Biomedical subjects

Ana Aleixo

Publications and source records attributed to Ana Aleixo.

4 recordsLinked to original sources

PubMed2006

Acutely decompensated heart failure: characteristics of hospitalized patients and opportunities to improve their care.

UNLABELLED: Heart failure (HF) remains a major public health problem in western countries, despite the enormous progress in its diagnosis and treatment. Acute and chronic decompensated HF are leading medical causes of hospitalization among people aged over 65 years in European countries, the USA, Australia and New Zealand. However, there have been few studies on acute and chronic decompensated HF and the European Society of Cardiology (ESC) guidelines on this subject have only just been published. AIM: To evaluate the overall prevalence of hospitalization due to HF according to its subtypes, comorbidities, and decompensating factors, in the Medical Department of a central teaching hospital in an urban area. METHODS: We performed a retrospective observational study of patients admitted consecutively to the Medical Department via the emergency room between January and June 2001. Discharge casenotes on 1038 admissions were reviewed. Those with a diagnosis of HF or cardiovascular conditions associated with or precursors of HF were analyzed. Cases with a final diagnosis of HF according to the criteria of the ESC guidelines were included in the study. We evaluated the overall prevalence of HF and subtypes of cardiac dysfunction, etiological risk factors, patients' demographic characteristics, decompensating factors, comorbidity, mean length of hospital stay, and in-hospital mortality rate. RESULTS: We identified 180 patients with HF (17.4%), mean age 74.6 +/- 14; 87 were male (48%), aged 73.7 +/- 14.2, and 93 female (52%), aged 75.6 +/- 14. Left ventricular systolic dysfunction (LVSD) was present in 42.2% of cases, preserved left ventricular systolic function in 32.6%, and valvular heart disease in 10.6%. Hypertension and coronary artery disease were the main etiological risk factors (62.2% and 42.8% respectively). Atrial fibrillation was recorded in 43.4% of the patients, diabetes was diagnosed in 21.6%, and anemia and chronic obstructive pulmonary disease in about one third. Infection, predominantly respiratory, was the main factor triggering decompensation, followed by uncontrolled hypertension and supraventricular tachyarrhythmia. At admission, 42.2% of the patients were in NYHA class III and 44.8% in NYHA class IV. HF patients had a mean hospital stay of 13.8 days, slightly shorter than the mean overall stay of patients admitted to the Medical Department in the same period (14.5 days). In-hospital mortality for HF patients was 7.7%, with HF being the first cause of admission to the Medical Department, followed by stroke (10.6%). CONCLUSIONS: This study confirms the high prevalence of acute or chronic decompensated HF in patients hospitalized in the Medical Department of a central teaching hospital in an urban area. The patients were mainly elderly, of both genders, with a slightly higher proportion of HF due to LVSD. Most patients were in NYHA classes III and IV. Mean hospital stay was no longer than that of all patients admitted in the same period. The in-hospital mortality rate was low. The age-group affected and the high prevalence of multiple comorbidities emphasize the need to establish HF clinics with multidisciplinary teams to manage these patients, and health authorities must be made aware of the burden of this syndrome.

Acute Disease↗

PubMed2006

Recurrent syncope--a diagnostic challenge.

Several disorders resemble syncope. According to the European Society of Cardiology guidelines, certain key questions should be addressed during the initial evaluation of a patient presenting syncope. The physician should be alert to important clinical features that suggest the diagnosis and the evaluation strategy. However, syncope remains a diagnostic challenge. The authors report a case of a 60-year-old man admitted to the Emergency Department (ED) complaining of recurrent syncopal attacks that had begun one month before. He had daily transient, self-limited loss of consciousness lasting for seconds or even a few minutes, followed by prompt recovery. The attacks occurred mainly after exercise or urination. Prodromal symptoms were sweating and a sensation of imminent death. He learned to recognize these symptoms, reporting that he could control the duration of the attack by sitting down and voluntarily hyperventilating. He reported no prior pain, palpitations, tongue-biting or urinary incontinence. The episodes were witnessed and no abnormal movements were reported. The patient had been healthy until two months before, when he was diagnosed with diabetes mellitus by his general practitioner after routine analyses. Glycemia was controlled with diet and subcutaneous Actrapid insulin. No history of cardiac, cardiopulmonary, neurological or psychiatric disease was found and he was taking no other medication. On admission to the Emergency Department he was asymptomatic. Clinical examination was normal. The ECG showed sinus rhythm, heart rate of 70 bpm, and left bundle branch block; (LBBB). The chest X-ray was normal. As some medical features suggested a cardiac etiology (post-exercise, LBBB) and others indicated a neurally-mediated reflex syndrome or even situational syncope (after urination), a diagnostic strategy to exclude cardiac cause was adopted, including echocardiogram, and 24-hour ECG monitoring and stress test. The echocardiogram was normal. During Holter monitoring, he reported a syncopal event, in supine position, immediately after urination, and a 50-second period of cardiac arrest with persistent P waves--P-wave asystole--was recorded. Cardiac bradyarrhythmia was thus established as the cause of the syncope and a permanent pacemaker was implanted, with no recurrence of symptoms. This example of an unusually long-lasting cardiac arrest with spontaneous recovery illustrates the non-specific nature of clinical features and how difficult it is to diagnose syncope in an Emergency Department setting. The authors briefly review the topic according to recent guidelines.

Algorithms↗

PubMed2005

Medication errors in an internal medicine department. Evaluation of a computerized prescription system.

OBJECTIVE: Evaluation of a computerized physician order entry in an Internal Medicine Department, with a unit-dose distribution system. SETTING: Pharmacy Department, Internal Medicine Department. S. Francisco Xavier Hospital, Lisbon, Portugal. METHOD: This study was carried out in December 2001 and January 2002. After two years experience of the CPOE system, medication errors were evaluated prospectively, in an internal medical department of a 360-bed academic hospital. Data were collected once a week. Pharmacists reviewed all medical prescriptions as part of their routine work. Medication errors detected were recorded on a data collection form with a design based on the types of errors as defined by the American Society of Hospital Pharmacists (ASHP). Completed forms were reviewed and medication errors were classed according to ASHP guidelines. RESULTS: A total of 2268 orders were monitored (162 patients). In these orders, 73 medication errors (22.4% of the patients) were detected and documented (59 prescribing errors and 14 monitoring errors). The most common prescribing errors were deficiencies related to the right class but wrong drug (28.3%): omeprazole vs. ranitidine/sucralfate in stress ulcer prophylaxis; incorrect dose (30%) and unclear orders (13.3%). Errors related to incorrect frequency of administration (5%); maintenance of IV route (5%); duplicated drug therapy (11.7%); drug interactions (1.7%) and length of therapy (3.3%) were also detected. The 14 monitoring errors detected were failures to review a prescribed regimen for appropriateness and detection of problems. CONCLUSIONS: Computerized prescription order entry has demonstrated effectiveness in eliminating medication errors related to transcribing and patient identification. Nevertheless, medication errors related to prescription and monitoring still occur. The use of clinical decision support systems and pharmacist involvement is vital to achieve maximum medication safety and reduce medication error rates.

Drug Prescriptions↗

PubMed2003

Contrast echocardiography in segmental analysis and intraventricular gradient quantification in hypertrophic cardiomyopathy.

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is a hereditary disorder characterized by ventricular hypertrophy, diastolic dysfunction and hyperdynamic left ventricular systolic function. This excessive contraction is sometimes associated with significant intraventricular pressure gradients. These gradients are dynamic and therefore vary at different times. Echocardiography can identify and quantify the functional and morphologic changes characteristic of the disease. Ultrasound contrast agents (UCAs) are indicated in patients with poor transthoracic image quality, enabling better visualization of the endocardial border. These agents also strengthen the Doppler signal, which enables better quantification of the transvalvular and intraventricular gradients. In HCM, definition of the endocardial/blood interface and visualization of the myocardial structure, as well as quantification of intraventricular gradients, are fundamental to the study of the pathology. OBJECTIVES: The objective of this study was to evaluate the clinical utility of new UCAs in morphologic study (segmental analysis) and quantification of maximum intraventricular gradients (IVG Max) in HCM, as well as the feasibility and interest of determining mean gradients (IVG Med) in HCM. METHODS: Thirty-four patients with clinical and echocardiographic diagnosis of HCM were studied. Baseline IVG was considered significant when over 30 mmHg. Left ventricular morphology and IVG quantification were assessed before (study A) and after (study B) UCA injection. Maximum (Max) and mean (Med) values of delta IVG were calculated. Endocardial border definition of ventricular segments was analyzed in studies A and B and the percentage of ventricular segments that were completely visualized throughout the cardiac cycle was established. RESULTS: The mean values of delta IVG Max for studies A and B were 51 +/- 31 mmHg and 61 +/- 32 mmHg, p = NS. The mean values of delta IVG Med were 26 +/- 16 mmHg in study A and 31 +/- 17 mmHg in study B, p = NS. The correlation between delta IVG Max and Med in study A was r2 = 0.74, p < 0.01, while in study B it rose to a value of r2 = 0.82, p < 0.01. Segmental analysis: In all segments studied the visualization percentage was higher after UCA injection, with a statistically significant difference in all lateral and anterior wall segments. DISCUSSION AND CONCLUSIONS: HCM is usually evaluated in a non-invasive way by echocardiography. There are no references to systematic use of UCAs in HCM patients. The value of determining the maximum gradient in HCM is generally accepted, but the importance of the mean gradient is not known. In this work, UCAs improved the Doppler signal without distorting values. In HCM, values measured using UCAs have a better correlation, with a smaller discrepancy between Max and Med gradients. This study suggests that mean gradient determination enables better characterization of the dynamic variability of the gradients because there is a correlation between Max and Med gradients. The real importance of mean gradients is not yet established, so further studies are necessary. In conclusion. UCAs are very useful in morphological assessment. The interest of UCAs in determining intraventricular gradients and the value of mean gradients in HCM are not clearly demonstrated in this study.

Cardiomyopathy, Hypertrophic↗