Background: Race is a risk factor for coronary events that shows conflicting data and still has been scarcely studied in the Brazilian population. The present study aimed to assess the influence of race on the development of coronary artery disease, therapeutic outcomes, and major adverse events. Methods: Data from the Central Nacional de Intervenções Cardiovasculares (CENIC) were retrospectively analyzed from June 2006 to March 2016, comparing profiles and results of interventions according to race. Results: Mixed ethnic ancestry individuals presented a higher incidence of angina and more angioplasty procedures with drug-eluting and bare-metal stents. They showed lower prevalence of dyslipidemia and left ventricular dysfunction, as well as a lower percentage of adverse cardiac events (death, periprocedural infarction and revascularization), albeit with no statistical difference. Simple and multiple logistic regression models did not establish race as a significant isolated variable for cardiovascular events. Conclusion: Mixed ethnic ancestry individuals presented fewer cardiovascular events. However, there was no race-related statistical significance as to the number of deaths or periprocedural infarctions. RESUMO -Introdução:A raça constitui fator de risco para eventos coronarianos com dados conflitantes e ainda pouco estudados na população brasileira. Este trabalho teve como objetivo avaliar a influência dessa característica no surgimento de coronariopatia, bem como nos resultados terapêuticos e eventos adversos maiores. Métodos: Foram analisados, de forma retrospectiva, os dados da Central Nacional de Intervenções Cardiovasculares (CENIC), no período de junho de 2006 a março de 2016, comparando-se os perfis e os resultados de intervenções de acordo com a raça. Resultados: Os mestiços apresentaram maior incidência de angina e precisaram ser sujeitados a mais procedimentos de angioplastia com stents farmacológicos e não farmacológicos. Demonstraram menor prevalência de dislipidemia e menor incidência de disfunção ventricular, bem como menor porcentual de eventos cardíacos adversos (óbito, infarto periprocedimento e nova revascularização), sem diferença estatística. Os modelos de regressão logística simples ou múltipla não demonstraram a raça como variável isolada significativa para eventos cardiovasculares. Conclusão: Raça mestiça apresentou menor número de eventos cardiovasculares. Porém, não houve significância estatística quanto ao número de óbitos ou infartos periprocedimento relacionados à raça.Descritores: Doença das coronárias; Origem étnica e saúde; Intervenção coronária percutânea BACKGROUND Coronary diseases encompass a wide range of stable and unstable clinical syndromes with a high prevalence in the population. A number of risk factors, such as hypertension, hypercholesterolemia, diabetes mellitus, obesity, genetics, sedentary lifestyle and smoking, have been adequately reported, 1 while other factors, such as race, still present limited correlation in the medical literature. 2,3 Race has been analy...
We report a case of cardiogenic shock caused by an acute left ventricular aneurysm, similar to Takotsubo or Dumbbell, in a patient without obstructive coronary lesion. The case fulfills all criteria for Takotsubo cardiomiopathy, a pathology most frequent in Japan and that can simulate acute myocardial infarction. Case ReportA 70-year-old, female patient, with precordial discomfort under constriction for 6 hours, without irradiation, followed by difficulty to breathe, with stressed worsening in the last 3 hours. In the morning before the beginning of the symptoms, the family informed and intense emotion motivated by family discussion. There was no report of morbid history or use of medications.A patient showing stressed respiratory discomfort, pale, with abounding sudoresis. Tachycardic rhythmic sounds without other noises, bullous rales of medium and thin bubbles up to pulmonary apexes. Blood pressure was 90x60 mmHg, heart rate was 135 b.p.m, respiratory rate was 35 i.p.m., axillary temperature was 37°C. During the exam in the emergency room, the patient showed stressed worsening of respiratory discomfort, needing an urgent orotracheal intubation and mechanical ventilation. Dopamine IV was started. Electrocardiogram (ECG) of 12 derivations showed sinus tachycardia with non-specific changes of ventricular repolarization. Dosage of CKMB -mass collected at the admission was 22 u.The patient was transferred to this service with the diagnostic hypothesis of non-Q infarction and cardiogenic shock.She was under mechanical ventilation, tachycardic with rhythmic sounds, heart rate of 145 b.p.m, bullous rales up to the upper third of both pulmonary fields, blood pressure was 80x50 mmHg. The thoracic radiography showed right pneumothorax, of moderate size and signs of pulmonary congestion ( fig. 1). The ECG showed changes in ventricular repolarization and sinus tachycardia ( fig. 2). The CKMB-mass was 29 u, creatinine of 1,2 mg% and glycemia 140 mg%. The pneumothorax was immediately drained. An echocardiogram performed by the bed, showed left ventricular aneurysm of anterior wall, compromising the middle and apical regions ( fig. 3). After a fast hemodynamic stabilization with careful infusion of fluids, guided by the echocardiogram, institution of dobutamine at 12 mcg/kg/min and noradrenaline at 8 mcg/min, the patient was sent to hemodynamics laboratory, where the coronary angiography showed coronary arteries without obstructive lesions ( fig. 4) and the left ventriculography showed anterior wall aneurysm in a shape similar to Takotsubo or Dumbbell (fig. 5). The patient was kept under mechanical ventilation, with vasoactive drugs. Successive measurements of CKMB revealed a peak of 45 u in approximately 40 hours of evolution. After 48 hours there was an improvement of the features, with possibility of removal of mechanical ventilation and progressive discontinuity of vasoactive drugs. A new echocardiogram, by the bed, performed 72 hours after admission, did not show abnormalities of segmental contraction ( fig. 6). The pat...
A 43-year-old symptomatic woman (dyspnea and palpitation) had multiple coronary-pulmonary artery fistulae with high output; percutaneous embolization was successfully performed using controlled-release microcoils and disposable balloons.Coronary fistulae are communications between these arteries and the cardiac cavities or other mediastinal vessels; frequently, they are alterations in embryo development 1 . Several fistulae arising from both coronaries and ending in the pulmonary artery, such as in our patient's case, are rare clinical entities 2 . Fistulae with marked hemodynamic repercussions leading to symptoms of heart failure and thoracic pain are, classically, treated with surgery 3 ; however, catheter occlusion is currently increasing in frequency [4][5][6][7][8] . Case ReportA 43-year-old woman was referred to the hospital because of frequent episodes of palpitations and exercise-related dyspnea, with symptoms progressing in recent years. Specific clinical examination revealed a continuous cardiac murmur, heard at the left sternal border at the third and fourth intercostal spaces. Twelvelead electrocardiography revealed complete left bundle-branch block. Echocardiographic Doppler performed at another hospital showed large patent ductus arteriosus and pulmonary artery hypertension. The patient was referred for hemodynamic study because of this diagnosis. Manometry revealed a mild increase in pressure in the right chamber and pulmonary artery. A pulse oximetric recording peaked at the level of the pulmonary artery trunk. Patent ductus arteriosus was not found. Cardiac scintigraphy demonstrated large right coronary ( fig.1) and left coronary fistulae ( fig. 2) in the pulmonary artery.Percutaneous embolization was performed, using the right femoral artery for Access with a JR 4 6F guidewire catheter (Cordis, brite tip) for the right coronary and a JL 4 6F for the left coronary.After venous administration of 5000 U unfractionated heparin, a large fistula of the right coronary ostium was catheterized selectively (Excelsior microcatheter, Boston Scientific). Controlled-release coils were used to completely occlude fistula (MicroPlex, Microvention). Microcatheters were used to perform catheterization of the 2 large fistulae in the proximal and medium third of the anterior descending artery, the fistula being successively occluded with the same type of microcoils. These coils are produced by Microvention. New platinum microcoils were introduced into the market in 2002 for the embolization of brain aneurysms. We used 11 devices for the embolization of the fistulae: 2 microplex 4mm/8cm, 2 microplex 6mm/15cm, 2 microplex 8mm/20cm, 1 microplex 4mm/10cm, 1 microplex 5mm/12cm, 1 microplex 7mm/ 18cm, 1 microplex 7mm/30cmm, and 1 microplex 9/30cm ( fig. 3).A residual flow was left in the right coronary fistula by a lateral branch emerging before the site where the coils were released. The patient under local anesthesia tolerated the procedure well. Distal embolization was not observed for the coronary branches.After the ...
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