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- Acute total occlusion of the unprotected left main coronary artery: Patient characteristics and outcomesPublication . Calvão, João; Braga, Marta; Brandão, Mariana; Campinas, Andreia; Alexandre, André; Amador, Ana; Costa, Catarina; Silva, João C.; Silva, Marisa; Brochado, Bruno; Freitas, João; Macedo, FilipeIntroduction and objectives: Acute total occlusion of the unprotected left main coronary artery (LMCA) is a dramatic event. There are limited data regarding this population. We aimed to describe the clinical presentation and outcomes of patients and to determine predictors of in-hospital mortality. Methods: This retrospective study included patients presenting with acute (<12 h) myocardial infarction due to total occlusion of the LMCA (TIMI flow 0) between January 2008 and December 2020 in three tertiary hospitals. Results: During this period, 11036 emergent coronary angiographies were performed, 59 (0.5%) of which revealed acute total occlusion of the LMCA. Patients' mean age was 61.2 (SD±12.2) years and 73% were male. No patients had left dominance. At presentation, 73% were in cardiogenic shock, aborted cardiac arrest occurred in 27% and 97% underwent myocardial revascularization. Primary percutaneous coronary intervention was performed in 90% of cases and angiographic success was achieved in 56% of procedures, while 7% of patients underwent surgical revascularization. In-hospital mortality was 58%. Among survivors, 92% and 67% were alive after one and five years, respectively. After multivariate analysis, only cardiogenic shock and angiographic success were independent predictors of in-hospital mortality. Use of mechanical circulatory support and presence of well-developed collateral circulation were not predictive of short-term prognosis. Conclusion: Acute total occlusion of the LMCA is associated with a dismal prognosis. Cardiogenic shock and angiographic success play a major role in predicting the prognosis of these patients. The effect of mechanical circulatory support on patient prognosis remains to be determined.
- Amiodarone-Induced Electrical Storm: A Nightmare in the Emergency RoomPublication . Campinas, Andreia; Pereira Santos, Mariana; Sousa, Maria João; Gomes, Catarina; Torres, SeveroDrug-induced long QT syndrome (LQTS) is defined as prolonged corrected QT interval (QTc ≥460 ms) plus polymorphic ventricular arrhythmia fitting the description of torsades de pointes temporally associated with the administration of a drug or combination of drugs. Amiodarone therapy is a known uncommon cause of acquired QT interval prolongation that should not be underestimated. We present a case of an iatrogenic electrical storm with atrial fibrillation (AF) in which amiodarone was administered to attempt chemical cardioversion, resulting in an unnoticed prolongation of the QT interval, with subsequent repeated polymorphic ventricular tachycardia, managed with isoproterenol. Concomitant drugs and slight electrolyte disturbances potentiated this phenomenon. Given the widespread use of this drug in the emergency department, our case highlights a pertinent matter for all medical emergency practitioners. Additionally, it stresses the significance of potential precipitating factors, such as electrolyte imbalances, which are clinical conditions very frequent in the emergency context, along with the importance of recognizing drug interactions. Finally, this case also emphasizes the vital importance of closely monitoring the patient's receiving amiodarone.
- Uma Apresentação Atípica e Não-Cardíaca de Cardiomiopatia HipertróficaPublication . Alexandre, André; Roque, Carla; Sá, Isabel; Silveira, João; Torres, Severo
- Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary EmbolismPublication . Bikdeli, Behnood; Jiménez, David; del Toro, Jorge; Piazza, Gregory; Rivas, Agustina; Fernández‐Reyes, José Luis; Sampériz, Ángel; Otero, Remedios; Suriñach, José María; Siniscalchi, Carmine; Martín‐Guerra, Javier Miguel; Castro, Joaquín; Muriel, Alfonso; Lip, Gregory Y. H.; Goldhaber, Samuel Z.; Monreal, Manuel; Monreal, Manuel; Prandoni, Paolo; Brenner, Benjamin; Farge‐Bancel, Dominique; Barba, Raquel; Di Micco, Pierpaolo; Bertoletti, Laurent; Schellong, Sebastian; Tzoran, Inna; Reis, Abilio; Bosevski, Marijan; Bounameaux, Henri; Malý, Radovan; Verhamme, Peter; Caprini, Joseph A.; Bui, Hanh My; Adarraga, María Dolores; Agud, María; Aibar, Jesús; Aibar, Miguel Ángel; Amado, Cristina; Arcelus, Juan Ignacio; Baeza, Carlos; Ballaz, Aitor; Barba, Raquel; Barbagelata, Cristina; Barrón, Manuel; Barrón‐Andrés, Belén; Blanco‐Molina, Ángeles; Botella, Ernesto; Camon, Ana María; Cañas, Inmaculada; Casado, Ignacio; Castro, Joaquín; Chasco, Leyre; Criado, Juan; de Ancos, Cristina; de Miguel, Javier; del Toro, Jorge; Demelo‐Rodríguez, Pablo; Díaz‐Peromingo, José Antonio; Di Campli, Mario Virgilio; Díez‐Sierra, Javier; Domínguez, Irene Milagros; Escribano, José Carlos; Falgá, Conxita; Farfán‐Sedano, Ana Isabel; Fernández‐Capitán, Carmen; Fernández‐Reyes, Jose Luis; Fidalgo, María Ángeles; Flores, Katia; Font, Carme; Font, Llorenç; Francisco, Iria; Gabara, Cristina; Galeano‐Valle, Francisco; Galindo, David; García, María Angelina; García‐Bragado, Ferrán; García de Herreros, Marta; García‐Hernáez, Raquel; García‐Mullor, María Mar; García‐Raso, Arantxa; Gavín‐Sebastián, Olga; Gil‐Díaz, Aida; Gómez‐Cuervo, Covadonga; Grau, Enric; Guirado, Leticia; Gutiérrez, Javier; Hernández‐Blasco, Luis; Hernando, Elena; Herreros, Miguel; Jara‐Palomares, Luis; Jaras, María Jesús; Jiménez, David; Jiménez, Rafael; Joya, Maria Dolores; León, José Manuel; Lima, Jorge; Llamas, Pilar; Lobo, José Luis; López‐Jiménez, Luciano; López‐Miguel, Patricia; López‐Núñez, Juan José; López‐Reyes, Raquel; López‐Ruiz, Antonio; López‐Sáez, Juan Bosco; Lorenzo, Alicia; Madridano, Olga; Maestre, Ana; Marchena, Pablo Javier; Martín del Pozo, Mar; Martín‐Guerra, Javier Miguel; Martín‐Martos, Francisco; Mella, Carmen; Mellado, Meritxell; Mercado, Maria Isabel; Moisés, Jorge; Monreal, Manuel; del Valle Morales, María; Muñoz‐Blanco, Arturo; Muñoz‐Rivas, Nuria; Navas, María Sierra; Nieto, Jose Antonio; Núñez‐Fernández, Manuel Jesús; Obispo, Berta; Olid, Mónica; Olivares, María Carmen; Orcastegui, José Luis; Ortega‐Michel, Clara; Osorio, Jeisson; Otalora, Sonia; Otero, Remedios; Parra, Pedro; Parra, Virginia; Pedrajas, José María; Pellejero, Galadriel; Porras, José Antonio; Portillo, José; Riera‐Mestre, Antoni; Rivas, Agustina; Rivera‐Civico, Francisco; Rodríguez‐Chiaradía, Diego Agustín; Rodríguez‐Cobo, Ana; Rodríguez‐Matute, Consolación; Rogado, Jacobo; Roig, Sonia; Rosa, Vladimir; Ruiz‐Artacho, Pedro; Ruiz‐Giménez, Nuria; Ruiz‐Ruiz, Justo; Ruiz‐Sada, Pablo; Salgueiro, Giorgina; Sánchez‐Martínez, Rosario; Sánchez‐Muñoz‐Torrero, Juan Francisco; Sancho, Teresa; Sirisi, Merçe; Soler, Silvia; Suriñach, José María; Tirado, Raimundo; Torres, María Isabel; Tolosa, Carles; Trujillo‐Santos, Javier; Uresandi, Fernando; Valero, Beatriz; Valle, Reina; Vela, Jerónimo Ramón; Vidal, Gemma; Villares, Paula; Zamora, Carles; Gutiérrez, Paula; Vázquez, Fernando Javier; Engelen, Matthias; Vanassche, Thomas; Verhamme, Peter; Hirmerova, Jana; Malý, Radovan; Salgado, Estuardo; Ait Abdallah, Nassim; Bertoletti, Laurent; Bura‐Riviere, Alessandra; Crichi, Benjamin; Debourdeau, Philippe; Olivier, Espitia; Falvo, Nicolas; Farge‐Bancel, Dominique; Galliazzo, Silvia; Helfer, Hélène; Mahé, Isabelle; Moustafa, Farès; Poenou, Geraldine; Schellong, Sebastian; Braester, Andrei; Brenner, Benjamin; Tzoran, Inna; Bilora, Franca; Bucherini, Eugenio; Ciammaichella, Maurizio; Di Micco, Pierpaolo; Imbalzano, Egidio; Maida, Rosa; Mastroiacovo, Daniela; Pace, Federica; Pesavento, Raffaele; Pomero, Fulvio; Prandoni, Paolo; Quintavalla, Roberto; Rocci, Anna; Romualdi, Roberta; Siniscalchi, Carmine; Tufano, Antonella; Visonà, Adriana; Zalunardo, Beniamino; Gibietis, Valdis; Kigitovica, Dana; Skride, Andris; Fonseca, Samuel; Martins, Filipa; Meireles, Jose; Bosevski, Marijan; Bounameaux, Henri; Mazzolai, Lucia; Bikdeli, Behnood; Caprini, Joseph A.; Tafur, Alfonso J.; Ochoa‐Chaar, Cassius Iyad; Weinberg, Ido; Wilkins, Hannah; Bui, Hanh MyBackground Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.
- Cardiac Mass: Left Atrial MyxomaPublication . Fontes-Oliveira, Marta; Rodrigues, Patrícia; Silveira, Inês; Cabral, S.; Torres, S.
- Cardiac Mass: Left Atrial MyxomaPublication . Fontes-Oliveira, Marta; Rodrigues, Patrícia; Silveira, Inês; Cabral, Sofia; Torres, Severo
- Cardiac rehabilitation programs for heart failure patients in the time of COVID-19Publication . Schmidt, Cristine; Magalhães, Sandra; Barreira, Ana; Ribeiro, Fernando; Fernandes, Preza; Santos, Mario
- Cardiovascular Complications of COVID-19 InfectionPublication . Trêpa, Maria; Hipólito-Reis, António; Oliveira, MarioIntroduction: Reports of cardiovascular complications related to the COVID-19 infection have been frequent. Methods: Narrative review for relevant articles on the topic. The classic cardiovascular risk factors, like age, obesity, diabetes, and hypertension are associated with adverse outcomes in COVID-19 patients. Cardiovascular complications can have a diverse clinical presentation including silent myocardial injury, acute coronary syndromes, thromboembolism, cardiac arrhythmias, and heart failure. There are multiple mechanisms of cardiac injury that are not mutually exclusive. The approach to diagnosis and management should be carried out according to usual practice, while considering the particularities of COVID-19 infection. Conclusion: The interaction between SARS-CoV-2 and the heart is complex and is manifested in multiple ways. Regardless of the clinical presentation, cardiac complications convey a worse prognosis. Patients should be actively monitored and treated accordingly.
- Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patientsPublication . Fontes-Oliveira, Marta; Trêpa, Maria; Rodrigues, Patrícia; Preza-Fernandes; Magalhães, Sandra; Cabral, Sofia; Santos, Mario; Torres, SeveroBackground: The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods: We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results: Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion: As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.