CAR - Artigos publicados em revistas indexadas
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- Ecocardiografia de sobrecarga no enfarte do miocárdioPublication . Mota, PNos doentes com enfarte do miocárdio recente, os principais determinantes de prognóstico são: a extensão da necrose transmural, o estado da artéria relacionada com o enfarte e a presença e extensão de miocárdio em risco. A utilização da ecocardiografia de sobrecarga pressupõe que a sobrecarga farmacológica induz isquemia miocárdica a qual provoca alteração da motilidade segmentar. Esta dissinergia é um marcador precoce, sensível e específico de isquemia miocárdi ca. A infusão de dobutamina permite avaliar a resposta contráctil do miocárdio. Em baixas doses dá-nos informação sobre a reserva contráctil e, inerentemente, viabilidade. Sob doses elevadas de dobutamina a função sistólica torna-se dependente da capacidade da árvore coronária aumen tar o fluxo sanguíneo miocárdico. Quando existem estenoses coronárias significativas, o ter ritório dependente torna-se isquémico, o que se revela como hipo ou acinesia segmentar. O dipiridamol produz vasodilatação coronária provocando, em dose baixa, aumento da perfusão de zonas isquémicas e, em doses elevadas, efeito de roubo nos territórios dependentes de artérias com estenoses significativas. Com qualquer dos métodos, um teste de sobrecarga negativo tem um excelente valor predizente negativo e um teste positivo traduz risco aumentado de eventos.
- Endocardite a streptococcus bovis e envolvimento do colonPublication . Baptista, SB; Duarte, F; Galrinho, A; Dutschmann, LMcNeal and Blevins published the first report of Streptococcus bovis infective endocarditis in 1945. In 1951, McCoy suggested, for the first time, that an association could exist between Group D Streptococcus infective endocarditis and colon carcinoma; this association would be demonstrated later (1977) by Klein and unquestionably confirmed by several posterior works. Due to a clinical case of Streptococcus bovis infective endocarditis, which we had the opportunity of diagnosing, a review is made of the existent literature about the association between infection by this agent and the presence of lesions in the colon. Some recommendations are made in what respects the diagnosis and evaluation of patients with Streptococcus bovis infective endocarditis. Finally, the implications and therapeutic strategies in these patients are discussed
- Hamartoma of the mitral valve with blood cysts: a rare tumor detected by echocardiographyPublication . Abreu, A; Galrinho, A; Sá, E; Ramos, S; Martins, A; Fragata, J; Ferreira, RA 16-year-old boy was submitted to a cardiac examination after an episode of faintness. A transthoracic echocardiogram was performed, which revealed a very mobile multicystic tumor attached to the mitral valve. A small solid mass adherent to the cysts was better defined by transesophageal echocardiography. The patient was submitted to cardiac surgery consisting of tumor resection and a mitral prosthesis implant. The surgery was successful. The tumor consisted of three bright red tense cysts with hematic content, each 1 to 2 cm in diameter. The cysts were coalescent and adherent to a solid mass attached to the posterior papillary muscle head. Histopathologic examination revealed a hamartoma with a cystic part composed of the proliferation of myofibroblast cells in a stroma with vessels, collagen, and elastin fibers. Valvular hamartoma with blood cysts is a very rare cardiac tumor both for its histopathology and its localization.
- Importância da ecocardiografia transesofágica multiplanar no diagnóstico de tromboembolismo pulmonarPublication . Galrinho, A; Abreu, A; Freitas, A; Loureiro, J; Sá, E; Ferreira, R; Santos, TPulmonary thromboembolism (PTE) is a clinical entity difficult to diagnose, its setting is often confused with other pathological entities. The inexistence of isotopic techniques in most centres and the difficulty and delay in performing a pulmonary angiography leads transesophageal echocardiography (TEE) to be, a method of increasing importance for its diagnosis. From January 1996 to November 1997, echocardiographic evaluation was requested for 33 patients due to clinical suspicion of pulmonary thromboembolism. A transthoracic assessment was made previously in 21 patients (average ages 58.3 years, 52% males) which had signs of right overload (dilatation of the right cavities, anomalous movement of the intraventricular septum and pulmonary hypertension) a TEE was performed. The TEE was negative in 10 patients (TEEn) without evidence of thrombi in the trunk and main branches of the pulmonary artery (PA); there was one death on this group for repeated pulmonary microembolisms confirmed by necropsy. The TEE was positive in 11 patients (TEEp) with evidence of thrombi in the PA trunk in 3 patients, bilaterally in both branches in 3 patients and in the right branch in 5 patients. There were dilatations of the right cavities in all patients, paradoxal movement of the interventricular septum and bulging of the intra-auricular septum to the left atria. Foramen ovale was detected in 2 patients. The best visualisation of the PA was achieved in the intermediate planes between 30-70 degrees and between 90-130 degrees (plane for transverse slice of the right branch of the pulmonary artery). In 7 patients with TEEp, PTE was confirmed by CT-scan (visualisation of the thrombi in the trunk and main branches of the PA) and/or ventilation-perfusion scintigraphy and/or pulmonary angiography. In three cases of massive pulmonary embolism in young patients, with severe pulmonary hypertension, thrombolysis was performed with rTPA, under TEE control before and after rTPA in one of the cases. In conclusion, transesophageal echocardiography is an easy technique to be performed in the case of clinical suspicion of PTE. The existence of a negative examination does not invalidate the existence of PTE since only the trunk and the main branches of the PA are accessible by this technique. The detection of thrombi at this level in patients with clinical suspicion of massive pulmonary embolism confirms the diagnosis and supports the indication of thrombolysis.
- Trombólise na embolia pulmonar: experiência inicialPublication . Galrinho, A; Ferreira, D; Abreu, A; Santos, L; Sá, E; Ferreira, R
- Endocardite da valvula tricuspide e embolias pulmonares tipo pneumatoceloPublication . Galrinho, A; Antunes, I; Freitas, A; Ferreira, R
- Normas práticas para a profilaxia da endocardite bacterianaPublication . Ferreira, R
- Vegetações volumosas na válvula mitral e aórtica em jovem toxicodependente e com sépsisPublication . Freitas, A; Baptista, SB; Ferreira, R
- Electrocardiografia do pacing (do normal ao patológico)Publication . Morais, C