Fernando Friões - Profile on Academia.edu (original) (raw)
Papers by Fernando Friões
Journal of Medical Cases, 2013
Anti NMDA (N-methyl D-aspartate) receptor encephalitis has been recently described in young women... more Anti NMDA (N-methyl D-aspartate) receptor encephalitis has been recently described in young women with ovarian teratoma. Memory and psychiatric disturbances are frequent followed by respiratory and autonomic failure warranting long intensive care admissions. We report on a female patient with paraneoplastic encephalitis manifested by behavioural changes and neurological impairment, followed by respiratory and hemodynamic instability. Anti-NMDA receptor antibodies were found in blood and spinal fluid in association with an imamature grade 2 ovarian teratoma. She made a full recovery after complete oophorectomy and institution of intravenous immunoglobulin and corticosteroids. Anti-NMDA encephalitis should be considered in any female patient presenting with de novo psychiatric symptoms. As in other paraneoplastic syndrome, its therapy is based in resection of the underlying tumor associated with immunomodulators. Timely initiation of therapy may significantly improve outcome as in this case.
566 Absolute lymphocyte count in heart failure patients: determinants and prognosis
European Journal of Heart Failure Supplements, 2004
Interleukin-6, infection and cardiovascular outcomes in acute heart failure: Findings from the EDIFICA registry
Cytokine
Journal of Medical Cases, 2015
The number of lung transplants has increased in the last years. Besides, the complications of imm... more The number of lung transplants has increased in the last years. Besides, the complications of immunosuppressive treatment, such as infections, have also been raising. Another complication, although seldom described, is thrombotic microangiopathy associated with calcineurin inhibitors. We report a case of a 65-year-old woman with a 6-month bi-pulmonary transplant, admitted for pneumonia. Addressing the differential diagnosis, pneumonia in immunosuppressed patient, aspergillosis, CMV disease and acute rejection were considered. High levels of tacrolimus were identified. The patient evolved with multiple organ dysfunctions. Hemodialysis was started on the third day. On the 5th day, patient developed progressive anemia, leukopenia and thrombocytopenia, schistocytes were present on peripheral smear and Coombs test was negative. A thrombotic microangiopathy probably related to tacrolimus high levels was identified. Plasma exchange was initiated on the eighth day, and intensified on the 11th day, without success, and on 14th day, the patient died. We believe our case report is relevant, since thrombotic microangiopathy in lung transplant has rarely been described and lung transplant is a growing reality, as well as its complications. Furthermore, our case is more severe than the ones described in literature, possibly due to prolonged tacrolimus toxic levels and concomitant infection.
Clinical Research Prognostic Value of Osteoprotegerin in Acute Heart Failure
Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients wi... more Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF. Methods: In a prospective study, we enrolled 338 patients consecutively admitted with AHF to the internal medicine department of a tertiary care university hospital in Porto, Portugal between March 2009 and December 2010. OPG was measured using a commercial enzymelinked immunosorbent assay and was both analyzed as a continuous variable and categorized by quartiles. Patients were followed for up to RESUME
Revista Portuguesa de Imunoalergologia
A 71-year-old male was admitted to the emergency room for dyspnea, thoracic pain and palpitations... more A 71-year-old male was admitted to the emergency room for dyspnea, thoracic pain and palpitations, where he was diagnosed with atrial flutter (AFL) with rapid ventricular rate (RVR), and was treated with bisoprolol, digoxine and verapamil. Because the RVR persisted, an amiodarone perfusion was started, during which an immediate episode of generalized urticaria occurred. The patient had a history of urticaria during an infusion of amiodarone in a previous episode of AFL with RVR. Although he was already medicated with digoxin and bisoprolol, he was still at high risk of RVR. Due to the reproducible immediate reactions to amiodarone, and the fact that amiodarone was the only therapeutic option, a 13-step desensitization protocol was designed, starting with an initial dose of 0.03 mg/mL (1/10 000 of the target cumulative dose) and ending with a final dose of 300 mg. The desensitization was successfully performed, without any immediate or late reactions. Then, a 200 mg oral daily dose was kept in order to maintain the desensitization state.
European Journal of Case Reports in Internal Medicine
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops ... more Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.
Galicia Clínica
Bilateral diagonal earlobe crease A seventy-year-old male with hypertension, dyslipidemia and cer... more Bilateral diagonal earlobe crease A seventy-year-old male with hypertension, dyslipidemia and cerebrovascular disease is admitted after recurrent syncope. Physical examination was relevant for bilateral diagonal earlobe crease, also known as Frank sign (figure 1), with no other findings. Patient had no history of myocardial infarction, angina and there were no relevant abnormalities in the electrocardiogram or echocardiogram. Computed tomography of thorax showed atheromatous calcifications of aorta and coronary vasculature. Patient was diagnosed with carotid sinus syndrome and had done well after implantation of a cardiac pacemaker. Frank sign was initially described in association with coronary artery disease 1 , with moderate sensitivity and specificity, that still has some accuracy even with contemporary diagnostic imaging 2. There after it has been associated with atherosclerotic disease in other territories 3 .
Proteus mirabilis endocarditis
BMJ Case Reports
A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. ... more A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction. He was an hepatic transplant recipient and was medicated with everolimus. He underwent mitral and aortic valve replacement with prosthetic valves 4 years ago. Due to his medical background, therapy and clinical presentation, empirical therapy for infective endocarditis was started. Transoesophageal echocardiogram showed severe aortic valve regurgitation but no other findings suggestive of endocarditis. Computed tomography (CT) revealed pulmonary infiltrates compatible with infection and no evidence of septic embolisation. Multiple sets of blood cultures were negative. Proteus mirabilis was isolated in bronchial lavage and antibiotic therapy was adjusted. The patient underwent aortic valve replacement, with no macroscopic findings suggestive of endocarditis. P. mirabilis was isolated in the surgically removed valve. ...
Terry’s nails, tracking an underneath disease
Postgraduate Medical Journal
Seronegative neuromyelitis optica spectrum disorder: severe polysymptomatic presentation with successful treatment response
BMJ Case Reports
We report the case of a 50-year-old caucasian man presenting with lumbar pain, bilateral ataxia, ... more We report the case of a 50-year-old caucasian man presenting with lumbar pain, bilateral ataxia, central facial palsy, ophthalmoparesis and urinary retention. Cerebral MRI hinted a hyperintensity of the medulla oblongata and cervical medulla suggestive of myelitis. Cerebrospinal fluid displayed lymphocytic pleocytosis and elevated protein concentration. Without the possibility to rule out an infectious or inflammatory aetiology, antibiotics and corticosteroids were started. Nevertheless, neurological status deteriorated with loss of muscle strength and left eye amaurosis. A neuroaxis MRI exhibited encephalomyelitis with signal abnormalities involving the pons, medulla oblongata, left optic nerve and cervicodorsal medulla. Although negative for aquaporin-4-IgG antibodies, the patient fulfilled criteria for seronegative neuromyelitis optica spectrum disorder with the presence of multiple core clinical characteristics. Through early institution of corticosteroids, plasma exchange and r...
Prognostic Effect of Renal Function in Ambulatory Patients With Heart Failure Reduced Ejection Fraction: The Kidney Is a Marker of Cardiac Function
The Canadian journal of cardiology, Jan 15, 2018
Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased... more Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased mortality. The impact of temporal evolution of kidney function in HF prognosis is largely unknown. We evaluated the effect of renal function over time in all-cause mortality among ambulatory patients with HF. We retrospectively analyzed data from 560 patients with HF with left ventricular systolic dysfunction followed for a median of 25.1 months at an outpatient clinic. Demographics and comorbidities were collected at baseline. Creatinine values were abstracted from records at each clinical visit. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and was categorized into 3 classes. Extended Cox models were performed to study the association between time-varying eGFR and death. Patients' mean age was 67.5 ± 13.9 years, 67.0% were men, 46.1% had ischemic etiology, the majority had moderate-to-severe left ventricular systolic dysfunction, and 45.9% had chronic...
544 Haemoglobin in heart failure patients: determinants and prognosis
European Journal of Heart Failure Supplements
BNP argues against considering impaired relaxation pattern in the definition of stages of heart failure - a population based study
European Journal of Heart Failure Supplements
![Research paper thumbnail of [Syndrome of Irreversible Lithium-Effectuated NeuroToxicity]](https://attachments.academia-assets.com/66855167/thumbnails/1.jpg)
](Acta medica portuguesa, Jan 27, 2017
Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical si... more Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. We report the case of a man with lithium poisoning, with persistent neurologic signs and symptoms even after removal of lithium from circulation - a diagnosis of syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) was made.
Journal of cardiac failure, Jan 5, 2017
Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We ass... more Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. Methods and Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/ d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively). Conclusion: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition. (
Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction
Revista Portuguesa de Cardiologia, 2017
Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%... more Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.
B-type natriuretic peptide and lefe ventricular hypertrophy in hypertensive patients
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
ABSTRACT
![Research paper thumbnail of Prognóstico em Doentes com Insuficiência Cardíaca e Função Sistólica do Ventrículo Esquerdo Preservada [ 95 ]](https://attachments.academia-assets.com/66855182/thumbnails/1.jpg)
](Os doentes com insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada têm te... more Os doentes com insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada têm tendencialmente um melhor prognóstico do que aqueles com depressão da função sistólica do ventrículo esquerdo, apesar de algumas observações em contrário. Contudo, são escassos os estudos que avaliam as variáveis com possível interesse prognóstico neste grupo de doentes. Objectivo: Determinação de variáveis com interesse prognóstico em doentes com clínica de insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada (fracção de ejecção > 40 %). Material e métodos: De entre 157 doentes ambulatórios consecutivos com insuficiência cardíaca incluíram-se neste estudo os que tinham fracção de ejecção > 40 % (n=46). Efectuou-se entrevista clínica e exame físico, ECG, ecocardiograma (modo-M, 2D e Doppler pulsado do fluxo transmitral), estudo bioquímico e determinação dos níveis séricos do peptídeo natriurético tipo B (BNP). Os doentes foram divididos em 2 grupos: Grupo Idoentes com fibrilhação auricular e Grupo II -doentes em ritmo sinusal. Os doentes do grupo II foram subdivididos em 2 grupos consoante tinham ou não padrão de enchimento ventricular esquerdo de tipo restritivo. Realizou-se seguimento clínico com determinação de morte ou internamento de causa cardíaca. O tempo de seguimento foi em média de 682,2±55 dias. Resultados: Os 46 doentes estudados tinham em média 70,4±1,2 anos, sendo 54,3 % do sexo feminino; a fracção de ejecção média foi de 49,6±1 %. O valor médio do BNP foi de 202,9±41,3 pg/ml.
Journal of Medical Cases, 2013
Anti NMDA (N-methyl D-aspartate) receptor encephalitis has been recently described in young women... more Anti NMDA (N-methyl D-aspartate) receptor encephalitis has been recently described in young women with ovarian teratoma. Memory and psychiatric disturbances are frequent followed by respiratory and autonomic failure warranting long intensive care admissions. We report on a female patient with paraneoplastic encephalitis manifested by behavioural changes and neurological impairment, followed by respiratory and hemodynamic instability. Anti-NMDA receptor antibodies were found in blood and spinal fluid in association with an imamature grade 2 ovarian teratoma. She made a full recovery after complete oophorectomy and institution of intravenous immunoglobulin and corticosteroids. Anti-NMDA encephalitis should be considered in any female patient presenting with de novo psychiatric symptoms. As in other paraneoplastic syndrome, its therapy is based in resection of the underlying tumor associated with immunomodulators. Timely initiation of therapy may significantly improve outcome as in this case.
566 Absolute lymphocyte count in heart failure patients: determinants and prognosis
European Journal of Heart Failure Supplements, 2004
Interleukin-6, infection and cardiovascular outcomes in acute heart failure: Findings from the EDIFICA registry
Cytokine
Journal of Medical Cases, 2015
The number of lung transplants has increased in the last years. Besides, the complications of imm... more The number of lung transplants has increased in the last years. Besides, the complications of immunosuppressive treatment, such as infections, have also been raising. Another complication, although seldom described, is thrombotic microangiopathy associated with calcineurin inhibitors. We report a case of a 65-year-old woman with a 6-month bi-pulmonary transplant, admitted for pneumonia. Addressing the differential diagnosis, pneumonia in immunosuppressed patient, aspergillosis, CMV disease and acute rejection were considered. High levels of tacrolimus were identified. The patient evolved with multiple organ dysfunctions. Hemodialysis was started on the third day. On the 5th day, patient developed progressive anemia, leukopenia and thrombocytopenia, schistocytes were present on peripheral smear and Coombs test was negative. A thrombotic microangiopathy probably related to tacrolimus high levels was identified. Plasma exchange was initiated on the eighth day, and intensified on the 11th day, without success, and on 14th day, the patient died. We believe our case report is relevant, since thrombotic microangiopathy in lung transplant has rarely been described and lung transplant is a growing reality, as well as its complications. Furthermore, our case is more severe than the ones described in literature, possibly due to prolonged tacrolimus toxic levels and concomitant infection.
Clinical Research Prognostic Value of Osteoprotegerin in Acute Heart Failure
Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients wi... more Background: Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF. Methods: In a prospective study, we enrolled 338 patients consecutively admitted with AHF to the internal medicine department of a tertiary care university hospital in Porto, Portugal between March 2009 and December 2010. OPG was measured using a commercial enzymelinked immunosorbent assay and was both analyzed as a continuous variable and categorized by quartiles. Patients were followed for up to RESUME
Revista Portuguesa de Imunoalergologia
A 71-year-old male was admitted to the emergency room for dyspnea, thoracic pain and palpitations... more A 71-year-old male was admitted to the emergency room for dyspnea, thoracic pain and palpitations, where he was diagnosed with atrial flutter (AFL) with rapid ventricular rate (RVR), and was treated with bisoprolol, digoxine and verapamil. Because the RVR persisted, an amiodarone perfusion was started, during which an immediate episode of generalized urticaria occurred. The patient had a history of urticaria during an infusion of amiodarone in a previous episode of AFL with RVR. Although he was already medicated with digoxin and bisoprolol, he was still at high risk of RVR. Due to the reproducible immediate reactions to amiodarone, and the fact that amiodarone was the only therapeutic option, a 13-step desensitization protocol was designed, starting with an initial dose of 0.03 mg/mL (1/10 000 of the target cumulative dose) and ending with a final dose of 300 mg. The desensitization was successfully performed, without any immediate or late reactions. Then, a 200 mg oral daily dose was kept in order to maintain the desensitization state.
European Journal of Case Reports in Internal Medicine
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops ... more Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.
Galicia Clínica
Bilateral diagonal earlobe crease A seventy-year-old male with hypertension, dyslipidemia and cer... more Bilateral diagonal earlobe crease A seventy-year-old male with hypertension, dyslipidemia and cerebrovascular disease is admitted after recurrent syncope. Physical examination was relevant for bilateral diagonal earlobe crease, also known as Frank sign (figure 1), with no other findings. Patient had no history of myocardial infarction, angina and there were no relevant abnormalities in the electrocardiogram or echocardiogram. Computed tomography of thorax showed atheromatous calcifications of aorta and coronary vasculature. Patient was diagnosed with carotid sinus syndrome and had done well after implantation of a cardiac pacemaker. Frank sign was initially described in association with coronary artery disease 1 , with moderate sensitivity and specificity, that still has some accuracy even with contemporary diagnostic imaging 2. There after it has been associated with atherosclerotic disease in other territories 3 .
Proteus mirabilis endocarditis
BMJ Case Reports
A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. ... more A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction. He was an hepatic transplant recipient and was medicated with everolimus. He underwent mitral and aortic valve replacement with prosthetic valves 4 years ago. Due to his medical background, therapy and clinical presentation, empirical therapy for infective endocarditis was started. Transoesophageal echocardiogram showed severe aortic valve regurgitation but no other findings suggestive of endocarditis. Computed tomography (CT) revealed pulmonary infiltrates compatible with infection and no evidence of septic embolisation. Multiple sets of blood cultures were negative. Proteus mirabilis was isolated in bronchial lavage and antibiotic therapy was adjusted. The patient underwent aortic valve replacement, with no macroscopic findings suggestive of endocarditis. P. mirabilis was isolated in the surgically removed valve. ...
Terry’s nails, tracking an underneath disease
Postgraduate Medical Journal
Seronegative neuromyelitis optica spectrum disorder: severe polysymptomatic presentation with successful treatment response
BMJ Case Reports
We report the case of a 50-year-old caucasian man presenting with lumbar pain, bilateral ataxia, ... more We report the case of a 50-year-old caucasian man presenting with lumbar pain, bilateral ataxia, central facial palsy, ophthalmoparesis and urinary retention. Cerebral MRI hinted a hyperintensity of the medulla oblongata and cervical medulla suggestive of myelitis. Cerebrospinal fluid displayed lymphocytic pleocytosis and elevated protein concentration. Without the possibility to rule out an infectious or inflammatory aetiology, antibiotics and corticosteroids were started. Nevertheless, neurological status deteriorated with loss of muscle strength and left eye amaurosis. A neuroaxis MRI exhibited encephalomyelitis with signal abnormalities involving the pons, medulla oblongata, left optic nerve and cervicodorsal medulla. Although negative for aquaporin-4-IgG antibodies, the patient fulfilled criteria for seronegative neuromyelitis optica spectrum disorder with the presence of multiple core clinical characteristics. Through early institution of corticosteroids, plasma exchange and r...
Prognostic Effect of Renal Function in Ambulatory Patients With Heart Failure Reduced Ejection Fraction: The Kidney Is a Marker of Cardiac Function
The Canadian journal of cardiology, Jan 15, 2018
Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased... more Chronic kidney disease is a frequent comorbidity in heart failure (HF), associated with increased mortality. The impact of temporal evolution of kidney function in HF prognosis is largely unknown. We evaluated the effect of renal function over time in all-cause mortality among ambulatory patients with HF. We retrospectively analyzed data from 560 patients with HF with left ventricular systolic dysfunction followed for a median of 25.1 months at an outpatient clinic. Demographics and comorbidities were collected at baseline. Creatinine values were abstracted from records at each clinical visit. Kidney function was assessed by estimated glomerular filtration rate (eGFR) and was categorized into 3 classes. Extended Cox models were performed to study the association between time-varying eGFR and death. Patients' mean age was 67.5 ± 13.9 years, 67.0% were men, 46.1% had ischemic etiology, the majority had moderate-to-severe left ventricular systolic dysfunction, and 45.9% had chronic...
544 Haemoglobin in heart failure patients: determinants and prognosis
European Journal of Heart Failure Supplements
BNP argues against considering impaired relaxation pattern in the definition of stages of heart failure - a population based study
European Journal of Heart Failure Supplements
Acta medica portuguesa, Jan 27, 2017
Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical si... more Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. We report the case of a man with lithium poisoning, with persistent neurologic signs and symptoms even after removal of lithium from circulation - a diagnosis of syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) was made.
Journal of cardiac failure, Jan 5, 2017
Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We ass... more Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. Methods and Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/ d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively). Conclusion: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition. (
Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction
Revista Portuguesa de Cardiologia, 2017
Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%... more Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.
B-type natriuretic peptide and lefe ventricular hypertrophy in hypertensive patients
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology
ABSTRACT
Os doentes com insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada têm te... more Os doentes com insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada têm tendencialmente um melhor prognóstico do que aqueles com depressão da função sistólica do ventrículo esquerdo, apesar de algumas observações em contrário. Contudo, são escassos os estudos que avaliam as variáveis com possível interesse prognóstico neste grupo de doentes. Objectivo: Determinação de variáveis com interesse prognóstico em doentes com clínica de insuficiência cardíaca e função sistólica do ventrículo esquerdo preservada (fracção de ejecção > 40 %). Material e métodos: De entre 157 doentes ambulatórios consecutivos com insuficiência cardíaca incluíram-se neste estudo os que tinham fracção de ejecção > 40 % (n=46). Efectuou-se entrevista clínica e exame físico, ECG, ecocardiograma (modo-M, 2D e Doppler pulsado do fluxo transmitral), estudo bioquímico e determinação dos níveis séricos do peptídeo natriurético tipo B (BNP). Os doentes foram divididos em 2 grupos: Grupo Idoentes com fibrilhação auricular e Grupo II -doentes em ritmo sinusal. Os doentes do grupo II foram subdivididos em 2 grupos consoante tinham ou não padrão de enchimento ventricular esquerdo de tipo restritivo. Realizou-se seguimento clínico com determinação de morte ou internamento de causa cardíaca. O tempo de seguimento foi em média de 682,2±55 dias. Resultados: Os 46 doentes estudados tinham em média 70,4±1,2 anos, sendo 54,3 % do sexo feminino; a fracção de ejecção média foi de 49,6±1 %. O valor médio do BNP foi de 202,9±41,3 pg/ml.