Asymptomatic giant pericardial cyst.

BACKGROUND: Pericardial cysts are uncommon masses and are the third most common cystic mass of the mediastinum. The majority are asymptomatic, however, they can be associated with serious complications such as cardiac tamponade, bronchial obstruction, or even sudden death. CASE REPORT: An asymptomatic female patient, who was referred due to a chest radiograph showing cardiomegaly. The transthoracic echocardiogram showed an image consistent with a pericardial cyst, the diagnosis was confirmed with a magnetic resonance imaging. CONCLUSIONS: Pericardial cysts may appear as an incidental finding in the chest radiograph, either computed tomography scan or magnetic resonance imaging are useful to confirm the diagnosis.

ANTECEDENTES: Los quistes pericárdicos son masas poco comunes; ocupan el tercer lugar entre las masas mediastinales quísticas. La mayoría son asintomáticos, pero se pueden asociar a complicaciones serias como tamponade cardiaco, obstrucción bronquial e incluso muerte súbita. CASO CLÍNICO: Mujer asintomática con cardiomegalia en la tele de tórax a quien se diagnostica de forma incidental, mediante ecocardiograma, un quiste pericárdico gigante, que se corroboró por resonancia magnética. CONCLUSIONES: Los quistes pericárdicos pueden ser hallazgos incidentales en la radiografía de tórax. Tanto la tomografía computarizada como la resonancia magnética son estudios útiles para confirmar el diagnóstico.

Cannabidiol-mediated RISK PI3K/AKT and MAPK/ERK pathways decreasing reperfusion myocardial damage.

Myocardial ischemia continues to be the first cause of morbimortality in the world; the definitive treatment is reperfusion; however, this action causes additional damage to ischemic myocardial tissue; this forces to seek therapies of cardioprotection to reduce this additional damage. There are many cardioprotective agents; within these, cannabinoids have shown to have beneficial effects, mainly cannabidiol (CBD). CBD is a non psychoactive cannabinoid. To evaluate the effect in experimental models of CBD in myocardial ischemia reperfusion in rats, twelve-week-old male rats have been used. The animals were divides in 3 groups: control(C), ischemia reperfusion (IR) and CBD pretreatment (1/day/5mg/kg /10days). Langendorff organ isolate studies were performed, and the area of infarction was assessed with triphenyl tetrazolium, in addition to molecular analysis of AT1 and AT2 receptors and Akt and Erk proteins and their phosphorylated forms related to RISK pathways. It was observed that there is an improvement with the use of CBD increasing inotropism and cardiac lusitropism, improving considerably the cardiovascular functionality. These could be related to the reduction of the area of infarction and activation of the AT2 receptor and the RISK pathway with absence of activation of the AT2 receptor (these could relate the reduction of the infarct area and the restoration of cardiovascular function with the activation of the AT2 receptor and the RISK pathway with the absence of activation of the AT2 receptor). The use of cannabinoids was shown to have beneficial effects when used as a treatment for myocardial reperfusion damage.

LEFT ATRIAL FUNCTION AND VOLUME BY MAGNETIC RESONANCE IN PATIENTS WITH HEREDITARY AMYLOIDOSIS.

BACKGROUND: Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]). METHODS: All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated. RESULTS: Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions. CONCLUSIONS: Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Left atrial function and volume by magnetic resonance in patients with hereditary amyloidosis

ABSTRACT Background Left atrial (LA) enlargement is a reliable predictor of adverse cardiovascular events, and reduced atrial function is an independent risk factor for mortality in patients with amyloidosis. The objective of this study was to characterize the LA function in Mexican patients with a confirmed diagnosis of hereditary transthyretin amyloidosis (amyloid transthyretin [ATTR]) Methods All consecutive patients with diagnosis of hereditary ATTR who underwent a cardiac magnetic resonance study in the period from March 2016 to June 2017 were included in the study; the volumes and function of the left atrium were evaluated Results Patients were divided into two groups, one with and one without cardiac amyloidosis. Statistically significant differences were observed between both groups in terms of indexed maximal LA volume, 26 mL versus 35.9mL, p = 0.03; indexed minimal LA volume, 10.7 mL versus 13.6mL, p = 0.03; and indexed LA pre-contraction volume, 17 mL versus 22.4mL, p = 0.03. No statistically significant differences were observed between both groups when comparing neither different ejection volumes nor the different ejection fractions Conclusions Patients with hereditary ATTR with cardiac involvement have remodeling of the left atrium, with increased atrial volumes, without diminishing its function.

Prevalencia de derrame pericárdico en enfermedades sistémicas.

INTRODUCTION: The presence of 50 mL of fluid or more in the pericardial sac is known as pericardial effusion. OBJECTIVE: To determine the prevalence of pericardial effusion in patients with systemic diseases. METHOD: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. RESULTS: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). CONCLUSIONS: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

INTRODUCCIÓN: La presencia de 50 mL o más de líquido dentro del saco pericárdico se denomina derrame pericárdico. OBJETIVO: Determinar la prevalencia de derrame pericárdico en pacientes con enfermedades sistémicas. MÉTODO: Se revisaron los estudios ecocardiográficos efectuados en el Servicio de Cardiología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI, entre 2006 y 2016. Conforme los criterios de Weitzman, el derrame pericárdico se clasificó en ligero, < 10 mm, moderado de 10 a 20 mm y severo, > 20 mm. RESULTADOS: Se revisaron 10 653 estudios; la prevalencia del derrame pericárdico fue de 3.5 % (380), 209 mujeres (55 %, 45.9 ± 19.0 años) y 171 hombres (45 %, 41.9 ± 18.5 años). La etiología fue urémica en 227 (59.7 %), reducción del drenaje linfático en 73 (15.8 %), enfermedades autoinmunes en 30 (7.9 %), neoplásicas en 26 (6.8 %), infecciosas en 19 (5 %), idiopáticas en 14 (3.7 %), hipotiroidismo en dos (0.5 %), iatrogénica en uno (0.3 %) y posinfarto en uno (0.3 %). La severidad fue ligera en 87 (22.9 %), moderada en 147 (38.7 %) y severa en 146 (38.4 %). CONCLUSIONES: La prevalencia de derrame pericárdico fue de 3.5 % en pacientes con enfermedades sistémicas.

Prevalence of pericardial effusion in systemic diseases / Prevalencia de derrame pericárdico en enfermedades sistémicas

Abstract Introduction: The presence of 50 ml of fluid or more in the pericardial sac is known as pericardial effusion. Objective: To determine the prevalence of pericardial effusion in patients with systemic diseases. Method: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. Results: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). Conclusions: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

[Factors related to residual renal function loss in patients in peritoneal dialysis]. / Factores relacionados con pérdida de la función renal residual en pacientes en diálisis peritoneal.

BACKGROUND: Residual renal function (RRF) contributes to the quality of life of patients on dialysis. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient survival. The aim of this study is to know the factors related to RRF loss in prevalent patients in continuous ambulatory peritoneal dialysis (CAPD). METHODS: This is an analysis of secondary outcomes. Forty-three adult patients with type 2 diabetes were included. They had RRF preserved. Clinical and laboratory assessments were done in each visit during a year. RESULTS: The male gender (p = 0.042), systolic (p = 0.009) and diastolic (p = 0.006) blood pressure (BP), hemoglobin (p = 0.008), peritoneal creatinine clearance (p = 0.014), peritoneal ultrafiltration (p = 0.017) and levels of tumor necrosis factor-alpha (TNF-alpha) in plasma (p = 0.022) and dialysate (p = 0.008) were related with RRF loss. CONCLUSIONS: It is important to understand the factors associated with RRF loss in our patients to prevent the gradual loss and its implications on the mortality and quality of life.

Introducción: la conservación de la función renal residual (FRR) en los pacientes en diálisis peritoneal (DP) tiene una clara influencia sobre la calidad de vida, independientemente de que su preservación ha demostrado influir en la mayor supervivencia de los pacientes. El objetivo del presente estudio fue conocer los factores relacionados con pérdida de la FRR en un grupo de pacientes prevalentes en diálisis peritoneal continua ambulatoria (DPCA). Métodos: se trata de un estudio de análisis de resultados secundarios. Se incluyeron 43 adultos con diabetes tipo 2 (DT2), con FRR conservada, a quienes se les dio seguimiento durante un año. Resultados: los factores relacionados con la pérdida de la FRR fueron: género masculino (p = 0.042), presión arterial sistólica (p = 0.009) y diastólica (p = 0.006), hemoglobina (p = 0.008), aclaramiento peritoneal de creatinina (p = 0.014), ultrafiltración (p = 0.017), niveles de factor de necrosis tumoral alfa (FNT­alfa) en plasma (p = 0.022) y dializado (p = 0.008). Conclusiones: es importante conocer los factores relacionados con pérdida de la FRR en nuestros pacientes para evitar la pérdida gradual de la misma y sus implicaciones sobre la mortalidad y calidad de vida.

De novo development of heart valve calcification in incident peritoneal dialysis patients.

BACKGROUND AND AIMS: Cardiac valve calcification (VC) is a frequent complication in chronic kidney disease and is considered a risk factor for all-cause and cardiovascular mortality. However, little is known about the pathophysiology mechanisms that originate it and the factors associated with its development. We undertook this study to analyze the frequency and factors related to de novo development of mitral valve calcification (MVC) and aortic valve calcifications (AVC) in incident peritoneal dialysis (PD) patients. METHODS: A prospective cohort of 124 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1 year of follow-up for calcium, phosphorus, glucose, urea, creatinine, cholesterol, triglycerides by spectrophotometry assay; high-sensitivity C-reactive protein (CRP) by immunoturbidimetric ultrasensitive assay, intact parathormone (iPTH) and osteocalcin by electrochemiluminescence, fetuin-A and osteoprotegerin by EDI-ELISA. Valve calcification was evaluated by M-mode bidimensional echocardiogram. RESULTS: Sixty eight percent of patients were male, ages 43 ± 13 years; 51% were diabetic with 1.4 ± 1 months on PD. After 12.3 ± 1 months, 57 patients (46%) developed VC: AVC in 33 (57.8%), MVC in 15 (26.3%) and 9 (15.8%) patients in both valves. There was no correlation between AVC and MCV. In univariate logistic regression analysis, age, diabetes and elevated concentrations of OPG, iPTH and CRP were risk factors for development MVC. In multivariate analysis, only iPTH remained an independent risk factor as was also the case in AVC. CONCLUSIONS: Age, diabetes, osteoprotegerin, parathormone and C-reactive protein are risk factors related to de novo development of MVC and iPTH for AVC in incident dialysis patients.

Infarto del miocardio provocado por ingesta de bebida fría inmediatamente después de ejercicio físico intenso / Myocardial infarction after ingestion of cold beverage and strenous physical exercise

Se describe el caso de un paciente del sexo masculino de 36 años de edad, con sólo sexo masculino como factor mayor de riesgo coronario, quien presentó infarto agudo del miocardio asociado a ingestión de bebida fría inmediatamente después de ejercicio físico intenso. El estudio coronariográfico postinfarto mostró una lesión mínima de la DA. Se concluye que el espasmo coronario más ateroesclerosis es la causa más probable del infarto del miocardio en este caso. Se hace una revisión de la literatura sobre el tema.

Papel de la ecocardiografía transtorácica en el manejo multidisciplinario del embolislmo sistémico / Role of the transthoracic echocardiography in the multidisciplinary management of systemic embolism

Se presenta la experiencia del Servicio de Cardiología del Hospital de Especialidades ®Bernardo Sepúlveda¼ y se revisa la literatura internacional con respecto a la utilidad del estudio ecocardiográfico transtorácico en el manejo multidisciplinario de la embolia sistémica. Se analizan en forma suscinta los resultados obtenidos mediante el uso de este método diagnóstico en 38 pacientes y se analizan los resultados obtenidos mediante el uso de este método diagnóstico en 38 pacientes y se analizan los resultados obtenidos en diferentes centros ecocardiográficos internacionales y del país. Se concluye que el método ecocardiográfico transtorácico es el primer paso obligado en el estudio de pacientes en quienes se sospecha embolia arterial de orgien central tanto con fines diagnósticos como una herramienta para indicar tratamiento médico o quirúrgico en estos casos e incluso como guía en la evolución de estos pacientes

Contrapulsación con balón intraaórtico / Intraaortic ballon counterpulsation

La insuficiencia cardiaca aguda grave, refractaria al tratamiento farmacológico, es resultado de múltiples condiciones patológicas y se asocia con una elevada mortalidad. Para estos casos, se han desarrollado diversos dispositivos para la asistencia mecánica circulatoria, entre los cuales el balón de contrapulsación aórtica (IABC) es el más utilizado para contribuir a la estabilidad hemodinámica, condición necesaria para llevar a cabo el tratamiento definitivo para cada caso en particular. Con objetivo de describir los antecedentes históricos, mecanismos de acción, indicaciones, contraindicaciones, técnicas de instalación, efectos hemodinámicos,complicaciones y resultados del uso de IABC, se revisó la literatura internacional especializada, para presentar el estado actual de un recurso más en el arsenal terapéutico para la atención del enfermo grave y en estado crítico