Showing papers in "Arquivos Brasileiros De Cardiologia in 1990"

Empiric therapy with amiodarone in patients with chronic Chagas cardiomyopathy and sustained ventricular tachycardia

Abstract: PURPOSE To evaluate the efficacy and safety of long-term empiric amiodarone therapy in patients with recurrent Sustained Ventricular Tachycardia (SVT) and Chronic Chagasic Myocarditis (CCM). PATIENTS AND METHODS Thirty-five patients with CCM and SVT, eighteen (51%) of them were refractory to other antiarrhythmic drugs. The Amiodarone loading dose was between 600 and 1200 mg/day, mean of 883 +/- 239 mg/day, from a period of one to four weeks. The maintenance dose was decreasing in the follow-up period, it fell down to 356 +/- 125 mg/day at the end of six to 80 (mean = 27 +/- 20) months. Cumulative, event-free interval curves were generated by the Kaplan-Meier method. Clinical variables were compared with the use of the Student t-test or by means of chi-square tests. RESULTS The probability to suppress SVT was, 0.62 in 12 months, 0.56 in 24 months and 0.44 in 36 months, with regular use of amiodarone. The probability to the occurrence of sudden death was 0.0 in 12 months, 0.04 in 24 months and 0.11 in 36 months. The stratification of risk to clinical recurrence was significative to the left ventricular disfunction. All patients with functional class III or IV and LV ejection fraction less than 30% at radioisotopic ventriculography had clinical recurrence, while just 30% of patients with functional class I and II have got it (p less than 0.05). Fifteen (42.8%) patients had side effects. The treatment was discontinued in four patients (11.5%). CONCLUSION The empiric treatment with amiodarone apparently was effective in patients with SVT and CCM and functional class I and II. Patients with functional class III and IV did not get benefits from the treatment. In these cases other therapy must be pointed out.

[Prevalence of arterial hypertension in Araraquara, Brazil].

Abstract: PURPOSE To study the prevalence of high blood pressure (HBP) in Araraquara, Sao Paulo, Brazil. PATIENTS AND METHODS Cross sectional study: cluster equiprobabilistic sampling of 1.8% of the urban population aged 15-74 years, old (1.199 adults: 533 men and 66 women). For each subject, an interview was performed, with the fulfilling of a questionnaire; measures of blood pressure (BP, systolic and 2nd diastolic) as well as height and weight were taken. Criteria of definition for HBP were those of WHO (greater than or equal to 160/95). RESULTS Systolic BP (mean +/- standard error) for men 137.6 +/- 0.8 mmHg, and for women 130.9 +/- 1.0 mmHg. Second diastolic BP for men 88.5 +/- 0.5 mmHg and for women 84.0 +/- 0.6 mmHg. Prevalence of definite HBP: 32.0% of men and 25.3% women (28.3% both sexes). Prevalence of borderline HBP; 18.7% of men and 12.0% of women (14.8% for both sexes). The greater part of hypertensives (68.3%) was of mild cases (less than 105 mmHg the second diastolic BP). CONCLUSION It is the highest prevalence of HBP in Brazil described till now, and, therefore, an important public health problem.

[Indeterminate form of Chagas' disease. A polymorphic disease].

Abstract: PURPOSE To evaluate the association between the indeterminate form of Chagas' disease and abnormalities in non-invasive cardiovascular propedeutics. PATIENTS AND METHODS Twenty-two patients in the indeterminate form of Chagas' disease, 17 female, with ages between 25 and 50 years were submitted to studies of: vectorcardiography, echocardiography, stress test, dynamic electrocardiography and scintigraphic studies (scintigraphic ventriculography and cardiac mapping with pyrophosphate of technetium), in a period of two months after first consultation. RESULTS The analysis shows the percentual of altered exams: vectorcardiogram--68.2% (conduction disturbance--22.7%); echocardiogram--15.8% (apical hypokinesia); cardiac mapping 61.8%; scintigraphic ventriculography--68.2%; stress test--72.2% (reduced delta PS--50%, ventricular arrhythmia--50%); and dynamic electrocardiographic--50% (ventricular arrhythmias). We could observe also that the great majority of the patients has more than three exams altered (63.6%). The study of relation between methods, shows only association between reduced delta PS and ventricular arrhythmia, with concordant results in 72.7%. CONCLUSION Indeterminate form of Chagas' disease appears to be a really chronic form, may be of attenuate aggressive potential, with indeterminate evolution and with polymorphic clinical exteriorization seeing only through invasive and non invasive propedeutic techniques.

Endocarditis caused by Streptococcus bovis and colorectal neoplasms

Abstract: PURPOSE To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms. PATIENTS AND METHOD Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990. The mean age was 57.68 years, 16 (84.21%) were males. Previous heart disease was not known in nine (45%). Previous manipulation that might induce bacteremia was identified in three patients. Symptoms related to neoplasia of the digestive system were not informed. The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months. Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients). RESULTS Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%). Two patients are waiting for colonoscopic resection. In one patient the polyp was lost after colonoscopic resection. CONCLUSION The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S. bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease.

Myocardial lesions after snake bites by the Crotalus durissus terrificus species (rattlesnake). A case report

Abstract: Extensive and severe myocardial lesions are reported in a patient who died due to snakebite (Crotalus Durissus Terrificus). These lesions are documented by clinical, electrocardiographic, enzymatic and histological evidences. The main pathological features are represented by sarcoplasmatic vacuoles, densely clumped myofibrils and amorphous acidophilic mass into the cardiac fibers. These lesions are identical to those which have already been described in skeletal muscle after snakebite. This seems to be the first case report that shows undoubt myocardial lesions due to snakebite with anatomopathological documentation.

[Infective endocarditis: analysis of 300 episodes].

Abstract: PURPOSE Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE). PATIENTS AND METHODS 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males. RESULTS a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococci) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non-group D streptococci) and 62% (gram-positive bacteria other than streptococci and staphylococci); in relation to the underlying heart disease, the mortality was 16% in patients with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves. CONCLUSION The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the different etiologic agents and in relation to the cardiac status before the IE.

Acute myocardial infarction in patients under 40 years of age

Abstract: Purpose To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. Patients and methods In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded. Results Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3). Conclusion Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.

Hemodynamic changes after an intensive short-term exercise and nutrition program in hypertensive and obese patients with and without coronary artery disease.

Abstract: Purpose To assess the effectiveness of the Pritikin diet and exercise program on cardiovascular hemodynamics using the noninvasive technique of Thoracic Electrical Bioimpedance (TEB). Material and methods Twenty subjects divided in two groups, according to their body habitus and hemodynamic disturbances. These data were compared to a group of 10 healthy individuals not involved in the program. Hemodynamic parameters were collected at admission and at the end of the intensive 26-day program of exercise and nutrition. Results In obese and hypertensive subjects not on medication we observed that cardiac index increased from 3.27 +/- 0.4 to 3.58 + 0.5 L/min/m2; mean arterial pressure decreased from 100 +/- 8.5 to 94.8 +/- 7.9 mmHg while systemic vascular resistance index decreased from 2362 +/- 391 to 1934 +/- 357 dynes. sec. cm-5/m2; p less than 0.05 (Data obtained in supine position). Also documented was a improvement in ventricular performance after postural changes from upright to supine based on indices of left ventricular performance, uniquely obtained by the TEB technique. From admission to discharge, changes were: Ejection fraction 48% to 53%; Peak flow index 295 to 316 ml/s/m2 and Index of contractility 40 to 47 s-1, explained by a shift on the ascending limb of the Starling curve. Conclusion In a selected population, this rehabilitation program is effective for hemodynamic improvement that can be partially explained by metabolic and biochemical changes already reported from this Center.

Cholesterol and other cardiovascular risk factors among employees of the Universidade Federal do Rio de Janeiro. Prevalence and influence of social variables

Abstract: Purpose To investigate the presence of cardiovascular risk factors in employees of the "Universidade Federal do Rio de Janeiro". Patients and methods A survey of 250 men age ranging from 35 to 64 years, randomly selected among 4651 employees of URFJ, was done. They were invited by letter to a consultation at which previously trained personnel applied a questionnaire to investigate about their education level, income, occupation, smoking habit, and use of anti-hypertensive drugs. They also had their blood pressure, height and weight measured and underwent a blood sample collection for serum cholesterol and HDL-cholesterol analysis. This procedure followed a standardized protocol. Results Two hundred and nine subjects (83.6%) were examined. The characteristics of age, education, and occupation were similar for responders and non-responders. The mean (+/- standard deviation) for total cholesterol, HDL-cholesterol, systolic and diastolic blood pressure were respectively: 210 +/- 21.9 mg/dl; 41.1 +/- 12.4 mg/dl; 129.7 +/- 24.0 and 80.4 +/- 17.7. The prevalence of hypertension, hypercholesterolemia and smoking were: 30%, 22% and 38%. The prevalence of these risk factors together was 4%. Only SBP and DBP were statistically different when analyzed by income or education strata. There was a strong positive correlation between body mass index and serum cholesterol and blood pressure levels. Conclusion In spite of the high education level and income of this sample for brazilian standards, the prevalence of risk factors for cardiovascular diseases is very high, especially for the overweight and the socially less favoured. More precise indicators of dietary habits and socio-economic and cultural status are necessary to develop adequate interventional strategies. The control of obesity seems to be a desirable goal in achieving the concurrent control of associated risk factors.

Staphylococcus aureus endocarditis in a puerperal woman with mitral and tricuspid valve prolapse

Abstract: A 17-year-old woman with mitral and tricuspid valve prolapse and myxomatous degeneration presented puerperal infection by Staphylococcus aureus with clinical picture of sepsis and multiple septic embolism (right eye, left thumb, spleen, and left calf). She underwent total hysterectomy on the 10th day postdelivery and right eye enucleation on the 16th. Temporary total AV block occurred on the 14th day with temporary external pacing during the next couple of days. Acute endocarditis with acute mitral regurgitation was diagnosed on the 13th day, demanding immediate valve replacement. On the 46th day she developed moderate tricuspid valve regurgitation due to another episode of endocarditis. Final clinical discharge took place on the 62nd day after antibiotic therapy completion.

Fatal acute myocardial infarction in a young cocaine addict

Abstract: A 28 year-old male cocaine abuser without coronary atherosclerosis suffered fatal myocardial infarction. Necropsy revealed several myocardial infarctions of different ages. Examination of the coronary arteries revealed fibrointimal thickening of the intimal layer of the coronary arteries.

Echocardiographic diagnosis of accessory leaflet of mitral valve

Abstract: The accessory mitral valve leaflet is a rare cardiac congenital anomaly usually associated to complex cardiac congenital malformations. It also represents a rare cause of left ventricular outflow tract obstruction. Its diagnosis has often been ignored by conventional diagnostic methods. This fact may represent a cause for relative surgical failure, when operations for cardiac complex anomalies are performed. Echodopplercardiography is the choice and more accurate method for its diagnosis. In our case, parasternal and apical long axis planes, allowed an unmistakable visualization of a parachute shape fibrous structure, with its concave surface turned up towards the aortic valve. Chordae tendinae proper to the anomalous accessory mitral valve tissue were connected to chordae or to papillary muscles of the mitral valve. A careful echodopplercardiographic study will allow us, not only to diagnose this malformation, as well as to differentiate it from other conditions like tumors, vegetations or other types of subaortic obstruction.

Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm

Abstract: A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.

Chronic Chagas cardiopathy in patients aged 12 to 15 years

Abstract: PURPOSE A comparison between pathological features of chronic chagasic cardiomyopathy (CCC) in adolescents and adults. PATIENTS AND METHODS Adolescents under the age of 15, with amastigote trypanosomal forms in the myocardium, a positive xenodiagnosis and/or serology for trypanosoma cruzi infection, were selected from 4.583 necropsies performed between 1958-86 at the Professor Edgard Santos Hospital in Bahia, Brazil. RESULTS Nine CCC cases between the ages of 12 and 15 years were identified. Mean heart weight was under twice normal. Intracardiac thrombi were present in five (55.6%), apical left ventricle aneurysm in four (44.4%) and parasites in the myocardium in three (33.3%) cases. Systemic or pulmonary thromboembolism was found in six (66.7%) patients. Mitral regurgitation was present in six (66.7%) cases, two with valvar anatomic alterations. CONCLUSION Pathological features of CCC in adolescents did not differ from those found in adult patients.

Cerebral malformation of the conceptus associated with maternal bacterial endocarditis and with aortic valve replacement during pregnancy

Abstract: A twenty-three years old woman, without previous heart disease developed endocarditis with negative bloods cultures on the fourth month of her third pregnancy. Fever was controlled through antibiotics, however she developed cardiac insufficiency and was submitted to surgery for replacement of aortic valve with a bioprosthesis. The post operative period showed no problems and the patient was discharged on the forty second day after admission. On the thirty ninth week of pregnancy she gave cesarean birth, without complications. The newly born, apgar 5 (1 min.) and 7 (5 min) presented signs of neurological problems, characterized on the second month as a cerebral atrophy. Among various possible factors, the most likely would be cardiopulmonary bypass circulation as the cause of the neurological malformation.

Hemolytic anemia following surgical repair of mitral valve insufficiency in children

Abstract: The description of hemolytic anemia after mitral valve repair has been infrequent. The present paper presents this complication, discussing its diagnosis and surgical aspects, such as the association with the use of teflon felt for posterior annuloplasty. This complication happened in two children at our institution, one treated medically with supplementation of folic acid and ferrous sulfate and another requiring surgery for replacement of the teflon felt using a piece of heterologous pericardium for a new annuloplasty and leaflet advancement.

[Endomyocardial biopsy and myocardial imaging with 67-gallium in the diagnosis of active myocarditis in children with dilated myocardiopathy].

Abstract: PURPOSE This study was designed to compare 67Ga imaging and endomyocardial biopsy (EB) in children with severe dilated cardiomyopathy (DC), as well as to evaluate the results in a group of patients with active myocarditis submitted to immunosuppressive therapy. PATIENTS AND METHODS Forty-four pediatric patients with severe DC were studied. Twenty males and 24 females from 10 months to 15 year old (median = 2.6 years). All patients were submitted to a protocol including 67Ga uptake and EB. In patients submitted to immunosuppressive therapy these procedures were repeated after six months. RESULTS In 32 patients (72.7%) the EB revealed presence of inflammatory process; 21 (65.6%) of these had a positive 67Ga uptake and 11 (34.4%) negative. Twelve patients with no evidence of inflammatory process in the EB, nine (75%) presented negative 67Ga uptake. However, when the intensity of myocardial inflammatory was analysed (mild, moderate and severe) and correlated with 67Ga imaging, was observed that the majority of patients with negative 67Ga uptake (11 patients) had mild inflammatory infiltration (nine patients). In this way the 67Ga uptake demonstrated a good correlation in the diagnosis of moderate and severe inflammatory process in children with DC. This is important because the use of immunosuppressive drugs is indicated only in these group. CONCLUSION The 67Ga imaging is a noninvasive diagnostic method with a good sensitivity to the diagnostic method with a good sensitivity to the diagnosis of AM in children with severe DC, demonstrating to be very useful in the therapeutic approach.

[Comparative study of cardioplegia and intermittent cross-clamping in myocardial revascularization surgery].

Abstract: PURPOSE To compare the effects of two methods for myocardial preservation during coronary artery by pass graft (CABG): the intermittent aortic cross-clamping (IACC) and the cold hyperkalemic solution (CHS). PATIENTS AND METHODS One hundred and sixty-three patients operated for CABG between October/83 to May/84 were studied retrospectively. Those operated in emergency situations, reoperations and those who required concomitant additional procedures were excluded. The surgical technique used in both groups was essentially the same. Group I comprised 93 cases (40-70 years-old, median 57.7% y; 86% male) in which IACC were used. Group II comprised 70 cases (37-72 years old, median 67.7 y; 80% male) in which CHS (St. Thomas) was injected into the aortic root. The patients were evaluated in the immediate postoperative period at 3, 6, 12 months and then in variable periods until the 61 months of late follow-up. Myocardial ischemia and infarction, the use of drugs and the hospital time recovery were evaluated. The occurrence of symptoms, return to work, physical capacity, reinternations, reoperations and late deaths were evaluated in the late follow-up. RESULTS During hospital period, no death was observed. Perioperative myocardial infarct was similar in both groups (group I = 2.1% and group II = 1.4%) statistical difference in the others parameters was observed. Of 95.5% of the patients who had postoperative observations, 80% had a late follow-up ranged from 30 to 61 months (median 38 months). One patient of each group had a cardiac death. In both groups (group I--1 patient and group II--4 patients) coronary insufficiency symptoms related were present and no statistical difference in the others parameters was observed. CONCLUSION CHS or IACC were efficient and similar methods for myocardial protection in an elective group of patients submitted to a CABG in the immediate and late follow-up.

Drogas imunossupressoras no tratamento da miocardite ativa na crianca: avaliacao hemodinamica

Abstract: Objetivo — Analisar parâmetros hemodinâmicos (fracao de ejecao do ventriculo esquerdo (FEVE), indice cardiaco (IC), pressao media de capilar pulmonar (PCP) e diâmetro diastolico do ventriculo esquerdo (DdVE) em um grupo de criancas portadoras de miocardite ativa (MA), diagnosticadas atraves de biopsia endomiocardica, submetidas a terapeutica convencional e a diferentes drogas imunossupressoras (prednisona isolada ou prednisona associada a azatioprina ou ciclosporina).

Cineventriculography with radionuclides and intravenous dipyridamole in the prognostic evaluation after acute myocardial infarction

Abstract: PURPOSE To evaluate safety and usefulness of dipyridamole-radionuclide ventriculography (D-RVG), soon after acute myocardial infarction (MI), in the prediction of future cardiac events. Traditionally performed tests were also compared. PATIENTS AND METHODS Forty-one patients (4 females) with recent MI underwent rest and dipyridamole (0.58 mg/kg of body weight) radionuclide ventriculography. The criteria for a positive test for ischemia was failure to increase left ventricular ejection fraction in 0.05 from baseline value. All patients had also coronary angiography and 36 patients underwent thallium-201 scintigraphy for comparison. The mean follow-up was 16 +/- 3 months. The following findings were considered future for events: cardiac death, reinfarction, significant angina or heart failure. RESULTS During the follow-up 18 of the 20 patients who had cardiac events had shown positive dipyridamole-RVG, as opposed to 5 of 21 event-free patients (p less than 0.01). The ventriculographic criteria for a positive test and dipyridamole left ventricular ejection fraction were the strongest predictors of those medical events (p less than 0.01 and p less than 0.001). Among the 36 patients who had thallium-201 imaging, 16 subsequently had cardiac events and the scans were positive in 82% (p less than 0.01). Twelve (29%) patients experienced reactions during dipyridamole infusion although no fatal complications were noted. CONCLUSION Dipyridamole-RVG is relatively safe and a sensitive predictor of future cardiac events soon after acute MI, although additional experience is required before this new technique should be routinely recommended as an alternative approach.

[Simvastatin (MK-733), a new HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients with atherosclerosis].

Abstract: PURPOSE To evaluate the efficacy and tolerability of simvastatin, a new and potent HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients. PATIENTS AND METHODS Twenty patients, 14 female and 6 male, aged 65 to 72 years (x = 69 +/- 3), with total cholesterol (TC) above 260 mg/dl and triglycerides below 350 mg/dl were studied. All patients presented clinical evidences of atherosclerotic disease and were followed up for 6 months. Monthly visits were required for clinical and laboratory evaluation. The initial dosage of simvastatin was 10 mg/day; dosage was titrated up to 10 mg/day or to a minimum of 5 mg/day in intervals of at least 4 weeks, in order to maintain LDL-cholesterol below 140 mg/dl. To evaluate the changes on plasma lipid levels, the mean value of determinations during the placebo baseline period was compared to the mean value of determinations during the active treatment period. RESULTS There were significant reductions of total cholesterol (-26.4%), triglycerides (-16.0%), LDL-cholesterol (-35.2%), VLDL-cholesterol (-15.4%), TC/HDL-C (-30.7%), and LDL/HDL-C (-39.5%). There was significant elevation of HDL-cholesterol (+5.2%), although this response was not uniform. The drug was well tolerated: only five patients reported transient clinical adverse experiences that subsided spontaneously. Two patients had elevation of CPK and one of TGP. The drug did not have to be discontinued in any case. Ophthalmological examinations performed before treatment compared to examinations at the end of the study showed no signficant alterations. CONCLUSION Simvastatin in elderly patients appeared to be a potent TC and LDL-C lowering drug and presented mild but significant effect on the elevation of HDL-C. There was good tolerability, with low incidence of adverse experiences. This fact is important when one considers drug therapy for hypercholesterolemia in this age group.