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Biomedical subjects

R B Bestetti

Publications and source records attributed to R B Bestetti.

At least 37 records · Page 2Linked to original sources
PubMed1994

Noninvasive predictors of mortality for patients with Chagas' heart disease: a multivariate stepwise logistic regression study.

This prospective investigation was conducted in an attempt to identify noninvasive predictors of mortality for patients with Chagas' heart disease through a multivariate stepwise logistic regression study. Fifty-six patients with a positive complement fixation test for Chagas' disease were followed up at the Cardiomyopathy Clinic of our institution from April 1990 to April 1992. Patient age was 59 +/- 17 years; 28 (50%) were male. Upon admission, 19 patients (33%) were in the New York Heart Association (NYHA) class III and 8 (14%) in the NYHA class IV. Systolic blood pressure was 125 +/- 23 mm Hg, diastolic blood pressure 76 +/- 11 mm Hg and resting heart rate 77 +/- 11 beats/min. Forty patients (71%) were given digitalis and 39 (69%) angiotensin-converting enzyme inhibitors. Plasma Na+ was 140 +/- 4 mEq/l, K+ was 4.34 +/- 0.73 mEq/l and creatinine level 1.34 +/- 0.31 mg/100 ml. Cardiomegaly was observed in the chest X-ray of 41 of 51 (79%) available patients. Atrial fibrillation was observed in the resting ECG of 24 of 54 (44%) available patients, premature ventricular contractions in 23 (41%), right bundle branch block in 26 (46%) and left anterior hemiblock in 26 (46%) patients. Echocardiography revealed a left ventricular ejection fraction of 0.45 +/- 0.16, left ventricular systolic dimension of 51.23 +/- 13.53 mm and left ventricular diastolic dimension of 62.94 +/- 19 mm. Sixteen (28%) patients died during the 2-year study, 11 of them suddenly.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' disease.

The medical records of 24 patients with Chagas disease who died suddenly, between 1982 and 1988, were examined in an attempt to determine the clinical profile of sudden death in Chagas disease. Patient age ranged from 33 to 72 years (average: 51). Seventeen (70%) were male: Five (20%) were asymptomatic. Dyspnoea at rest was observed in 16 (66%) and palpitations in eight (33%). On physical examination, arrhythmias were observed in 14 (58%), ankle swelling in 13 (54%) and liver enlargement in 12 (50%) patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram: ventricular premature contractions were observed in 19 patients (79%) and a left anterior fascicular block in 14 (58%). The chest X-ray revealed cardiomegaly in 20 patients (82%), which was moderate in three (13%) and severe in 11 (45%). At autopsy, mean heart weight was 496 g. Dilatation of all cardiac chambers was detected in 22 (91%), and apical aneurysm in 19 (79%) patients. When compared with symptomatic patients, asymptomatic patients with Chagas disease had a higher frequency of normal physical examination (3/5 vs 1/19, P < 0.004), normal chest X-ray (3/5 vs 1/19, P < 0.01), and a lower heart weight (400 +/- 43 g vs 521.58 +/- 146.26 g, P < 0.03). The majority of patients with Chagas disease who die suddenly have severe underlying myocardial disease. In some of them, however, sudden cardiac death may occur in the presence of minimal, if any, heart involvement.

Adult↗
PubMed1993

Giant aneurysm of the ascending aorta secondary to medial agenesis in infancy.

A 14-month-old infant was found to have a giant aneurysm of the ascending aorta at the time he underwent angiography. At the time of autopsy, a saccular chamber was found to take the place of the aorta. Histologic examination of the aneurysm revealed absence of the medial layer. Thus, medial genesis may be another cause of aneurysm of the ascending aorta.

Aorta↗
PubMed1993

Superior vena cava syndrome as a complication of permanent cardiac pacemaker in a patient with Chagas' heart disease.

A 51-year-old man with Chagas' heart disease wearing a cardiac pacemaker developed a Superior Vena Cava Syndrome. Right-sided heart catheterization showed a Superior Vena Cava obstruction with extensive collateral flow via the azygous vein. The Superior Vena Cava Syndrome can be another complication of cardiac pacemaker implantation in patients with Chagas' heart disease.

Chagas Cardiomyopathy↗
PubMed1993

Congenital circumflex coronary artery fistula with drainage into the left ventricle.

Congenital coronary fistula is a rare heart defect, which consists of a communication between a coronary artery and a cardiac chamber of coronary vessel. Most such fistulae drain into a right heart chamber or into the pulmonary artery. Congenital left coronary artery-left ventricle fistula is even more uncommon. In a search of the literature, we were able to find only 15 other cases of congenital left coronary artery-left ventricle fistula. We describe here the clinical picture of a patient with left circumflex coronary artery draining into the left ventricle, and the successful surgical repair of the lesion. As far as we know, such a case has never before been reported in detail.

Adolescent↗
PubMed1992

Clinical characteristics of acute myocardial infarction in patients with Chagas' disease.

From 1981 to 1988, 404 patients at our institution were found to have acute myocardial infarction. Of them, 18 (4%) had a positive fixation test for Chagas' disease. Patient age ranged from 41 to 80 years (median = 59). Eleven patients were males. Eighteen nonchagasic patients were matched by 2 year age intervals and sex with each chagasic patient. Before acute myocardial infarction, there were no differences between chagasic and nonchagasic patients with regard to the proportion of stable angina, unstable angina and coronary risk factors. Atypical chest pain occurred in 8 of 15 (53%) chagasic patients for whom this information was found in the medical records and in 1 of 18 (5%) nonchagasic patients (p = 0.003); dyspnea and palpitations occurred in 6 of 15 (40%) chagasic and 1 of 17 (5%) nonchagasic patients (p = 0.025). There were no differences between chagasic and nonchagasic patients with respect to both clinical characteristics and cardiac complications of acute myocardial infarction. Nonetheless, 4 of 11 (36%) chagasic patients for whom this information was listed in the medical records but none of 16 nonchagasic patients had normal coronary arteries (p = 0.019). Thus, chagasic patients who develop acute myocardial infarction have some peculiarities both in the clinical profile before the acute event and in the anatomy of the coronary arteries.

Adult↗
PubMed1991

Salmonella tricuspid endocarditis in an intravenous drug abuser with human immunodeficiency virus infection.

We describe a case of Salmonella tricuspid endocarditis in an intravenous drug abuser with human immunodeficiency virus infection. He was successfully treated with antibiotics with no clinical relapse. To our knowledge, this is the first case of this kind reported in the literature. Physicians should be on the alert for this potentially curable cardiac complication of human immunodeficiency virus infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Changes in electrocardiographic patterns at different stages of Chagas' heart disease in rats.

1. The resting electrocardiogram was obtained from 25 Trypanosoma cruzi-infected rats 30 days after infection (phase I). The resting electrocardiogram was abnormal in 12 (group I) and normal in 13 (group II) animals. Nineteen similar but non-infected animals served as controls. Both the resting electrocardiogram and the ajmaline test were performed 120 and 350 days after infection (phases II and III, respectively). 2. With regard to the resting electrocardiogram of group I animals, left axis deviation was found in 10 of 12 (83%) in phase I, one of 12 (8%) in phase II (P less than 0.05) and in none of phase III (P less than 0.05). An intraventricular conduction delay was found in four of 12 (33%) rats in phase I, two of 12 rats (16%) in phase II (P greater than 0.05) and six of 12 rats (50%) in phase III (P greater than 0.05). The ajmaline test was abnormal in nine of 10 (90%) rats of group I with normal resting electrocardiogram in phase II, and in three of six (50%) animals in phase III (P greater than 0.05). 3. An intraventricular conduction delay was found in the resting electrocardiogram of one of 13 (7%) rats of group II in phase III. The ajmaline test was abnormal in one of 13 (7%) rats in phase II and in one of 12 (8%) rats in phase III. 4. No control rat showed pathological changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Ajmaline↗
PubMed1990

Clinical profile of patients with Chagas' disease before and during sustained ventricular tachycardia.

Sustained ventricular tachycardia was diagnosed in 15 patients undergoing ordinary activity with Chagas' disease seen at our Institute from 1978 to 1989. Palpitations were observed in 11 (66%) of the patients, dyspnea in 7 (46%), atypical chest pain in 5 (33%) and syncope in 2 (13%). Cardiac arrhythmia was detected in 4 (26%) on physical examination. The resting electrocardiogram showed premature ventricular contractions in 13 (86%) patients, ST-T changes in 12 (80%), left axis deviation in 9 (60%) and right bundle branch block in 4 (26%). Chest X-rays showed mild cardiomegaly in 8 (53%) and moderate cardiomegaly in 3 (20%) patients. Mild left ventricular dysfunction was detected echocardiographically in 1 (10%), moderate in 3 (30%) and severe in 1 (10%) of the 10 patients studied. During sustained ventricular tachycardia, dyspnea was found in 7 of 15 (46%) patients, palpitations in 6 (40%), atypical chest pain in 6 (40%), syncope in 1 (6%), systemic arterial hypotension in 3 (20%) and cardiogenic shock in 2 (13%). The electrocardiographic findings were as follows: mean heart rate was 201 bpm; mean QRS lengthening was 0.16 sec; right bundle branch block plus right axis deviation was seen in 5 of 15 (33%) patients; right bundle branch block plus left axis deviation in 4 (26%); and a positive concordance of all precordial leads in 5 (33%) patients. Based on these findings, we conclude that the majority of patients with Chagas' disease who develop sustained ventricular tachycardia do not have severe myocardial disease, show an uncommon electrocardiographic pattern of this arrhythmia, and most importantly, have a benign clinical course.

Adult↗
PubMed1990

Effects of long term metoprolol administration on the electrocardiogram of rats infected with T cruzi.

STUDY OBJECTIVE: The aim of the study was to evaluate the role of beta receptor antagonists in the evolution of experimental Chagas' disease. DESIGN: Rats were infected with T cruzi, 2000 parasites.g-1 body weight, soon after weaning. One group was then given metoprolol, 100 mg.kg-1.d-1, in drinking water. A comparison group received no metoprolol. Two control groups of non-infected rats were also studied, one with and one without metoprolol in the same dose. SUBJECTS: Adult male albino rats were used: 144 were infected with T cruzi and received metoprolol (group IM), 137 were infected and received no metoprolol (group IW), 46 non-infected rats received metoprolol (group CM), and 43 non-infected rats did not receive metoprolol (group CW). MEASUREMENTS and main results--30 d after infection, resting ECG was performed in all surviving rats. (There were 63 deaths in the infected groups and none in the non-infected groups.) Abnormal ECG was found in 20/81 infected rats in group IM and in 30/74 in group IW (p less than 0.05). No ECG changes were found in the non-infected rats. Of rats in group IM with normal resting ECG, 31 continued to take metoprolol (group IMNM), while 30 similar rats did not (group IMNW); in group IM with abnormal ECG, 10 rats continued to take metoprolol (group IMAM), while 10 similar rats did not (group IMAW). Of rats in group IW with normal ECG, 22 were started on metoprolol (group IWNM), while 22 similar rats were not (group IWNW); in group IW with abnormal ECG, 15 rats were started on metoprolol (group IWAM), while 15 similar rats did not (group IWAW). After 120 d and 300 d infection there were no differences in mortality rate and Ajmaline test in any of the matched groups (IMNM X IMNW; IMAM X IMAW; IWNM X IWNW; IWAM X IWAW). After 120 d there was no difference in ECG between the groups, but after 300 d there was a decrease in abnormal ECG in group IWAM (IWAM v IWAW, 0/12 v 5/12, p less than 0.05). No histological differences were found. CONCLUSIONS: Metoprolol decreases the proportion of rats with abnormal resting ECG in both the acute and the chronic stage of T cruzi infection.

Animals↗
PubMed1990

The surface electrocardiogram: a simple and reliable method for detecting overt and latent heart disease in rats.

1. The following changes may be observed in the resting ECG of Wistar rats having different forms of heart disease: pathological Q wave, QRS deviations, lengthening of both P wave and QRS complex, increased PR interval and J point alterations. 2. The ajmaline test, when applied to rats with myocardial disease but with normal resting ECG, presented the following ECG alterations which were not observed in normal rats: indeterminate axis (QRS axis in the 3rd space), increased PR interval and lengthening of both P wave and QRS complex. 3. When compared with histopathological studies, the ECG changes have a high positive predictive value for detecting underlying myocardial disease. 4. The surface ECG can be a useful tool for detecting myocardial disease in different experimental models of rat heart disease. It can also be used to characterize rat models of heart disease and to evaluate treatment of experimental rat heart disease.

Ajmaline↗