Biomedical subjects
Publications and source records attributed to Luís Oliveira.
Myocarditis is one of the many possible forms of cardiac involvement in systemic lupus erythematosus. Its clinical presentation ranges from asymptomatic patients with self-limited disease to fulminant heart failure that can lead to death. In most cases treatment consists of supportive care only. The authors present the case of a patient with lupus myocarditis.
Congenital aortocaval fistulae are a rare cause of left-to-right shunt. In this clinical case, an 8-year-old child was referred by the family doctor for pediatric cardiology consultation after detection of a chest murmur. Cardiac auscultation revealed a continuous murmur, best heard on the left sternal edge and back. During the study, cardiac angiography showed a large collateral vessel in the middle third of the thoracic aorta with a complex and sinuous route that ended at the superior vena cava. Percutaneous embolization was performed using a coil. Due to the large size of the collateral a total of three coils were necessary for complete occlusion. No complications were recorded and six-month follow-up confirmed absence of shunt. Compared to the surgical option, this procedure is less invasive and apparently with less risk to the patient.
INTRODUCTION: Diabetes mellitus has a high prevalence in developed countries and is associated with high cardiovascular morbidity and mortality rates. In this study we evaluated in-hospital evolution of diabetic patients admitted to a cardiac care unit with acute coronary syndrome without ST segment elevation. METHODS: We analyzed a population of 176 consecutive patients, 36 (21%) with diabetes, admitted with chest pain at rest, elevated biological markers for myocardial necrosis and/or ST segment/T wave changes suggestive of myocardial ischemia. RESULTS: The groups were similar in terms of age, sex, presence of other risk factors for coronary artery disease (CAD), past history of CAD or myocardial revascularization. There were no differences between the groups with respect to extent of CAD, left ventricular function or blood levels of biological markers. The comparison between the two groups did not show any statistical difference concerning the following in-hospital events: non-Q wave MI, Q-wave MI, PTCA and death. On the other hand, the diabetic patients had a worse outcome in term of congestive heart failure (25% and 11%, p = 0.04), CABG (25% and 10%, p = 0.02) and combination of death, congestive heart failure and Q-wave MI (42% and 23%, p = 0.02). CONCLUSION: In spite of similar extent of CAD and similar left ventricular function, diabetes mellitus in patients with acute coronary syndrome without ST segment elevation identifies a higher-risk population with more complicated in-hospital outcome.