AimAcute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation.MethodsTwenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured.ResultsCompared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 ± 33.2 ms vs. 472.5 ± 36.3 ms, p = 0.001) and after T treatment (439.7 ± 33.2 ms vs. 467.9 ± 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0–85.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0–80.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) compared to baseline values.ConclusionIn this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.
BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. METHODS: The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. RESULTS: The 5-year cumulative probability of LTAE was 30%, and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P =0.010), HF symptoms (HR: 4.37; P =0.010), epsilon wave (HR: 4.99; P =0.015), and number of leads with low QRS voltage (HR: 1.28; P =0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P =0.040), number of leads with T wave inversion (HR: 1.17; P =0.039), low QRS voltage (HR: 1.12; P =0.021), younger age (HR: 0.97; P =0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P =0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P =0.023) was independently associated with HF-death/HTx. CONCLUSIONS: Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
Laboratory assessment (March 8, 2001) showed hemoglobin = 14.4 g/dL, hematocrit = 43%, uric acid = 9 mg/dL, creatinine = 1.6 mg/dL, potassium = 4.4 mEq/L, sodium =145 mEq/L, fasting glycemia = 148 mg/dL, total cholesterol = 121 mg/dL, triglycerides = 57 mg/dL; urinalysis showed proteinuria of 0.25 g/L, with no other alterations. TSH was 5.28 U/mL, free T4 was 1.1 ng/dL, leptin was 31 ng/mL (normal range =3.8±1.8 ng/mL), testosterone = 336 ng/mL, FSH = 2.6 UI/L, LH = 2.0 UI/L, estradiol = 40.2 pg/mL, insulin = 7.9 Ul/mL, urinary cortisol = 261 g/24 h and DHEAS = 1457 ng/mL.The echocardiogram (April 26, 2001) showed septum and posterior wall thickness of 10 mm, aortic diameter of 32 mm, left atrial diameter of 52 mm, left ventricular (LV) diastolic diameter of 70 mm and LV systolic diameter of 57 mm, with ejection fraction of 46%, due to accentuated diffuse hypokinesis. The patient presented moderate mitral regurgitation.The kidney ultrasonography disclosed normal-sized kidneys, both with 12.1 cm in length, whereas the liver showed signs of steatosis; there were signs suggestive of cholelithiasis.The patient was medicated with 40 mg of enalapril, 40 mg of furosemide, 25 mg of chlorthalidone, 5 mg of amlodipine, 500 mg of methyldopa, 25 mg of spironolactone, 100 mg of acetylsalicylic acid and 1,700 mg of metformin daily, in addition to dietary recommendations of a low-salt, lowcalorie diet for type II diabetes. The patient's adherence to treatment, together with dietary changes, resulted in a weight loss of 28 kg, symptom improvement and BP decrease to 150/90 mm Hg.Three years later the patient weighed 149 kg and the BP was 180/130 mm Hg.The fundoscopy showed retinal exudates in the temporal region, abnormal arteriovenous crossings with venous stasis and arterial reflex narrowing, compatible with hypertensive retinopathy.Laboratory assessment (February 2004) showed cholesterol = 172 mg/dL, HDL-cholesterol = 41 mg/dL, LDL-cholesterol = 114 mg/dL, triglycerides = 87 mg/dL, creatinine = 1.1 mg/dL, urea = 29 mg/dL and glycemia = 126 mg/dL.The metformin dose was increased to 2550 mg and the furosemide dose to 80 mg/day; the patient was then referred to bariatric surgery.The patient evolved with few symptoms until April 2006, when he presented syncope and was admitted at the hospital A 59-year-old obese male patient was admitted at the hospital with left hemiplegia. He had been first admitted at the age of 54, due to intense dyspnea and arterial hypertension.He was diagnosed with arterial hypertension at 44 years, when he presented intense dyspnea and arterial hypertension with blood pressure (BP) levels of 220/120 mm Hg. He sought emergency medical care and was medicated. The patient evolved with dyspnea, intense sudoresis and retrosternal pressure, triggered by moderate exertion. His adherence to treatment was irregular. He started to present episodes of intense snoring during sleep and a sensation of suffocation upon awakening. The patient knew he had been obese since a young age, but his weight had progressively inc...
Prezados leitores, esta obra apresenta evidências sobre o perfil sociodemográfico e capacidade funcional de pacientes de uma clínica escola no contexto da pandemia de COVID-19. Diante disso, o perfil sociodemográfico e a capacidade funcional dos pacientes com COVID-19 podem variar dependendo de vários fatores, como idade, sexo, comorbidades pré-existentes e gravidade da doença. Os pacientes mais velhos têm maior risco de desenvolver complicações graves e apresentam maior taxa de mortalidade. Além disso, a capacidade funcional geralmente diminui com a idade, o que pode afetar a recuperação após uma infecção pelo COVID-19. Diante disso, esta obra tem como foco analisar o perfil sociodemográfico e capacidade funcional dos pacientes atendidos em uma clínica escola de uma instituição de ensino superior. Para isso, foi realizado uma pesquisa epidemiológica descritiva, observacional delineada transversalmente com uso de dados secundários (fichas de avaliação) do setor de fisioterapia aquática na coleta de dados. A amostra do estudo consistiu em 190 fichas de avaliação e evolução da Fisioterapia Aquática dos pacientes maiores de 18 anos e que apresentavam algum sinal ou sintomas osteomusculares. Em continuidade, foi observado que o perfil sociodemográfico e capacidade funcional dos pacientes apresenta como principais características: Prevalência do público feminino (73,16%) e da faixa etária de 51 a 60 anos (27,89%), seguida de 61 a 70 anos (26,32%), compondo juntas a maior parte da amostra total. Ademais, no que diz respeito a ocupação dos participantes, as três mais frequentes foram MEI (16,84%), seguidos de aposentados (12,64%) e domésticas (12,64%). Além disso, os principais achados de saúde que implicam na capacidade funcional e qualidade de vida foram: Maior acometimento de MMII (25%), pré-existência de HAS (38,94%), maior frequência de patologias como Artrose (11%) Acidente Vascular Cerebral (9%) e Fibromialgia (8%). Logo, dentre os pacientes atendidos, percebe-se uma maior prevalência de adultos e idosos, principalmente mulheres, as quais apresentam alterações de saúde significativas, como o maior acometimento de MMII, a pré-existência de HAS e maior frequência de patologias como Artrose, acidente Vascular Cerebral e Fibromialgia. Dessa forma, destaca-se a importância da avaliação e tratamento fisioterapêutico a este público, o qual pode se beneficiar no quesito funcional e consequentemente ter uma melhor qualidade de vida.
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