[Comparison of peak oxygen uptake and VE/VCO2 slope, between children with and without heart failure]. / Comparación del consumo de oxígeno pico y la pendienteVE/VCO2 entre niños con y sin insuficiencia cardiaca (IC).

Heart failure is a health problem associated with disability and mortality. Physicians may stratify the risk of adult patients with heart failure using a cardiopulmonary exercise testing. Until now, in childhood this evaluation has been poorly used. The purpose of this study is to compare the peak oxygen uptake and minute ventilation/carbon dioxide production slope among children with heart failure versus children without heart disease (control). METHODS: Thirty-eight children with heart failure were compared with 194 children without heart disease. All of them performed cardiopulmonary exercise testing using a symptom-limited ramp protocol. Differences between groups were compared using Chi-squared test, Student's t test, or ANOVA. Any value of p < 0.05 was considered significant. RESULTS: Children with heart failure were older, taller, and with a higher prevalence of male gender. This group had also a lower peak oxygen uptake (27 ± 10 ml O2/kg/min) compared to the control group (37 ± 10 ml O2/kg/min); p < 0.001. The minute ventilation/carbon dioxide production was higher in the heart failure group (31 ± 4) than in controls (28 ± 6); p < 0.001. CONCLUSION: Children with heart failure showed lower peak oxygen uptake and higher minute ventilation/carbon dioxide production slope than the control group.

Pregnancy in teenagers with heart disease.

The prevalence of pregnancy in adolescent women is high in Mexico and represents a public health problem. The pregnant teenager with heart disease has a high probability of complications during pregnancy and the delivery, which carries a risk of death of both the mother and the product. In many cases the pregnancy should have been avoided, planned or interrupted, however the majority at this age is vulnerable and although certain cases must be interrupted by their high risk of maternal-fetal death, prevention and legal aspects should be considered. In some cases the woman wants a pregnancy although her health condition does not allow it, but there are options of adoption or recourse to a surrogate belly. In response to this growing social problem, the National Cardiology Institute Ignacio Chávez and National Institute of Perinatology, with the coordination of Ministry of Health in Mexico, started a pregnancy prevention module within a clinic of follow-up of cardiopathy and pregnancy. This review raises the global problem in our country that occupies the first place in pregnancies in adolescents, with more than 400,000 pregnancies a year and the form of immediate response in a multidisciplinary way.

La prevalencia de embarazo en mujeres adolescentes es muy alta en México, y representa un problema de salud pública. La adolescente embarazada con cardiopatía tiene altas posibilidades de complicaciones durante el embarazo y su resolución, lo que pone en riesgo la vida tanto de la madre como del producto. En muchos casos el embarazo debió ser evitado, planeado o interrumpido, sin embargo la mayoría a esta edad es vulnerable y si bien ciertos casos deben ser interrumpidos por su alto riesgo de muerte materno-fetal, es fundamental considerar la prevención y los aspectos legales. En algunos casos la mujer desea un embarazo aunque su condición de salud no se lo permite, pero existen opciones de adopción o recurrir a un vientre subrogado. Atendiendo este problema social cada vez más creciente, el Instituto Nacional de Cardiología Ignacio Chávez, en coordinación con la Comisión Coordinadora de la Secretaría de Salud y el Instituto Nacional de Perinatología, echaron a andar un módulo de prevención de embarazo dentro de una clínica de seguimiento de cardiopatía y embarazo. Esta revisión plantea el problema global en nuestro país, que ocupa el primer lugar en embarazos en adolescentes, con más de 400 mil embarazos al año y la forma de dar respuesta inmediata de manera multidisciplinaria.

Antiarrhythmic and arrhythmogenic action of inosine in experimental ventricular tachyarrhythmias.

OBJECTIVE: To study the possible action of inosine on experimental ventricular tachyarrhythmias. MATERIAL AND METHODS: We used 92 mongrel dogs weighing 13 kg-17 kg, anesthetized with 30 mg/kg sodium pentobarbital applied intravenously. Myocardial lesions were induced by injecting 1 ml-1.5 ml of 70% phenol in the free wall of the left ventricle. In 36 dogs, the ventricular arrhythmia (VT) was induced 30 min later with aconitine crystals inserted into the periphery of the damaged area; in 16, VT was due only to myocardial damage and in the other 13 VT was spontaneously originated. Twenty-nine animals constituted the control group; no inosine was administered to them. The possible effects of inosine were studied in 63 animals. Leads II, aVR or aVL, right and Left unipolar intraventricular leads and that on the wall of the superior vena cava were recorded under control conditions, once the myocardial damage had been induced, during the ventricular tachycardia, and following the injection of inosine. Of the 63 inosine-treated animals; in 34, VT was due to aconitine; in 16, it was produced only by the myocardial damage and, in 13, VT was presented spontaneously. RESULTS: Sinus rhythm was not reestablished in the animals of the control group. Inosine reestablished the sinus rhythm in 26 of 34 dogs (76%) that received phenol and aconitine, in 13 of the 16 (81%) presenting only the myocardial damage, and in 6 of the 13 (46%) with spontaneous ventricular tachycardia. In some experiments, inosine induced supraventricular tachycardias, ventricular-atrial blocks, and ventricular pre-excitation phenomena. CONCLUSIONS: In this experimental series, inosine showed antiarrhythmic and arrhythmogenic effects, similar to those of adenosine from which it derives.

[Recent advances in risk factors]. / Nuevos enfoques enfactores de riesgo.

Focusing now the news about cardiovascular risk factors, they should be appreciated with their potential to reach the true value to warrant common benefit desired, not just cardiovascular health, but also as the equity to life quality. So far the advance can be pointed at least with a number of items: more number of risk factors identified; additional evidence to increase the cause effect relationship value; better, easier and practical ways to apply them to population as well as to individuals; notable progress in the knowledge of taking decisions as cumulative, not just alternative; and in the way of holistic thinking to approach the welfare to global community as a whole.

[Early and late effects of adenosine in experimental ventricular tachycardia]. / Efectos tempranos y tardíos de la adenosina en taquicardias ventriculares experimentales.

INTRODUCTION AND OBJECTIVE: To study the action of adenosine in experimental ventricular tachycardia. MATERIAL AND METHOD: We studied 173 mongrel dogs weighing 13-17 kg anesthetized with 30 mg/kg sodium pentobarbital given intravenously. Myocardial lesions were provoked with the injection of 1-1.5 mL phenol in the free wall of the left ventricle. Ventricular arrhythmia was induced 30 min later with aconitine crystals inserted into the periphery of the damaged area. The potential early and delayed antiarrhythmic action of adenosine was systematically investigated in 85 animals. Leads DII, aVR and aVL, unipolar right and left intraventricular leads, and one unipolar lead on the wall of the superior vena cava were used to record control tracings and tracings in the presence of myocardial damage during ventricular tachycardia and after injection of the drug. RESULTS: Sinus rhythm did not reappear in 72 control animals that did not receive adenosine. In the 63 animals with aconitine-induced ventricular tachycardia associated to myocardial damage, the optimal response to 6 mg adenosine-early and fleeting sinus rhythm-was seen in 45% of the dogs; delayed sinus rhythm was seen in 5%. In 67% of the 18 animals with ventricular tachycardia due only to myocardial damage, early and late sinus rhythm appeared with doses of 6 and 12 mg, and late sinus rhythm was seen with a dose of 12 mg. CONCLUSIONS: The antiarrhythmic action of adenosine was seen not only in ventricular tachycardia due to aconitine (triggered activity), but also in tachycardia induced by the myocardial damage (microreentries).

Pregnancy in teenagers with heart disease / Embarazo en pacientes adolescentes con cardiopatía

Abstract The prevalence of pregnancy in adolescent women is high in Mexico and represents a public health problem. The pregnant teenager with heart disease has a high probability of complications during pregnancy and the delivery, which carries a risk of death of both the mother and the product. In many cases the pregnancy should have been avoided, planned or interrupted, however the majority at this age is vulnerable and although certain cases must be interrupted by their high risk of maternal-fetal death, prevention and legal aspects should be considered. In some cases the woman wants a pregnancy although her health condition does not allow it, but there are options of adoption or recourse to a surrogate belly. In response to this growing social problem, the National Cardiology Institute Ignacio Chávez and National Institute of Perinatology, with the coordination of Ministry of Health in Mexico, started a pregnancy prevention module within a clinic of follow-up of cardiopathy and pregnancy. This review raises the global problem in our country that occupies the first place in pregnancies in adolescents, with more than 400,000 pregnancies a year and the form of immediate response in a multidisciplinary way.

Resumen La prevalencia de embarazo en mujeres adolescentes es muy alta en México, y representa un problema de salud pública. La adolescente embarazada con cardiopatía tiene altas posibilidades de complicaciones durante el embarazo y su resolución, lo que pone en riesgo la vida tanto de la madre como del producto. En muchos casos el embarazo debió ser evitado, planeado o interrumpido, sin embargo la mayoría a esta edad es vulnerable y si bien ciertos casos deben ser interrumpidos por su alto riesgo de muerte materno-fetal, es fundamental considerar la prevención y los aspectos legales. En algunos casos la mujer desea un embarazo aunque su condición de salud no se lo permite, pero existen opciones de adopción o recurrir a un vientre subrogado. Atendiendo este problema social cada vez más creciente, el Instituto Nacional de Cardiología Ignacio Chávez, en coordinación con la Comisión Coordinadora de la Secretaría de Salud y el Instituto Nacional de Perinatología, echaron a andar un módulo de prevención de embarazo dentro de una clínica de seguimiento de cardiopatía y embarazo. Esta revisión plantea el problema global en nuestro país, que ocupa el primer lugar en embarazos en adolescentes, con más de 400 mil embarazos al año y la forma de dar respuesta inmediata de manera multidisciplinaria.

[Epistemological focus on sphygmomanometry]. / Un enfoque epistemológico en la esfigmomanometría.

In the XVIII century, the English naturalist Stephen Hales started to apply blood sphygmomanometry in animals. Direct recording of the blood pressure was first applied, in the XIX century, by AE Chauveau and JLM Poiseuille. However, it was not until 1856 that it was possible to perform a direct determination of blood pressure in humans by means of a device designed by Faivre. The first sphygmomanometer appeared at the end of the XIX century. The physician Samuel K. von Basch, native of Prague and who lived a few years in Mexico, fabricated successively three models of sphygmomanometers. The first (1881), with a mercury column, proved to be the most practical and useful. This instrument inspired the sphygmomanometer of the Italian physician Scipione Riva-Rocci who presented it in 1896. His sphygmomanometer, supported on the Vierordt principle, could measure manometrically the force needed to stop the pulse wave. Thanks to the research of Russian physician N. Korotkoff, the auscultatory method was added to sphygmomanometry. During the XX century other instruments to measure blood pressure were fabricated: the Pachon's and Plesch's oscillometers, as well as the aneroid manometer. On the other side, the use of direct tensional recordings has subsisted which has allowed to document the wide oscillations of arterial pressure levels during the day. Anyway, the sphygmomanometer with a mercury column has persisted until the present and will still be used for a long time. A new evolving methodology is the continuous ambulatory sphygmomanometry.

[Coronary heart disease in Mexico and the clinical epidemiological and preventive relevance]. / La cardiopatía coronaria en México y su importancia clínica, epidemiológica y preventiva.

Coronary heart disease is dominant among heart diseases in the population, a problem to control. Heart diseases have been first place in the general mortality for the last 20 years. The trend show an annual increase without control. Atherosclerosis is responsible for at least for one fourth of all deaths in the country. The combined data of mortality and morbidity, from hospital discharges or the whole country, disclose that one out of three die of acute myocardial infarction (AMI). While only 8% of all deaths registered were admitted to a hospital. Most, 92% were never admitted to any hospital for some reason. The estimated annual incidence of AMI cases is 140,000, on the basis of 3 cases surviving for each case death, accounted by the Death Certification System, which rounds 35,000. Standardized mortality rates of AMI in Mexico are greater than in USA o Canada creating a more concerned worry. The most probable explanation to that situation is lack of preventive care, which should also include the acute care and before reaching the hospital facilities. Running the same chances are hypertension crisis and strokes and diabetic complications. The appropriate care for critical situations might reduce significantly the cardiovascular mortality in the country, in a short and middle term. Prevention is not only for chronic conditions but for acute and critical situations. The programs of preventive care should also include cultural promotion and community awareness. The timely care is life and myocardium saving. The reinforcement of prior to hospital care reduces the delay for AMI adequate intervention. These activities agree quite well with the ongoing programs of CPR, organizing the surviving chain and the training programs for paramedical emergency technicians.

An experimental contribution to the concept of "jumping wave" phenomenon in the interventricular septum.

OBJECTIVE: The purpose of this study was to evaluate the existence of a histologically bipartite interventricular septum and the electrical independence of both septal masses, as well as to understand the changes of septal activation fronts in the presence of bundle branch blocks. METHODOLOGY: We examined the histological characteristics of both septal masses in 12 canine hearts. Furthermore, in another 11 anesthetized dog hearts, we analyzed morphological and chronological data of intraseptal records with normal activation and in the presence of proximal blocks. RESULTS: A histological discontinuity between the two septal masses in canine hearts seems to exist. Analysis of intraseptal and intracavitary electrical records confirmed slow transmission of the activation fronts from one septal mass to the other when proximal blocks were present. Morphological and chronological changes of the intracavitary complexes agree with the "jumping wave" phenomenon theory. CONCLUSIONS: These results support the validity of this approach to the activation of both septal masses and explain the chronological and morphological changes of the intracavitary records in the presence of ventricular blocks. In addition, this approach is a useful tool to detect the possible coexistence of dead septal tissue.

[Therapeutic adherence]. / Apego terapéutico. Informe a la comunidad cardiológica.

The lack of adherence to treatment of chronic cardiovascular disease is a clinical problem. Goes beyond doctor-patient relationship to what's new in social and public health worldwide. There is no one solution, but the potential for broad collaboration to resolve it with doctors, patients and facilities that provide organized community action. The Mexican Society of Cardiology aware of its leading role in the affair has taken the initiative to master the problem. This article is the initial report containing a review of the literature and a qualitative research study. Has focused on the interpretation of statements organized discussion "on purpose" at the recent Congress of Cardiology. Stresses the need to organize, promote the culture of health, acting in the rehabilitation of the doctor patient relationship according to the new demands of modernity and radical changes.

[Humanitarian care of the heart. Celebrating World Heart Day: "Wellness in the workplace"]. / El cuidado humanitario del corazón. En ocasión de celebrarse el Día Mundial de corazón "Trabajo con el corazón"

Heart care is the biggest challenge of cardiovascular disease, a problem of humanity and not just of the individual. Holistic approach offers the opportunity to know determinants from near and far, and look forward at the possible solutions. The issue is open to the contribution of everybody. The World Heart Day is a good opportunity to communicate and nurture the spirit for cooperation, with the interest of the heart health. Health care, life care and heart care are complementary and comply as an indissoluble unity.

[Smoking. The natural cause asks for respect]. / Tabaquismo. La naturaleza causal pide respeto.

Smoking is responsible for atherosclerosis-mediated cardiovascular pandemic. Change and accelerate reactions in structures and functions. Form factors and stimulates tumor atheroma. Induces thrombosis and occludes arteries. The sinister intrusion attacks the cardiovascular system. The damage occurs in their genetic foundations and bimolecular intimacy. The remedy is abstinence, solves everything and it is just behavior. Addiction feeds dissent that is based on fallacies and irrelevant controversies. Much is ignorance, misjudgments, bad experiences which originates controversies. Why are things this way? it is not understood as it should. Public opinion is manipulated information, reductionism and negative Manichaeism. The solutions are provided through interdisciplinary and holistic reasoning. They suggest sticking to education based on universal values from early ages. Also abstinence promotion and self-control culture, for the sake of oneself and towards neighborhood. The new paradigm should pursue a doctrine of conversion, which nobody is exempt from benefit. Interpreting the alternative posed by nature of stating Phyisiodulia or Physiopathology is equivalent to: respect, or illness and death.

Apego terapéutico. Informe a la comunidad cardiológica / Therapeutic adherence

La falta de apego al tratamiento de las enfermedades cardiovasculares crónicas es un problema clínico. Trasciende de la relación médico-paciente a lo social y es nuevo en la salud pública. No existe una solución integral, pero está el potencial de resolverlo con la colaboración amplia de médicos, pacientes y las facilidades que brinde la acción comunitaria organizada. La Sociedad Mexicana de Cardiología, consciente de su papel rector en el asunto, ha tomado la iniciativa de conocer a fondo el problema. Este artículo es el informe inicial que contiene una revisión del tema y de un Estudio de Investigación Cualitativa. Se ha enfocado a la interpretación de las declaraciones públicas de un debate organizado ex profeso en el reciente Congreso de Cardiología. Destaca la necesidad de organizarse, fomentar la cultura de la salud, actuar en la readaptación de la relación médico-paciente de acuerdo a las nuevas exigencias de cambios radicales que la modernidad involucra.

The lack of adherence to treatment of chronic cardiovascular disease is a clinical problem. Goes beyond doctor-patient relationship to what's new in social and public health worldwide. There is no one solution, but the potential for broad collaboration to resolve it with doctors, patients and facilities that provide organized community action. The Mexican Society of Cardiology aware of its leading role in the affair has taken the initiative to master the problem. This article is the initial report containing a review of the literature and a qualitative research study. Has focused on the interpretation of statements organized discussion "on purpose" at the recent Congress of Cardiology. Stresses the need to organize, promote the culture of health, acting in the rehabilitation of the doctor patient relationship according to the new demands of modernity and radical changes.

El cuidado humanitario del corazón: En ocasión de celebrarse el Día Mundial de Corazón: "Trabajo con el Corazón" / Humanitarian care of the heart: Celebrating World Heart Day: "Wellness in the workplace"

El cuidado del corazón es el mayor reto de las enfermedades cardiovasculares, es un problema de la humanidad y no sólo del individuo. El enfoque holístico ofrece la oportunidad de conocer de cerca y de lejos los determinantes, para contemplar sus posibles soluciones. El asunto está abierto a la contribución de todo mundo. El Día Mundial del Corazón es la buena ocasión para comunicar y alimentar el espíritu de cooperación en beneficio de la Salud del Corazón. La salud, los cuidados de vida y del corazón se complementan y conforman una unidad indisoluble.

The heart care is the biggest challenge of cardiovascular disease, a problem of humanity and not just of the individual. Holistic approach offers the opportunity to learn about it, by far the determinants, and look forward at the possible solutions. The issue is open to the contribution of everybody. The World Heart Day is good opportunity to communicate and nurture the spirit for cooperation, with the interest of the heart health. Health care, life care and heart care are complementary and comply as an indissoluble unity.

Tabaquismo. La naturaleza causal pide respeto / Smoking. The natural cause asks for respect

El tabaquismo es responsable de la pandemia cardiovascular mediada por aterosclerosis. Altera y acelera cambios en estructuras y funciones. Estimula factores tumorales y forma el ateroma. Induce trombosis y ocluye las arterias. La siniestra intromisión arremete contra el sistema cardiovascular. Lo daña desde sus cimientos genéticos e intimidad bimolecular. El remedio es abstención, lo resuelve todo y es sólo conducta. La adicción alimenta disentimiento que se sustenta en falacias y controversias improcedentes. Buena parte es ignorancia, juicios equivocados, experiencias y argumentos mal planteados. El porqué son las cosas de esta manera no es comprendido como se debe. La opinión pública es manipulada negativamente con información reduccionista y maniqueísmo. Las soluciones se facilitan vía razonamiento transdisciplinario y visión holística. Sugieren apegarse a una educación basada en valores universales desde temprana edad. Fomentar la abstención con la cultura del autodominio, propia y hacia el prójimo. El nuevo paradigma a perseguir es una doctrina de conversión, de la que nadie está exento de beneficiarse. Interpretando la alternativa planteada por la naturaleza que declara Fisiodulia o Fisiopatología, equivalente a: respeto, o enfermedad y muerte.

Smoking is responsible for atherosclerosis-mediated cardiovascular pandemic. Change and accelerate reactions in structures and functions. Form factors and stimulates tumor atheroma. Induces thrombosis and occludes arteries. The sinister intrusion attacks the cardiovascular system. The damage occurs in their genetic foundations and bimolecular intimacy. The remedy is abstinence, solves everything and it is just behavior. Addiction feeds dissent that is based on fallacies and irrelevant controversies. Much is ignorance, misjudgments, bad experiences which originates controversies. Why are things this way? it is not understood as it should. Public opinion is manipulated information, reductionism and negative Manichaeism. The solutions are provided through interdisciplinary and holistic reasoning. They suggest sticking to education based on universal values from early ages. Also abstinence promotion and self-control culture, for the sake of oneself and towards neighborhood. The new paradigm should pursue a doctrine of conversion, which nobody is exempt from benefit. Interpreting the alternative posed by nature of stating Phyisiodulia or Physiopathology is equivalent to: respect, or illness and death.

Antiarrhythmic and arrhythmogenic action of inosine in experimental ventricular tachyarrhythmias / Efectos antiarrítmicos y arritmogénicos de la inosina en taquiarritmias ventriculares experimentales

OBJECTIVE: To study the possible action of inosine on experimental ventricular tachyarrhythmias. MATERIAL AND METHODS: We used 92 mongrel dogs weighing 13 kg-17 kg, anesthetized with 30 mg/kg sodium pentobarbital applied intravenously. Myocardial lesions were induced by injecting 1 ml-1.5 ml of 70% phenol in the free wall of the left ventricle. In 36 dogs, the ventricular arrhythmia (VT) was induced 30 min later with aconitine crystals inserted into the periphery of the damaged area; in 16, VT was due only to myocardial damage and in the other 13 VT was spontaneously originated. Twenty-nine animals constituted the control group; no inosine was administered to them. The possible effects of inosine were studied in 63 animals. Leads II, aVR or aVL, right and Left unipolar intraventricular leads and that on the wall of the superior vena cava were recorded under control conditions, once the myocardial damage had been induced, during the ventricular tachycardia, and following the injection of inosine. Of the 63 inosine-treated animals; in 34, VT was due to aconitine; in 16, it was produced only by the myocardial damage and, in 13, VT was presented spontaneously. RESULTS: Sinus rhythm was not reestablished in the animals of the control group. Inosine reestablished the sinus rhythm in 26 of 34 dogs (76%) that received phenol and aconitine, in 13 of the 16 (81%) presenting only the myocardial damage, and in 6 of the 13 (46%) with spontaneous ventricular tachycardia. In some experiments, inosine induced supraventricular tachycardias, ventricular-atrial blocks, and ventricular pre-excitation phenomena. CONCLUSIONS: In this experimental series, inosine showed antiarrhythmic and arrhythmogenic effects, similar to those of adenosine from which it derives.

Nuevos enfoques enfactores de riesgo / Recent advances in risk factors

Focusing now the news about cardiovascular risk factors, they should be appreciated with their potential to reach the true value to warrant common benefit desired, not just cardiovascular health, but also as the equity to life quality. So far the advance can be pointed at least with a number of items: more number of risk factors identified; additional evidence to increase the cause effect relationship value; better, easier and practical ways to apply them to population as well as to individuals; notable progress in the knowledge of taking decisions as cumulative, not just alternative; and in the way of holistic thinking to approach the welfare to global community as a whole.