tag:blogger.com,1999:blog-41732742680310566842024-03-13T07:58:03.187-03:00Heart Disease - Alair Castro - StudiesNews on Cardiology continually updated.
"The twenty thousand biomedical journals now published are increasing by six to seven per cent a year. To review ten journals in internal medicine, a physician must read about two hundred articles and seventy editorials a month."
Phil Manning, M.D. and Lois DeBakey, Ph.DUnknownnoreply@blogger.comBlogger525125tag:blogger.com,1999:blog-4173274268031056684.post-3035143770663993412011-04-19T00:48:00.001-03:002011-04-19T00:50:56.757-03:00FUNÇÃO DIASTÓLICANESSE VÍDEO FICA FÁCIL ENTENDER <div>VALE A PENA CONFERIR </div>JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com73tag:blogger.com,1999:blog-4173274268031056684.post-6347537690398519322011-04-06T18:55:00.005-03:002011-04-06T20:50:51.561-03:00DABIGRATANA<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) publicado em setembro 2009 fez com que a Dabigratana fosse liberada pelo FDA agora no início de 2011.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span lang="EN-US" style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; color:black;mso-ansi-language:EN-US;mso-fareast-language:PT-BR">Em 2011 ACCF/AHA/HRS (</span><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";color:#666666;mso-ansi-language:EN-US; mso-fareast-language:PT-BR">American College of Cardiology, the American Heart Association and the Heart Rhythm Society)</span><span lang="EN-US" style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-ansi-language:EN-US;mso-fareast-language:PT-BR">publicou um UPDATE </span><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><a href="http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820f14c0v1"><span lang="EN-US" style="color:blue;mso-ansi-language:EN-US">http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820f14c0v1</span></a></span><span lang="EN-US" style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-ansi-language:EN-US;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">com a seguinte recomendação:<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">CLASSE I: Dabigratana é útil como uma alternativa ao Warfarin para a prevenção de AVC e Tromboembolismo sistêmico em pacientes com FA paroxística e FA permanente com fatores de risco para AVC ou embolização sistêmica que não utilizam prótese valvar cardíaca ou que tenham doença valvar hemodinamicamente significante, Insuficiência renal grave (ClCr < 15 ml/min) ou doença hepática avançada (Nível de evidência B)<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">Abaixo vou listar como usar DABIGRATANA -<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">ref: <a href="http://www.theheart.org/article/1142899.do"><span style="color:blue">http://www.theheart.org/article/1142899.do</span></a><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p> </o:p></span></p> <p class="MsoListParagraphCxSpFirst" style="margin-bottom:0cm;margin-bottom:.0001pt; mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list:l0 level1 lfo1"><!--[if !supportLists]--><span style="font-size:12.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol;color:black;mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; color:black;mso-fareast-language:PT-BR">Paciente em uso de Marevan: Se o INR for menor que 2, iniciar imediatamente Dabigratana.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" style="margin-bottom:0cm;margin-bottom:.0001pt; mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list:l0 level1 lfo1"><!--[if !supportLists]--><span lang="EN-US" style="font-size:12.0pt;font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol;color:black;mso-ansi-language:EN-US; mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size:12.0pt; font-family:"Georgia","serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";color:black;mso-ansi-language:EN-US; mso-fareast-language:PT-BR">Dose:<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><b><span lang="EN-US" style="font-size:10.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";color:black;mso-ansi-language:EN-US; mso-fareast-language:PT-BR">ClCr > 30 mL/min – 150 mg 2xd</span></b><span lang="EN-US" style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-ansi-language:EN-US;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";color:black;mso-fareast-language: PT-BR">ClCr 15-30 mL/min – 75 mg 2xd</span></b><span style="font-size:12.0pt; font-family:"Georgia","serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";color:black;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><b><span style="font-size:10.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";color:black;mso-fareast-language: PT-BR">ClCr < ;15 mL/min – não aprovado para uso</span></b><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpFirst" style="margin-bottom:0cm;margin-bottom:.0001pt; mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list:l1 level1 lfo2"><!--[if !supportLists]--><span style="font-size:12.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol;color:black;mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Arial; color:black;mso-fareast-language:PT-BR">É extremamente recomendado que se use 2 x dia, caso o paciente esqueça uma tomada, poderá tomar a dose com até 6 horas de atraso, caso contrário seguir a prescrição.</span><span style="font-size: 12.0pt;font-family:"Georgia","serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";color:black;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-bottom:0cm;margin-bottom: .0001pt;mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list: l1 level1 lfo2"><!--[if !supportLists]--><span style="font-size:12.0pt;font-family: Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;color:black; mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Arial; color:black;mso-fareast-language:PT-BR"><span style="mso-spacerun:yes"> </span>Antes de cirugia eletiva com função renal normal suspender a Dabigratana com 24 horas, se função renal anormal suspender com 48 horas.</span><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; color:black;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-bottom:0cm;margin-bottom: .0001pt;mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list: l1 level1 lfo2"><!--[if !supportLists]--><span style="font-size:12.0pt;font-family: Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol;color:black; mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Arial; color:black;mso-fareast-language:PT-BR">Contra indicado o uso com Rifampicina, ClCr < 15 mL/min e Protese Mecânica.</span><span style="font-size:12.0pt; font-family:"Georgia","serif";mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";color:black;mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" style="margin-bottom:0cm;margin-bottom:.0001pt; mso-add-space:auto;text-indent:-18.0pt;line-height:normal;mso-list:l1 level1 lfo2"><!--[if !supportLists]--><span style="font-size:12.0pt;font-family:Symbol;mso-fareast-font-family:Symbol; mso-bidi-font-family:Symbol;color:black;mso-fareast-language:PT-BR"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman""> </span></span></span><!--[endif]--><span style="font-size:12.0pt;font-family:"Georgia","serif"; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:Arial; color:black;mso-fareast-language:PT-BR">Se ocorrer um sangramento - parar a medicação, se for um sangramento abundante pode-se optar pela diálise.</span><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal"><span style="font-size:12.0pt;font-family:"Georgia","serif";mso-fareast-font-family: "Times New Roman";mso-bidi-font-family:"Times New Roman";color:black; mso-fareast-language:PT-BR">No Brasil já é comercializada a Dabigratana com o nome de Pradaxa® - Boehringer Ingelheim, de largo uso já na ortopedia para prevenir TVP em pacientes submetidos a cirurgias ortopédicas<o:p></o:p></span></p>JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-21221817398417804942011-03-13T23:42:00.004-03:002011-03-13T23:48:22.646-03:00VOCÊ É UM FUMANTE ?1. Voce fuma cigarros atualmente?<br /><br /> 1. sim, regularmente (vá para 2)<br /> 2. não (vá para 5)<br /> 3. ocasionalmente (vá para 3)<br /><br />2.Em média, quantos cigarros voce fuma por dia? Número:<br /><br /> (vá para 7)<br /><br />3. Em quantos dias da semana você fuma cigarros?<br /><br /> 1. Em 1 dia ou menos<br /> 2. Em 2 ou 4 dias<br /> 3. Quase todos os dia<br /><br />4. Em média, quantos cigarros você fuma por dia?<br /> <br /> = Número:<br /><br />5. Alguma vez voce fumou cigarros no passado?<br /><br /> 1. Sim (vá para 6)<br /> 2. Não (vá para 9)<br /><br />6. Quando voce parou de fumar cigarros regularmente? Ano:<br /><br /> Se nos últimos 12 meses<br /><br /> 1. menos de 1 mês<br /> 2. entre 1 e 6 meses<br /> 3. entre 6 e 12 meses<br /><br />7. Qual o número máximo de cigarros que você que você alguma vez já fumou<br /> diariamente por cerca de 1 ano? Número:<br /><br /><br />8 . Com que idade voce começou a fumar regularmente? Idade:<br /><br /><br />9. Alguma vez voce fumou charutos ou cigarrilhas?<br /><br /> 1. atualmente, fumo regularmente (vá para 10)<br /> 2. Não (vá para 11)<br /> 3. Atualmente, só ocasionalmente – menos de 1 por dia (vá para 10)<br /> 4. Fumei, mas atualmente não (vá para 11)<br /><br /><br />10. Quantos você fuma por semana? Número:<br /><br />11. Alguma vez voce fumou cachimbo?<br /><br /> 1. atualmente, fumo regularmente (vá para 12)<br /> 2. Não (vá para 13)<br /> 3. Atualmente, só ocasionalmente – menos de 1 por dia (vá para 12)<br /> 4. Fumei, mas atualmente não (vá para 13)<br /><br /><br />12. Quantas gramas de tabaco (fumo), voce fuma por semana? Gramas:<br /><br /><br />13. Para ser completada apenas por fumantes ocasionais ou não fumante<br /> (i.e. quando o item 1 é codificado como 2 ou 3)<br /> Por quantas horas, em média cada dia, está você em contacto com outra pessoa que fuma?<br /> <br />A OMS tem trabalhado para normatizar a terminologia e definições de “Fumante”. A terminologia é mencionada abaixo:<br /><br />Qualquer população pode ser dividida em fumantes e não-fumantes.<br /><br /><strong>A. - Um fumante é qualquer pessoa que até o momento da pesquisa, fuma qualquer tipo de produto de tabaco diariamente ou ocasionalmente<br /></strong> Fumantes podem ser divididos em duas categorias:<br />1. Fumante diário: aqule que fuma qualquer produto de tabaco pelo menos uma vez ao dia.<br />2. Fumante ocasional: aquele que fuma, mas não diariamente<br />Podem ser:<br /> i. redutores – aqueles que fumavam diariamente, mas atualmente, não mais<br /> ii. ocasionais – aqueles que nunca fumaram diariamente, mas que fumaram 100 ou mais cigarros (ou quantidade equivalente de tabaco) e atualmente fumam ocasionalmente<br /> iii. experimentadores – aqueles que fumaram menos de 100 cigarros (ou quantidade equivalente de tabaco) e atualmente fumam ocasionalmente<br /><br /><strong>B. Não-fumantes</strong> podem ser divididos em três categorias:<br />1. Ex fumantes: aqueles que foram fumantes diários mas que atualmente não mais fumam.<br />2. Nunca fumantes: aqules que ou nunca fumaram ou que nunca fumaram diariamente e que fumaram menos de 100 cigarros (ou quantidade equivalente de tabaco) durante sua vida.<br />3. Ex fumantes ocasionais: anteriormente, fumantes ocasionais, mas nunca fumantes diários e que fumaram 100 cigarros (ou quantidade equivalente de tabaco) durante sua vida.<br />Estas definições podem ser usadas para classificar uma população de acordo com o seu estado de fumante durante toda a sua vida. Em particular:<br /><br /><strong>C– Fumantes em algum momento:</strong> aqueles que em algum tempo fumaram pelo menos 100 cigarros (ou quantidadeequivalente de tabaco) durante sua vida.<br /><br />The WHO classification is a general one where all tobacco products are taken into account in the definition of a smoker. In the MONICA Project only cigarette, pipe and cigar smoking are considered. In the MONICA countries other types of tobacco consumption are unknown or at least rare. In addition, in most of the RUAs the proportion of pipe or cigar smokers is small. In MONICA the smoking questionnaire has been mainly directed towards cigarette smoking and therefore gives the best information about it.JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-51506716927793842312011-03-13T22:12:00.005-03:002011-03-13T22:58:49.789-03:00RISCO DE SANGRAMENTOS EM PACIENTES ANTICOAGULADOS<p>Postado anteriormente como se deve usar o escore para medir risco de eventos cerebrais em pacientes portadores de FA, fica a duvida quanto ao risco do paciente desenvolver sangramento se iniciado terapia com anticoagulantes.</p><p>HAS-BLED escore traz 9 fatores de risco para sangramento em pacientes usando marevan, cada fator soma 1 ponto na conta final. Quanto maior o número de fatores de risco, maior o risco de sangramento.</p><p>Escore maior ou igual a 3: ALTO RISCO</p><p>Deixo claro que esses paciente não possuem contra-indicação para terapêutica com anticoagulantes, e o AAS entra na predição de risco de sangramento assim como o Marevan.</p><p>Novos anticoagulantes (rivaroxaban, apixaban, dabigatrana) não foram avaliados.</p>Score if present<br />Hypertension (Systolic ≥ 160mmHg) : 1<br />Abnormal renal function : 1<br />Abnormal liver function : 1<br />Age ≥ 65 years : 1<br />Stroke in past : 1<br />Bleeding : 1<br />Labile INRs : 1<br />Taking other drugs as well : 1<br />Alcohol intake at same time : 1<br /><br />Um escore maior ou igual a 3 indica um aumento do risco de sangramento em um ano sob anticoagulação o que seria suficiente para justificar precaução ou uma avaliação mais freqüente.<br />O risco é o risco de hemorragia intracraniana, hemorragia exigindo hospitalização ou uma queda da hemoglobina > 2g / L ou um episódio de hemorragia que requer transfusão.<br /><br />Em um artigo recente validando este escore, diabetes e disfunção ventricular esquerda foram identificados como fatores de risco para hemorragia.<br />(<a href="http://www.ncbi.nlm.nih.gov/pubmed/21111555">http://www.ncbi.nlm.nih.gov/pubmed/21111555</a>).JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-68330086266792588062011-03-04T13:03:00.007-03:002011-03-04T14:04:12.909-03:00Aperfeiçoamento da estratificação de risco para tromboembolismo na fibrilação atrial utilizando uma nova abordagem (CHA2DS2-VASC)<a href="http://1.bp.blogspot.com/-ynkLdHo2-Qk/TXEV_7T-bCI/AAAAAAAAAoU/7vuoCo6vczs/s1600/tabela%2B2%2Bchads.png"><img style="WIDTH: 200px; HEIGHT: 125px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5580265601286171682" border="0" alt="" src="http://1.bp.blogspot.com/-ynkLdHo2-Qk/TXEV_7T-bCI/AAAAAAAAAoU/7vuoCo6vczs/s200/tabela%2B2%2Bchads.png" /></a><br /><div><a href="http://2.bp.blogspot.com/-pqZOwXh0_8k/TXEV_lKwPoI/AAAAAAAAAoM/NoLiTh7WwVg/s1600/tabela%2B1%2Bchads.png"><img style="WIDTH: 200px; HEIGHT: 125px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5580265595341913730" border="0" alt="" src="http://2.bp.blogspot.com/-pqZOwXh0_8k/TXEV_lKwPoI/AAAAAAAAAoM/NoLiTh7WwVg/s200/tabela%2B1%2Bchads.png" /></a><br /><br /><div><strong>Resumo:</strong> Atualmente a estratificação de risco para tromboembolismo (TE) e acidente vascular cerebral (AVC) em pacientes com fibrilação atrial (FA) é baseada em fatores de risco identificados em coortes, sem considerar algumas comorbidades sabidamente relevantes, pois nem todas foram sistematicamente documentadas em ensaios clínicos. Desta maneira, foi desenvolvida uma nova abordagem, com a sigla (ou acrônimo) CHA2DS2-VASC, que proporciona melhor valor preditivo do risco de TE em relação aos outros esquemas de estratificação preexistentes, incluindo o clássico CHADS2. O novo esquema proposto mantém bom valor preditivo em indivíduos de baixo risco, reclassificando o grupo de indivíduos de risco intermediário. </div><div><strong>Objetivo</strong>: Definir um esquema prático e eficiente para predizer o risco de AVC/ AIT/TE na população com FA e compará-lo a nove outros esquemas preexistentes (entre eles Framingham, NICE guidelines 2006 e CHADS 2) quanto à capacidade de predição de eventos tromboembólicos. </div><div><strong>Métodos</strong>: Para testar a capacidade preditiva do novo esquema Birmingham 2009 (CHA2DS2-VASc) e compará-lo com o desempenho de outros esquemas, foi utilizada uma coorte de pacientes com FA proveniente do "Euro Heart Survey for AF", conduzido em 35 países e 182 hospitais, entre 2003 e 2004. Foram selecionados pacientes sem doença valvar mitral ou cirurgia valvar prévia, que não faziam uso de varfarina ou heparina e com evolução clínica conhecida após um ano (n=1084). Os fatores de risco foram denominados definitivos (AVC/ AIT/TE e idade> 75 anos) ou combinados (disfunção ventricular moderada a grave, HAS, DM, doença vascular, sexo feminino e idade entre 65 e 74 anos), resultando no escore CHA2DS2-VASc [fig. 1]. Quando somados os pontos obtidos de cada fator de risco, os pacientes podem ser considerados de baixo risco (zero pontos), risco intermediário (1 ponto) ou alto risco (≥2 pontos). Para avaliar o efeito dos fatores de risco individuais sobre a ocorrência de TE na coorte, foi realizada análise de regressão logística multivariada, com as seguintes variáveis independentes: idade, sexo, diabetes, doença arterial coronariana, insuficiência cardíaca, hipertensão, AVC prévio / AIT, além de outros TE prévios e doença vascular periférica. Resultados: Há discordância relevante entre os esquemas analisados. Os pacientes classificados como de alto risco variaram de 10,2% com o esquema de Framingham, para 75,7% com o novo esquema (Birmingham). O CHADS2 categorizou a maioria dos pacientes em risco intermediário (61,9%), enquanto a classificação Birmingham 2009 teve 15,1% nesta categoria. No esquema de Birmingham 2009, apenas 9,2% foram classificados como de baixo<br />risco, enquanto no Framingham 48,3% estavam nesta faixa de risco. Pela análise (estatística C), o valor preditivo para TE é modesto em todos os esquemas propostos. O esquema de Birmingham 2009 foi um pouco melhor (estatística C = 0,606) do que o CHADS2 (estatística C=0,586). Aqueles classificados como de baixo risco pelo Birmingham 2009 e pelo esquema do guideline de NICE 2006 eram verdadeiramente de baixo risco, sem eventos tromboembólicos registrados, enquanto estes eventos ocorreram em 1,4% dos pacientes de baixo risco pelo CHADS2. Além disso, enquanto o grupo de risco intermediário teve uma taxa de eventos em torno de 3% no CHADS2, o mesmo grupo pelo esquema de Birmingham 2009 teve apenas 1 caso (0,6%). Quando expressado em um sistema de pontuação, esse novo esquema também mostrou um aumento na taxa de TE com o aumento progressivo da pontuação e aqueles com pontuação de zero (ou seja, baixo risco) não tiveram eventos tromboembólicos. </div><div><strong>Conclusão:</strong> O esquema CHA2DS2 – VASc é prático e demonstrou melhor valor preditivo para TE, quando comparado ao esquema CHADS2. Mantém baixa taxa de eventos em indivíduos de baixo risco, e reduz a proporção de indivíduos na categoria de risco intermediário. Perspectiva: O envelhecimento da população, a evolução dos métodos diagnósticos e da terapêutica exige reavaliação constante dos escores de risco, a fim de beneficiar um grupo maior de pacientes, sem acrescentar riscos. O escore de Birmigham 2009 (CHA2DS2-VASc), avaliado neste estudo, demonstrou superioridade deste em relação aos esquemas antigo, principalmente pela sua capacidade de discriminar melhor os pacientes de risco intermediário (onde há dúvida da relação risco-benefício com o uso de antiagregação plaquetária x anticoagulação). Portanto, com base neste novo esquema, recomendamos que a escolha do tratamento para a prevenção de TE nos pacientes com FA seja feita conforme algoritmo da figura 2. Apesar do resultado expressivo, este foi o primeiro estudo a utilizar o novo escore e sua validação em outras populações de pacientes com FA, de diferentes raças/etnias, poderá confirmar o seu verdadeiro valor. </div><div></div><div></div></div><br /><span style="font-size:78%;"><em><strong>Autor: Dra. Luciana Sacilotto Referência: Gregory Y. H. Lip, Robby Nieuwlaat, Ron Pisters, Deirdre A. Lane and Harry J. G. M. Crijns. Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based approach. The Euro Heart Survey on Atrial Fibrillation. CHEST 2010; 137(2):263–272</strong></em></span>JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com2tag:blogger.com,1999:blog-4173274268031056684.post-6409189317422289572011-03-04T08:19:00.005-03:002011-03-04T08:46:13.148-03:00MÉDICOS X MÉDICOS COM IPHONESComo meu irmão Iago dizia: Existem médicos e médicos com Palm, como esses deixaram o mercado para o Iphone, existem agora médicos e médicos com Iphone.<br />Sem falar nos Tablets, que chegaram pra ficar, Steve Jobs lançou ontem a segunda geração - o Ipad 2.<br />Considero ferramenta indispensável para o estudante de medicina e para o médico atual.<br />Fica o link para o blog de um colega, o Guilherme Aquino, que já acompanho há algum tempo.JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-33867395696454646722011-03-04T07:41:00.003-03:002011-03-04T07:45:09.771-03:00ECHOTALKSugiro visita regular e obrigatória para cardiologistas e ecocardiografista.<br />Blog sério, de gente experiente que traz ferramentas para uma cardiologia mais eficiente.JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-25453159703642086462009-10-05T21:57:00.000-03:002009-10-06T00:23:48.203-03:00New ASCOT Analysis: Beta Blockers Not Beneficial in Hypertensives With TachycardiaSeptember 24, 2009 — A new analysis of the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm (ASCOT-BPLA) shows that the amlodipine (Norvasc, Pfizer)-based arm of the study remained superior to the beta-blocker arm, even when resting heart rate was taken into account [1].<br />The study was published in the September 22, 2009 issue of the Journal of the American College of Cardiology.<br />The findings mean that "there is no reason to believe that beta blockers should be used earlier on in the treatment of hypertension on the basis of heart rate," lead author Dr Neil R Poulter (Imperial College London, UK) told heartwire . He said many cardiologists have had "a hindbrain belief" that "if there is a touch of tachycardia, beta blockers are the right drugs to use in hypertension management." But prior to this analysis, there had been no data from randomized controlled trials available to assess the impact of this advice on patient outcomes, he noted.<br />"We thought, if it's true that a touch of tachycardia should push you toward beta blockers, we'd be able to see that in ASCOT," Poulter added. Noting that the ASCOT-BPLA study–-reported in 2005--confirmed the superiority of an amlodipine-based regimen over an atenolol-based regimen, "we looked to see whether, if you started with tachycardia, was that still the case?" he noted. "The bottom line is, yes, it is. Pulse rate should not be the determinant of what drugs you use in hypertension."<br />These findings "reinforce the UK guidelines that state that, in primary prevention, beta blockers should be kept to a much later stage of intervention," Poulter says.<br />No Attenuation of Amlodipine Superiority on Basis of Heart Rate<br />The ASCOT trial enrolled 19 257 hypertensive patients with at least three other cardiovascular risk factors from 650 general practices in the UK, Ireland, and the Nordic countries. The results showed that an antihypertensive strategy based on amlodipine, with perindopril added as required, significantly reduced all-cause mortality and other cardiovascular end points, including stroke, compared with an atenolol-based strategy, with the diuretic bendroflumethiazide added as required.<br />In this new subgroup analysis, patients with atrial fibrillation or taking rate-limiting antihypertensive drugs at baseline were excluded. The potential attenuation of the treatment effect with higher baseline heart rate on total cardiovascular events and procedures (TCVP) was assessed via an interaction term. Secondary analyses evaluated coronary and stroke outcomes.<br />There were 12 759 of the ASCOT patients included and 1966 total cardiovascular events and procedures. At the final visit, mean heart-rate reduction from baseline was 12.0 and 1.3 beats per minute in the atenolol- and amlodipine-based groups, respectively. There was a reduction in total cardiovascular events and procedures in those allocated to amlodipine-based therapy compared with those on atenolol-based therapy (unadjusted hazard ratio 0.81; p<0.001).<br />Until further notice, beta blockers should not come up the pecking order on the basis of pulse rate.<br />This benefit was unattenuated at higher heart rates (interaction p value=0.82). Similar results were obtained for coronary and total stroke outcomes.<br />"These analyses provide no evidence that atenolol-based therapy is superior to amlodipine-based therapy for patients with hypertension uncomplicated by coronary heart disease across the wide range of baseline heart rates observed in the ASCOT database," say Poulter et al.<br />"Pending further information--which could perhaps be gleaned from other studies such as [Losartan Intervention for Endpoint Reduction in Hypertension] LIFE--beta-blocker–based therapies are not appropriate to select as initial therapy for hypertension on the basis of a higher heart rate unless congestive heart failure and/or symptomatic ischemic heart disease coexist," they conclude.<br />Results Apply to All Beta Blockers, Until Further Notice<br />Poulter added to heartwire that "some cardiologists will say that if we hadn’t used atenolol the results would have been different: 'If you'd used my favorite "olol," ' for example, and I say, 'Prove it!' "<br />He believes that beta blockers "are not all the same, they do have different effects on all sorts of things," but "there is no evidence of heterogeneity in terms of cardiovascular outcomes," he maintains.<br />"Until further notice, beta blockers should not come up the pecking order on the basis of pulse rate."<br />Poulter has served as a consultant to and received travel expenses, payment for speaking at meetings, or funding for research from one or more pharmaceutical companies marketing BP-lowering or lipid-lowering drugs. Poulter has also previously received financial support from Pfizer to cover administrative and staffing costs of the ASCOT study and travel or accommodation expenses or both incurred by attending relevant meetings. Disclosures for the coauthors are listed in the paper.<br />References<br />Poulter NR, Dobson JE, Sever PS, et al. Baseline heart rate, antihypertensive treatment, and prevention of cardiovascular outcomes in ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial). J Am Coll Cardiol 2009; 54:1154-1161.JAN JOHANN REINEL DE CASTROhttp://www.blogger.com/profile/12755511036056328939noreply@blogger.com4tag:blogger.com,1999:blog-4173274268031056684.post-7015331761029817922008-03-13T15:19:00.000-03:002008-03-13T15:19:09.506-03:00Gmail - MedWire Cardiology News - 13 March 2008<a href="http://mail.google.com/mail/?account_id=aidaubitiite%40gmail.com&zx=1szd6ewwolez2">Gmail - MedWire Cardiology News - 13 March 2008</a><br /><br />Plausible role for CAPON gene in QRT variationResearchers have shown cardiac expression and biologic effects of the CAPON protein, supporting its potential influence on QT interval variation in human populations.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73666/Cardiology_News/Plausible_role_for_CAPON_gene_in_QRT_variation.html" target="_blank">http://www.medwire-news.md/38/73666/Cardiology_News/Plausible_role_for_CAPON_gene_in_QRT_variation.html</a><br /><br /><br />Implantable pressure monitor fails to reduce HF-related eventsUse of an implantable continuous hemodynamic monitor to guide optimal medical management of patients with heart failure failed to significantly reduce rates of HF-related events, report researchers.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73667/Cardiology_News/Implantable_pressure_monitor_fails_to_reduce_HF-related_events.html" target="_blank">http://www.medwire-news.md/38/73667/Cardiology_News/Implantable_pressure_monitor_fails_to_reduce_HF-related_events.html</a><br /><br /><br />No evidence of link between bisphosphonates and AF, flutterScientists have found no evidence to suggest that use of bisphosphonates increases the risk for atrial fibrillation and flutter.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73668/Cardiology_News/No_evidence_of_link_between_bisphosphonates_and_AF,_flutter.html" target="_blank">http://www.medwire-news.md/38/73668/Cardiology_News/No_evidence_of_link_between_bisphosphonates_and_AF,_flutter.html</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-49575837785430478752008-03-12T19:20:00.003-03:002008-03-12T19:33:41.050-03:00Migraine Intervention With STARFlex Technology (MIST)Summary<br /><br />Posted: 3/10/2008<br /><br />Writer: <a onclick="JavaScript:openAuthor('../../pops/author.asp?authID=814843'); return false;" href="http://www.cardiosource.com/clinicaltrials/trial.asp?trialID=1655#">Anthony A. Bavry, M.D., M.P.H.</a><br /><br />Description<br /><br /><strong><span style="color:#3333ff;"><em>The goal of this trial was to evaluate closure of patent foramen ovale (PFO) compared with a sham procedure in patients with refractory migraine headache.<br /></em></span></strong><br /><strong><span style="color:#cc0000;">Hypothesis</span></strong><br /><br />Closure of a PFO with the STARFlex device will be more effective in reducing migraine headache.<br /><br /><strong><span style="color:#cc0000;">Drugs/Procedures Used</span></strong><br /><br />After general anesthesia, patients underwent transesophageal echocardiography to assess the interatrial septal anatomy. Patients were then randomized to PFO closure (n = 74) or a sham procedure that consisted of a skin incision (n = 73).<br /><br /><strong><span style="color:#cc0000;">Concomitant Medications</span></strong><br /><br />Patients received aspirin (300 mg) and clopidogrel (300 mg) 24 hours prior to the procedure and for 90 days after the procedure at a dose of 75 mg daily for both medications. Patients continued any prophylactic medication that they were on at the start of the trial.<br /><br /><strong><span style="color:#cc0000;">Principal Findings</span></strong><br /><br />Of the migraine patients referred for potential study enrollment, a right-to-left shunt from a moderate-to-large PFO was documented by transthoracic echocardiography in 38%. Any type of shunt, including atrial septal defect, was present in 60%. The mean number of migraine attacks in the 30 days prior to the procedure was 4.82 in the closure group and 4.51 in the sham group. No PFO was identifiable in 7% of the closure group. Residual moderate-to-large right-to-left shunt was present in four patients at 6 months. There were more serious procedural-related adverse events in the closure group (atrial fibrillation, n = 2; pericardial tamponade, n = 2; retroperitoneal hemorrhage, n = 1; and chest pain, n = 2).<br />Three patients in each group reported migraine cessation (p = 1.0). Similarly, for closure versus sham, there was no difference in any of the secondary endpoints; frequency of migraine attacks per month (3.23 vs. 3.52, p = 0.14), total MIDAS headache score (17 vs. 18, p = 0.88), or headache days per 3 months (18 vs. 21, p = 0.79).<br />No difference in treatment effect was noted, regardless of whether a residual shunt was present at follow-up. Two patient outliers accounted for one-third of the study headache burden. When these patients were removed from analysis, there was a reduction of 2.2 headache days per month in the closure group versus 1.3 days per month in the sham group (p = 0.027).<br /><br /><strong><span style="color:#cc0000;">Interpretation</span></strong><br /><br />This was the first randomized sham-controlled trial to study the effect of PFO closure in patients with refractory migraine. An important finding was that among migraine patients referred for analysis, some type of right-to-left shunt was documented in 60% (in 38% due to PFO). The primary outcome, cessation of migraine, occurred in three patients in each group. Secondary outcomes such as frequency of migraines and headache scores were also similar between the two groups.When the two patient outliers were excluded from analysis, a difference was noted in the reduction of headache days favoring PFO closure; however, this finding should only be hypothesis generating since it was a post-hoc analysis.<br />Failure to detect a difference between treatment groups may have been at least partly explained by lack of adequate power. It is unknown if a longer duration of follow-up to allow for more complete healing of the defect would have also been beneficial. Additionally, patients continued prophylactic medications throughout the trial, which may have made it more difficult for the PFO device to show benefit. Additional trials on the topic are forthcoming.<br /><br /><strong><span style="color:#cc0000;">References:</span> </strong><br /><br />Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) Trial. A Prospective, Multicenter, Double-Blind, Sham-Controlled Trial to Evaluate the Effectiveness of Patent Foramen Ovale Closure With STARFlex Septal Repair Implant to Resolve Refractory Migraine Headache. <a href="http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.727271v1" target="_blank">Circulation 2008;Mar 3:[Epub ahead of print].</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-21303285834261907512008-03-12T15:58:00.001-03:002008-03-12T15:58:13.552-03:00Gmail - MedWire Cardiology News - 12 March 2008<a href="http://mail.google.com/mail/?account_id=aidaubitiite%40gmail.com&zx=67ex5stt3fu">Gmail - MedWire Cardiology News - 12 March 2008</a><br /><br /><br />Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html" target="_blank">http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html</a><br /><br /><br />Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html" target="_blank">http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html</a><br /><br /><br />Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html" target="_blank">http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-1824555894094241102008-03-12T15:58:00.000-03:002008-03-12T15:58:11.236-03:00Gmail - MedWire Cardiology News - 12 March 2008<a href="http://mail.google.com/mail/?account_id=aidaubitiite%40gmail.com&zx=67ex5stt3fu">Gmail - MedWire Cardiology News - 12 March 2008</a><br /><br /><br />Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html" target="_blank">http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html</a><br /><br /><br />Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html" target="_blank">http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html</a><br /><br /><br />Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html" target="_blank">http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-62328670715382928262008-03-11T12:25:00.002-03:002008-03-11T12:29:13.480-03:00What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?Title: Association of Early Follow-Up After Acute Myocardial Infarction With Higher Rates of Medication<br />Date Posted: 3/10/2008<br />Author(s): Daugherty SL, Ho PM, Spertus JA, et al.<br />Citation: <a href="http://archinte.ama-assn.org/cgi/content/abstract/168/5/485" target="_blank">Arch Intern Med 2008;168:485-491.</a><br /><br /><br />Study Question: What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?<br /><br />Methods: A total of 1,516 patients hospitalized with AMI participated in the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider versus those receiving follow-up from both provider types.<br /><br />Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs. 71.3%; p = 0.001), aspirin (82.9% vs. 77.1%; p = 0.01), or statins (75.9% vs. 68.6%; p = 0.005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio [RR], 1.08; 95% confidence interval [CI], 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (RR, 1.11; 95% CI, 1.01-1.22).<br /><br />Conclusions: Early outpatient follow-up and collaborative follow-up after AMI are associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.<br /><br />Perspective: This prospective observational study demonstrated a modest advantage of early follow-up post-MI, but which could infer a significant clinical outcome benefit. I suspect it underestimates the value of the cardiologist assessment and opportunity for referral to cardiac rehabilitation, smoking cessation, and education. Our experience is that early follow-up by a nurse practitioner can be effective as well. <a onclick="JavaScript:openAuthor('../pops/author.asp?authID=361206'); return false;" href="http://www.cardiosource.com/cjrpicks/CJRPick.asp?cjrID=3961#">Melvyn Rubenfire, M.D., F.A.C.C.</a>Larahttp://www.blogger.com/profile/13096985368996122154noreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-21634191661220514032008-03-10T22:21:00.000-03:002008-03-10T22:21:16.534-03:00Gmail - MedWire Cardiology News - 10 March 2008<a href="http://mail.google.com/mail/?account_id=aidaubitiite%40gmail.com&zx=5w1aoaqdartg">Gmail - MedWire Cardiology News - 10 March 2008</a><br /><br />CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html" target="_blank">http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html</a><br /><br />Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle_age_has_heart_benefits.html" target="_blank">http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle<br />_age_has_heart_benefits.html</a><br /><br />Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html" target="_blank">http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-10739955299798785822008-03-09T11:32:00.000-03:002008-03-09T11:32:08.204-03:00Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)<a href="http://www.cardiosource.com/clinicaltrials/trial.asp?trialID=1652">Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)</a><br /><br />Interpretation<br />The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.<br />This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.<br />There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.<br /><br />Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-31650186887044244302008-03-07T13:01:00.002-03:002008-03-07T13:04:50.653-03:00Angiotensin II Vaccine Lowers Blood PressurePhysician's First Watch for March 7, 2008David G. Fairchild, MD, MPH, Editor-in-Chief<br /><br />A vaccine against angiotensin II lowers blood pressure, reports Lancet.<br /><br />In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.<br /><br />By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).<br /><br />Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."<br /><br /><a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66890506%3BdPZVzV9geK3DnCG%2BRjUSZUKYqNtucCM3XR7Z5KjmpAk%3D" target="_blank">Lancet abstract</a> (Free abstract; full text requires subscription)<br /><a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66890506%3BdPZVzV9geK3DnCG%2BRjUSZXHaESWP8xxXXR7Z5KjmpAk%3D" target="_blank">Lancet comment</a> (Subscription requiredUnknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-88631360429631148252008-03-06T15:16:00.002-03:002008-03-07T08:49:41.926-03:00Case Studies IncorporatingACC/AHA Practice GuidelinesPerioperative Guidelines Case Studies <br /><br /><a href="http://www.cardiosource.com/casestudies/index.asp#guidelines">Case Studies IncorporatingACC/AHA Practice Guidelines</a><br /><br /><a href="http://www.cardiosource.com/casestudies/index.asp">Cardiosource</a>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-36363111159319189332008-03-05T15:58:00.000-03:002008-03-05T15:58:28.596-03:00Gmail - MedWire Cardiology News - 05 March 2008<a href="http://mail.google.com/mail/?account_id=aidaubitiite%40gmail.com">Gmail - MedWire Cardiology News - 05 March 2008</a>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-5953578739968300922008-03-05T00:38:00.000-03:002008-03-05T00:38:30.661-03:00Pulmonary Arterial Hypertension (PAH): Clinical Applications for the Cardiologist Today and Tomorrow<a href="http://www.medscape.com/viewprogram/6423">Pulmonary Arterial Hypertension (PAH): Clinical Applications for the Cardiologist Today and Tomorrow</a>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-68765928930933137332008-03-02T09:46:00.003-03:002008-03-02T09:50:43.498-03:00Loud Snoring Associated With Higher Stroke And Heart Disease Risk01 Mar 2008<br /><br />If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.<br /><br /><strong>You can read about this in the journal Sleep.</strong><br /><strong></strong><br />The authors explain that everybody snores to some extent at some period in their lives.<br /><br />Estimates indicate that approximately 40% of men and 24% of women snore regularly.<br /><br />Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.<br /><br />The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.<br /><br />The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.<br /><br />They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.<br /><br />The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."<br /><br /><strong><span style="color:#990000;">"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"</span></strong><br /><br />Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD<br /><br /><strong><em><span style="color:#3333ff;">SLEEP Volume 31, Issue 03, Pages 411-416</span></em></strong><br /><br /><a href="http://www.journalsleep.org/ViewAbstract.aspx?citationid=3508" target="_blank" rel="nofollow">Click here to view abstract online</a>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-4173274268031056684.post-34952008268562883052008-03-01T10:04:00.000-03:002008-03-01T10:06:00.357-03:00Medwire - 29.02.08<a class="linkD" href="http://www.medwire-news.md/38/73381/Cardiology/Minority_of_CHD_patients_do_recommended_exercise.html">Minority of CHD patients do recommended exercise</a><br />29 February 2008<br />Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.<br /><br /><a class="linkD" href="http://www.medwire-news.md/38/73382/Cardiology/Information,_reassurance,_and_support_aid_post-CABG_recovery_.html">Information, reassurance, and support aid post-CABG recovery </a><br />29 February 2008<br />The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.<br /><br /><a class="linkD" href="http://www.medwire-news.md/38/73380/Cardiology/Persistent_hyperglycemia_in_AMI_predicts_in-hospital_mortality_.html">Persistent hyperglycemia in AMI predicts in-hospital mortality </a><br />29 February 2008<br />Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-8952940545744774372008-02-28T17:43:00.002-03:002008-02-28T17:45:51.982-03:00Medwire -<a class="linkD" href="http://www.medwire-news.md/38/73340/Cardiology/Meta-analysis_shows_PCI_beats_medical_therapy_for_late_reperfusion.html">Meta-analysis shows PCI beats medical therapy for late reperfusion</a><br />28 February 2008<br />Patients who undergo percutaneous coronary intervention more than 12 hours after suffering an acute myocardial infarction have improved cardiac function and survival compared with those who receive medical management, a meta-analysis indicates.<br /><br /><br /><a class="linkD" href="http://www.medwire-news.md/38/73341/Cardiology/Chest_pain_causes_sustained_psychological_distress.html">Chest pain causes sustained psychological distress</a><br />28 February 2008<br />Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.<br /><br /><br /><a class="linkD" href="http://www.medwire-news.md/38/73348/Cardiology/Eye_disease_more_than_doubles_MI_risk.html">Eye disease more than doubles MI risk</a><br />28 February 2008<br />The progressive eye disease age-related macular degeneration doubles the risk for death due to cardiovascular disease, reveals a study from Australia.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-91920778002045160542008-02-26T18:34:00.000-03:002008-02-26T18:36:56.764-03:00Top 10 Articles on MedscapeTop 10 Most Read Articles by Cardiologists:<br /><br /> 1.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7U0Ev" target="_blank">A 57-Year-Old Asymptomatic Male Presents for Evaluation of an Abnormal ECG Obtained During a Physical CME</a>The patient presents with an abnormal ECG. Is there cause for concern?<br /><br /> 2.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7V0Ew" target="_blank">ENHANCE Saga Continues: Experts Dispute Ezetimibe's Future and "Weight" of Imaging Studies </a><br /><br /> 3.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7W0Ex" target="_blank">Questioning the Importance of LDL Cholesterol: The ENHANCE Fallout </a><br /><br /> 4.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7X0Ey" target="_blank">Atrial Fibrillation: Diagnosis and Management<br /> CME</a><br /><br /> 5.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7Y0Ez" target="_blank">Nebivolol Approved in US CME</a><br /><br /> 6.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7Z0E1" target="_blank">Abnormal ECG Patterns in Athletes: An Initial Expression of Underlying Cardiomyopathy? </a><br /><br /> 7.<a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7a0E8" target="_blank"><br />ENHANCE Results Yield Disappointment for Ezetimibe </a><br /><br /> 8.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF6l0EJ" target="_blank">Staying Active and Drinking Moderately Is Key to a Long Life CME</a><br /><br /> 9.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7b0EA" target="_blank">Meta-Analysis Shows Statins Reduce All-Cause Mortality 22% in Elderly CHD Patients </a><br /><br />10.<br /><br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://mp.medscape.com/cgi-bin1/DM/y/hBh1A0NM1mM0V7C0JF7c0EB" target="_blank">Folic Acid -- Finally Some Good News: A Best Evidence Review CME/CE</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-7704437142978237822008-02-26T18:30:00.002-03:002008-02-26T18:33:40.906-03:00HF burden increasing in USABy Caroline Price<br />26 February 2008<br />Arch Intern Med 2008; 168: 418-424<br /><br />MedWire News: <strong><span style="color:#990000;">The prevalence of heart failure (HF) has increased recently in the USA, despite a decline in its incidence, study findings indicate.</span></strong><br /><br />They show that the incidence of HF fell overall among both men and women from 1994 to 2003, but, owing to improved survival rates, the number of people living with HF increased during this period.<br /><br />Lesley Curtis (Duke University School of Medicine, Durham, North Carolina) and colleagues studied a nationally representative 5% sample of Medicare beneficiaries, of whom 622,786 were diagnosed with HF between 1994 and 2003.<br /><br />"Estimates of the incidence and prevalence of HF in elderly persons translate directly into projections of resource use for the Medicare program, so accurate estimates are essential," they note.<br /><br /><strong><span style="color:#990000;">The researchers report in the Archives of Internal Medicine that the incidence of HF declined slightly from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (p<0.01).</span></strong><br /><br />The incidence actually increased over this time in patients aged 65-69 years, but this was offset by the decline among patients aged 75 years or over.<br /><br />Meanwhile, the prevalence of HF increased steadily from around 140,000 in 1994 to 200,000 in 2003. These numbers equated to rates of around 90 and 121 per 1000 beneficiaries, respectively. Each yearly increase in the prevalence rate was significant (p<0.01) for the whole group and in both men and women.<br /><br /><strong><span style="color:#990000;">The increase in prevalence reflected improved survival rates. </span></strong>Between 1994 and 2003, both unadjusted and risk-adjusted mortality declined slightly. Risk-adjusted 30-day mortality decreased by over 5%, from 13.0% to 12.6% in men and from 11.5% to 10.8% for women. There was a 5% decrease in 1-year mortality, from 28.9% to 27.5% overall. And 5-year mortality fell by 3%, from 67.5% to 64.9% in men and from 61.7% to 60.2% in women.<br /><br />Closer inspection showed that the rate of increase in prevalence slowed over time, growing from 90 per 1000 beneficiaries in 1994 to 121 per 1000 in 2000, after which it remained at around 120 per 1000 up to 2003. This reflected declines in incidence and relatively steady mortality rates, the authors note.<br /><br />They conclude: "Identifying optimal strategies for the treatment and management of HF will become increasingly important as the size of the Medicare population grows."<br />Curtis commented: <strong><span style="color:#990000;">"From all indications, HF will continue to be a major public health burden, consuming billions of dollars each year."</span></strong><br /><br /><a class="date" href="http://heart.bmj.com/cgi/content/abstract/94/3/284" target="_blank">Free abstract </a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-4173274268031056684.post-32766873725095332692008-02-22T15:44:00.001-03:002008-02-22T15:47:12.526-03:00Only One-Third of Adults Know Heart Attack SignsOnly about one-third of U.S. adults are aware of the five major warning signs of heart attacks, according to a CDC survey in MMWR.<br /><br />The telephone survey of 72,000 people, conducted in 2005, found that, nationally:<br /><br /><br />48% recognize pain or discomfort in the jaw, neck, or back as a warning sign;<br />62%, feeling weak, lightheaded, or faint;<br />85%, pain or discomfort in the arms or shoulder;<br />92%, chest pain or discomfort;<br />93%, shortness of breath.<br /><br />The numbers were even lower among non-Hispanic blacks and Hispanics, men, and those with less than a high school education.<br /><br /><br />To ensure you receive Physician's First Watch, add <a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:FirstWatch@jwatch.org" target="_blank">FirstWatch@jwatch.org</a> to your address book.<br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbetUOsSN%2BwPP4VyQ7DHNfceKE%3D" target="_blank"></a><br /><a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3Bizqd6CCE2tJjYUS83yYZ1Q%3D%3D" target="_blank">Forward</a> <a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbeta%2FKdVtJe40DyQ7DHNfceKE%3D" target="_blank">Sign Up</a> <a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbetX6Lmb3ombBXyQ7DHNfceKE%3D" target="_blank"><br />My Alerts</a> <a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbetQkwXOeCq6W5yQ7DHNfceKE%3D" target="_blank">About Physician's First Watch</a> <a style="TEXT-DECORATION: none" onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbetaUPftL6q%2BUkyQ7DHNfceKE%3D" target="_blank">Editorial Board</a><br /><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://click.jwatch.org/cts/click?q=227%3B66879022%3BZloOt0mxiLoK1EnLyvbetatSr%2F1IW4EAyQ7DHNfceKE%3D" target="_blank"></a>Advertisement*<br /><br />Physician's First Watch for February 22, 2008<br />David G. Fairchild, MD, MPH, Editor-in-Chief<br /><a style="TEXT-DECORATION: none" href="http://mail.google.com/mail/?ui=1&ik=ce1cc6ec6c&view=cv&search=inbox&th=11841300f5c5e17b&ww=780&cvap=7&qt=&zx=udmoeykyz6dy#11841300f5c5e17b_article1">Only One-Third of Adults Know Heart Attack Signs</a><br /><a style="TEXT-DECORATION: none" href="http://mail.google.com/mail/?ui=1&ik=ce1cc6ec6c&view=cv&search=inbox&th=11841300f5c5e17b&ww=780&cvap=7&qt=&zx=udmoeykyz6dy#11841300f5c5e17b_article2">Google Prototyping Personal Health Records</a><br /><a style="TEXT-DECORATION: none" href="http://mail.google.com/mail/?ui=1&ik=ce1cc6ec6c&view=cv&search=inbox&th=11841300f5c5e17b&ww=780&cvap=7&qt=&zx=udmoeykyz6dy#11841300f5c5e17b_article3">Early Immunosuppression Better Than Conventional Therapy in Crohn Disease</a><br /><a style="TEXT-DECORATION: none" href="http://mail.google.com/mail/?ui=1&ik=ce1cc6ec6c&view=cv&search=inbox&th=11841300f5c5e17b&ww=780&cvap=7&qt=&zx=udmoeykyz6dy#11841300f5c5e17b_article4">Antioxidants, Folate of No Developmental Benefit to Infants with Down Syndrome</a> <a name="11841300f5c5e17b_article1"></a><br />Only One-Third of Adults Know Heart Attack Signs<br />Only about one-third of U.S. adults are aware of the five major warning signs of heart attacks, according to a CDC survey in MMWR.<br />The telephone survey of 72,000 people, conducted in 2005, found that, nationally:<br /><br />48% recognize pain or discomfort in the jaw, neck, or back as a warning sign;<br />62%, feeling weak, lightheaded, or faint;<br />85%, pain or discomfort in the arms or shoulder;<br />92%, chest pain or discomfort;<br />93%, shortness of breath.<br /><br />The numbers were even lower among non-Hispanic blacks and Hispanics, men, and those with less than a high school education.<br /><br />In addition, 86% said they would dial 911 if they thought someone was having a heart attack or stroke.Unknownnoreply@blogger.com0