Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
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Morbidity and mortality are increased in diabetic patients with ischemic heart disease. Sulfonylureas are the therapeutic group most frequently used and contributing to this. ⋯ This is probably attributed to the action of these drugs on the ATP-sensitive potassium channels via blocking the ischemic preconditioning. This article puts forward evidence on sulfonylureas cellular and molecular pharmacodynamics and the real clinical incidence in the ATP-sensitive potassium channels inhibition in the diabetic patient's ischemic heart.
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Transesophageal echocardiography (TEE) is accepted as a valuable tool in the evaluation of ischemic stroke patients, particularly in the young and in cases of unknown cause. However, the real clinical impact of additional TEE data remains to be defined. ⋯ TEE identified additional findings with possible embolic potential in a considerable number of cases, the majority of which were of a debatable cause-effect relation. A higher diagnostic yield and clinical relevance was found in older patients, which argues against age being used as a selective criterion for it. Our experience suggests that routine TEE in this setting is of questionable value and has little impact on clinical management, for which reason TEE referral should be decided on an individual patient basis.
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In order to study the status of Cardiac Rehabilitation (CR) in Portugal in 1998 and 1999, a questionnaire was drafted and sent to all the heads of the CR centres in Portugal, with questions about their nature, location, staff, type of activity, movement, diagnosis leading to patient referral and funding. The rate of coronary patients admitted to the programs existing in the cities of Lisbon and Oporto was calculated. The total number of patients included in all the CR centres in both cities was subtracted from the total number of public hospital discharges of coronary patients in 1998, patients admitted due to acute ischaemic coronary syndrome or for revascularization in Portugal and in each of the two cities. ⋯ These rates are well below the figures for countries of the European Union and for the USA. It is very important to increase the establishment and spread of CR centres throughout the country, creating the financial conditions and promoting a change in culture regarding physical activity and CR on the part of the Portuguese population, patients and health care providers responsible for the referral of cardiac patients to a therapeutic intervention that can increase quality of life and longevity. Doctors should be involved in programs that will train them to recognize the benefits of physical activity and secondary prevention.
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Thrombolytic therapy is still widely used to restore antegrade flow in the infarct related artery (IRA), with unquestionable benefits in mortality reduction of such patients. The aim of this study was to evaluate early (< or = 28 days) and one-year mortality of patients with a first Q wave myocardial infarction (Q AMI), comparing those who underwent thrombolytic therapy with those who did not. ⋯ 1--Patients who did not undergo thrombolytic therapy initially had a profile of greater severity, and a higher early and one-year mortality rate. 2--Those who underwent thrombolytic therapy presented a significantly lower mortality, a benefit that was still observed after one year of follow-up and after multivariate correction.