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Filipa Marques

Publications and source records attributed to Filipa Marques.

2 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↗