que se leu este artigo
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Do they influence outcomes in hospitalized patients?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "581" "paginaFinal" => "582" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Mário Oliveira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Mário" "apellidos" => "Oliveira" "email" => array:1 [ 0 => "m.martinsoliveira@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Central University Hospital Center, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital CUF Tejo, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Institute of Physiology and Centro Cardiovascular da Universidade de Lisboa, Faculty of Medicine of Lisbon, Lisbon, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Arritmias na COVID-19. Têm impacto prognóstico nos doentes hospitalizados?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The SARS-CoV-2 pandemic infection has been reported in 223 countries, with about 136 million cases and almost 3 million deaths since December 2019.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Although the real mortality associated with COVID-19 remains unknown, the current global case fatality reported across countries ranges from 0.2% (in Germany) to 7.7% (in Italy).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Cardiovascular disease, diabetes and age have been outlined as risk factors for poorer outcomes in COVID-19 patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical presentation varies widely, from asymptomatic or mild flu-like symptoms to acute severe respiratory distress syndrome and systemic complications impacting several organs. Cardiovascular complications from COVID-19 infection are being reported more frequently, ranging from silent myocardial injury to thromboembolic events, acute coronary syndromes, cardiogenic shock and arrhythmias.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Arrhythmias have been described in 17% of the hospitalized cases and in almost 50% of patients in the intensive care units (ICU), probably with a potential contribution to a higher risk of adverse outcomes, with an increased risk of in-hospital death.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> There are various reported series of different types of arrhythmias, including bradycardia (less common), sinus tachycardia and atrial arrhythmias (atrial fibrillation [AF] and atrial flutter) and ventricular dysrhythmias, including cardiac arrest.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the study “Cardiac arrhythmias in patients presenting with COVID-19 treated in Portuguese hospitals. A national registry from Portuguese Association of Arrhythmology, Pacing and Electrophysiology”, published in this issue of the <span class="elsevierStyleItalic">Journal</span>, Dinis Mesquita et al. present the results of a survey conducted by the Portuguese Association of Arrhythmology, Pacing and Electrophysiology to assess the occurrence of arrhythmias in COVID-19 patients in 20 Portuguese hospitals.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> They report data from 692 hospitalized patients, with arrhythmic episodes in 11.7% of the cases, including paroxysmal supraventricular tachycardia, atrial flutter and AF (the most common, being recurrence of previously existing arrhythmia in 35.9%), bradycardia and ventricular tachycardia. Surprisingly, none had arrhythmia-related complications nor arrhythmic death despite their elderly age (mean 73.5 years; minimum 61, maximum 80.3), associated comorbidities in a large majority of the reported arrhythmias (79.7%), and more severe COVID-19 disease, with mechanical ventilation, hemodynamic instability and multiple organ failure (in those patients with supraventricular arrhythmias) and high mortality rate (31.3%).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although continuous cardiac rhythm monitoring was obtained only in the subgroup of 393 patients admitted to the ICU or with continuous cardiac monitoring, with detailed information available limited to 79% of the cases with documented arrhythmias, these are useful real clinical data for our understanding of the severity and impact of arrhythmias in COVID-19 infection.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The survey also reports the assessment of QT interval during hospital admission in 443 patients under therapy with ritonavir/lopinavir, hydroxychloroquine or azithromycin. Interestingly, despite medication capable of QT prolongation in 76.6% of the cases with arrhythmias, only seven patients (10.9%) had an increased QTc interval (ranging between 480 ms and 596 ms).</p><p id="par0035" class="elsevierStylePara elsevierViewall">As pointed out by the authors, the availability of continuous cardiac monitoring in only 56.8% of the population poses strong limitations to the conclusions of the registry. Of course, it seems that the occurrence of arrhythmias (mostly supraventricular) is a common finding, particularly in patients with co-morbidities and more severe COVID-19 manifestations, but data from the whole population could identify clinical variables associated with higher risk of new onset (or reappearance) of arrhythmias, and contribute to a better approach to this specific group of patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">According to the most recent literature, risk factors for the appearance of arrhythmias are: respiratory insufficiency, myocardial strain and ischemia or myocarditis, cardiogenic shock, sepsis or systemic inflammation, hyperactivity of the sympathetic nervous system, hypercoagulability status, electrolyte disturbances, and proarrhythmic drug side effects.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,6,8</span></a> Therefore, the incidence of arrhythmias in patients with COVID-19 is a likely consequence of systemic illness and not solely the direct cardiac effect of the infection.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO Coronavirus Disease (COVID-19) dashboard" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "WH Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2021" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19 in Italy: momentous decisions and many uncertainties" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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2024 Julho | 90 | 31 | 121 |
2024 Junho | 53 | 34 | 87 |
2024 Maio | 67 | 25 | 92 |
2024 Abril | 53 | 24 | 77 |
2024 Maro | 50 | 27 | 77 |
2024 Fevereiro | 54 | 27 | 81 |
2024 Janeiro | 58 | 34 | 92 |
2023 Dezembro | 48 | 19 | 67 |
2023 Novembro | 80 | 47 | 127 |
2023 Outubro | 49 | 18 | 67 |
2023 Setembro | 57 | 19 | 76 |
2023 Agosto | 31 | 12 | 43 |
2023 Julho | 52 | 14 | 66 |
2023 Junho | 55 | 19 | 74 |
2023 Maio | 60 | 31 | 91 |
2023 Abril | 39 | 8 | 47 |
2023 Maro | 55 | 24 | 79 |
2023 Fevereiro | 50 | 25 | 75 |
2023 Janeiro | 47 | 28 | 75 |
2022 Dezembro | 53 | 26 | 79 |
2022 Novembro | 76 | 40 | 116 |
2022 Outubro | 77 | 37 | 114 |
2022 Setembro | 89 | 38 | 127 |
2022 Agosto | 83 | 51 | 134 |
2022 Julho | 83 | 43 | 126 |
2022 Junho | 66 | 39 | 105 |
2022 Maio | 54 | 32 | 86 |
2022 Abril | 66 | 44 | 110 |
2022 Maro | 91 | 58 | 149 |
2022 Fevereiro | 69 | 44 | 113 |
2022 Janeiro | 84 | 48 | 132 |
2021 Dezembro | 71 | 43 | 114 |
2021 Novembro | 59 | 46 | 105 |
2021 Outubro | 76 | 75 | 151 |
2021 Setembro | 49 | 42 | 91 |
2021 Agosto | 167 | 113 | 280 |
2021 Julho | 27 | 35 | 62 |