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Biomedical subjects

Isabel Silvestre

Publications and source records attributed to Isabel Silvestre.

6 recordsLinked to original sources
PubMed2004

Transesophageal echocardiography-guided cardioversion of atrial fibrillation. Selection of a low-risk group for immediate cardioversion.

INTRODUCTION: In patients (pts) with atrial fibrillation (AF) of more than 48 hours' duration, electrical cardioversion (ECV) should only be performed after 3 weeks of effective anticoagulation. Transesophageal echocardiography (TEE) allows earlier ECV; however, despite exclusion of thrombi in the atrium and left atrial appendage (LAA), cases of thromboembolism related to ECV have been documented in AF. To define a low-risk group for cardioversion without previous anticoagulation, pts were selected for immediate ECV if no thrombi or dynamic spontaneous echo contrast (auto-contrast) were found after TEE and if LAA velocity was more than 0.25 m/sec. METHODS AND RESULTS: We performed TEE in 31 consecutive pts referred for ECV for AF of more than 48 hours' duration and without previous anticoagulation. After TEE the pts eligible for immediate ECV began anticoagulation with low molecular weight heparin (enoxaparin), subcutaneously in therapeutic doses, together with warfarin immediately before cardioversion. Enoxaparin was continued until an INR of over 2 was reached. Based on the TEE findings, the pts were divided in 2 groups: immediate ECV, group A, 20 pts with a mean age of 62 +/- 13 years, 6 female; and conventional therapy with warfarin before ECV, group B, 11 pts, mean age of 67 +/- 10 years (p < 0.05), 2 female. None of the pts in either group had mitral stenosis or previous episodes of thromboembolism. The mean transverse diameter of the left atrium in the 31 pts was 47 +/- 4.5 mm, without statistically significant differences between the 2 groups. Of the 11 pts in group B, 3 had a thrombus in the LAA, 6 dynamic spontaneous echo contrast and the remainder LAA velocities of less than 0.25 m/sec. ECV was achieved in all the pts, with no complications. Oral anticoagulation was maintained for at least a month. At one month, sinus rhythm was maintained in 75% of group A and 45% of group B (p < 0.01). CONCLUSION: In pts with AF of more than 48 hours' duration and no previous history of thromboembolism, the use of our exclusion criteria during TEE enabled stratification of a low-risk population for immediate ECV, which was accomplished effectively and safely in 2/3 of the pts. This strategy is associated with early symptomatic improvement, and may contribute to maintenance of sinus rhythm after one month, which was significantly better than in the pts who had prolonged therapy with warfarin before ECV, despite the differences found in age and left ventricular function.

Aged↗
PubMed2004

Acute myocardial infarction in patients aged under 45 years.

INTRODUCTION: Coronary artery disease (CAD) becomes an important cause of morbidity and mortality after the age of 45 years. OBJECTIVE: To evaluate the epidemiology and clinical features of all patients under 45 years old admitted with myocardial infarction. METHODS: We studied 595 patients admitted with myocardial infarction between January 2000 and December 2002. We analyzed risk factors for CAD, clinical profile, therapeutics and complications (arrhythmic, mechanical and ischemic). The patients were divided into two groups: A--under 45 years old and B-- aged 45 or over. RESULTS: Group A--56 patients (9.4%); group B--539 patients (90.6 %). There was a higher prevalence of smoking in group A (57% vs. 23.6%; p < 0.01). Hypertension, diabetes and history of CAD were significantly more common in group B. There were no differences in hyperlipidemia (group A: 43% vs. group B: 43.5%). Fibrinolysis was performed in 28 patients (70%) from group A compared to 40 patients (45.9%; p < 0.01) from group B. Use of digitalis and inotropic agents was greater in group B. No differences were found in other pharmacological therapeutics. We found more complications in group B (24% vs. 11%). CONCLUSIONS: There was a higher prevalence of smoking in patients under 45 years old and of hypertension, diabetes and CAD in patients aged over 45. The high rate of hyperlipidemia in both groups highlights the importance of primary prevention. Fibrinolysis was performed more frequently in younger patients. There were more complications in older patients.

Adult↗
PubMed2003

Hyperhomocysteinemia--case report.

The authors present the case of a 25-year-old female patient, white, with mental retardation and proptosis, and a history of repeated cerebrovascular events. During investigation elevated levels of homocysteinemia and homocystinuria were demonstrated. The authors present a review of related literature.

Adult↗
PubMed2002

Leiomyosarcoma of the inferior vena cava--a very rare case report.

The authors present a case report of a patient with abdominal pain that began 6 months before hospital admission. Ambulatory abdominal echography and computed tomography (CT) revealed partial thrombosis of the inferior vena cava (IVC) with right atrial extension. During hospitalization, magnetic resonance imaging (MRI) revealed aspects suggesting a tumoral lesion of the right atrium, rather than a thrombus, with tumoral extension to the IVC. The echocardiogram showed images suggesting a right atrial tumor. Transesophageal echocardiography confirmed the diagnosis. During surgery, an IVC tumor was found invading the right atrium, which histopathology confirmed as a leiomyosarcoma. The authors present this case because this type of tumor is rare (21 cases worldwide at this anatomic site), it is difficult to diagnose, and its management has not been adequately described. The authors review the literature relevant to this case.

Heart Neoplasms↗