Papers by Ademir Da Cunha
Revista Portuguesa de Cardiologia (English Edition), 2013
Chagas disease (CD) is an infection caused by the protozoan flagellate Trypanosoma cruzi, and tra... more Chagas disease (CD) is an infection caused by the protozoan flagellate Trypanosoma cruzi, and transmitted by insects of the genera Triatoma, Rhodnius and Panstrongylus. The heart is affected to varying degrees by inflammatory and destructive lesions in atrial and ventricular myocardial fibers. Several studies have demonstrated the benefits of exercise in patients with congestive heart failure (CHF), including reduced sympathetic tone and increased parasympathetic tone, the result of reduced epinephrine and norepinephrine levels, both at rest and during exercise, including at submaximal levels. It has been hypothesized that the increase in sympathetic arousal during exercise improves peripheral muscle metabolism. Objectives: The objectives of this study were to select patients with chronic Chagas cardiomyopathy (CCC) with dysautonomia on 24-h Holter monitoring, assess autonomic function after rehabilitation, and determine whether it resulted in reduced daytime levels of SDNN and increased daytime and nighttime levels of pNN50 and rMSSD. Methods: We analyzed time-domain indices of heart rate variability through 24-h Holter monitoring before and after a supervised exercise program. We studied 18 CCC patients (five men), mean age 57.33 ± 9.73 years, followed at the CD outpatient clinic of the National Institute of Cardiology and IPEC/Fiocruz in Rio de Janeiro, Brazil, between April 2009 and November 2010. The following tests were used to assess the severity of CCC: clinical examination, functional evaluation by cardiopulmonary stress testing, electrocardiogram and conventional Doppler echocardiography. The exams were performed within a month of the start and end of the exercise program, which consisted of 60-min sessions of aerobic exercise on a treadmill and resistance training three times a week for six months. The goal was to reach the patients' ଝ Please cite this article as: Amaral da Silva Souza MV, et al. Variabilidade da frequência cardíaca: análise dos índices no domínio do tempo em portadores de cardiopatia chagásica crónica, antes e após um programa de exercícios. Rev Port Cardiol. 2013. http://dx.et al.
Revista da Sociedade Brasileira de Medicina Tropical
Despite all efforts to restrict its transmission, Chagas' disease remains a severe public hea... more Despite all efforts to restrict its transmission, Chagas' disease remains a severe public health problem in Latin America, affecting 8-12 million individuals. Chronic Chagas' heart disease, the chief factor in the high mortality rate associated with the illness, affects more than half a million Brazilians. Its evolution may result in severe heart failure associated with loss of functional capacity and quality of life, with important social and medical/labor consequences. Many studies have shown the beneficial effect of regular exercise on cardiac patients, but few of them have focused on chronic Chagas' heart disease. This study evaluated the effects of an exercise program on the functional capacity of patients with chronic Chagas' disease who were treated in outpatient clinics at the Evandro Chagas Institute of Clinical Research and the National Institute of Cardiology, Rio de Janeiro, Brazil. The exercises were performed 3 times a week for 1 h (30 min of aerobic ac...
Arquivos Brasileiros De Cardiologia, 2007
Methods -Forty five normal adolescents ), 10-18 years old. Results -ABPM recordings showed a mean... more Methods -Forty five normal adolescents ), 10-18 years old. Results -ABPM recordings showed a mean of 90% successful readings; 30% of the patients complained of sleep disruption related to the functioning of the ABPM monitor; the mean systolic, diastolic and heart rate fall during sleep was 13%, 23% and 24% respectively; the mean systolic and diastolic blood pressure load, while awake, was in male adolescents 25.4±27.7% and 11.8±14.6%, and in female adolescents, 17.5±18.7% and 11.8±11.4%, respectively; the mean systolic and diastolic blood pressure load, while asleep, was in male adolescents 15.4±22.9% and 2.8±4.9% and, in female adolescents, 10.5±18.2% and 1.8±2.7%, respectively; the mean diastolic values of the first two hours of recording were higher than the ones obtained during the rest of the hours of recording while awake; different mean systolic, diastolic and heart rate values were found during the afternoon and nocturnal sleep periods. Conclusion -ABPM was well accepted by the adolescent population, with good technical results. Key-words: blood pressure, ambulatory blood pressure monitoring, adolescent Objetivo -Avaliar tecnicamente a monitorização ambulatorial de pressão arterial (MAPA) em adolescentes normais. Métodos -Quarenta e cinco adolescentes eutróficos, entre 10-18 anos de idade, sendo 27 do sexo feminino. Resultados -Verificaram-se, em média, 90% de medidas bem sucedidas: incômodo relacionado ao funcionamento do monitor em 30% dos casos; valores médios de descenso sistólico, diastólico e de diminuição de PAS e PAD; medidas diastólicas mais elevadas nas duas primeiras horas de monitorização; diferenças entre sono noturno e vespertino quanto aos parâmetros cardiovasculares estudados.
Arquivos Brasileiros de Cardiologia, 2006
Arquivos Brasileiros de Cardiologia, 2001
To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and... more To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.
Arquivos Brasileiros de Cardiologia, 2007
We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the... more We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.
Arquivos Brasileiros de Cardiologia, 2010
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Papers by Ademir Da Cunha