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F Pais

Publications and source records attributed to F Pais.

13 recordsLinked to original sources
PubMed1999

Echocardiographic evaluation in 485 aeronautical workers exposed to different noise environments.

INTRODUCTION: Vibroacoustic disease (VAD) is a heterogeneous and systemic entity, caused by long term (> or =10 yr) exposure to noise environments characterized by large pressure amplitude and low frequency (LPALF) (> or =90 dB SPL, < or = 500 Hz), and not explained by other possible etiologic agents. The goal of this study was to identify possible structural changes in hearts of men with suspected VAD. METHODS: A total of 485 men were divided into 3 noise groups: no noise exposure (< or =70 dB), n = 48 (Group I); moderate noise exposure, (>70dB and < 90 dB), n = 113 (Group II); and intense noise exposure (> or =90 dB), n = 324 (Group III). Echo-Doppler studies were performed (HP SONOS 1500) and recorded on coded videotapes. Three observers performed blinded evaluations of 26 echo-Doppler parameters. For the purpose of the present study only 12 morphological parameters were compared among the groups: thickening of the mitral, aortic, tricuspid, and pulmonary valves, pericardium and endocardium; mitral valve regurgitation, prolapse and ruptured chordae tendinae; and inflow velocities. Thickness and severity of the applicable parameters were scored in seven-grade scale (0,0.5,1, ...,3). RESULTS: All evaluated parameters were statistically significantly different in Group I vs. Group III, except flow velocity E. Comparison of Group I vs. Group II revealed statistically significant differences in mitral, aortic, tricuspid and pericardial thickening, with the strongest evidence for mitral and pericardial structures. CONCLUSIONS: This confirms the results of previous studies. Occupational exposure to noise environments characterized by LPALF noise causes structural changes in the heart. Mitral valve and pericardial thickening constitute the first signs of VAD.

Adult↗
PubMed1994

[The transesophageal echocardiogram in the evaluation of cerebrovascular diseases].

We evaluated the diagnostic sensitivity and clinical value of transesophageal echocardiogram in 72 patients with a potential cardiogenic embolic stroke or transient ischemic attacks at the Neurological Department/Cerebrovascular disorders out-patient clinic of Santa Maria Hospital between February 1991 - February 1993. The transesophageal echocardiogram was performed in UTIC-Arsénio Cordeiro after current diagnostic evaluation. Eighteen patients had previous cardiac disease and in 58 the transthoracic echocardiogram was normal. Transesophageal echocardiography detected the presence of cardiac abnormalities in 49 patients (68%) and a potential cardiac embolic source in 38 (53%). Twenty-eight patients were started on anticoagulants. The most frequent cardiogenic embolic sources were: patent foramen ovale, atrial septal aneurysm and a left auricular/auricular appendicular dilatation. Twelve of these patients, who had a non cardiac cause for their stroke, were considered as a control group. The remaining cases (n = 60) had significantly more (+32%; 95% CI = 2-62) cardiac abnormalities than this control group. We performed a separate analysis of 3 subgroups of patients: 1--without and 2--with cardiac disease; 3--age < or = 45 years. No significant differences were found between group 1 and 2. Among the subjects aged < or = 45 years, undiagnosed cardiopathy was less frequent (-21%; 95% CI = 1-43). These results confirm the diagnostic sensitivity and the clinical value of transesophageal echocardiogram in detecting potential embolic sources in patients with stroke/transient ischemic attacks irrespective of age or previous cardiac disease.

Adolescent↗
PubMed1993

[Dilated cardiomyopathy in a patient with Becker's muscular dystrophy. A clinical case report].

The authors report a case of dilated cardiomyopathy caused by a muscular dystrophy, namely Becker's disease. The peculiarity of this case is the fact that the patient has lived enough time to have clinical manifestations of myocardiopathy because, in general, in this myopathy, the affected males have a short life and the early myocardial involvement is rare. A particular attention is paid to the need of consulting the cardiac patients not forgetting an eventual causal systemic disease and to the crucial importance of the genetic counselling in that kind of diseases.

Adult↗
PubMed1993

[The clinical significance of mitral insufficiency detected by Doppler echocardiography in acute myocardial infarct].

OBJECTIVE: To assess the clinical significance of mitral regurgitation (MR) diagnosed by pulsed Echo-Doppler in patients with acute myocardial infarction (AMI). SETTING: Admission in a coronary care unit and a mean follow-up of 12 months. PATIENTS: Seventy nine patients admitted in a coronary care unit, and 66 patients were followed-up for 12 months (mean). METHODS: Pulsed Echo-Doppler were performed within three days after admission and the presence of MR was analyzed by apical four and two chamber views. RESULTS: There were 62 males and 17 females (mean age: 61.4 +/- 10.8 (31-84) years). The location of AMI was: anterior--40, inferior--30, non-Q wave--6, indeterminate--2 and combined--1. Killip classes were: class I--50, class II--20, class III--7 and class IV--2. 17 patients had a previous AMI. The in-hospital mortality was 9 patients (12%) and the post-hospital mortality was 3 patients (4.5%). MR was detected in 24 patients (30%) in whom 14 (58%) had no murmur of MR previously auscultated. MR was considered moderate in 10 patients and mild in the others 14 patients. There were no significant statistical differences in the frequency of MR in relation to AMI location: anterior 57%, inferior 40% (chi 2 = 0.71, NS); to the presence of a previous AMI: 47% vs 26% (chi 2 = 1.93, NS); to age (61 vs 62 years). The patients with MR suffered a more serious degree of heart failure (class III + class IV): 29% vs 4% (chi 2 = 8.41, p < 0.005); higher hospital mortality: 29% vs 4% (chi 2 = 8.41, p < 0.005); and higher one year mortality: 37.5% vs 5.5% (chi 2 = 10.9, p < 0.001). CONCLUSION: The presence of MR had no relationship with AMI location, the presence of a previous AMI or patients age. The patients with MR had a more serious degree of heart failure, higher hospital and one year mortality. The presence of MR detected by pulsed Echo-Doppler is a sign of bad prognosis although being auscultatory silent in a half of patients.

Adult↗
PubMed1992

[Formation of left ventricular thrombus in acute myocardial infarction: significance of the determination of fibrinogen, of products of fibrinogen degradation, and of plasminogen].

OBJECTIVE: To evaluate the significance of the fibrinogen, the plasminogen and the fibrinogen degradation products levels as marks of left intraventricular thrombosis (LIVT) in acute myocardial infarction (AMI). METHODS: 219 consecutive patients of AMI admitted in a Coronary Care Unit of an University Hospital, were prospectively studied. All protocols included a clinical evaluation, an M-mode and 2D echocardiographic study and blood samples, at day 1, 3, 7 and at hospital discharge. In the intraventricular thrombus evaluation just the 4 Asinger grade was considered. In the laboratory evaluation we used: the Clauss chronometric method for the fibrinogen, the colorimetric method for the plasminogen and the agglutination in plaque for the FDP. The patients with ECO in the 2 or 3 Asinger grades and those in which ECO and laboratory study were not performed in the same day, were excluded. 101 patients remained on the study, and they were divided in two groups: 53 patients with LIVT and 48 patients without it. RESULTS: In both groups the fibrinogen raised along the first six days of the AMI, however in the group with LIVT this level didn't raise as high as in the group without LIVT (p < 0.001). In the FDP evaluation two peaks were found, one at 48 hours and another on the 6 th day, but there were no differences between the two groups. The plasminogen values raised along the first week of AMI, in a similar way in both groups. CONCLUSIONS: a) Fibrinogen levels raises in AMI, but this elevation is significantly smaller in the group with LIVT, which suggests fibrinogen consume in fibrin formation of the thrombus. b) FDP and plasminogen levels raise along the first week of AMI, but in a similar way in the two groups. c) None of these parameters permitted to individualize patients with thrombus formation.

Aged↗
PubMed1992

[A case of incessant junctional tachycardia in a female patient with aneurysm of the interauricular septum].

A permanent supraventricular tachycardia (SVT) was diagnosed in a 54-year-old hypertensive but cardiologically asymptomatic female patient, admitted to a surgery department for biliary lithiasis and hepatic echinococcosis. Heart rate was about 130 bpm and ECGs showed negative P waves in leads I, II, III, aVF, and precordial leads V2 to V6, being the RP' interval longer than P'R interval. Pharmacological intervention during Holter monitoring (20 hours) was instituted: following i.v. propranolol (4 mg), heart rate progressively decreased (to 112 bpm), mainly due to an increase in SVT RP' interval, and brief, spontaneous SVT interruptions occurred, preceded by P'R interval prolongation; SVT stopped after P' recording, and resumed after 2 sinus beats, (showing enlarged P waves and slightly prolonged PR interval), induced by cycle length shortening; later on, under i.v. amiodarone infusion (100 mg/hour) and coincident with the sleeping period, SVT cycle length progressively increased (to 600 msec), due to equivalent increases in P'R and R'P intervals. Two premature ventricular contractions (PVC) occurred during Holter monitoring at a coupling interval of 80-85% of SVT cycle length (480 msec): one PVC apparently originated in left ventricle lateral wall, captured the atria, which were activated 75 msec earlier than expected; the other PVC, apparently originated in left ventricle septoapical region, did not interfere with SVT cycle length. Before these data, a diagnosis of circus movement tachycardia, incorporating a concealed accessory pathway with slow retrograde conduction and ventricular insertion in the postoroseptal or left posterior paraseptal region, and showing minor impairment of antegrade AV nodal conduction, was made. Invasive electrophysiological study was then discarded. With combined oral antiarrhythmic therapy (amiodarone, 600 mg/d), plus propafenone, 450 mg/d), sinus rhythm was permanently restored, with evidence of intraatrial block, slightly prolonged PR interval and no preexcitation. Transesophageal echocardiography revealed a small atrial septal aneurysm associated with a small atrial septal defect; echocardiographic features were consistent with the hypothesis of incomplete regression of the atrial septal aneurysm after partial closure of the atrial septal defect. Abdominal surgery (cholecystectomy plus partial hepatic pericystectomy) was performed without any complications or SVT recurrences. During a 6-month follow-up period, maintaining amiodarone (200 mg/d) and propafenone (450 mg/d), the patient remained SVT-free, and Holter monitoring performed at 3 and 5 months showed permanent sinus rhythm and 1:1 AV conduction with slightly prolonged PR interval (less than 0.29 sec and shortening at faster heart rates). This case documents Holter monitoring capability for the evaluation of tachycardia mechanisms in patients with permanent SVT.

Amiodarone↗
PubMed1990

[A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully].

The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity.

Female↗
PubMed1989

[Early left ventricular dysfunction in acute myocardial infarct. Evaluation using imaging methods].

A patient admitted in a Coronary Care Unit with an acute anterior myocardial infarction, is presented. He had initially normal left ventricular function and, on the 11th day he had, suddenly, an acute pulmonary edema. The reason for this episode was detected through imaging techniques--echocardiography and isotopic studies, and consisted on infarct expansion with early evolution for apical aneurysm. Contrast angiography confirmed the presence of a huge aneurysm and two vessels disease. Tallium Scintigraphy showed reversible ischemia beyond necrotic areas. The patient was submitted to aneurysmectomy and received three aorto-coronary bypass. He is now doing well, in class I, NYHA. The discussion emphasizes the actual role of imaging techniques in the diagnosis of infarct expansion and early functional aneurysm. We discuss the prognostic of infarct expansion and the importance of perfusion studies on defining areas of myocardium in jeopardy, enabling a better surgical approach.

Echocardiography↗
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↗