Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology最新文献

{"title":"Antiplatelet drugs in secondary prevention after acute myocardial infarction.","authors":"I Thizon-de-Gaulle","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Clopidogrel, a new ADP receptor antagonist, selectively and irreversibly inhibits ADP-induced platelet activation and aggregation thereby preventing atherothrombosis. Clopidogrel 75 mg o.d. and aspirin 325 mg o.d. were compared in the CAPRIE trial, a prospective international multicenter double-blind trial conducted in 19,185 high- risk patients with symptomatic atherosclerotic disease. Qualifying events for inclusion into the trial were ischemic stroke (IS) within the past six months, myocardial infarction (MI) within the past 35 days or peripheral arterial disease. Duration of treatment was one to three years. The primary efficacy end point was a composite cluster of IS, MI of vascular death. Overall, clopidogrel provided an 8.7% relative risk reduction (p = 0.043) in the occurrence of a first event of the cluster over and above aspirin and a favorable trend on each of the components of the primary end point. The greatest relative risk reduction was noted for prevention of MI (19.2%). In terms of number of events prevented per 1,000 patients and per year, clopidogrel is expected to prevent 24 major atherothrombotic events versus 19 with aspirin. Clopidogrel shows a favorable safety profile with fewer cases of gastrointestinal bleeding and better gastric tolerability.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"993-7"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729557","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":"Thrombolysis in the management of acute myocardial infarction. Current status and future perspectives.","authors":"F Verheugt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The optimal thrombolytic regimen is front-loaded alteplase with vigorous heparinization: the reperfusion treatment that leads to the lowest 30 day mortality. The role of heparin alone or in combination with thrombolysis is still unclear. Hirudin does not provide benefit over heparin, as we have seen in the trials, and glycoprotein blockers are promising in PTCA. They can also be effective in unstable angina and possibly in acute myocardial infarction.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"959-65"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729632","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":"[Therapeutic exhaustion in patients with an implantable cardioverter-defibrillator. Are there predisposing factors?].","authors":"M Oliveira,&nbsp;N da Silva,&nbsp;E Antunes,&nbsp;L Sousa,&nbsp;P Bico,&nbsp;J M Conceição,&nbsp;J Roquette,&nbsp;A M Antunes","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>In patients (pts) with implantable cardioverter-defibrillators (ICD), antitachycardia pacing (ATP) schemes may be used followed by a limited number of endocavitary shocks in the same episode of ventricular tachycardia (VT) with the potential risk of therapeutic exhaustion.</p><p><strong>Objective: </strong>To assess the incidence of episodes of therapeutic exhaustion in a population of ICD carriers with ATP programmes and to attempt to determine their correlation with clinical variables.</p><p><strong>Methods: </strong>Study of the episodes of VT treated by ICD in 8 patients (6 male; 2 female) with an average age of 56 +/- 17 years with a follow-up > 6 months. The underlying pathology was: ischemic heart disease-5 patients; arrhythmogenic dysplasia of the right ventricle-1 patient; hypertrophic cardiomyopathy-1 patient; and operated pulmonary valve stenosis-1 patient. The authors considered therapeutic exhaustion to be the occurrence of episodes in which VT persisted after the application of ATP and the maximum number of shocks. The patients with episodes of therapeutic exhaustion (group A-3 patients) were compared with the remaining patients (group B-5 patients) with regard to the following parameters: age; ejection fraction; previous myocardial infarction (pMI; cardiac frequency during VT (cfVT); number of episodes of non-maintained VT (NMVT) without therapeutic intervention; > 20% reduction of the VT cycle after ATP (VTATP); intensity of programmable shocks (Icho); and medication with anti-arrhythmia drugs (AA).</p><p><strong>Results: </strong>In a total of 262 VT records (duration > 2.5 sec. after detection) with treatment by ICD during an average follow-up of 11 months, 6 episodes (2.3%) of therapeutic exhaustion were detected in 3 patients. Four of the episodes occurred in the same patient in a period of 4 hours, hospitalisation being necessary following syncope. In the other two cases, there were complaints of dizziness which subsided spontaneously a short time after the application of the last shock by the ICD. [table: see text]</p><p><strong>Conclusion: </strong>Therapeutic exhaustion occurred in about 2% of the VT treated with this population. The possibility of a high number of non maintained VT episodes being associated to a greater possibility of therapeutic exhaustion may have implications on ICD programming.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"1013-20"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729560","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":"[Streptococcus bovis endocarditis and colonic involvement].","authors":"S B Baptista,&nbsp;F P Duarte,&nbsp;A Galrinho,&nbsp;L Dutschmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>McNeal and Blevins published the first report of Streptococcus bovis infective endocarditis in 1945. In 1951, McCoy suggested, for the first time, that an association could exist between Group D Streptococcus infective endocarditis and colon carcinoma; this association would be demonstrated later (1977) by Klein and unquestionably confirmed by several posterior works. Due to a clinical case of Streptococcus bovis infective endocarditis, which we had the opportunity of diagnosing, a review is made of the existent literature about the association between infection by this agent and the presence of lesions in the colon. Some recommendations are made in what respects the diagnosis and evaluation of patients with Streptococcus bovis infective endocarditis. Finally, the implications and therapeutic strategies in these patients are discussed.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"1025-30"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729561","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":"New trends in echocardiographic evaluation of patients after myocardial infarction.","authors":"V Marangelli","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"975-9"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729555","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":"[Adjuvant therapy with a glycoprotein IIb-IIa inhibitor (abciximab) in coronary angioplasties with a high thrombotic risk].","authors":"V Matos,&nbsp;A M Marques,&nbsp;H Oliveira,&nbsp;D Ramos,&nbsp;P Lopes,&nbsp;M Camacho,&nbsp;A Gonsalves","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>We retrospectively studied our experience with adjunctive therapy with glycoprotein IIb-IIIa inhibitor (abciximab) on patients with a high risk of thrombotic complications during coronary angioplasty (PTCA).</p><p><strong>Patients and methods: </strong>From September 1996 to November 1997, we performed PTCA in 210 patients, and abciximab was given to 38 (18%) of them. The interventions were urgent (primary PTCA in acute myocardial infarction) in 55% of the cases. The mean age of patients was 68.6 +/- 12 years and 71% were male. The reasons for coronary intervention were: acute myocardial infarction in 21 patients (55.3%), unstable angina in 9 (23.7%) and stable angina in 8 (21%). Coronary stents were implanted in 13 patients (34%) and an intra aortic balloon pump was used in 4 (11%). The reasons for using abciximab were: thrombus containing lesion: 22 (57.9%); other type B2/C lesion characteristics: 6 (15.9%); acute closure post balloon PTCA: 9 (23.7%), sub-acute stent thrombosis: 1 (2.6%). Oral acetilsalicilic acid and intravenous heparin were given to all patients at the beginning of the intervention. The mean APTT was 124 +/- 32 seconds at the end of the procedure.</p><p><strong>Results: </strong>The arterial sheaths (8 French) were removed six hours after procedure, according to the normalisation of APTT values. Angiographic success in this group of patients was 100%. One patient died during hospitalisation due to left ventricular failure. There was no need for repeated angioplasty or coronary bypass grafting during hospital stay. The main complications related to the use of abciximab were: bleeding (requiring transfusion) in four patients 10.5%); severe thrombocytopenia (< 50,000 platelets/mm3): 1 (2.6%): cardiac tamponade (requiring pericardiocentesis): 1 (2.6%) and pseudo-aneurysm of femoral artery (requiring vascular surgery): 1 (2.6%).</p><p><strong>Conclusions: </strong>The use of abciximab as adjunctive therapy in this small group of patients undergoing coronary interventions with high risk of thrombotic complications is associated with high procedural success, but at the expense of high rates of bleeding complications. Therefore, special care must be applied during and after the procedure to enhance the safety of the patients treated with this drug.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"1001-5"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729558","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":"[The surgical treatment of acute myocardial infarct in the 90s].","authors":"J M de Oliveira","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>At present, the treatment for acute myocardial infarction is revascularization during the critical initial period of six hours after the beginning of coronary occlusion. Despite the fact that surgery performed within this time period presents a hospital of mortality around 2%, and with excellent results in the long term, it is seldom used due to logistic limitations and capabilities of hospital infrastructures, high costs and the possibility of the surgical team initiating surgery inside the useful time period. Surgery is thus limited to the patients with suitable anatomy, who are not candidates or had failure of thrombolytic/angioplasty therapy and are in the six-hour period after initiation of symptoms. Surgery performed at a later stage has good results if performed in a non emergency situation, specially after the first 72 hours. Surgery continues to be the only treatment for the mechanical complications of infarction, and good results have recently been shown in ventricular septal ruptures, with hospital mortality of 14%, due to the use of an endoventricular patch in patients operated early, before the consequences of low cardiac output develop at systemic level. In the surgical treatment of mitral regurgitation, the tendency has been to use repair techniques whenever possible, but still with hospital mortality up to 15%. The recent advances of the techniques and tactics of myocardial preservation during surgery have made a very significant contribution to the better results we see today.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"967-73"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729554","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":"[An increase in renal dopamine production after the administration of radiographic contrast agents].","authors":"J Santos,&nbsp;V Araújo,&nbsp;L Moura,&nbsp;P Serrão,&nbsp;L Guerra,&nbsp;J Maciel,&nbsp;M Pestana","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Renal vasoconstriction and anti-natriuresis conditioned by radiographic contrast agents (CA) may be antagonised by the administration of exogenous dopamine. However, the influence of CA on the activity of renal synthesis of dopamine has not been studied. This study assessed the daily urinary excretion of dopamine, its precursor. L-3, 4-dihydroxyphenylaline (L-DOPA), and its metabolites (acid 3, 4-dihydroxyphenylacetic, DOPAC; homovanillic acid, HVA) 24 hours before and 48 hours following administration of a non ionic and hyposmolar (lopromide) CA in patients (n = 10; average age 61.3 +/- 4.3 years) submitted to coronary angiography. Urinary excretion of noradrenalin, a marker of sympathetic activity, was also assessed during the same period. The deputation of creatinine (Ccr) and the urinary excretion of sodium (UNa+) lowered after the administration of the CA (Ccr, 79.2 +/- 10.2 vs 72.2 +/- 9.6 ml/min/1.73 m2, p < 0.05; UNa+, 112.8 +/- 9.6 vs 61.7 +/- 25.1 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of potassium increased in the period of 24 h following the administration of the AC (31.7 +/- 5.2 vs 103.8 +/- 10.8 mmol/24 h, p < 0.05). There was an increase in the urinary excretion of dopamine as well as noradrelalin during the 24 hour period following the administration of the CA (dopamine, 1260.2 +/- 196.8 vs 1571.5 +/- 170.2 mmol/24 h p < 0.5; noradrenalin, 186 +/- 36.6 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of L-DOPA lowered after the administration of the CA (115.4 +/- 25.5 vs 80.5 +/- 13.2 mmol/24 h, p < 0.05). These results conditioned an increase in the dopamine/L-DOPA ratio in the urine, after the administration of the CA (12.2 +/- 1.5 vs 22.2 +/- 4.5 mmol/24 h, p < 0.05). In conclusion, the administration of CA is accompanied by an increase in the renal production of dopamine which, in these conditions, may act as a compensatory natriuretic hormone.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"1007-11"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729559","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":"Recommendations of a Task Force of the the European Society of Cardiology and the European Resuscitation Council.","authors":"D Ferreira","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"1047-8"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729562","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":"Philosophy of antiarrhythmic approaches to ventricular tachyarrhythmias close to the 21st century.","authors":"G Breithardt,&nbsp;W Haverkamp,&nbsp;D Böcker,&nbsp;M Borggrefe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The scientific basis and the reasoning underlying the changes in antiarrhythmic approaches to ventricular arrhythmias during recent decades are discussed. The early enthusiasm in the use of antiarrhythmic drugs in patients after myocardial infarction to prevent sudden cardiac death was severely affected by the results of the Cardiac Arrhythmia Suppression Trial (CAST) which show an increased mortality of patients on sodium-channel antagonist antiarrhythmic drugs. A transient euphoria for drugs that prolong repolarization received criticism after premature termination of the Survival With Oral D-sotalol-trial (SWORD). Recently, attention has focused on the use of the implantable cardioverter defibrillator in both secondary and primary prevention of sudden death. In contrast, catheter ablation, although very useful in supraventricular tachycardia, still plays a limited role in the management of ventricular tachyarrhythmias in the presence of organic heart disease.</p>","PeriodicalId":503648,"journal":{"name":"Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology","volume":" ","pages":"981-91"},"PeriodicalIF":1.8,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40729556","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}