Echocardiographic diagnosis of persistent left superior vena cava.
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Adult↗
Biomedical subjects
António Freitas
Publications and source records attributed to António Freitas.
Intraventricular thrombi with systemic embolization: two clinical cases.
Ventricular thrombi are a frequent complication of dilated cardiomyopathy and acute myocardial infarction, with variable risk of embolization according to the clinical setting and thrombus morphology. The authors report two cases of patients admitted on the same day for acute myocardial infarction and dilated cardiomyopathy respectively, with high embolic risk left ventricular thrombi that embolized to the lower limbs after admission. Echocardiography, considered the gold standard diagnostic tool for intraventricular thrombi, is also the mainstay of embolic risk evaluation, for characterizing their size, mobility and echostructure. In the absence of evidence-based guidelines, management options--anticoagulation therapy, thrombolysis or thrombectomy--must be decided according to each specific case, taking account of embolic, bleeding and surgical risk.
Adult↗
New diagnostic criteria for acute myocardial infarction and in-hospital mortality.
BACKGROUND: The recent introduction of new diagnostic criteria for acute myocardial infarction (AMI), with troponin measurement, has increased the number of patients admitted with this diagnosis. OBJECTIVE: To evaluate the epidemiologic and prognostic implications of the new diagnostic criteria for AMI. METHODS: This was a retrospective study of 586 patients admitted for acute coronary syndrome (ACS) to the coronary care unit of our hospital, between 2002 and 2003. Data were collected from RECIMA, the Madeira Ischemic Heart Disease Registry. The population was analyzed following two different definitions of ACS: 1 - old criteria (Group I): AMI with ST elevation (typical symptoms or ECG with ST-segment elevation and raised CK-MB >2x), AMI without ST elevation (typical symptoms or ECG without ST elevation and raised CK-MB >2x) and unstable angina (UA) (symptoms or ECG indicative of ischemia, with normal CK-MB, regardless of troponin status); 2 - new criteria (Group II): AMI with ST elevation (typical symptoms or ECG with segment ST elevation and raised CK-MB >2x or troponin), AMI without ST elevation (typical symptoms or ECG without ST-segment elevation and raised CK-MB >2x or troponin) and UA (symptoms or ECG indicative of ischemia, with normal enzymes). We evaluated whether this change in criteria had any influence on in-hospital mortality. RESULTS: The new criteria significantly (by 11.9 %) increased the total number of patients admitted with AMI. This was due to an increase in AMI without ST elevation (p < 0.001) and a decrease in patients with UA (p < 0.001), with no changes in AMI with ST elevation. In-hospital mortality was lower in patients with AMI diagnosed by the new criteria and in those with UA. CONCLUSION: The overall increase in AMI resulting from the new diagnostic classification was accompanied by a decrease, although not statistically significant, of in-hospital mortality, probably due to the lower risk of the population analyzed.
Aged↗
The complementary role of cardiac magnetic resonance imaging in the evaluation of patients with aortic stenosis.
OBJECTIVE: To compare direct planimetry of aortic valve area (AVA) by cardiac magnetic resonance (CMR) imaging with transthoracic echocardiography (TTE), using the continuity equation. METHODS: 15 symptomatic patients with aortic stenosis were studied. AVA was measured with CMR from steady state free precession imaging by planimetry. AVA was also calculated by TTE images using the continuity equation. RESULTS: The evaluation of AVA by both CMR and TTE was possible in twelve out of fifteen patients. CMR was able to determine the AVA in all fifteen patients. AVAs obtained by CMR and TTE were very similar and a good correlation existed between the values obtained by either technique. CONCLUSION: CMR planimetry is highly reliable and reproducible. AVAs obtained by CMR compare well with those obtained by TTE. Therefore, CMR planimetry of AVA with steady state free precession is a useful diagnostic tool, particularly if uncertainty exists.
Aortic Valve Stenosis↗
Double orifice mitral valve in an asymptomatic adult with an unusual combination of congenital malformations: a case report.
We report a case of an asymptomatic adult patient, with several congenital malformations including an infrequent variant of double orifice mitral valve, postductal aortic coarctation, bicuspid aortic valve and an aneurysm of the right Valsalva sinus. The loss of support of the right coronary cusp of the aortic valve caused major aortic regurgitation. With the exception of the mitral valve, which was left untouched because it was neither stenotic nor regurgitant, all the other abnormalities were successfully corrected, in a two-step surgical approach.
Abnormalities, Multiple↗
Left ventricular pseudoaneurysm with a double oriffice after myocardial infarction.
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Aged↗
Special program to reduce cardiology consultation waiting lists: report on an innovatory experience.
The problem of waiting lists has been widely debated in the Portuguese society. In this paper, the authors report the first results of a prioritization approach, started in March 2000. In this program cardiologists and general practitioners work in close proximity, coordinating efforts in order to improve the establishment of clinical priorities, and consequently optimize hospital referral. Working as cardiology consultants, the authors were able to reduce the number of first consultation requests by 77.9% (December 2002). For the first time it was possible to match the number of requests with the available consultation times, halting the growth of the waiting list.
Cardiology↗