O infarto e a ruptura com o cotidiano: possível atuação da enfermagem na prevenção

Qualidade de Vida de pacientes submetidos à revascularização do miocárdio

OBJETIVO: Determinar o impacto da cirurgia de revascularização do miocárdio na Qualidade de Vida dos pacientes; analisar e comparar dimensões da Qualidade de Vida antes e após a intervenção cirúrgica; comparar variáveis sociodemográficas e clínicas aos aspectos de depressão e ansiedade, pré e pós-operatórios. MÉTODOS: Estudo descritivo exploratório no qual foram incluídos 78 pacientes no pré e pós-operatório. Foram utilizados instrumentos de pesquisa internacionais e validados para avaliar a qualidade de vida e os aspectos de depressão e ansiedade. RESULTADOS: Houve melhora significativa em todos os domínios da Qualidade de Vida, depressão e ansiedade (p=0,05). Domínios físico e social do 36-Item Short-Form Health Survey apresentaram menor pontuação dos escores (13,46 e 3,03, respectivamente), bem como o domínio social do instrumento Macnew (3,03). CONCLUSÃO: Cirurgia de revascularização ocasionou impacto positivo na Qualidade de Vida desses pacientes.

Crenças e comportamentos de pessoas com doença arterial coronária

O estudo descreveu crenças e comportamentos sobre causas e medidas de controle da doença arterial coronária (DAC). Cem adultos foram entrevistados em ambulatório público, em Salvador (BA). Os resultados foram analisados em percentuais, médias e por técnica de análise de dados qualitativos. Predominaram homens, idade < 60 anos, cor negra, baixas escolaridade e renda, casados e sem ocupação. A média de crenças para a causa da DAC foi de 1,53 por participante incluindo fatores comportamentais, biológicos, relacionais e religiosos e representaram sobretudo acúmulo de excessos quanto às tensões cotidianas e alimentação. A maioria dos participantes não considerou a enfermidade de caráter crônico acreditando que o tratamento não duraria a vida toda e na cura da doença. A média de crenças para medidas de controle foi de 1,45 prevalecendo seguimento do regime alimentar e uso das medicações. Predominou sedentarismo, redução do tabagismo e consumo de bebida alcoólica, preparo de alimentos com menos sal e gordura saturada, maior consumo de carnes brancas, alimentos cozidos e industrializados. Apenas 66% cumpriam a receita médica. O entendimento insatisfatório sobre causas e medidas de controle da DAC torna essencial a implementação de cuidados contemplando as distintas condições de vida e saúde e projetos para o cuidar de si.

Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction

This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI). A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fisher's exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%), musculoskeletal (29.7%), food and/or medication poisoning (8.5%) and arising from the respiratory apparatus (6.3%). The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.

Patients with acute myocardial infarction and interfering factors when seeking emergency care: implications for health education

With the objective of estimating the time elapsed between the beginning of the signs and symptoms of a heart attack until the arrival at the cardiology emergency service (Delta T) and the factors that influence in this process, 112 patients were studied, with an infarction diagnosis with supraunleveling ST segment. The delta T was on average of 3h59±2h55min; 99(88%) of those patients sought out an emergency service within 1h after the beginning of the event. Unmarried patients presented a delta T smaller in relation to the others (P=0,006), as well as those that recognized the symptoms as a heart event; thoracic pain with burning symptoms, were described by 25 (24%) of patients, and the first attitude taken, in view those symptoms, was self-medication 37(33%). The recognition of the signs and symptoms of Acute Myocardium Infarction, is a decisive factor for the seeking of a specialized service.

Delay factors on the administration of thrombolytic therapy in patients diagnosed with acute myocardial infarction in a general hospital

OBJECTIVE: To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). METHODS: A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. RESULTS: The average age of the studied population was 57.5 ± 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 ± 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 ± 7.3 minutes and the door-to-needle time was 51.1 ± 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). CONCLUSIONS: Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.