Tolerance of benznidazole in a United States Chagas Disease clinic.

The US-based Center of Excellence for Chagas Disease performed an observational study on the safety and tolerance of benznidazole 5 mg/kg/day for 60 days in 30 adults with chronic Chagas disease. The side-effect profile was suboptimal, including 5 cases of debilitating neuropathy and an unusually high angioedema rate.

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with orthotopic heart transplantation by bicaval anastomosis.

Patients with orthotopic heart transplantation may have a variety of arrhythmias. There are reports of successful radiofrequency catheter ablation of some of them. Two months after orthotopic cardiac transplantation by bicaval anastomosis, a 49-year-old man developed episodes of tachycardia. The patient developed with dyspnoea and hypotension during typical atrioventricular nodal reentrant tachycardia (AVNRT) revealed by electrocardiogram. During programmed atrial stimulation with progressively increasing prematurity, dual auriculoventricular nodal physiology was observed and AVNRT was induced. This tachycardia was successfully eliminated without complications by radiofrequency catheter ablation of the slow pathway. The patient remained asymptomatic at 4-month follow-up.

Antithrombotic options for atrial fibrillation in 2012.

Atrial fibrillation (AF) is a common arrhythmia in clinical practice. An important component of the management of patients with AF involves prevention of thromboembolism and stroke. Coumarins, such as warfarin had been the only available oral antithrombotic agent for prevention of thromboembolism for many decades. Following intestinal absorption, coumarins inhibit multiple steps of the clotting cascade that leads to inhibition of coagulation factors II, VII, IX and X. In addition to delayed and variable inhibition of coagulation, coumarin therapy has a narrow therapeutic window for optimal balance of risk and benefit, which requires regular assessment of the international normalized ratio (INR) to monitor coagulation. A quest for safer, more effective therapies that do not need monitoring has led to the development of dabigatran, rivaroxaban, and apixaban. In this article, we review these newer antithrombotic agents and discuss role of these drugs in clinical practice.

Factores de riesgo, manifestaciones clínicas y tratamiento de la insuficiencia cardiaca en mayores de 65 años / Risk factors, clinical manifestations and treatment of heart failure in over 65 years-old patients

Se realizó un estudio poblacional en 10 consultorios de médicos de familia seleccionados al azar para conocer la etiología, los síntomas, signos y el tratamiento de la insuficiencia cardiaca en pacientes mayores de 65 años. Se entrevistaron y examinaron 805 casos, se recogieron enfermedades previas, síntomas y signos, y tratamientos utilizados en ese momento. A los que tenían 2 síntomas y signos o más, se les realizó ecocardiograma y si existía disfunción sistólica y/o diastólica se consideraron casos positivos de insuficiencia cardiaca. Los principales factores etiológicos (solos o asociados) fueron hipertensión arterial 75,7 por ciento y cardiopatía isquémica 61,3 por ciento; la combinación de disnea de esfuerzo y edemas de miembros inferiores fue la más frecuente (54 por ciento). Usaban diuréticos 55,1 por ciento, inhibidores de la enzima convertidora de angiotensina 42,5 por ciento, betabloqueadores 18,3 por ciento y digoxina 43,6 por ciento. La hipertensión arterial fue el principal factor etiológico. Hubo casos con insuficiencia cardiaca que estando ambulatorios, presentaron pocos síntomas. La mayoría no estaba recibiendo tratamiento adecuado.

A population-based study was carried out in ten randomly selected family physician` offices in order to find out the etiology, symptoms, signs and treatment of heart failure in over 65 years-old patients. Eight hundred and five cases were surveyed and examined, data on previous diseases, symptoms, signs and therapies at that moment were collected. Those patients with two or more symptoms and signs underwent echocardiogram and in case of systolic and/or diastolic dysfunction, they were classified as heart failure cases. The main etiological factors (single or associated) were blood hypertension in 75,7 percent of cases and ischemic cardiopathy in 61,3 percent; the combination of effort dyspnea and swollen low limbers was the most common (54 percent). Of the total number of patients, 55,1 percent used diuretics; 42,5 percent took angiotensin- converting enzyme inhibitors; 18,3 percent used beta blockers whereas 43,6 percent was prescribed Digoxin. Hypertension was the main etiological factor. There were cases of heart failure seen at outpatient service, but with few symptoms. Most of patients were not being properly treated.

Prevalencia y formas de insuficiencia cardíaca en mayores de 65 años / Prevalence and heart failure in over 65 years-old elders

Se realizó un estudio poblacional en 10 consultorios de médicos de familia seleccionados al azar, con el objetivo de conocer la prevalencia y formas de insuficiencia cardíaca en pacientes mayores de 65 años, del policlínico Marcio Manduley de Centro Habana. Fueron entrevistados y examinados 805 casos, de los cuales se recogieron síntomas y signos de insuficiencia cardíaca. A los que tenían 2 síntomas y signos o más, se les realizó ecocardiograma y si existía disfunción sistólica o diastólica, o ambas, se consideraron casos positivos de insuficiencia cardíaca. Se obtuvieron 2 síntomas y signos o más, en 111 casos, el ecocardiograma fue positivo de insuficiencia cardíaca en 87 de estos, o sea, la prevalencia total cardíaca fue 10,8 por ciento. Presentaron disfunción sistólica 18,4 por ciento, diastólica 42,5 por ciento y mixta 39,0 por ciento. Se concluyó que la prevalencia de insuficiencia cardíaca fue elevada. La presencia de insuficiencia cardíaca diastólica aislada debe ser buscada activamente.

A population-based study was carried out in 10 randomly selected family physician’s offices, with the objective of determining the prevalence and forms of heart failure in patients aged over 65 years seen at Marcio Manduley polyclinics in Centro Habana municipality. Eight hundred and five cases were interviewed and tested to collect heart failure symptoms and signs. Echocardiogram was performed in those who presented with two or more symptoms and signs; if there was systolic or diastolic dysfunction or both, these cases were considered positive to heart failure. One hundred and eleven cases showed two or more symptoms and signs, echocardiogram showed heart failure in 87 cases, that is, the total heart failure prevalence was 10.8 percent. 18.4 percent had systolic dysfunction, 42.5 percent diastolic and 39 percent both. It was concluded that heart failure prevalence was high. Isolated diastolic heart failure should be actively traced.

Índice de Tei, nuevo indicador doppler para el estudio de la insuficiencia cardíaca / Tei's index, a new doppler indicator for the study of heart failure

La mayoría de los pacientes con insuficiencia cardíaca (IC) presentan afectación sistólica y diastólica combinadas; un índice derivado del doppler, conocido cono índice de Tei, permite evaluar de forma no invasiva ambas alteraciones. Se estudiaron 25 pacientes con edad promedio de 55 ± 16 años con IC. Se compararon los datos obtenidos con los de un grupo de personas sanas. Se observó un incremento de IT en los pacientes con IC. Se halló una relación estadísticamente significativa entre el IT y la fracción de eyección ventricular izquierda y el tiempo de desaceleración del pico E en el flujograma mitral de doppler. Se presentaron los resultados del seguimiento de los pacientes en un período de 3 y 6 meses. Se concluyó que aquellos que presentan el índice de Tei elevado tienen una evolución desfavorable a los 6 meses