Navegando por Palavras-chave "Coronary disease"
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- ItemAcesso aberto (Open Access)Avaliação cardiovascular de pacientes diabéticos em ambulatório universitário(Sociedade Brasileira de Endocrinologia e Metabologia, 2007-03-01) Alvarenga, Marcelo A. [UNIFESP]; Oliveira, Carolina Soares Viana de [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Reis, André Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Type 2 diabetes is a cardiovascular disease. The morbidity and mortality among these patients are primarily due to cardiovascular diseases. There are many guidelines regarding clinical evaluation of cardiovascular disease in those patients. Implementation of these guidelines has been an argued subject. Our objective in this paper is to describe what basal cardiovascular evaluation has been carried out at a specialized university Diabetes Center. SUBJECTS AND METHODS: Data were collected from February to October 2006 of 121 type 2 diabetes individuals who were enrolled at the Diabetes Center of Federal University of São Paulo. We analyzed the type of cardiovascular disease evaluation that they had been submitted in the year that preceded the consultation. RESULTS: We have observed a high prevalence of several other cardiovascular risk factors in this population. The cardiovascular evaluations during this period has shown 36% of the patients had not been submitted to any cardiovascular test, 17% had been submitted to resting electrocardiogram and 27% of the patients had been submitted to exercise test. Rest echocardiogram, pharmacologic stress echocardiogram, myocardial perfusion scintigraphy, and coronary angiography have been carried out in a much lesser ratio. CONCLUSION: Our data has shown the variability and limitations on boarding diagnosing of DAC in university environment patients and point us the necessity of constructing defined and directed directives for the peculiarities of the Brazilian population and health system.
- ItemAcesso aberto (Open Access)Avaliação dos efeitos da circulação extracorpórea na formação de cálculos biliares(Sociedade Brasileira de Cirurgia Cardiovascular, 2006-03-01) Costa, Sergio Renato Pais [UNIFESP]; Goldenberg, Alberto [UNIFESP]; Matos, Delcio [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The objective of the present study was to clarify the relationship between cardiopulmonary bypass with the use of a heart-lung machine and gallstones in a short-term follow-up. METHOD: A total of 135 patients with ischaemic heart disease were included in this study. All were followed up by the Cardiology Department of Hospital São Paulo, Federal University of São Paulo. They were divided into three groups: Group 1 - 51 patients who were treated clinically; Group 2 - 43 patients who underwent coronary artery grafting bypass without cardiopulmonary bypass; and Group 3 - 41 patients who underwent coronary artery grafting bypass with cardiopulmonary bypass and the use of a heart-lung machine. There were no statistically significant differences between the groups in relation to gender, age, body mass index or associated diseases (p<0.05). All the patients underwent ultrasound examination 12 months after beginning their cardiological treatment (clinical treatment alone or surgical plus follow-up). RESULTS: The prevalence of gallstones in the groups was: Group 1 - 7.84%, Group 2 - 11.62%, and Group 3 - 19.51%. There was no statistically significant differences between the groups (p = 0.248). CONCLUSION: It was concluded that cardiopulmonary bypass does not appear to have a close relationship with gallstone formation one year after coronary artery bypass grafting. However, long-term follow-up is advisable.
- ItemAcesso aberto (Open Access)Caracterização tecidual e fenotípica in vivo da placa aterosclerótica em pacientes com infarto agudo do miocárdio: análise pelo ultrassom intravascular utilizando o mapeamento tecidual iMAP®(Universidade Federal de São Paulo (UNIFESP), 2016-11-11) Souza, Cristiano Freitas de [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; http://lattes.cnpq.br/6569055379421505; http://lattes.cnpq.br/2847246252774147; Universidade Federal de São Paulo (UNIFESP)Background: There is limited data on plaque tissue characterization and phenotype classification using radiofrequency iMAP-IVUS?. Methods: In the iWonder study patients presenting with non-ST-elevation myocardial infarction (STEMI) or STEMI underwent 3-vessel grayscale IVUS and iMAP-IVUS? tissue characterization prior to percutaneous intervention. In total, 385 lesions from 100 patients were divided into culprit (n=100) and non-culprit (n=285) lesions. Lesion phenotype was classified in a hierarchical fashion into: (1) TCFA (thin-cap fibroatheroma ? at least 1 frame with >30° of necrotic core [NC] abutting to the lumen); (2) ThCFA (NC >10%, confluent dense calcium [DC] >10%, well-defined fibrous cap); (3) PIT (pathological intimal thickening ? mainly fibrofatty tissue, <10% confluent NC); (4) fibrotic plaque (mainly fibrous tissue, <10% confluent NC, <10% confluent DC) and (5) fibrocalcific plaque (mainly fibrous tissue, >10% confluent DC and <10% confluent NC). Results: Culprit lesions had smaller minimum lumen area with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS? revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the minimum lumen area (MLA) site (all p<0.001). Any fibroatheroma was more frequently identified in the culprit lesions compared to non-culprit lesions (93% vs. 78.9%, p=0.001). Also, a TCFA was more prevalent within culprit vs. non-culprit lesions (39.0% vs. 19.0%, p<0.001) anywhere within the lesion as well as at the MLA site (18.0% vs. 9.5%, p=0.07). Conclusion: Three-vessel radiofrequency iMAP-IVUS? study demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as TCFAs in culprit vs non-culprit lesions in patients presenting with STEMI or non-STEMI and undergoing percutaneous intervention.
- ItemAcesso aberto (Open Access)Functional status change in older adults undergoing coronary artery bypass surgery(Associação Paulista de Medicina - APM, 2011-03-01) Guimarães, Márcio Niemeyer Martins De Queiroz; Almada Filho, Clineu De Mello [UNIFESP]; Quinta D'Or Hospital; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
- ItemAcesso aberto (Open Access)Macroangiopatia diabética coronariana precoce no diabetes do jovem: relato de dois casos(Sociedade Brasileira de Endocrinologia e Metabologia, 2005-12-01) Giuffrida, Fernando M.a. [UNIFESP]; Fusaro, Annunziata Sonia [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Macroangiopathy is multifactorial. It is more severe and frequent in association with nephropathy in diabetes mellitus (DM), being the first cause of mortality in both types of DM. Nevertheless, it is poorly understood in young patients. We report on 2 young diabetic patients with early-onset coronary disease. Case 1, 40yo, Caucasian, female, type 2 DM for 21y: treated with sulphonylureas until 25y, she was switched to insulin upon becoming pregnant. Preeclampsia ensued, but no premature delivery occurred. Macroproteinuria remained (0.99g/24h), and she progressed to renal failure (clearance 52.7mg/min) (conservative treatment). At age 36, she had an acute myocardial infarction. Severe tri-arterial disease was diagnosed, and coronary bypass grafting (CABG) performed. Case 2, 34yo, black, female, type 1 DM for 24y: diagnosed by diabetic ketoacidosis. Due to poor metabolic control (HbA1c chronically above 4 points beyond upper limit for normal) she progressed to microalbuminuria (0.26g/24h) at age 22, after pregnancy. Macroproteinuria (1.7g/24h) ensued after a second pregnancy. At 31y, she presented with stable angina. After coronary angiography, CABG was indicated. These two cases of macroangiopathy in patients diagnosed with DM at an early age show acceleration in the development of coronary disease, suggesting aggressive multifactorial approach of related risk factors from the beginning, regardless of its etiology.
- ItemAcesso aberto (Open Access)Revascularização miocárdica com circulação extracorpórea: aspectos bioquímicos, hormonais e celulares(Sociedade Brasileira de Cirurgia Cardiovascular, 2011-12-01) Gabriel, Edmo Atique [UNIFESP]; Locali, Rafael Fagionato; Matsuoka, Priscila Katsumi; Cherbo, Tiago [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The authors sought to assess biochemical, hormonal and cellular repercussions from use of cardiopulmonary bypass (CPB) in coronary artery bypass graft (CABG) surgery. METHODS: Eighteen patients underwent on-pump CABG surgery. Mean time of CPB was 80.3 minutes. Hormonal, biochemical and cellular measurements were taken in some time points - preoperatively, immediately after coming off CPB, 24 and 48 hours postoperatively. Friedman and Wilcoxon tests were applied based on significance level of 5%. RESULTS: There was activation and significant elevation of total leukocytes and neutrophils count over CPB, remaining this way up to 48 hours postoperatively. Total platelets count, in turn, was marked by relevant reduction immediately after coming off CPB as well as in two postoperative time points. Serum levels of total proteins and albumin, immediately after coming off CPB and also in two postoperative time points, were significantly decreased comparing with preoperative status. There was remarkable reduction of total T3, free T3 and total T4 particularly up to first 24 hours postoperatively. CONCLUSION: In on-pump CABG surgery, inflammatory effects encompass activation of total leukocytes, neutrophils and platelets, reduction of serum level of total proteins and albumin and decreased thyroid hormones levels, especially within first postoperative 24 hours.
- ItemAcesso aberto (Open Access)Trombose simultânea em duas artérias coronárias epicárdicas durante infarto agudo do miocárdio(Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI, 2012-12-01) Lanaro, Eduardo [UNIFESP]; Pereira Júnior, Edilberto Castilho [UNIFESP]; Falcão, Felipe José de Andrade [UNIFESP]; Barbosa, Adriano Henrique Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Young patient with a history of smoking, hypertension and use of illicit drugs (cannabis, cocaine and crack) was admitted with precordial pain after physical exercise within the previous two hours. Electrocardiogram demonstrated ST segment elevation in leads V1 to V4 and the patient was referred to cardiac catheterization, which showed total occlusion of the left anterior descending artery and a large amount of thrombi in the right coronary artery. The patient was treated with direct stenting in the left anterior descending artery and triple antiplatelet therapy with aspirin, clopidogrel and abciximab in combination with non-fractioned heparin for 24 hours. Angiography and intravascular ultrasound assessment after 48 hours demonstrated a complete resolution of thrombi in both coronary arteries.