RESUMO
Pre-existing (chronic) atrial fibrillation (AF) has been identified as a risk factor for cardiovascular complications and mortality in patients with COVID-19; however, evidence in Latin America (LATAM) is scarce. This prospective and multicenter study from the CARDIO COVID 19-20 database includes hospitalized adults with COVID-19 from 14 countries in LATAM. A parsimonious logistic regression model was used to identify the main factors associated with mortality in a simulated case-control setting comparing patients with a history of AF to those without. In total, 3260 patients were included, of which 115 had AF. The AF group was older, had a higher prevalence of comorbidities, and had greater use of cardiovascular medications. In the model, AF, chronic kidney disease, and a respiratory rate > 25 at admission were associated with higher in-hospital mortality. The use of corticosteroids did not reach statistical significance; however, an effect was seen through the confidence interval. Thus, pre-existing AF increases mortality risk irrespective of other concomitant factors. Chronic kidney disease and a high respiratory rate at admission are also key factors for in-hospital mortality. These findings highlight the importance of comorbidities and regional characteristics in COVID-19 outcomes, in this instance, enhancing the evidence for patients from LATAM.
RESUMO
El síndrome de tako-tsubo (STT) o cardiomiopatía inducida por estrés es una afección cardíaca que se manifiesta de manera similar a un infarto de miocardio, aunque tiene características particulares: estrés agudo físico y/o psíquico, como causa desencadenante, cambios del segmento ST y onda T en el electrocardiograma, elevación moderada de los biomarcadores de mionecrosis (troponina ultrasensible), trastorno de la movilidad miocárdica de los segmentos medios y apicales del ventrículo izquierdo y arterias coronarias sin lesiones angiográficamente evidentes (obstrucción o ruptura de placa). El presente artículo describe a una paciente de sexo femenino de 67 años de edad, que ingresó al hospital por dolor precordial opresivo característico de un síndrome coronario agudo, cambios electrocardiográficos inespecíficos de isquemia y arterias coronarias normales, cuyo diagnóstico fue síndrome de tako-tsubo y, concomitantemente, estenosis aórtica moderada secundaria a válvula aórtica bivalva de patrón típico (fusión de la coronaria derecha e izquierda); esta asociación patológica no está descrita en la literatura médica. Se realizó una revisión bibliográfica poniendo hincapié en el diagnóstico de esta infrecuente patología.
Tako-tsubo syndrome (STT) or stress-induced cardiomyopathy is a cardiac condition with a clinical presentation similar to a myocardial infarction and specific features of this syndrome, such as: causes triggering of acute physical and / or psychic stress, ST segment changes, and T wave on the electrocardiogram, moderate elevation of myonecrosis biomarkers (ultrasensitive troponin), myocardial mobility disorder of the mid and apical segments of the left ventricle and coronary arteries without any evident angiographical lesions (obstruction or plaque rupture). This article will describe a female patient of 67 years old, who entered in the hospital due to oppressive precordial pain characteristic of an acute coronary syndrome, non-specific electrocardiographic changes of ischemia and normal coronary arteries, which we concluded with takotsubo syndrome; concomitantly moderate aortic stenosis secondary to a trival aortic valve with raphe confirmed by echocardiography; Clinical association is not described in medical literature. Later we will make a bibliographical review on the subject with emphasis on the diagnosis of this infrequent pathology.Key words: urethra, foreign body.
