Revista da Sociedade de Cardiologia do Estado de São Paulo最新文献

{"title":"CASE REPORT OF INFERIOR WALL MYOCARDIAL INFARCTION RESULTING FROM COMPRESSION OF THE MIDPORTION OF THE RIGHT CORONARY ARTERY BY GIANT ANEURYSM COMMUNICATING PROXIMALLY WITH THE RIGHT CORONARY ARTERY","authors":"C. Cardoso, C. Kiyochi Takimura, Dirceu Oscar Faeli Jr., Luana Vieira Diago, Luccas Alves Moreira Uchoa, Luis Tamayo, Marina Costa Atherinos Pierri, Vanessa Baudichon Domingues Maintinguer","doi":"10.29381/0103-8559/20223204504-8","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204504-8","url":null,"abstract":"Giant coronary aneurysms are defined as dilatation greater than 4.0 cm in diameter, or 4 times the normal diameter of the coronary artery. It is a rare pathology in the general popula-tion and most commonly affects the right coronary artery. The most common etiology of this aneurysm subtype is atherosclerosis. The clinical presentation varies, from asymptomatic to acute myocardial infarction with ST-segment elevation. The present case report describes a patient with acute myocardial infarction that underwent coronary cineangiography, which revealed a giant coronary aneurysm in the right coronary ostium, between the aorta and the superior vena cava, measuring 55 mm in diameter. It was compressing the middle portion of the coronary artery. Subsequently, resection of the coronary aneurysm, correction of the aortic defect resulting from the resection, and right coronary artery bypass graft surgery, using an aortovenous graft, were prescribed.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129717754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MULTIVESSEL CORONARY VASOSPASM WITH ABORTED SUDDEN DEATH AND REFRACTORY ANGINA: EFFICACY OF ALPHA-BLOCKERS AND INDICATION OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR","authors":"Luhanda Leonora Cardoso Monti Sousa, Felipe Carvalho Guimanães, Caio Menezes Machado de Mendonça, L. A. Machado César, B. Mahler Mioto","doi":"10.29381/0103-8559/20223204499-503","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204499-503","url":null,"abstract":"Vasospasm of the coronary arteries is an uncommon and underdiagnosed cause of angina pectoris. There is a myriad of clinical presentations with variable prognoses. The typical presentation in the scenario of chronic coronary syndrome includes angina at rest or with variable threshold, from late evening to early morning, including transient ischemia responsive to nitrates, detectable by 12-lead electrocardiogram or Holter. Concurrent multivessel vasospasm is rare and with worse prognosis, given the potential for acute ST-elevation myocardial infarction, ventricular arrhythmias and subsequent sudden cardiac death. The presence of refractory angina is a sign of persistent vasospasm, indicating severe manifestations. The complex physiopathology, including hypercontractility of the vascular smooth muscle, endothelial dysfunction and adrenergic receptor activation has not been fully elucidated, which makes it difficult to define a targeted therapy. We present a case of refractory angina after multivessel vasospasm with aborted sudden death, which responded to alpha-blocker and had implantable cardioverter-defibrillator implantation postponed.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123333925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OPTIMAL MEDICAL THERAPY: FOR SYMPTOMS CONTROL","authors":"N. Tavares Poppi","doi":"10.29381/0103-8559/20223204454-9","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204454-9","url":null,"abstract":"One of the main objectives in the treatment of chronic coronary artery disease is to improve quality of life, by controlling the symptoms of angina, which are often limiting. To perform this task, the physician must offer the patient what we call optimal medical therapy, which includes education on lifestyle modifications, control of risk factors and comorbidities, pharmacological treatment and, in selected cases, myocardial revascu-larization. The initial drug therapy usually consists of one or two classes of antianginal drugs plus secondary prevention medications. A significant proportion of patients do not satisfactorily achieve the goal of controlling the symptoms of angina, many of which for not receiving a truly optimal medical therapy, with maximum tolerated doses of antianginal drugs, in combination therapy, according to the individual characteristics of each patient. There is strong evidence indicating that all classes of antianginals have similar efficacy in the treatment of angina and myocardial ischemia and, nevertheless, none of them reduce cardiovascular events, except for beta-blockers in patients with left ventricular dysfunction or recent myocardial infarction. There is no definition of which drug or combination is optimal, and there is no evidence to support the use of the terms “first- and second-line” drugs in the treatment of angina. We suggest, therefore, that the best strategy should be individualized, choosing the antianginal drug according to the patients’ clinical charac-teristics and comorbidities.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130650465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CARDIOVASCULAR REHABILITATION BASED ON AEROBIC AND RESISTANCE TRAINING IN PATIENTS WITH CHRONIC CORONARY SYNDROMES","authors":"Camila Quaglio Bertini, V. Papa, J. Crescêncio, Leonardo Pippa Gadioli, A. Schmidt, L. Gallo Júnior, F. Marques","doi":"10.29381/0103-8559/20223204532-40","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204532-40","url":null,"abstract":"Cardiovascular diseases (CVD) are the leading cause of death in Brazil and, among them, coronary artery disease (CAD) was the leading cause of death in the country. CAD includes symptomatic and asymptomatic clinical conditions related to reduced blood flow to the heart muscle. Chest pain caused by myocardial ischemia, known as angina pectoris, is usually brought on by exertion or emotional stress. Physical exercise has numerous benefits on cardiovascular risk factors and the cardiovascular system, such as improvement in angina through increased myocardial oxygen delivery and increased exercise capacity, an independent predictor of increa-sed survival. Cardiovascular rehabilitation (CVR) based on physical exercises has consistently demonstrated its effectiveness in reducing cardiovascular mortality and hospitalizations in patients with CAD. CVR is recommended for a healthy lifestyle and for managing cardiovascular risk factors by prescribing 30 to 60 minutes of moderate-intensity aerobic activity five or more days a week, and resistance exercise to maintain muscle mass, strength and function two to three days a week. CVR has been recommended as a treatment also for refractory angina. Although CVR has already been considered a feasible and safe therapeutic possibility for these patients, cardiac rehabilitation centers are reluctant to accept patients with angina or complicated cardiovascular history due to fear of adverse events during physical training despite scientifically proven safety.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131357152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORONARY ARTERY BYPASS SURGERY: NEW SURGICAL APPROACHES","authors":"L. A. F Lisboa, Marco Antonio P. Oliveira","doi":"10.29381/0103-8559/20223204467-74","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204467-74","url":null,"abstract":"In April 1968, Renee Favaloro published the first series of coronary artery bypass graft surgeries. Over the years since that landmark publication, coronary artery bypass graft sur-gery has been enthusiastically embraced by cardiac surgeons around the world. Currently, according to the most recent data from Brazilian registries and the American database of the Society of Thoracic Surgeons, most cardiac surgery procedures in adults are coronary artery bypass graft operations. Over five decades since the first Favaloro procedure, coronary artery bypass graft surgery has witnessed substantial changes and evolution. Continuous technical and technological improvements have made the operation safer and less invasive. Surgeries without cardiopulmonary bypass, by miniaccess, with a greater number of arterial grafts, hybrid revascularization, and surgeries with robotic assistance represent the extreme evolution of the procedure originally described in 1968. All these new techniques share the issue of increasing technique and logistics, and more limited evidence of support and applicability compared to standard operations. However, these techniques have been developed in a safe and less aggressive way, making them more attractive for patients with coronary artery disease who need surgical treatment. In this article, the techniques are reviewed and a summary of different state-of-the-art approaches to coronary artery bypass graft surgery is provided.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123865553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STABLE ANGINA IN SPECIAL SITUATIONS: IN REFRACTORY CONDITIONS","authors":"Luciana Oliveira Cascaes Dourado","doi":"10.29381/0103-8559/20223204492-8","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204492-8","url":null,"abstract":"Refractory angina is a chronic condition that affects an increasing number of patients due to the increased survival of the population with coronary artery disease as a result of therapeutic advances in the area. The presence of limiting angina pectoris that causes loss of quality of life despite optimized clinical treatment, due to myocardial ischemia, in individuals not eligible for conventional coronary artery bypass grafting procedures, characterizes refractory angina. The focus of treatment is the improvement of symptoms, quality of life and psychological morbidity. Multidisciplinary approach in the evaluation and management of patients is of paramount impor-tance. Clinical treatment involves, in addition to fine antianginal pharmacological adjustment, control of associated conditions. In the case of conditions refractory to conventional treatment, alternative therapies are options for symptom improvement. These alternative therapies should be recommended according to local availability and individual clinical characteristics. Mana-gement of patients with refractory angina represents a major clinical challenge.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122912654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INNOVATIONS IN DIAGNOSTIC METHODS: ECHOCARDIOGRAPHY –STRAIN – WORKLOAD – BUBBLE CONTRAST","authors":"Marcelo L Campos Vieira, Rafael Bonafim Piveta, Miguel Osman Dias Aguiar, W. Mathias Jr","doi":"10.29381/0103-8559/20223204412-20","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204412-20","url":null,"abstract":"Echocardiography was introduced as a method of investigation for different heart diseases in the 1950s. Since then, several new echocardiographic techniques have been introduced into clinical practice with the aim of expanding the possibilities of diagnostic investigation and making it possible to understand the pathophysiology of various heart diseases. In the context of evolution of cardiac investigation techniques using echocardiography, in the 1990s, the possibility of observing myocardial strain for the analysis of myocardial systolic function, added diagnostic information as well as prognostic impact to the analysis of ventricular volumetric va-riation (ejection fraction). Echocardiography performed with the addition of intravenous contrast, conducted for the first time at the end of the 1960s, takes on a new status in the analysis of heart diseases using new-generation contrast agents and ventricular analysis software dedicated to the specific physics of contrast agents. Myocardial strain analysis and echocardiography with contrast agents add information to the diagnosis of acute and chronic coronary artery disease.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125912751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EPIDEMIOLOGICAL CHANGES IN CORONARY ARTERY DISEASE IN BRAZIL","authors":"A. de Pádua Mansur","doi":"10.29381/0103-8559/20223204404-7","DOIUrl":"https://doi.org/10.29381/0103-8559/20223204404-7","url":null,"abstract":"Cardiovascular diseases (CVD) are the leading cause of death in Brazil. The main etiologies are ischemic heart disease (IHD) and stroke. Since 1984, we have observed a continuous and significant reduction in mortality from these diseases in men and women, but the death rate was consistently higher in men than in women. The prevalence and death rate from CVD predominated in the South and Southeast and capitals in the 1990s. In the 2000s, we observed the proximity of CVD mortality in the five regions due to the more significant reduction in mortality in the South and Southeast. The proximity of stroke mortality trends occurred earlier than those due to IHD, reflecting the population's greater awareness of hypertension control. Between 2007 and 2012, we had a short interruption in the downward trend in the IHD death rate in women and men, but not for all CVD and stroke, which continued to decline. However, from that period, the downward trend continued. Recent studies showed that mortality from all causes of cancer would exceed mortality from CVD in the population aged between 35 to 74. The intensification of primary prevention with greater access to a healthy life and control of risk factors can have an even more significant impact on reducing mortality from CVD.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116847156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FISIOPATOLOGIA E CLASSIFICAÇÃO DAS SÍNDROMESCORONARIANAS AGUDAS","authors":"Carlos Costa Magalhães","doi":"10.29381/0103-8559/20223203281-8","DOIUrl":"https://doi.org/10.29381/0103-8559/20223203281-8","url":null,"abstract":"A descoberta do papel decisivo do endotélio na manutenção do equilíbrio vascular permitiu constatar que, em algumas condições específicas consideradas de risco para o desenvolvimento da aterosclerose, como a dislipidemia, hipertensão, diabetes ou a presen-ça de tabagismo, a função endotelial pode estar significativamente prejudicada. Além de interferir em processos crônicos, a disfunção endotelial pode induzir modificações agudas no equilíbrio vascular, facilitando os fenômenos de vasoespasmos ou mesmo de trombose intravascular. Este papel regulatório parece fundamental na circulação coronária, que fre-quentemente é acometida pela aterosclerose. Múltiplas evidências experimentais apontam a inflamação como processo regulatório chave em todos os estágios do desenvolvimento da aterosclerose. Como estratégia para orientação do tratamento das síndromes coronarianas agudas, classificamos os pacientes portadores de desconforto ou dor precordial que se apresentam nas unidades de emergência com novas elevações do segmento ST em duas ou mais derivações contínuas ou num novo bloqueio de ramo esquerdo no traçado eletro-cardiográfico, como um portador de infarto do miocárdio (IM) com supradesnivelamento de segmento ST (IMcSST). Em contraste, pacientes sem elevação do segmento ST nas derivações eletrocardiográficas são considerados portadores de infarto do miocárdio sem supradesnivelamento de segmento ST (IMsSST). Em associação a essas duas categorias de IM, podem ser classificados vários outros tipos, com base em diferenças patológicas, clínicas e prognósticas que apresentam diferentes formas de tratamento.","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125243061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CIRURGIA DE REVASCULARIZAÇÃO DO MIOCÁRDIO E REABILITAÇÃO CARDÍACA INTRA-HOSPITALAR NA SÍNDROME CORONARIANA AGUDA","authors":"Isadora Salvador Rocco, Caroline Bublitz, Isis Begot, Luiz Rodrigo da Silva Rodrigues, Rebeca Fortunato de Moura, Ludimila Pereira de Rezende, Gabriela de Araújo Raise, Juliana Teixeira Pereira, Paulo Mateus Sanches de Souza, Aislan Henrique bezerra Pinheiro Henrique bezerra Pinheiro, Luiz Augusto de Andrade Costa, Leonardo Paiva Ohashi, Marjory Passos Medeiros, Pedro Meira Reges, Matheus Ritto, Marcos Cruz Amaral, Rafael Queiroz de Souza Lima, Rita Simone Lopes Moreira, R. Trimer, Valéria Papa, Vera Lúcia dos Santos Alves, Carlos Alberto Telles, Nelson Américo Hossne Junior, João Nelson Rodrigues Branco, Guilherme Flora Vargas, Walter José Gomes, Solange Guizilini","doi":"10.29381/0103-8559/20223203360-9","DOIUrl":"https://doi.org/10.29381/0103-8559/20223203360-9","url":null,"abstract":"A síndrome coronariana aguda (SCA) constitui uma causa expressiva no número de internações e óbitos de origem cardiovascular no mundo. O risco de desenvolvimento de SCA não se restringe apenas em decorrência do grau de obstrução angiográfica das lesões, mas sim de suas características anatômicas, estruturais e atividade inflamatória. No tratamento do infarto agudo do miocárdio (IAM) complicado, a cirurgia de revascularização do miocárdio apresenta benefícios e vem demonstrando avanços nos resultados clínicos. A abordagem colaborativa do Heart Team tem se mostrado fundamental na tomada de decisão sobre a indicação e o momento ideal para operar os pacientes nessa difícil situação. A importância da reabilitação fase 1 em pacientes com SCA vem sendo solidificada a cada ano e sua aplicação tem contribuído muito para o tratamento clínico e evolução dos pacientes. Iniciar preco-cemente o programa de reabilitação cardiovascular baseado em exercícios após a SCA favorece o remodelamento cardíaco de maneira adequada. A equipe precisa incentivar os pacientes a compreender a importância da mudança de hábitos de vida para reduzir as taxas de reinternação hospitalar. Na elaboração da proposta de educação em saúde que irá ser fornecida ao paciente, as informações devem visar aumento da taxa de autogerenciamento e de conhecimento sobre os fatores de risco cardiovascular após o IAM","PeriodicalId":190881,"journal":{"name":"Revista da Sociedade de Cardiologia do Estado de São Paulo","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114153679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}