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OBJECTIVE: To study the differences between fluvastatin and pravastatin regarding LDL susceptibility to oxidation, plasma levels of total cholesterol (TC), HDL-C, LDL-C and triglycerides (TG) in hypercholesterolemic patients with established coronary heart disease (CHD). METHODS: A double-blind randomized parallel study was conducted that included 41 hypercholesterolemic outpatients with CHD treated at the Instituto de Cardiologia do Rio Grande do Sul. The inclusion criteria were LDL-C above 100 mg/dL and triglycerides below 400 mg/dL based on 2 measures. After 4 weeks on a low cholesterol diet, those patients that fullfilled the inclusion criteria were randomized into 2 groups: the fluvastatin group (fluvastatin 40 mg/day) and the pravastatin group (pravastatin 20 mg/day), for 24 weeks of treatment. LDL susceptibility to oxidation was analyzed with copper-induced production of conjugated dienes (Cu2+) and water-soluble free radical initiator azo-bis (2'-2'amidinopropanil) HCl (AAPH). Spectroscopy nuclear magnetic resonance was used for determination of lipids. RESULTS: After 24 weeks of drug therapy, fluvastatin and pravastatin significantly reduced LDL susceptibility to oxidation as demonstrated by the reduced rate of oxidation (azo and Cu) and by prolonged azo-induced lag time (azo lag). The TC, LDL-C, and TG reduced significantly and HDL-C increased significantly. No differences between the drugs were observed. CONCLUSION: In hypercholesterolemic patients with CHD, both fluvastatin and pravastatin reduced LDL susceptibility to oxidation.

To determine the incidence of atrial fibrillation in the postoperative period of cardiac surgery, its impact on morbidity, mortality, and hospital stay, and to analyze the risk factors in the pre, trans, and postoperative periods.Contemporary cohort study with 158 adult patients undergoing cardiac surgery, of whom those with atrial fibrillation in the preoperative period were excluded. The patients were assessed with continuous cardiac monitoring and daily electrocardiograms. Any episode of irregular rhythm with the presence of f waves of variable morphology and amplitude was considered atrial fibrillation.The general incidence of atrial fibrillation was 28.5%, being 21.6% for revascularized patients and 44.3% for those undergoing valvular repair. Factors independently associated with atrial fibrillation were left heart failure in the preoperative period (p=0.05; RC=2.2), total fluid balance (p=0.01; RC=1.0), duration of surgery (p=0.03; RC=1.01) [and other associated factors, age70 years, aortic valvular disease, psychomotor agitation, length of installation of the drains, pulmonary congestion and respiratory insufficiency in the postoperative period]. The use of beta-blockers (p=0.01; RC=0.3) was a protective factor. Atrial fibrillation in the postoperative period was associated with an increase in the length of hospital stay (16.9+/-12.3 days versus 9.2+/-4.0 days, p0.001) and a greater incidence of stroke or postoperative death (p=0.02).The incidence of atrial fibrillation in the postoperative period of cardiac surgery was high and caused a significant increase in morbidity, mortality, and the length of hospital stay. Among the independent risk factors, excessive fluid balance is significant. The use of beta-blockers was identified as a protective factor.

A 53-year-old man with myocardial infarction was found to have frequent premature ventricular beats. The predominant pattern was classical concealed trigeminy; i.e., the number of conducted sinus beats, S, between extrasystoles satisfied the equation S = 3n + 2, where "n" is zero or any positive integer. Two other transient patterns also occurred. The first one was characterized by exceptional values of S, which satisfied the equation S = 3n + 3. In the second transient pattern, all values of S fitted the classical equation, but there were singularly absent values; i.e., the "n" in the equation was exclusively an odd number, giving rise to only prime numbers of interectopic conducted sinus beats. It is proposed in this last form that there are two sites of fixed block proximal to a variable distal block in a re-entry loop responsible for the ventricular extrasystoles.

A combination of verapamil (V), methyldopa (M), and hydrochlorothiazide (H) was tried in hypertensive patients resistant to the usual stepped-care therapy. After at least 60 days with a third-step regimen, placebo was added during the last 2 weeks. Twenty patients whose diastolic blood pressure (DBP) remained greater than 100 mm Hg were assigned to the study. During the initial titration period patients received increasing doses of V (240-480 mg) and M (500-1,500 mg). H was kept at 50 mg/day. Other previously administered drugs were gradually withdrawn. Goal pressure was DBP less than or equal to 95 mm Hg. Follow-up lasted 3 years. Sixteen patients participated in the investigation until the end and all but one reached the goal DBP. Mean systolic BP dropped from 187 +/- 17 to 150 +/- 15 mm Hg (p less than 0.05) and DBP from 118 +/- 12 to 90 +/- 9 mm Hg (p less than 0.01). Adverse effects were rare and mild. Other control measurements did not show any change except improvement of the electrocardiogram of 11 patients, and of the optic fundus of 10 patients. The number of drug unities to be taken dropped from 10 +/- 4 to 7 +/- 2 (p less than 0.05). The abovementioned combination seems to be useful in the control of resistant hypertension. Efficacy was sustained and tolerability was excellent. A potential to reverse target organ damage, namely of the heart and optic fundus, is suggested.

It is a well-known fact that one fifth of ventricular septal defects (VSD) close spontaneously, especially before the age of 5, and that one third of them present at least some evidence of decreasing their size at any time. This study was carried out to test the hypothesis that the most frequent mechanism of spontaneous partial or complete closure of perimembranous VSD is the apposition of accessory tissue from the tricuspid valve to the margins of the defect, and that cross-sectional echocardiography is a safe and reliable tool to demonstrate it in the living person.