No abstract

Introduction: Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type ---new-onset (nAF) or pre-existing (pAF) ---is still controversial. Objectives: To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS). Methods: We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up. Results: AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with STelevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis. Conclusions: AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF. 2174-2049Document downloaded from http://www.elsevier.pt, day 01/07/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. ST (p=0,003). Por sua vez, a FAp foi mais comum em doentes idosos (p=0,032), com diâmetro superior da aurícula esquerda (p=0,001) e ausência de doença coronária (p=0,034). Quanto à estratégia terapêutica, os doentes com FAn foram mais vezes submetidos a controlo de ritmo durante o internamento (p<0,001), mas menos hipocoagulados à alta (p=0,001). Quando comparada com a população sem FA, a FAn foi preditora de morte hospitalar na análise univariada (p<0,001) e multivariada (OR 2,67, p=0,047), enquanto a FAp não. Já no follow-up, a FAp associou-se a maior mortalidade (p=0,014), enquanto os doentes com FAn apresentaram apenas uma tendência para um pior prognóstico. Conclusões: O impacto prognóstico negativo da FA na fase aguda das SCA parece ocorrer apenas nos doentes que apresentam FAn e não naqueles com FAp. PALAVRAS-CHAVE

Age, LVEF ≤40% and LA diameter are independent predictors of new-onset AF during ACS. This arrhythmia is associated with higher overall mortality (in-hospital and in follow-up).

MSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation.

In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall.

Mesalamine is a common treatment for Crohn's disease, and can be rarely associated with myocarditis through a mechanism of drug hypersensitivity. We present the case of a 19-year-old male who developed chest pain two weeks after beginning mesalamine therapy. The electrocardiogram showed slight ST-segment elevation with upward concavity in the inferolateral leads; blood tests demonstrated elevated troponin I and the echocardiogram revealed moderately depressed left ventricular systolic function with global hypocontractility. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis, revealing multiple areas of subepicardial fibrosis. The onset of symptoms after mesalamine, and improvement of chest pain, cardiac biomarkers and left ventricular systolic function after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalamine. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVEMiocardite; Mesalamina; Ecocardiografia transtorácica; Ressonância magnética cardíaca Miocardite induzida pela mesalamina após o diagnóstico de doença de Crohn ---relato de um caso clínico Resumo A mesalamina é um tratamento comum para a doença de Crohn, associando-se de forma rara à miocardite aguda, através de uma reação de hipersensibilidade ao fármaco. Os autores apresentam o caso clínico de um jovem de 19 anos com aparecimento de dor torá-cica duas semanas após ter iniciado tratamento com mesalamina para a doença de Crohn. O eletrocardiograma mostrou um discreto supradesnivelamento do segmento ST, de concavidade ascendente, nas derivações infero-laterais; as análises revelaram elevação da troponina I e o ecocardiograma exibiu uma depressão moderada da função sistólica do ventrículo esquerdo, por hipocontractilidade global. A ressonância magnética cardíaca confirmou o diagnóstico de miocardite, evidenciando múltiplas áreas de fibrose subepicárdica. O início dos sintomas após o começo da mesalamina e a melhoria da dor torácica, biomarcadores cardíacos e função sistólica * Corresponding author. E-mail address: carlos.galvaobraga@gmail.com (C. Galvão Braga).0870-2551/$ -see front matter © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. http://dx.doi.org/10.1016/j.repc.2012.12.018 Document downloaded from http://http://www.elsevier.pt, day 14/02/2014. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 718C. Galvão Braga et al. ventricular esquerda após a suspensão do medicamento, sugerem que o nosso paciente teve uma reação rara de hipersensibilidade à mesalamina.

No abstract

CONTEXT AND OBJECTIVE: Increased life expectancy among people with Down syndrome (DS) has introduced new environmental factors that may affect blood pressure (BP) and/or lead to obesity in this population. The aim here was to investigate BP levels and body mass index (BMI) in adults with DS, correlating these data with the patients' sex and age. DESIGN AND SETTING: Analytical cross-sectional observational study conducted in special schools in Curitiba (PR), Brazil. METHODS: 97 adult patients were included. BP was measured in accordance with the established guidelines. BMI was calculated by dividing the weight by the height squared (kg/m 2 ). RESULTS: Sex had no influence on BMI; nor did systolic BP (SBP) or diastolic BP (DBP). The age range was from 18 to 56 years. No correlation was observed between increasing age and greater BMI or BP. Eighty-six individuals (88.7%) presented normal BP, eleven (11.3%) prehypertension and none hypertension. Twenty patients (20.4%) presented BP lower than 90 × 60 mmHg. BMI ranged from 18 to 48 kg/m 2 (mean of 28.8 ± 3.92 kg/m 2 ): 21.9% had normal weight; 40.7% were overweight; and 25.3% had obesity class I, 9.9% class II and 2.2% class III. Higher BMI was associated with significantly greater SBP and DBP (P = 0.0175 and P = 0.0015). CONCLUSION: Sex and age did not influence SBP, DBP or BMI in Brazilian adults with DS. Higher BMI was associated with greater BP (both systolic and diastolic). RESUMOCONTEXTO E OBJETIVO: O aumento da expectativa de vida das pessoas com síndrome de Down (SD) introduziu novos fatores ambientais que podem afetar a pressão sanguínea e/ou levar a obesidade nessa população. O objetivo foi investigar os níveis de pressão arterial (PA) e o índice de massa corporal (IMC) em adultos com SD, correlacionando estes dados com a idade e o gênero dos pacientes. DESENHO E LOCAL: Estudo observacional, transversal e analítico, realizado em escolas especiais em Curitiba (PR), Brasil. MÉTODOS: Foram incluídos 97 pacientes adultos. A aferição da PA foi feita de acordo com as diretrizes estabelecidas. O IMC foi calculado dividindo-se o peso pela altura ao quadrado (kg/m 2 ). RESULTADOS: O gênero não influenciou o IMC, a pressão arterial sistólica (PAS) e diastólica (PAD). A idade variou de 18 a 56 anos. Não foi observada correlação entre aumento da idade e maior IMC ou pressão arterial. 86 indivíduos (88,7%) apresentaram PA normal, 11 (11,3%) pré-hipertensão e nenhum hipertensão. Vinte (20,4%) apresentaram PA inferior a 90 × 60 mmHg. O IMC variou entre 18 e 48 kg/m 2 (média de 28,8 ± 3,92), 21,9% tinham peso normal, 40,7% sobrepeso, 25,3% obesidade grau I, 9,9 % grau II e 2,2% obesidade grau III. Aumento significativo da PAS e PAD foi associado com elevação do IMC (P = 0,0175 e P = 0,0015). CONCLUSÃO: Verificou-se que sexo e idade não influenciaram PAS, PAD e IMC em adultos brasileiros com SD. O aumento significativo da PAS e PAD foi associado com o aumento do IMC.