Browsing by Author "Cabral, Margarida"
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- Cardiocerebral Infarction: A Combination to PreventPublication . Cabral, Margarida; Ponciano, Ana; Santos, Beatriz; Morais, JoãoBackground The acute complications of myocardial infarction (MI), such as mechanical, arrhythmic, ischemic, and inflammatory sequelae, may be responsible for significant cardiovascular morbimortality. Life-threatening arrhythmias, namely ventricular fibrillation or tachycardia, may be a challenging complication requiring a prompt approach. In some cases, acute ischemia leads to polymorphic ventricular tachycardia (PVT), and, rarely, to potentially lethal torsades de pointes ventricular tachycardia.
- Cardiovascular involvement in Sweet’s syndrome: A practical reviewPublication . Cabral, Margarida; Santos, Luís Graça; Ruivo, Catarina; Morais, JoãoSweet’s syndrome, also referred to as acute febrile neutrophilic dermatosis, presents a constellation of clinical features including fever, tender erythematous skin lesions, peripheral neutrophilia, and a predominant dermal infiltrate of neutrophils. This uncommon condition may arise through drug-induced mechanisms, as a secondary condition to malignant diseases, or idiopathically. Importantly, extracutaneous manifestations, including cardiovascular involvement such as arteritis, acute myocarditis, or coronary artery disease, frequently contribute to the intricacy of the clinical presentation. Despite its significance, the literature on Sweet’s syndrome with cardiovascular implications remains sparse, leading to ambiguity in clinical management. In this context, we highlight the need for a heightened index of suspicion to establish a diagnosis of Sweet’s syndrome with concurrent cardiovascular involvement, alongside considerations for treatment approaches and post-diagnostic monitoring strategies.
- Cor triatriatum sinistrum in adulthood: A case reportPublication . Cabral, Margarida; Santos, Luís Graça; Ruivo, Catarina; Morais, JoãoA case is presented of cor triatriatum sinistrum , which has been diagnosed in an adult. The findings of invasive and noninvasive studies have resulted in a diagnosis, which can be confirmed by using two-dimensional echocardiography.
- “A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapyPublication . Feijó, Salvato; Morais, João; Saraiva, Fátima; Silva, Sónia; Cabral, Margarida; Miguel Gonçalves, Carolina; Amorim, DianaBackground: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication. Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment. Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.
- Exuberant microvascular dysfunction: An indirect sign of coronary involvement in acute aortic syndrome?Publication . Cabral, Margarida; Martins, Hélia; Santos, Beatriz; Sousa, Pedro Jerónimo de; Morais, JoãoA 75-year-old obese woman with dyslipidemia and hypertension was admitted for acute chest pain. She presented anterolateral ST-segment elevationand slightly elevated troponin levels. She was transferred to a percutaneous coronary intervention-capable centre.
- Hybrid Cardiac Telerehabilitation After Acute Coronary Syndrome: Self-selection Predictors and OutcomesPublication . Ferreira, José Bernardo; Cabral, Margarida; Santos, Rita; Ferreira, Marta; Fonseca-Pinto, Rui; Antunes, Alexandre; Januário, FilipaAims: To evaluate the effectiveness of a hybrid cardiac telerehabilitation (HCTR) program after acute coronary syndrome (ACS) on patient quality of life (QoL) and physical activity indices throughout phases 2-3 and establish predictors for hybrid program self-selection. Methodology: This single-centre longitudinal retrospective study included patients who attended a cardiac rehabilitation program (CRP) between 2018-2021. Patients self-selected between two groups: Group 1 – conventional CRP (CCRP); Group 2 – HCTR. Baseline characteristics were registered. EuroQol-5D (EQ-5D) and International Physical Activity Questionnaire (IPAQ) were applied at three times: T0 – phase 2 onset; T1 – phase 3 onset; T2 – 3 months after T1. Results: 59 patients participated (Group 1 – 27; Group 2 – 32). We found significant between-group differences regarding occupation (p=0.003). Diabetic patients were less likely to self-select into HCTR (OR=0.21; p<0.05). EQ-5D visual analogue scale and IPAQ result significantly improved between T0-T2 only for HCTR (p=0.001; p=0.021). Conclusions: HCTR was superior to CCRP on physical activity indices and QoL of ACS patients.
- Letter to the Editor regarding “Suboptimal control of cardiovascular risk factor control in myocardial infarction survivors in a cardiac rehabilitation program”Publication . Antunes, Alexandre; Cabral, Margarida; Morais, JoãoIn this letter, we report on the experience of the Leiria Hospital Center CR unit, highlighting that in the analysis of our first patient series in which 68 patients had finished the phase II program, 66% achieved both ESC guideline LDL-C targets and 82% achieved one or other of the two targets. Nota: excerto retirado da carta ao Editor.
- P2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing a Late Invasive Strategy—A Portuguese Multicenter Nationwide Registry AnalysisPublication . Vazão, Adriana; Gonçalves, Carolina; Martins, André; Carvalho, Mariana; Cabral, Margarida; Santos, Luís; Pernencar, Sidarth; Carvalho, João; Morais, João; Riordan, Stephen; Wang, DongBackground/Objectives: Current guidelines do not specifically address the use of P2Y12 inhibitor (P2Y12i) pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who are expected to undergo a late invasive strategy. Nevertheless, such pretreatment may be considered in patients without a high bleeding risk (Class of Recommendation, IIb; Level of Evidence, C). Despite this ambiguity, P2Y12i pretreatment remains a common clinical practice. The present study aimed to evaluate the in-hospital prognostic impact of P2Y12i treatment prior to coronary angiography (CAG) in NSTE-ACS patients undergoing a late invasive strategy (CAG > 24 h after hospital admission). Methods: A retrospective analysis was conducted on NSTE-ACS patients undergoing a late invasive strategy included in the Portuguese Registry on Acute Coronary Syndromes between 2010 and 2023. The primary endpoint was a composite of in-hospital events, including all-cause mortality, non-fatal re-infarction, non-fatal stroke, and heart failure (HF). Secondary endpoints included the individual components of the primary endpoint and major bleeding (BARC types 3 and 4). Results: A total of 3776 patients were included (mean age, 66 ± 12 yrs; 29% female), of whom 1530 (41%) received P2Y12i pretreatment (group 1). Group 1 had a lower prevalence of prior myocardial infarction (16% vs. 21%) and prior percutaneous coronary intervention (12% vs. 15%) (both p ≤ 0.001). Although obstructive coronary artery disease was more frequent in group 1 (84% vs. 77%, p < 0.001), the presence of multivessel disease did not differ (52% vs. 52%, p = 0.667). Considering in-hospital antithrombotic therapy, group 1 had higher prescriptions of clopidogrel (68% vs. 56%), aspirin (99% vs. 81%), unfractionated heparin (21% vs. 8%), and enoxaparin (80% vs. 56%) (all p < 0.001). There was no significant difference in the primary composite endpoint between groups (9% vs. 9%, p = 0.906). Similarly, the secondary endpoints of all-cause mortality (0.6% vs. 0.7%), re-infarction (1.3% vs. 0.7%), stroke (0.7% vs. 0.4%), and HF (7% vs. 8%) did not differ significantly between groups (all p > 0.05). Nevertheless, group 1 exhibited higher rates of major bleeding (0.8 vs. 0.2%, OR 3.48, CI 95% 1.22–9.89, p = 0.013). Conclusions: Pretreatment with a P2Y12i in NSTE-ACS patients undergoing a late invasive strategy was not associated with reduction in the primary endpoint, although it was associated with higher rates of major bleeding.
- Predictors of mortality and neurological dysfunction in cardiac arrest: A retrospective single centre studyPublication . Cabral, Margarida; Castro, Diana; Palavras, Maria João; Santos, Flávia; Sequeira, Filipa; Pereira, Luís; Morais, JoãoObjective: The aim of this study was to identify the mortality rate of cardiac arrest in our insti tution and to determine the association between clinical available variables with early mortality and neurological outcomes. Design, setting, and patients: We performed a ret rospective study including all adult patients with the first diagnosis of “cardiac arrest” admitted to the intensive care unit of a Portuguese tertiary hospital, from 2015 to 2020. Outcomes were early mortality, including in-hospital and 1 month after discharge mortality, and neurological function after cardiac arrest as defined by the Cerebral Performance Category score scale. Results: 114 patients were included, 32 suffered from out-of-hospital cardiac arrest, and 82 from in-hospital cardiac arrest. In multivariate logistic analysis, a Glasgow Coma Score after the return of spontaneous circulation less than five and the existence of another cause for cardiac ar rest than ST-segment elevation myocardial infarction demonstrated to be predictive factors of early mortality. The poor neurological outcome was associated with a total cardiopulmonary resuscitation length greater than five minutes and a Glasgow Coma Score after the return of spon taneous circulation less than five. Conclusions: Cardiac arrest is still an important cause of morbimortality in our society. Efforts should be made to optimize its approach, minimizing the cardiorespiratory arrest length to reduce mortality and improve the neurologic prognosis of survivors.
- Sex-related differences in ST-segment elevation myocardial infarction: A Portuguese multicenter national registry analysisPublication . Gonçalves, Carolina Miguel; Carvalho, Mariana; Vazão, Adriana; Cabral, Margarida; Martins, André; Saraiva, Fátima; Morais, João; Oliveira, MárioIntroduction and objectives Sex differences among patients with acute myocardial infarctions remain a matter of debate. Inequalities in presentation, diagnosis, treatment, and prognosis are frequently observed, contributing to a worse prognosis in women. The aim of this study was to investigate sex-related differences in Portuguese ST-segment elevation myocardial infarction (STEMI) patients. Methods The authors conducted a retrospective analysis of STEMI patients included in the Portuguese Registry on Acute Coronary Syndromes, between October 2010 and 2022. The two co-primary endpoints were in-hospital and one-year mortality. Results A total of 14 470 STEMI patients were studied. Women were underrepresented with 3721 individuals (25.7%). They were significantly older (70 vs. 62 years, p<0.001), with higher prevalence of cardiovascular risk factors, and underwent less frequently coronary angiography (84.4% vs. 88.5%, p<0.001) and guideline-directed medical therapy (e.g., aspirin 92.5% vs. 95.4%, beta blockers 79.2% vs. 83%, p<0.001). Furthermore, they experienced more complications, such as congestive heart failure (23.4% vs. 14.6%), ischemic stroke (47% vs. 40%), and in-hospital mortality (8.5% vs. 4.1%) (p<0.001 for all comparisons). Similarly, they presented higher one-year mortality (11.5% vs. 6.3%, p<0.001). However, after a multivariate analysis testing significant clinical variables, female sex remained an independent predictor for in-hospital (odds ratio=1.633; 95% CI [1.065–2.504]; p=0.025), but not for one-year mortality. Conclusions This analysis reveals sex-related disparities in Portuguese STEMI patients. Despite limitations inherent to registry-based analysis, women were significantly older, with increased cardiovascular risk, less treated, and with higher in-hospital mortality. These disparities should be a concern for clinicians to further improve outcomes and move toward equitable medical care.