OBJECTIVE - Studies have shown that therapy with beta-blockers reduces mortality in patients with heart failure. However, there are no studies describing the effects of propranolol on the QT dispersion in this population. The objective of this study was to assess the electrophysiological profile, mainly QT dispersion, of patients with heart failure regularly using propranolol. METHODS - Fifteen patients with heart failure and using propranolol were assessed over a period of 12 months. Twelve-lead electrocardiograms (ECG) were recorded prior to the onset of beta-blocker therapy and after 3 months of drug use. RESULTS - A significant reduction in heart rate, in QT dispersion and in QTc dispersion was observed, as was also an increase in the PR interval and in the QT interval, after the use of propranolol in an average dosage of 100 mg/day. CONCLUSION - Reduction in QT dispersion in patients with heart failure using propranolol may explain the reduction in the risk of sudden cardiac death with beta-blocker therapy, in this specific group of patients.

OBJETIVO: Conhecer a evolução intra-hospitalar (IH) e pós-alta (PA) de uma população predominantemente idosa, com insuficiência cardíaca congestiva (ICC) na unidade de emergência (UE). MÉTODOS: Durante 11 meses, foram selecionados 57 pacientes consecutivos com ICC, atendidos em EU, com idade média de 69+15 (27 a 94) anos, sendo 39 (68,4%) homens. O diagnóstico de ICC baseou-se nos critérios de Boston. Avaliou-se a evolução IH e PA num período médio de 5,7+2,7 (1 a 12) meses, procurando-se identificar variáveis que se correlacionassem com a mortalidade e o mecanismo de morte, avaliado pelo sistema ACME . RESULTADOS: Oito (14%) pacientes faleceram na fase IH, sendo 7 por falência circulatória (FC), e 1 em pós-operatório (PO). Durante o seguimento ocorreram 9 (18,4%) óbitos, sendo 5 por FC, 2 mortes súbitas e 2 em PO (troca valvar mitral e ventriculectomia). A sobrevida dos pacientes que tiveram alta foi de 82% e 66%, aos 6 meses e 1 ano, respectivamente. Sódio sérico <135mEq/l (p= 0,004) e sexo feminino (p= 0,038) foram preditores independentes de mortalidade. CONCLUSÃO: Pacientes idosos com ICC atendidos em UE apresentam mortalidade IH e PA elevadas e alta taxa de reinternação hospitalar. A maioria morre por falência circulatória decorrente da progressão da ICC.

PURPOSE: To evaluate the in-hospital (IH) outcome and the short-term follow-up of predominantly elderly patients presenting to an emergency room (ER) with congestive heart failure (CHF). METHODS: In an 11 month period, 57 patients presenting to the ER with CHF were included. Mean age was 69+15 years (27 to 94) and 39 (68,4%) were male. CHF diagnosis was based on the Boston criteria. We evaluated IH outcome and prognosis in a mean follow-up of 5,7+2,7 months (1 to 12). In addition, some mortality predictors and mechanisms of death according on the ACME system were identified. RESULTS: Eight patients (14%) died in the IH period. Modes of death were circulatory failure (CF) in 7, and peri-operative (PO) in one (aortic valve replacement). During follow-up 9 deaths ocurred. Five were due to CF, 2 were sudden and 2 were PO (mitral valve replacement and ventriculectomy). Six-months and 1-year survival rates of the patients who were discharged were 82% and 66%, respectively. Sodium lower than 135mEq/l (p= 0.004) and female gender (p= 0.038) were independent predictors of mortality. CONCLUSION: Elderly patients with CHF admitted to the ER have high in-hospital and short-term follow up mortalities. The majority die from CF due to worsening heart failure.