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Hypertensive response in treadmill testing is associated with the development of hypertension, but it is still unclear if it is better identified by systolic or diastolic response, and measured directly or corrected by working capacity. We investigated 75 patients with normal office blood pressure through a treadmill testing, ambulatory blood pressure (ABP) monitoring, and two-dimensional Doppler echocardiogram. Characteristics associated with systolic blood pressure (SBP) response corrected by the estimated metabolic equivalent (MET) were identified in multiple linear regression models. SBP response was associated more consistently with age, body mass index (BMI), systolic ABP and left ventricular posterior wall thickness (p < 0.001) than diastolic response in the bivariate analysis, especially when corrected by MET. Age, BMI and nightly SBP were independently associated with SBP response corrected by MET in the multivariate analysis. Individuals from the top tertile of SBP response corrected by MET (> or =11.3 mmHg/MET) were older and had higher BMI, ABP and left ventricular septal and posterior wall thickness than individuals classified in the lower tertiles. These differences were more pronounced than the differences observed between individuals with and without a peak exercise blood pressure higher than 210 mmHg. We concluded that individuals with a high blood pressure response in treadmill testing have higher BMI, left ventricular posterior wall thickness and SBP measured by ABP monitoring than individuals without such a response. These differences were stronger when the variation of blood pressure during exercise was corrected by the amount of work performed.

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Background: Plaque volume (PV) is related to major cardiovascular events (MACE) after coronary stent implantation.

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A intervenção coronária percutânea (ICP), técnica de revascularização miocárdica mais empregada no tratamento da cardiopatia isquêmica 1-4 , é realizada sob anticoagulação e antiagregação plaquetária combinadas e a heparina não-fracionada (HNF) é, em nosso meio, o anticoagulante mais utilizado nesse cenário. A ação antitrombótica da HNF pode ser monitorizada na sala de hemodinâmica pelo tempo de coagulação ativada (TCA). Preconiza-se medida de TCA entre 250 segundos e 350 segundos para a realização da ICP e < 200 segundos para a retirada do introdutor arterial. 5-11 ABSTRACT Early Arterial Sheath Removal Guided by Activated Clotting Time after Percutaneous Coronary InterventionBackground: Activated clotting time (ACT) can be used for early arterial sheath removal after femoral-approach percutaneous coronary intervention (PCI). This study compared the time for arterial sheath removal, with and without ACT guidance, and bed rest after PCI. Methods: Randomized clinical trial including 78 patients submitted to elective PCI, allocated for ACT-guided (group 1) and non-ACT-guided (group 2) arterial sheath removal. In group 1, the sheath was removed when ACT was < 180 seconds. After removal of the arterial sheath, patients remained at bed rest for 6 hours in both groups. Results: Mean age was 60 ± 9 years and 57% of the patients were men. Groups were similar for clinical characteristics, coronary lesion complexity, arterial sheath caliber, number and type of stents used, drugs used and success rates. The time for arterial sheath removal (95 ± 35 minutes vs. 240 ± 16 minutes; P < 0.01) and bed rest (454 ± 33 minutes vs. 600 ± 12 minutes; P < 0.01) were significantly lower in group 1. Conclusions: Arterial sheath removal guided by ACT in patients undergoing PCI was performed earlier and allowed a reduction of the overall time of bed rest when compared to the institutional standard procedure.

The finding of ST segment elevation in the electrocardiogram identifies many patients with acute myocardial infarction, but presents low sensibility. Recently, some new electrocardiogram patterns have been described for the early identification of myocardial infarction. We report a case of a 53-year-old male patient who presented with an anterior myocardial infarction and an unusual electrocardiographic pattern. The electrocardiogram presented a slightly widened QRS complex, slow progression of the R wave in the anterior wall, and an ascending ST segment with tall and symmetrical positive T waves. Coronary angiography demonstrated a wraparound left anterior descendent artery with medial occlusion. The original report with the abovementioned electrocardiographic pattern occurred due to occlusions in the proximal segment of the left anterior descendent artery. Our patient is one of the few cases showing occlusion of the medial segment of the left anterior descendent artery described after the original report of this unusual electrocardiographic pattern. This case report illustrates the problem of uncommon electrocardiogram presentations in patients with myocardial infarction.RESUMO -O achado de supradesnivelamento do segmento ST no eletrocardiograma identifica muitos pacientes com infarto agudo do miocárdio, mas com baixa sensibilidade. Recentemente, alguns novos padrões eletrocardiográficos foram descritos para identificação precoce de infarto agudo do miocárdio. Relatamos o caso de um paciente do sexo masculino, 53 anos, com infarto agudo do miocárdio de parede anterior e padrão eletrocardiográfico incomum. O eletrocardiograma apresentou complexo QRS discretamente alargado, progressão lenta da onda R na parede anterior, e segmento ST ascendente com ondas T positivas, altas e simétricas. A cineangiocoronariografia demonstrou artéria coronária descendente anterior ultrapassando o ápice do ventrículo esquerdo e com oclusão medial. O relato original com o padrão eletrocardiográfico mencionado acima foi devido a oclusões no segmento proximal da artéria coronária descendente anterior. Nosso paciente foi um dos poucos casos de oclusão do segmento medial da artéria coronária descendente anterior descritos após o relato original desse padrão eletrocardiográfico incomum. Este relato de caso ilustra o problema de apresentações eletrocardiográficas incomuns em pacientes com infarto agudo do miocárdio. Descritores: Intervenção coronária percutânea; Eletrocardiograma; Infarto do miocárdioComo citar este artigo: Abelin AP, Zanettini MT, Gottschall CA, Quadros AS. Anterior myocardial infarction with an unusual electrocardiographic pattern. J Transcat Interven. 2019;27:eA20190002.