentarismo; 23,7 porciento obesidad, 71,1 porciento sobrepeso; y 5 porciento Gl alterada. El 22,8 porciento de la población tenía RCV entre 10 y 20 porciento y 5,6 porciento tenía RCV mayor a 20 porciento de tener un evento en los próximos 10 años. En los niveles de RCV >20 porciento, se encontró cifras significativamente mayores de PA, IMC, CC, CT, tabaquismo, sedentarismo y glicemia. Conclusiones: existe una alta prevalencia de FR. En el 28,4 porciento se encontró riesgo moderado/alto de presentar eventos cardiovasculares en los próximos 10 años. Este grupo presenta también otros FR no considerados en el modelo de estratificación.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Chile , Traumatismos Cardíacos , Grupos de RiscoRESUMO
Background. Detecting viability is important after recent myocardial infarction (MI). SPECT FDG/Tl flow-metabolism patterns for predicting functional recovery were analyzed in this setting. Method. Forty-one patients were studied (56ñ12 years; 80 percent males) with Tl 201 at rest and FDG F18 SPECT at a mean of 8.9 days post MI (range:1-24). All had baseline and 3 month follow-up echocardiography (ECHO) and initial coronary angiography. They were submitted to primary PTCA in 12 cases, late PTCA in 15 and bypass surgery in 10 and thrombolysis was performed in 4 patients as only procedure. A total of 345 culprit artery territory segments were interpreted by 3 nuclear independent observers. Analysis included segments with or without abnormal motion. Results. FDG/Tl 201 on patient basis, had: sensitivity 91percent; specificity 56 percent; positive predictive value 88 percent; negative predictive value (NPV) 63 percent and accuracy 83 percent. The analysis of segments with abnormal contractility showed values of 67 percent, 69 percent, 44 percent, 85 percent and 68 percent, respectively. Reverse mismatch with FDG/Tl appears to predict viability similarly to classical mismatch; severe or moderate match was highly associated with no functional recovery (NPV = 85 percent). Conclusion. Flow-perfusion patterns are variable in recent MI. FDG/Tl 201 SPECT has acceptable accuracy for predicting functional recovery and excellent NPV to further exclude viability
Assuntos
Humanos , Tomografia Computadorizada de Emissão de Fóton Único , Infarto do Miocárdio , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The detection of viability after acute myocardial infarction is primordial to select the most appropriate therapy, to decrease cardiac events and abnormal remodeling. Thallium201 SPECT is one of the radionuclide techniques used to detect viability. AIM: To evaluate the use of Thallium201 rest-redistribution SPECT to detect myocardial viability in reperfused patients after a recent myocardial infarction. PATIENTS AND METHODS: Forty one patients with up to of 24 days of evolution of a myocardial infarction were studied. All had angiographically demonstrated coronary artery disease and were subjected to a successful thrombolysis, angioplasty or bypass grafting. SPECT Thallium201 images were acquired at rest and after 4 h of redistribution. These results were compared with variations in wall motion score, studied at baseline and after 3 or 4 months with echocardiography. RESULTS: The sensitivity of rest-redistribution Thallium201 SPECT, to predict recovery of wall motion was 91% when patient analysis was performed and 79% when segmental analysis was done in the culprit region. The figures for specificity were 56 and 73% respectively. CONCLUSIONS: Rest-distribution Thallium201 SPECT has an excellent sensitivity to predict myocardial viability in recent myocardial infarction. The data obtained in this study is similar to that reported for chronic coronary artery disease.
Assuntos
Infarto do Miocárdio/diagnóstico por imagem , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Sobrevivência de TecidosRESUMO
El mejor examen disponible para evaluar viabilidad miocárdica es el Fluor18-fluordeoxiglucosa (F18FDG) que mide metabolismo celular y utilización de glucosa como sustrato. Su asociación a marcadores de flujo miocárdico permiten conocer la existencia y extensión de tejido con función potencialmente recuperable. El objetivo de este trabajo fue evaluar el rendimiento del F18FDG SPECT en pacientes con infarto reciente de miocardio. Material y Método: Se estudiaron preliminarmente 23 pacientes (7M,16H), edad promedio 63 ñ 13 años (rango:40-85), con evolución promedio de 10 días postinfarto (rango:5-24). En 14 casos, el infarto fue anterior y en 9 casos inferior. Se realizó F18FDG en cámara ADAC doble cabezal con colimadores de 511 Kev, con dosis promedio de 211 MBq (rango: 52-444) , con adquisición de las imágenes a los 45 min postinyección. Contemporáneamente, se efectuó Tl201 SPECT reposo redistribución con dosis de 148 MBq y adquisición de imágenes a los 10 min y 3 hrs. Se realizó análisis visual de ambos estudios en forma independiente dividiendo el miocardio en 17 segmentos (total de segmentos: 391). Resultados: Tanto en el SPECT con Tl201 como en el con F18 FDG hubo 21/23 (91 por ciento) de casos con segmentos alterados, en que hubo concordancia de 83 por ciento. En el Tl201 reposo redistribución, se encontraron 32 por ciento de segmentos alterados y en el estudio conjunto Tl201 reposo F18 FDG, se observó un 34 por ciento de segmentos alterados del total de los analizados. En dichos segmentos, el Tl201 reposo redistribución mostró 65 por ciento de segmentos viables y el Tl201 F18 FDG 77 por ciento de segmentos con viabilidad. Conclusión: 1) Tanto el Tl201 como el estudio con F18 FDG tienen buena concordancia, tanto por pacientes como por segmentos, en el infarto reciente de miocardio. 2) El SPECT Tl201 asociado a F18 FDG detecta un mayor número de segmentos viables que el examen de Tl201 reposo- redistribución aislado
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Sobrevivência de Tecidos , Fluordesoxiglucose F18 , Infarto do Miocárdio , Tomografia Computadorizada de Emissão de Fóton Único , Dobutamina , Angiografia Coronária , Radioisótopos de TálioRESUMO
El infarto del miocardio (IAM) de pared inferior, complicado con bloqueo auriculoventricular (BAV) se asocia a mayor mortalidad a pesar de ser en muchos casos transitorio. Con el objeto de analizar las causas de esta mayor mortallidad se estudiaron 307 pacientes (pts) consecutivos con IAM inferior, dividiéndolos en 421 pts sin BAV (grupo I) y 66 pts con BAV de 2o. ó 3o. grado (grupo II). La mortalidad global fue 10.7 (8.3% grupo I, p<0.001). No encontramos diferencias en ambos grupos respecto a factores de riesgo (excepto para tabaquismo, que fué mayor en el grupo I, p<0.001), antecedente de IAM, angina crónica o insuficiencia cardíaca previa. Encontramos diferencias significativas en ambos grupos respecto a edad (61 ñ 12 grupos I vs 68 ñ 9 años grupo 2, p<0.001) y en niveles máximos de CPK x ñ DS (1513 ñ 1135 grupo I vs 1958 ñ 1293 UI/1 grupo II, p<0.01). Durante su evolución los pacientes del grupo II presentaron mayor incidencia de arritmias ventriculares complejas, (p<0.01), de arritmias supraventriculares p<0.01) y de insuficiencia cardíaca Killip III y IV, (p<0.0001). Se estudiaron 123 pts con coronariografía, 106 del grupo I y 17 pts del grupo II. En los pts con BAV se encontró mayor incidencia de enfermedad de 3 arterias (47% vs 28%) y de lesiones críticas asociadas de arterias descendente anterior y derecha (29% vs 12%, p<0.06). En conclusión, los pts con IAM inferior complicado de BAV tienen mayor mortalidad en relación a edad más avanzada, necrosis más extensa, más complicaciones asociadas, y mayor incidencia de lesiones asociadas de arterias descendente anterior y derecha
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Bloqueio Cardíaco/mortalidade , Infarto do Miocárdio/complicações , Morbidade , PrognósticoRESUMO
La Hidatidosis Cardíaca es una entidad clínica poco frecuente, con una incidencia menor al 3% de todos los casos de Hidatidosis humana. Su diagnóstico es de vital importancia, pudiendo realizarse por medio de distintos métodos no invasivos, como Radiografía de Tórax. Electrocardiograma, Ecocardiograma Bidimensional y Scanner Torácico, permitiendo la cirugía precoz, antes que se presenten las complicaciones, lo que hace que la cirugía sea curativa. El propósito de esta publicación es presentar el caso de una paciente portadora de quiste hidatídico ventricular isquierdo, tratado con cirugía, y revisar la literatura pertinente