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Ponta Delgada, Portugal

Aguiar C.,Servico de Cardiologia
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2012

Atrial fibrillation (AF) is the most prevalent chronic arrhythmia in the general population. The prognosis of AF is mainly marked by the associated thromboembolic phenomena. Of every six ischemic strokes, one is due to AF, but the proportion of ischemic strokes attributable to AF increases with age. Thromboembolic risk stratification is a key component of the clinical evaluation of the AF patient, and a clinical performance measure, and should guide the antithrombotic therapeutic strategy. Oral anticoagulation with vitamin K antagonists is effective for the prevention of ischemic stroke in nonvalvular AF but, due to several reasons, it is largely underutilized in daily clinical practice, and INR values are often sub-therapeutic. The new oral anticoagulants (thrombin inhibitors or factor Xa inhibitors) are easier to manage, and don't require laboratorial monitoring. In phase III clinical trials they have shown to be at least as effective as warfarin, but safer, particularly regarding intracranial bleeding, a complication that is responsible for 90% of warfarin-attributable deaths. These results show a potential to increase the proportion of AF patients adequately anticoagulated, which will represent a significant advance in the prevention of stroke attributable to AF. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Antithrombotic therapy is the cornerstone of management of patients with acute coronary syndromes. Its role has become increasingly important with the widespread use of percutaneous revascularization, particularly after stent implantation. In this context, use of dual antiplatelet therapy is mandatory, combining aspirin with thienopyridines, mostly clopidogrel. As well as antiplatelets, anticoagulants are also required in patients with acute myocardial infarction up to the time of percutaneous intervention and stent implantation. Following the tremendous success of clopidogrel and enoxaparin over the last decade, new antithrombotic agents have been introduced, of which fondaparinux and prasugrel are examples, with both advantages and disadvantages compared to older drugs. The last European Congress in Barcelona in 2009 was particularly rich in this area as the results of three major clinical trials were presented, all with significant implications for clinical practice: the PLATO study testing the first reversible antiplatelet drug acting via the P2Y12 platelet receptor; the CURRENT-OASIS 7 study testing higher doses of aspirin and clopidogrel; and the SEPIA-ACS1 TIMI 42 trial launching the new parenteral anticoagulant otamixaban, a factor Xa inhibitor. These three trials are briefly reviewed in the current paper, high-lighting the characteristics that may lead to new recommendations and the implications for daily clinical practice.

Almeida A.R.,Servico de Cardiologia
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2010

The authors report the case of a 64-year-old patient with hypertrophic cardiomyopathy with latent obstruction. The patient complained of fatigue but the left ventricular outflow gradient at rest was not significant. He underwent exercise echocardiography that was stopped after 3 minutes due to exhaustion. The gradient at peak workload was 150 mmHg accompanied by a fall in arterial pressure. After the patient refused surgery, a double chamber pacemaker was implanted. A month later, exercise echocardiography lasted for 12 minutes and the gradient at peak workload was 60 mmHg. The authors highlight the importance of exercise echocardiography in the evaluation of symptomatic patients with hypertrophic cardiomyopathy without significant left ventricular outflow gradient at rest and the possible therapeutic role of pacing in these patients.

Cabanelas N.,Servico de Cardiologia | Freitas S.,Associacao Academica de Coimbra | Goncalves L.,University of Coimbra
Revista Portuguesa de Cardiologia | Year: 2013

This research aims to determine the cardiac morphological and functional changes that occur during the competitive season in elite athletes with previously-induced adaptive changes. Two echocardiographic examinations were performed in each player of a senior professional football team, the first at the beginning of the training phase and the other at the peak of the competitive season. It was demonstrated that after the brief period of deconditioning during the holiday period, further changes took place, even in these athletes with several years of prior professional activity. There was a significant increase between the two assessments in left ventricular wall thickness and mass, and in left atrial diameter, but left ventricular diastolic diameter and the diastolic function parameters considered remained the same. Greater left ventricular wall hypertrophy was related to more competitive playing time in these players. The main limitation of the study is the small number of athletes studied. © 2012 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved.

Toste A.,Servico de Cardiologia
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2010

Left ventricular noncompaction is a genetic disorder that is thought to be related to an arrest in endomyocardial development. It is characterized by the presence of a prominent trabecular meshwork and deep recesses. In order to better characterize this recently described disorder, whose prognosis remains unclear, we review eight cases diagnosed at our hospital, describing their clinical, electrocardiographic and echocardiographic features as well as therapy and follow-up. We also discuss the most relevant data from the literature concerning pathogenesis, clinical presentation, diagnostic criteria, therapy and prognosis.

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