Arq Bras Cardiol 2009; 93(6 supl.1): e110-e178 -Evolução na gestaçãoA maioria das publicações mais recentes descreve evolução materna favorável, embora tenham sido descritas algumas complicações, tais como o surgimento de hipertensão e a insuficiência cardíaca (as mais comuns), além de hemorragia cerebral e hemoptise maciça 7,8,10 . Na maioria dos casos, os resultados neonatais são favoráveis, embora possa ocorrer parto prematuro e restrição de crescimento intrauterino 8,9 . A gestação não parece afetar a atividade inflamatória da doença e as complicações maternas estão relacionadas com a resposta cardiovascular à gestação, trabalho de parto e parto. As oscilações da pressão sistólica é que se associam com mais frequência ao surgimento de insuficiência cardíaca e hemorragia cerebral 10 .As pacientes com doença de Takayasu devem ser avaliadas antes da concepção, com o objetivo de realizar cirurgia vascular ou intervenção vascular percutânea, se indicadas, e fora do período da gestação. Além disso, durante a gestação e o parto, deve ser feito um controle adequado da pressão arterial, a fim de evitar as complicações maternas referidas, sem comprometer o desenvolvimento fetal por hipoperfusão placentária 9 . Recomendações 1) Os corticosteroides são o tratamento de escolha para o controle da atividade inflamatória da doença e seu uso está indicado durante a gestação quando a paciente engravida na fase aguda da doença ou quando o diagnóstico é realizado durante a gestação 8,9,10 (IC).2) O parto vaginal é aconselhado, e com o uso de fórcipe, a fim de abreviar o segundo estágio do trabalho de parto, quando necessário 9 (IC).3) O parto cesáreo deve ser realizado quando há indicação obstétrica ou em situações de hipertensão ou insuficiência cardíaca refratárias ao tratamento clínico 9 (IC).
IntroductionMyocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study.Methods and analysisThis is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters.Ethics and disseminationThis protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field.Trial registration numberRBR-7g5s66.
Introduction The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top-ranking cause of all deaths globally. Purpose We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guideline-derived recommendations, after one year of the clinical practice registry Methods Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in “real world” clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9% (baseline) and 57.3% (follow-up). Percentage of patients who had a blood pressure <140/90 mm Hg, or who had a blood pressure ≥140/90 mm Hg and were prescribed ≥2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. Conclusion The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. Acknowledgement/Funding ACC Foundation
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