History Of Systemic Arterial Hypertension Research Articles

Acute Interstitial Nephritis Associated with Smilax Consumption: Case Report

The cocolmeca herb (Smilax) belongs to the smilacaceae family, comprising around 350 species of tropical and subtropical distribution, used as popular medicine in Central America and the Caribbean islands. In Mexico it has been used mainly for weight loss. Case presentation: A 52-year-old man with a history of systemic arterial hypertension and grade I obesity, with consumption of smilax for at least two months, presented deterioration in renal function, with initial studies with urea 90 mg/dl and serum creatinine 3.6. mg/dl, infectious and systemic causes were ruled out, acute tubulointerstitial nephritis was confirmed by percutaneous biopsy, management was given with methylprednisolone boluses and renal function improved. The use of traditional remedies is common throughout the world, with use rates exceeding 80% in some populations. It is considered that approximately 2% of chronic kidney disease (CKD) is due to AIN.

Toxic Epidermal Necrolysis Induced by Allopurinol, One Case in a Million

Background:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of one of the most serious dermatological conditions that occur in the hospital setting, considered a dermatological emergency. Stevens-Johnson syndrome is called toxic epidermal necrolysis (TEN) when ≥30% of the body surface is affected, and it is the most serious form of the disease, with adverse drug reactions being the main etiology, up to 80%. Clinical case:We present the clinical case of a 30-year-old male, with a history of systemic arterial hypertension, who began with symptoms after taking allopurinol after being diagnosed with hyperuricemia. It began with a picture of bilateral conjunctivitis, followed by a sudden appearance of localized dermatosis on the face, characterized by erythematous plaques with indistinct, non-painful borders, and later the appearance of ulcers and blisters, extending to 70% of the body surface. During his hospitalization, he developed a lesion acute renal failure, managed by the intensive care service, with total remission upon discharge and favorable response to treatment thanks to multidisciplinary management. Treatment was provided with human immunoglobulin, vancomycin-based antibiotic therapy, and ciprofloxacin for impetiginization of facial ulcers, fluid therapy, Vaseline gauze dressings, and topical ophthalmological treatment, achieving discharge without comorbidities. Conclusion:Toxic epidermal necrolysis is a severe picture of Steven Johnson Syndrome, potentially fatal, which requires early multidisciplinary management that leads to the recognition and management of associated comorbidities in a timely manner.Key words: Stevens-Johnson syndrome; toxic epidermal necrolysis; halopurinol, drug reaction.

Acute Mesenteric Ischemia: Basic concepts, Diagnosis, Treatment Options and Outcomes.

Acute mesenteric ischemia (AMI) is a group of diseases in which blood flow to the intestine is interrupted by occlusive or nonocclusive causes that include mesenteric arterial embolism, mesenteric arterial thrombosis, and mesenteric venous thrombosis. AMI risk factors include advanced age, Caucasian race, history of systemic arterial hypertension, arterial fibrillation, chronic kidney disease, and congestive heart failure. The clinical triad is characterized by the sudden onset of severe abdominal pain accompanied by gastrointestinal symptoms in the presence of an identified embolic source. Diagnosis is commonly made using computed tomography angiography, where the obstruction is observed directly in occlusive causes. Treatment involves fluid resuscitation and restoring mesenteric artery circulation using endovascular or surgical procedures. The mortality rate varies depending on the patient's clinical history and treatment approach, with a higher risk associated with open surgery. Lifelong anticoagulation or antiplatelet therapy may be necessary to prevent recurrence. Follow-up evaluations are recommended to monitor for restenosis and to prevent acute myocardial infarction.

Acute Cecal Perforated Diverticulitis Synchronous with Acute Appendicitis. Clinical Case

Introduction: Diverticular disease of the colon is an increasingly common condition in developed countries. Diverticula can develop in any segment of the colon, but are more common on the left side. The prevalence of cecal diverticula in Western countries is 1-2%, while in the East it represents 43-50% of colonic diverticula. Furthermore, in the West, the majority are solitary. When they are solitary, they are generally congenital and true, and if they are multiple, they are typically false (pseudodiverticula) and acquired. Clinical case: 50-year-old female, administrative employee, with a history of systemic arterial hypertension and mixed dyslipidemia; that she presented to the emergency medical service reporting anorexia, generalized abdominal pain, fever of 38.2 °C on one occasion and in the absence of alterations in fecal evacuations. On physical examination, the abdomen was presented with decreased peristalsis, slightly tympanic on percussion, painful on palpation in the left iliac fossa with involuntary muscular resistance. An abdominal mass was also palpated in the left iliac fossa. Additionally, he reported mild pain on palpation in the iliac fossa. right, doubtful Mc Burney sign, negative rebound. During his hospitalization, laboratory studies were performed, which reported leukocytosis, neutrophilia and thrombocytopenia, in addition to a simple and contrasted abdominopelvic tomography which reported multiple diverticular formations in the descending and sigmoid colon, which were accompanied by striation of the pericolic fat, with fluid. free in the left slide, pelvic and perihepatic cavity, with gas particles in the slide, thickening and increased enhancement of the walls of the descending colon and sigmoid. Discussion. Right-sided diverticulitis is a rare disease in the West, accounting for 1 to 3.6% of total cases of diverticular disease. Approximately 80% of right-sided diverticula are located on the anterior surface of the cecum, close to the ileocecal valve, and are usually asymptomatic.

Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people.

To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza. The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria. Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045). Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.

DENTISTRY INVOLVEMENT IN THE AMYLOIDOSIS DIAGNOSIS: CASE REPORT

A 79-year-old female patient was monitored under hospital care by the multidisciplinary team because of severe oropharyngeal dysphagia with a 3-year evolution. Clinical examination revealed a medical history of systemic arterial hypertension, left ventricle diastolic dysfunction, hypothyroidism, and bilateral carpal tunnel syndrome. In view of the clinical picture presented, amyloidosis was the main diagnostic hypothesis. During intraoral examination the hospital dental team's evaluation revealed macroglossia, crenated tongue and lingual varicosities, saliva accumulation in the oral cavity, and vestibularized anteroinferior teeth. Therefore, an incisional biopsy was performed in the tongue dorsum region and in the intraoral lower lip mucosa (minor salivary gland). After the anatomopathologic examination with a special Congo red stain, amyloidosis was diagnosed. With the diagnostic definition, the patient proceeded with specific medical treatment and speech therapy.

Clinical and epidemiological profile of elderly patients seen in a hypertensive emergency at a public hospital in the state of Rio de Janeiro – Hypertensive emergency in the elderly

Introduction: Hypertensive emergencies (HE) are clinicalentities characterized by an acute and significant increasein blood pressure (BP) associated with severe symptoms thatevidence target organ damage. Objective: To analyze the clinicaland epidemiological profile of elderly patients treated ina hypertensive emergency at a public hospital in the state ofRio de Janeiro. Method: This study is prospective and descriptive.Information was collected from August to October, 2020using medical records and processed using the Statistic Statsoftprogram. Pearson’s test was performed for univariate analysis.Results: The sample consisted of 109 patients. The averageage found was 73 years old, with a predominance of males(69.72%) and brown skin (36.69%). Approximately 72.48% ofthe patients had a history of Systemic Arterial Hypertension(SAH), however, (50.46%) reported that they did not regularlyuse antihypertensive medication. Target organ injuries wereischemic stroke (58.71%), followed by acute coronary syndrome(24.77%), hemorrhagic stroke (9.17%) and edema acutelung disease (7.33%). Regarding the BP values found at admission,the mean systolic pressure was 205.0 mmHg, while themean diastolic pressure was 127.0 mmHg. Conclusion: Ischemicstroke was the most frequent HE in the sample. It is necessaryto put in place measures to prevent risk factors associated withSAH, as well as to control blood pressure levels to reduce thenumber of consultations due to hypertensive emergencies andother complications of cardiovascular diseases.Keywords: Emergency; Hypertension; Prevalence.

Association between hyperuricemia and hypertension: a case-control study.

The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.

Important differences between hypertensive middle-aged women and men in cardiovascular autonomic control\u2014a critical appraisal

BackgroundNormotensive premenopausal women show a vagal predominance of cardiac autonomic modulation, whereas age-matched men show a predominance of sympathetic modulation. However, some women develop systemic arterial hypertension (SAH) even with preserved ovarian function. Our hypothesis is that these women may have cardiovascular autonomic parameters similar to those of hypertensive men, even when subjected to pharmacological treatment. We aimed to investigate cardiovascular autonomic control and baroreflex sensitivity (BRS) in hypertensive premenopausal women and age-matched men.MethodsOne hundred volunteers between 18 and 45 years of age were assigned to two groups (50 participants each): a hypertensive group including patients with a history of SAH for at least 6 months (25 men and 25 women), who were under treatment with monotherapy (losartan, 25–50 mg/kg); and a normotensive group (25 men and 25 women). Anthropometric, hemodynamic, metabolic, and autonomic cardiovascular assessments were performed focusing on BRS, autonomic modulation of heart rate variability (HRV), and blood pressure variability (BPV).ResultsOn HRV analysis, women showed higher values of high-frequency (HF) oscillations in absolute and normalized units, lower values ​of low-frequency (LF) in normalized units, and lower LF/HF ratio, as compared with men. When the normotensive and hypertensive groups were compared, hypertensive groups showed lower values ​of total variance and of LF and HF bands in absolute units. On BRS, hypertensive groups showed lower values than the normotensive group.ConclusionRegardless of blood pressure control through pharmacological treatment, hypertensive patients continued to have reduced HRV compared to normotensive, and hypertensive men had more autonomic impairment than hypertensive premenopausal women.

Ultrasonically Detected Subpleural Lung Consolidations in The Emergency Room: A Case Report

We report the clinical case of a 76- year-old patient who was admitted to the emergency department due to respiratory distress. He had a history of Systemic arterial hypertension, type 2 diabetes mellitus and hypothyroidism. The patient reports symptoms that began three days prior to admission, including dyspnea, fever, myalgia, arthralgia, headache and respiratory distress that was exacerbated 1 day prior to admission. Physical examination revealed a conscious patient with the following vital signs: blood pressure 120/62mmHg, heart rate 109bpm, respiratory rate 28rpm, temperature 38.8°C, arterial oxygen saturation 76%, dyspnea, use of accessory muscles, tachycardia, tachypnea, which met the operational definition for Covid-19. Upon admission to the service, a pulmonary ultrasound was performed in which subpleural consolidations were identified, predominantly in the right hemithorax, as well as an air bronchogram and little pleural effusion. Based on these observations, the patient was admitted to the unit, where management with supplemental oxygen was started using a face mask with a reservoir bag. A chest X-ray was performed in which a diffuse interstitial alveolar pattern was identified in both hemithoraxes. Later a simple chest tomography was performed in which changes compatible with CO-RADS 5 were identified. He continued with established management and during his stay in the service, he evolved to deterioration to need advanced management via air. This study suggests that pulmonary ultrasound may be an effective and reliable tool in the initial evaluation of patients with respiratory distress in the context of Covid-19 pneumonia and that the identification of subpleural consolidations represent a prognostic factor of the disease: identifying them quickly after admission suggests a worse evolution of the disease, thus prompting us to make correct and concrete decisions regarding the management and treatment of these patients, without having to wait for complementary studies such as chest radiography and even tomography.

Tendências na hospitalização de pacientes com Insuficiência Cardíaca Aguda

Objetivo: Identificar as causas de descompensação e as tendências na classificação e tratamento de pacientes internados com Insuficiência cardíaca. Métodos: Estudo observacional, realizado em um hospital privado de referência em cardiologia na cidade de Aracaju/SE. Foram analisados prontuários de junho de 2015 à agosto de 2018 e aplicou-se questionários em pacientes acima de 18 anos, que deram entrada com quadro de Insuficiência Cardíaca Aguda ou Crônica agudizada. Resultados: Incluíram-se 180 pacientes, com média de 73 anos e prevalência do sexo masculino (52,2%). Identificou-se que 94,4% dos pacientes apresentavam dispneia, 86,1% tinha história de Hipertensão arterial sistêmica, arritmia (33,3%) foi a principal causa de descompensação e a etiologia hipertensiva foi reconhecida em 39,4% dos casos. A Insuficiência Cardíaca com fração de ejeção reduzida foi identificada em 50,7%, tendo uma maior tendência no sexo masculino (p&lt;0,0001) e nos mais jovens (p=0,001). Os diuréticos (82,3%) e betabloqueadores (58,3%) foram as principais medicações usadas cronicamente e durante a internação 83,9% usaram diurético de alça para melhoria sintomática. O tempo médio de internação foi 12,45 dias e dos 6,1% que foram a óbito, 72,7% necessitaram de cuidados intensivos. Conclusão: As características identificadas nos pacientes com Insuficiência Cardíaca, como a associação de diversas comorbidades e o crescente diagnóstico de pacientes com fração de ejeção preservada, demonstram a necessidade de novas estratégias para o enfrentamento dessa síndrome.

Cardiovascular Risk Factors in Nurses Teachers

Background: Cardiovascular diseases are the main cause of death in Brazil and worldwide, being influenced by the presence of risk factors. In the current life context, these factors are increasingly present in individuals, also related to occupation, which require extensive workload, performance, reasoning, goal plan and maximum dedication from the individual, as is the case of undergraduate teachers in Brazil.&#x0D; Objective: To identify cardiovascular risk factors in teaching nurses of a private higher education institution (HEI) in Belém, PA, Brazil.&#x0D; Study Design: A cross-sectional, descriptive survey study with a quantitative approach. At a private HEI in Belém-PA, in March and April 2019.&#x0D; Methodology: Performed with 11 teachers nurses that the HEI had. A form was used on the teacher's profile and risk factors. Data were analyzed by simple descriptive statistics through the Bioestat 5.0 program.&#x0D; Results: They are young adults, married, with an extensive workload; 45.45% of them have already had alterations in the HDL and LDL levels, with a family history of Systemic Arterial Hypertension 72.73% and Diabetes Mellitus 81.82%. 45.45% use oral contraceptives. They have a low-fiber diet, rich in lipids and sodium, and practice physical activity. 72.73% consume alcoholic beverages, and none are smokers.&#x0D; Conclusion: The teaching profession, due to extensive workload and stressful activities, offers a risk for inadequate nutrition, sedentary lifestyle, and lack of time for leisure. These factors are associated with other existing factors, which may increase the chances of cardiovascular diseases in these professionals.

Miocardiopatía hipertrófica. Reporte de caso

Hypertrophic cardiomyopathy is a common inherited disease, which occurs in 1 in 500 individuals and affects both sexes.It presents with left ventricular hypertrophy in the absence of another cardiac or systemic disease capable of producing an increase in the thickness of the left ventricle wall. The clinical manifestations of hypertrophic cardiomyopathy are varied, from asymptomatic left ventricular hypertrophy or progressive heart failure to sudden cardiac death. Common symptoms include dyspnea, chest pain, palpitations, pre-syncope and syncope. Most of the time, left ventricular hypertrophy is evident during adolescence or youth. We describe the case of a male patient of 43 years, who presented a hypertensive emergency without previous history of systemic arterial hypertension. Through complementary exams, hypertrophic middle-apical myocardiopathy was diagnosed without obstruction of the left ventricular outflow tract.

267. Sociodemographic profile of pregnant women affected by preeclampsia

Preeclampsia (PE) causes morbidity and mortality in several women in the productive phase, including definitive sequels. Recognizing the socio-demographic profile of pregnant women may justify the allocation of resources to promote an effective care for this population. To describe the socio-demographic profile of pregnant women diagnosed with preeclampsia. Retrospective study of medical records of 98 patients. Place: Hospital Guilherme Álvaro Santos/ Brazil, (from May 2017 to April 2018). Variables analyzed: Previous history of systemic arterial hypertension (SAH) and preeclampsia, first-degree relative with SAH, recreational drug use, cohabitation with the partner, pre-eclampsia, employment status, years of schooling, average number of pregnancies and body mass index (BMI). For all the information in the sample, a description of the data was made through numerical means and descriptive measures of variables with the intention of searching for clues about the behavior of the phenomena studied. The study has ethical approval. We identified that 53.1% had previous SAH; 29% reported a history of preeclampsia; 83% had first-degree relative with SAH; 19% used recreational drugs; 32% lived with partner; 38% were unemployed. How many means: the time of schooling was of 10,23 years; that of pregnancies of 2.27 previous; and the BMI of 31.93 (obesity). These data suggest that it is necessary to create strategies for reproductive planning access for this population because several women were in the third gestation and advised of the risks identified in their own history as relatives with SAH. Avoiding additional complications due to drug use, especially among obese women, hypertensive and with a history of pre-eclampsia and that these guidelines need to be reinforced also by low education. These aspects can be recognized by the anamnesis itself, which can optimize resources and optimize financial resources.

Correlation between chronic venous ulcer exudate proteins and clinical profile: A cross-sectional study

Chronic venous ulcers affect the quality of life of patients around the world. The aims of this study were to identify the proteins expressed in chronic venous ulcer exudates, to categorize them according to their roles and to correlate them with the clinical and epidemiological aspects of the disease. The study population consisted of 37 ulcers from 28 patients, and the inflammatory exudates of these thirty-seven ulcers were subjected to tryptic digestion and mass spectrometry analysis. Twenty-three patients were female (62.2%), and five (37.8%) were male. The patients had a mean age of 70 (±10.1) years. Of the patients, 73% adhered to compression and rest, 81.1% reported a history of primary varices, 54.1% reported a history of systemic arterial hypertension, 54.1% reported a history of devitalized tissue in the wound bed and 64.9% reported ulcers with more than ten years of evolution. Seventy-six proteins were identified, and they were grouped according to their primary role in the healing process. Eight correlations between clinical and epidemiological data and protein expression were noteworthy: diabetes mellitus vs. Ig gamma-2 and apolipoprotein-A1 and albumin; congestive heart failure vs. Ig lambda-2; colonization vs. actin; compressive therapy vs. Ig kappa; systemic arterial hypertension vs. alpha-2-macroglobulin and apolipoprotein-A1; area of ulcer vs. apolipoprotein-A1; race vs. heavy chain Ig and Ig γ-1 chain; age and race vs. Ig γ-1 chain. These associations may help to elucidate the prognosis and chronicity of chronic venous ulcers based on secreted proteins.

Fatores de risco para hipertensão arterial sistêmica em idosas de um centro de referência

Introdução: Há evidência de que conforme os indivíduos envelhecem, as doenças crônicas não transmissíveis tornam-se as principais causas de morbidade, incapacidades e mortalidade em todo o mundo.Objetivo: Este trabalho buscou identificar fatores de risco para hipertensão arterial sistêmica em idosas de um Centro de Referência e Atenção ao Idoso.Materiais e Métodos: Este estudo transversal está aninhado no Estudo Longitudinal do Centro de Referência e Atenção ao Idoso (Elo-Creati). Os fatores de risco investigados foram: consumo de bebidas alcóolicas, uso de tabaco, história familiar de hipertensão arterial sistêmica, nível de atividade física e estado nutricional. Também foram investigadas variáveis demográficas e socioeconômicas. A análise dos dados foi realizada por meio de frequências absoluta e relativa simples e teste Qui-quadrado.Resultados: Foram avaliadas 313 idosas, sendo 262 (84,5%) de cor branca, a maioria com idade entre 60 a 69 (57,2%; n=179) anos e pertencente a classe econômica B (52,1%; n=162). Das idosas participantes deste estudo, 187 (59,9%) referiram a presença de hipertensão arterial sistêmica, e os fatores associados encontrados foram: classe econômica, IMC e nível de atividade física (p&lt;0,05).Conclusão: Entre os fatores de risco estudados, destaca-se a presença de história familiar de hipertensão arterial sistêmica, excesso de peso e inatividade física. Assim, sugere-se ações dos órgãos públicos e setores privados no enfrentamento efetivo desta realidade.

Patients with Chagas Disease and Cardiac Arrest Treated at the Emergency Department of a Reference Hospital in Brazil

: People with Chagas disease are at a higher risk of death due to cardiac arrest (CA). Considering that Chagas disease remains a serious health problem in Latin America, studies in this regard are still needed. The aim of this study was to present 2 patients with Chagas that developed CA and were treated at the emergency department of a reference hospital in Brazil (Sao Paulo city). Case one: Male (73 years old and Caucasian) with a history of systemic arterial hypertension, diabetes mellitus, liver cirrhosis, and Chagas disease associated with megacolon and megaesophagus. After cardiac collapse and 30 minutes of cardiopulmonary resuscitation (CPR), unfortunately the patient died. Case two: A female patient (64 years old and Caucasian), with a history of systemic arterial hypertension, obesity, and Chagas disease. After 23 days of hospitalization, pharmacological therapy, and implantation of a cardioverter defibrillator, the patient was discharged. People with Chagas disease are at a higher risk of CA. The researchers believe that a prompt and efficient treatment (advanced life support) allied with educational programs on CA recognition targeted at health professionals and caregivers (basic life support knowledge) could improve the prognoses of these patients.

Autonomic and Vascular Control in Prehypertensive Subjects with a Family History of Arterial Hypertension.

BackgroundIndividuals with a family history of systemic arterial hypertension (FHSAH) and / or prehypertension have a higher risk of developing this pathology.ObjectiveTo evaluate the autonomic and vascular functions of prehypertensive patients with FHSAH.MethodsTwenty-five young volunteers with FHSAH, 14 normotensive and 11 prehypertensive subjects were submitted to vascular function evaluation by forearm vascular conductance(VC) during resting and reactive hyperemia (Hokanson®) and cardiac and peripheral autonomic modulation, quantified, respectively, by spectral analysis of heart rate (ECG) and systolic blood pressure (SBP) (FinometerPRO®). The transfer function analysis was used to measure the gain and response time of baroreflex. The statistical significance adopted was p ≤ 0.05.ResultsPre-hypertensive individuals, in relation to normotensive individuals, have higher VC both at rest (3.48 ± 1.26 vs. 2.67 ± 0.72 units, p = 0.05) and peak reactive hyperemia (25, 02 ± 8.18 vs. 18.66 ± 6.07 units, p = 0.04). The indices of cardiac autonomic modulation were similar between the groups. However, in the peripheral autonomic modulation, greater variability was observed in prehypertensive patients compared to normotensive individuals (9.4 [4.9-12.7] vs. 18.3 [14.8-26.7] mmHg2; p < 0.01) and higher spectral components of very low (6.9 [2.0-11.1] vs. 13.5 [10.7-22.4] mmHg2, p = 0.01) and low frequencies (1.7 [1.0-3.0] vs. 3.0 [2.0-4.0] mmHg2, p = 0.04) of SBP. Additionally, we observed a lower gain of baroreflex control in prehypertensive patients compared to normotensive patients (12.16 ± 4.18 vs. 18.23 ± 7.11 ms/mmHg, p = 0.03), but similar delay time (-1.55 ± 0.66 vs. -1.58 ± 0.72 s, p = 0.90).ConclusionPrehypertensive patients with FHSAH have autonomic dysfunction and increased vascular conductance when compared to normotensive patients with the same risk factor.

Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery.

Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.

Myocardial Infarction with Ventricular Septal Rupture and Cardiogenic Shock

A 72-year-old woman with a history of systemic arterial hypertension presented to the emergency department with chest pain, and an electrocardiogram showed acute anterior myocardial infarction with striking ST-segment elevation, upright T waves, and large Q waves in leads V1 to V4 (Figure). Furthermore, the ST-segment elevation > 0.25 mV in lead V1, the ST depression ≥ 0.1 mV in lead III, and the ST elevation ≥ 0.1 mV in lead aVL indicated that the left anterior descending coronary artery was occluded proximal to both the first major septal perforating branch and the first diagonal branch (1–4). Figure. Electrocardiogram recorded on the patient's arrival in the emergency department. See text for explication. Also, note that there was sinus rhythm at a rate of 106 beats/min with the next to last QRS complex being a fusion of a premature ventricular complex ... Anterior infarcts from such proximal left anterior descending occlusions tend to be quite large and are often associated with cardiogenic shock (2, 4, 5), which this woman manifested soon after her arrival in the emergency department. An echocardiogram showed a left ventricular ejection fraction of approximately 40% with akinesis of the apex and distal two-thirds of the ventricular septum. The right ventricle was considerably dilated. Through a defect in the distal ventricular septum, blood shunted from left to right during systole with reversal of flow during diastole, suggesting an elevated right ventricular diastolic pressure. Laboratory studies of the patient's blood confirmed myocardial damage and indicated chronic kidney disease and acute metabolic acidosis (Table). Table. Laboratory results from blood drawn on admission The patient had a run of ventricular tachycardia while in the emergency department. Once stable, she was transported to the cardiac catheterization laboratory; an intra-aortic balloon was placed via the left femoral artery, and 1:1 counterpulsation was begun. Coronary arteriography, performed via the right femoral artery, showed proximal total occlusion of the left anterior descending coronary artery, diffuse disease of the left circumflex coronary artery with a totally occluded first obtuse marginal branch and 90% narrowing of the third obtuse marginal branch, and diffuse disease of the right coronary artery with a long 80% to 90% narrowing in its mid segment. Despite repeated inflations of first a 2.5 × 20 mm balloon and then a 2.0 × 25 mm balloon in the proximal and distal portions of the left anterior descending artery, there was no flow. Hypotension, bradycardia, and acidosis (arterial blood pH = 6.9; reference = 7.4) were temporarily combated with atropine, epinephrine, and sodium bicarbonate, and the patient was sent to the intensive care unit with an intravenous dopamine infusion and 1:1 intra-aortic balloon counterpulsation. She died several hours later. Ventricular septal rupture formerly occurred in 1% to 3% of patients with acute myocardial infarction and did so within the first week in more than 75% of them (6). Subsequently, among patients treated with fibrinolysis, the incidence of ventricular septal rupture was only 0.2%, and the median time from the onset of the infarct was 1 day (7). Approximately one-half of ventricular septal ruptures are in the setting of an anterior infarct, and one-half occur in patients with inferior infarcts (8, 9). At least two-thirds of patients with myocardial infarction and ventricular septal rupture die, and many of these, like our patient, are older and have cardiogenic shock; early operation by superb surgeons seems to improve the chances of survival (10). The large upright fused ST segments and T waves seen in the figure have been referred to as “tombstoning,” probably because of the appearance of tombstones and because they are signs of more extensive myocardial damage and of a poor prognosis (11). Sclarovsky believes that this pattern of deep anterior Q waves with persistently elevated ST segments and tall T waves indicates lack of reperfusion of the myocardium due to a severely damaged microcirculation (12).