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C Perdigão

Publications and source records attributed to C Perdigão.

32 records · Page 2Linked to original sources
PubMed1989

[Clinical methods for evaluating infarct size and its anatomic correlations. A study conducted with 193 cases. II. Evaluation of infarct size by determining maximal creatine phosphokinase in serum. Enzimatico-anatomic correlations].

AIMS: To compare the infarct size calculated by the peak serum CK method with the anatomic infarct size in a population dying of acute myocardial infarction. CONCEPT AND PLACE OF THE STUDY: To use the method of peak serum CK in the assessment of infarct size, calculated by a method developed by the authors, in a population dying of acute myocardial infarction in a coronary care unit. METHODS: 193 patients who successively died with acute myocardial infarction entered the study. After establishing the exclusion criteria the anatomical infarct size was measured using the method developed by the authors of myocardial slices after fixation of the heart and by the peak CK method. The two methods were correlated using linear regression curves. RESULTS AND CONCLUSIONS: A global correlation between the two methods was found although wide scattered values were found. After dividing the population in several subgroups, the analysis showed that survival below 48 hours, death in left ventricular failure, inferior infarcts and reinfarction influenced negatively this correlation. The anatomical method showed its value for this kind of evaluation having always in mind its known limitations. The enzyme method looked less discriminating as peak CK, obtained by 12 h sampling will seldom reflect the peaks of CK liberation curve. As the study was applied to a population of patients dying of acute myocardial infarction its results cannot be applied without caution to a population of survivors. We anticipate that in such a population peak CK will have a better correlation with real CK peaks even with 12 hours sampling and therefore reflecting more accurately infarct size.

Autopsy↗
PubMed1989

[Clinical methods for evaluating infarct size and its anatomic correlations. Study carried out in 193 cases. III. Comparison of data on the evaluation of the infarct size using the QRS score and a method of maximal creatine kinase determination in the serum].

AIMS: To compare two methods concerning the clinical evaluation of infarct size--one using a QRS score, the other based on peak Ck values--applied to the same population. CONCEPT AND PLACE OF THE STUDY: to determine--based on previously established correlations between a QRS score and the anatomic total infarct size on one hand, and between the peak CK values and the anatomic recent infarct size on the other hand--which myocardial infarction subgroup constitutes the best indication for each method. The study took place in a Coronary Care Unit of a Central Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction through out 4 years were studied. After establishing the exclusion critéria, the QRS score was calculated according to the method of Selvester modified by Wagner, and peak CK values were evaluated. Infarct size, either recent or old, was determined by means of an anatomical method developed by the authors and based on Hackel's and Alonso's previous works. Correlations were established between data from each clinical method and those from the anatomical method. Several myocardial infarction subgroups were considered for comparison of the correlations found in each subset. RESULTS AND CONCLUSIONS: As long as QRS score was regarded, significant correlations were found between the evaluation by QRS score and anatomical infarct size in the subgroups of patients with severe pump failure, prior myocardial infarction, or total loss of ventricular muscle mass of at least 20 percent; however, a significant correlation was missing when the whole myocardial infarction group was taken into consideration. When peak CK value were considered, a weak significant correlation was found between the evaluation by enzyme determination and anatomical infarct size in the whole group of patients, but a stronger correlation was present in the subgroups of patients with survival longer than 24 hours, anterior wall myocardial infarction, free wall cardiac rupture, or first acute myocardial infarction. In conclusion the choice of the method to be used in the clinical evaluation of infarct size should take into account the type of population beeing studied, and follow the results obtained in different myocardial infarction subgroups as mentioned above.

Creatine Kinase↗
PubMed1989

[2 cases of acute myocardial infarct complicated by fatal pulmonary embolism].

Two cases of pulmonary embolism with lethal course in the setting of acute myocardial infarction are presented. Both cases are clinically characterized by a late pulmonary embolism occurrence (2nd and 3rd week, respectively), and the presence of a large infarct, heart failure during acute myocardial infarction evolution and the interruption of anticoagulant therapy due to a complication. From the anatomic point of view, both cases had large hearts and very large biventricular infarctions. On the other hand, deep venous plexus constituted the pulmonary embolism origin in one case, and right ventricular thrombosis in the other.

Aged↗
PubMed1989

[Intraventricular thrombi in acute myocardial infarct. Clinicoanatomic study carried out in 193 consecutive cases].

AIMS: To determine the incidence of intraventricular thrombi in patients who died of acute myocardial infarction, as well as to define the clinico-anatomical parameters of the population with thrombi. CONCEPT OF THE STUDY: To apply a clinical as well as an anatomical protocol of prospective study, in patients who died of acute myocardial infarction. The clinical protocol contemplates 64 parameters and the anatomical protocol contemplates 34. in the anatomical study were used very discriminative technics, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of an University Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction in a CCU between 1983 and 1986. The only criteria for the inclusion in the study was the possibility of doing a necropsy study, which was done in 77% of the patients who died in that period. The study was a prospective one, being excluded only the patients in whom the anatomical study didnt confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 88 (43%) presented thrombus in at least one of the ventricular cavities, 38 (26%) only in left ventricle, 15 (8%) only in right ventricle and 35 (18%) in both ventricles. The set with thrombus has presented a few characteristics which granted it some individuality. Thus, this group presented: a higher delay between the beginning of acute myocardial infarction and the admission in the CCU (and so in the beginning of the anticoagulant therapy), lower prevalence of diabetes, higher prevalence of left ventricular failure (Killip class III or IV), higher prevalence of cardiogenic shock and so a higher need of inotropic therapy, higher heart weight, higher prevalence of auricular thrombi and bigger infarct size when evaluated by a QRS score. In the group with left ventricular thrombi, the anterior infarct was more frequent and in the group with right ventricular thrombi the right ventricular infarct was also more frequent. The systemic embolism was uncommon in this group (1 case in 193 patients). CONCLUSIONS: 1. The intraventricular thrombi occurs in about half of the patients who died of acute myocardial infarction. 2. The group with thrombi has presented some characteristics which makes it different from the group with no thrombi. 3. The delay in the beginning of the anticoagulant therapy seems to be a risk factor of intraventricular thrombosis.

Aged↗
PubMedDate not supplied

[Incidence and forms of clinical presentation of the various morphologic types of myocardial laceration in the acute phase of infarct. A 4 years' caseload at a coronary unit. A clinico-anatomic study of 193 successive cases].

AIMS: To determine the incidence of different morphological type of myocardial laceration (wall rupture) in patients who died of acute myocardial infarction, as well as to study the several clinical forms of presentation of different types of myocardial laceration. CONCEPT OF THE STUDY: To apply a protocol of prospective study, that includes 64 clinical and 34 anatomical parameters, using very discriminative technics in the anatomical study, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of a University Hospital. POPULATION: Of 1308 patients successively admitted in a CCU with acute myocardial infarction between 1983-1986, 252 have died. It was possible to perform a necropsy study in 193. The only criterion for inclusion was the family agreement. METHODS: The study was a prospective one, being excluded only the patients in whom the anatomical study didn't confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU, using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. In the study of the myocardial laceration a fourteen septal perpendicular cuts technic was applied, with a laceration development macroscopic study, and microscopic study of the more interesting cuts. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 49 presented a complete free wall rupture (25%) and in two others there were an interventricular septal rupture and free wall rupture. The amount of free wall rupture was then 51 cases (26%), with a corrected incidence for the population with AMI of 5.1%. In 7 cases we found an interventricular septal rupture (in two cases associated with complete free wall rupture and in other two cases with an incomplete left ventricular rupture), what represents an incidence in necropsy of 3.6%. Since that in this period five patients with septal rupture have been operated and in three others the hemodynamic diagnosis was made, dying this patients without being performed necropsic study, the amount of septal ruptures was of 15 cases, what represents a corrected incidence of 1.1% in the population with AMI. The clinical forms of presentation of free wall rupture were the following: syncope followed by death (60%), shock (21%), transitory syncope (4%), psycho-motor troubling (4%). Pain persistence or recurrence associated with other clinical symptoms occurred in 63% of the patients. Hypotension, not always evoluting to shock, occurred in 33%, and pericarditis in 21% of the cases. When the different anatomical types of free wall rupture were considered (type I-direct rupture; type II-multicanalicular rupture; type III-rupture covered by an interventricular thrombus), we observed that in type I there was prevalence of syncope (71% and only 50% showed pain persistence or recurrence, when in type II syncope occurred in 67% and shock in 22%, with pain in 56%, and in type III the occurrence of syncope and shock were similar (44% vs 38%), with pain in 81% of the cases. Hypotension was verified in 56% in type III, 21% in type I and 22% in type II. Pericarditis never occurred in type I, happened in 33% in type II and 25% in type III. The terminal accident took an average 44 minutes long in type I, 3.8 hours in type II and 9.2 hours in type III. The delay in admission was nine hours in type I, 19 in type II and 30 in type III, and the time between the onset of symptoms and death was 2.9, 2.7 and 5.4 days respectively in types I, II and III. In what concerns the interventricular septal rupture shock occurred in all cases but one, in which association with free wall rupture determined cardiac tamponade with syncope.(ABSTRACT TRUNCATED AT 400 WORDS)

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PubMedDate not supplied

[A case of perforation of the interventricular septum with free wall rupture, in the acute phase of myocardial infarct, successfully treated with surgery].

The authors present a case of interventricular septal rupture with left ventricular free wall rupture post acute myocardial infarction operated on the third day after the onset of symptoms, by enfartectomy and application of a septal patch. Then, they compare this case with four cases referred in the literature, discussing the different and similar points between them. They emphasize the good results of this kind of surgery, but they also remark the need of an early diagnosis and surgery in these patients.

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PubMedDate not supplied

[Pulmonary embolism in acute myocardial infarct. Clinico-anatomic study of 19 cases].

The aim of this study was to evaluate the incidence of pulmonary embolism as the cause of death in acute myocardial infarction; to define the anatomic and clinical profile of a subset of patients deceased by pulmonary embolism; to study the localization and characteristics of pulmonary emboli. An anatomic and clinical protocol was systematically applied to the dying patients with acute myocardial infarction admitted in a CCU of an University Hospital. Therefore, 193 patients consecutively deceased by acute myocardial infarction were studied. Sixty-four clinical parameters were evaluated together with 34 anatomic parameters concerning a very discriminative anatomic study protocol. The sole exclusion criterion for necrotic study was the lack of family consent; necropsy was thus performed in 77% of patients. Therefore, we verified that the incidence of pulmonary embolism as the cause of death was 9.8%. Delay in admission as well as the interval between the onset of symptoms and death, were longer in the deceased by pulmonary embolism than in subjects showing other causes of death. Bradycardia was absent in pulmonary embolism patients, and asystole was the terminal electric accident in the great majority of cases; heart weight was greater, and biventricular infarction and right ventricular thrombosis were also more frequent in this subset of patients. In almost half of cases, pulmonary emboli were located in the main pulmonary artery, being multiple and peripheral in four.

Aged↗
PubMedDate not supplied

[Coronary thrombosis in patients who have died of acute myocardial infarct. A clinico-anatomical study of 167 successive cases].

AIM: To determine the incidence of recent coronary thrombus in a population died of acute myocardial infarction (AMI) and to evaluate the relation between its presence and some clinical parameters (age, gender, time interval between the onset of symptoms and death and cause of death). POPULATION AND METHODS: 167 hearts of consecutive patients died of AMI and without thrombolytic therapy. Hearts were fixed in formaldehyde 10% for two weeks and then the epicardial coronary arteries were divided in 5 mm segments, which were examined by visual inspection to identify recent thrombi. Cuts for microscopical observation were obtained in cause of doubt. In each patients a clinical protocol with 64 parameters is performed. In statistical treatment Pearson's dispersion test and Student's t test were used. RESULTS: We found coronary thrombus in the infarction related artery in 74%. The thrombus distribution in the epicardiac coronary arteries was the following: 47% in the anterior descendent artery, 27% in the right coronary artery, 21% in the left circumflex and 5% in the left main. The comparison between the groups with and without coronary thrombus showed no differences in age and gender, but the time interval between AMI and death was shorter in the group with thrombus. Concerning the different causes of death (cardiac failure, cardiac rupture and others) the coronary thrombus prevailed in the group with left ventricule free wall rupture. There was no influence of the time interval between AMI and death on the larger prevalence of coronary thrombus found in cardiac rupture. CONCLUSIONS: The frequency of recent coronary thrombus in the infarction related artery was of 74% in this group of patients died of AMI without thrombolytic therapy. The presence of coronary thrombus was not related with patients age or gender. The frequency of coronary thrombus was inversely proportional to the time interval between AMI and death, and larger in the group with left ventricule free wall rupture.

Age Factors↗
PubMedDate not supplied

[Myocardial fibrosis--the theoretical bases, clinical aspects and therapeutic implications].

A review on the present knowledges of the myocardial structure, with particular emphasis on the collagen network and its degradation/synthesis process was performed. Myocardial fibrosis and cardiac remodeling concepts are analysed, explaining them in the context of ventricular hypertrophy, arterial hypertension, myocardial remodeling in ischemic heart disease and cardiac remodeling in the aged. We also review the role of the renin-angiotensin-aldosterone system in myocardial fibrosis, as well as the results of preventing action of angiotensin converting enzyme inhibitors and aldosterone antagonists in myocardial fibrosis and consequent cardiac remodeling in the animal experimentation. Clinical and therapeutic implications of this knowledge are discussed as well as therapeutic implication in man, in view of recent studies.

Animals↗
PubMedDate not supplied

[Acute myocardial infarct and left ventricular dysfunction. Morphologic bases, clinical aspects and pharmacologic prevention].

The morphological bases which condition left ventricular disfunction after acute myocardial infarction as well as the concepts of expansion and remodelling of the myocardium are reviewed. The clinical aspects indicating ventricular disfunction are presented and several pharmacological effects which have been proposed for the prevention of this situation. Particular emphasis is given to the role of angiotensin-converting enzyme inhibitors in the prevention of left ventricular disfunction after acute myocardial infarctions, based on the most recent clinical trials.

Angiotensin-Converting Enzyme Inhibitors↗