Cysticercosis & Heart: A Systematic Review.

Cysticercosis is a parasitic tissue infection caused by larval cysts of the tapeworm Taenia solium. These larval cysts infect brain, muscle, or other tissue, and are a major cause of adult-onset seizures in most low-income countries with tropical climate. Prevalence it's around 50 million people. Although cardiovascular system is not the most affected, this disease can also be associated with multiple and randomly distributed cysts in the subpericardium, subendocardium and myocardium in up to 25% of infected patients. Most cardiac cysticercosis' cases are asymptomatic, but it can manifest with ventricular arrhythmias and conduction disorders. Area Covered: The "Neglected Tropical Diseases and other Infectious Diseases affecting the Heart" (NET-Heart project) is an initiative by the Emerging Leaders group of the Interamerican Society of Cardiology to systematically review all these endemic conditions affecting the heart. A systematic review was conducted following preferred reporting items for systematic review and meta-analysis guidelines and including articles published in MEDLINE, ScienceDirect, PubMed and LILACS databases. A total of 41 papers were included in this review. Expert Opinion: In the areas of greatest prevalence, unhealthiness and poverty favor the development of this disease, which highlights the need to establish global health policies that reduce morbidity and mortality, economic losses of the affected population, and health costs related to hospitalizations for cardiovascular involvement. Authors provide an algorithm to evaluate the possibility of Cysticercosis' cardiovascular complications.

Embolismo por cristales de colesterol con síndrome de disfunción multiorgánica / Cholesterol crystal embolism with multiorgan dysfunction syndrome

Resumen: La embolia por cristales de colesterol es una enfermedad sistémica caracterizada por la oclusión de pequeñas arterias debido al desprendimiento de los mismos desde las placas de ateroma formadas en las paredes de arterias principales. Este caso clínico corresponde a un paciente masculino de 77 años de edad con factores de riesgo de enfermedad vascular que ingresó al servicio de urgencias por disnea y ortopnea. Se diagnosticó un cuadro clínico de insuficiencia cardiaca aguda y recibió tratamiento médico con buena respuesta. Se realizó una cinecoronariografía que evidenció severa ateroesclerosis coronaria con enfermedad de tres vasos, recibió tratamiento endovascular con colocación de endoprótesis vasculares. Luego de 20 días el paciente evolucionó con deposiciones melénicas, oligoanuria y claudicación intermitente progresiva en ambos miembros inferiores. Se observó obstrucción del flujo arterial en ambas arterias pedias por ecografía doppler; las biopsias de la piel de los pies revelaron signos vasculares correspondientes a depósitos de cristales de colesterol. Se interpretó enfermedad por embolia de cristales de colesterol secundario a las maniobras de cateterización previa, que provocaron alteraciones multiorgánicas isquémicas y persistentes. Resulta interesante este padecimiento porque es un proceso grave que demanda alto grado de sospecha clínica, el diagnóstico definitivo se establece mediante biopsia de las lesiones cutáneas, el pronóstico depende de la extensión de la enfermedad y en la actualidad no existe un tratamiento específico.

Abstract: The cholesterol crystal embolism is a systemic disease characterized by the occlusion of small arteries due these crystals, which come from the atheroma plaques of the walls of major arteries. This clinical case corresponds to a 77-year-old male patient with risk factors for cardiovascular disease who entered at the emergency service due dyspnea and orthopnea. In the Coronary Unit, a clinical status of acute heart failure was diagnosed, receiving medical treatment with good response. It was decided to perform a coronary angiography which showed a severe coronary atherosclerosis with 3-vessel compromised and endovascular treatment was performed with stent placement. After 20 days, the patient evolved with melenic depositions oligoanuria and progressive intermittent claudication in both lower limbs. Obstruction of arterial flow was observed in both pedia arteries by doppler ultrasound. Skin biopsies of lower limbs revealed vascular signs of deposits of cholesterol crystals. It was recognized as a cholesterol crystal disease secondary to previous medical catheterization procedures, causing ischemia and persistent alterations in the digestive and renal systems as well as in the skin of the lower limbs. This is an important affection because it is a serious process that demands a high level of clinical suspicion, the definitive diagnosis is established through the biopsy of the cutaneous lesions and the prognosis depends on the extension of the disease. Nowadays, there is no specific medical treatment of this disease.

Ateromatosis de la aorta torácica: su valor como predictora de mortalidad cardiovascular y eventos vasculares cerebrales y coronarios / Atheromatosis of the Thoracic Aorta: as Predictor of Cardiovascular Mortality and Cerebrovascular and Coronary Events

Objetivo Evaluar la gravedad de la ateromatosis de la aorta torácica y su relación con la mortalidad y los eventos vasculares cerebrales y coronarios. Material y métodos Entre 2005 y 2007 ingresaron prospectivamente 601 pacientes (p) enviados para ecocardiograma transesofágico (ETE). Edad: 64,53±13,61 años. Sexo masculino: 337 p. Se registró: Motivo del estudio: foco embolígeno (37,7%), endocarditis (22,1%), precardioversión (11,5%), valvulopatía mitral (9,8%), otros (18,95%). Factores de riesgo: diabetes, tabaquismo, hipertensión arterial, dislipemia. Presencia de fibrilación auricular. Los p fueron agrupados en: a. Con placas aórticas <4 mm y no complicadas: p = 465. b. Con placas ≥ 4 mm y/o ulceradas, con trombos o debris (ateromatosis aórtica compleja [AAC]): p = 136. Seguimiento: 1596 días (media: 759 días). Se contactaron 520 p (86,52%), considerándose los siguientes eventos: accidente cerebrovascular transitorio o permanente, IAM, angina, revascularización y/o causa de muerte en dicho período. Se utilizó el análisis multivariado para hallar predictores independientes. Se consideró significativa un p < de 0,01. Resultados Mortalidad cardiovascular: 3,2% (13/407 p) en el grupo a y 18,6% (21/113 p) en el grupo b (p < 0,01). Eventos vasculares combinados: 91/407 p (22,4%) en el grupo a y 45/113 p (39,8%) en el grupo b (p < 0,01). En el análisis multivariado, la AAC fue predictora independiente de mortalidad cardiovascular (OR 4,54, 95% IC 1,52-13,58 p < 0,01) y de eventos vasculares cerebrales y/o coronarios (OR 3,33, 95% IC 1,66-6,67 p < 0,01). Conclusión En esta población, la AAC fue predictora independiente de mortalidad cardiovascular y de eventos vasculares combinados.

Objective To evaluate the severity of atheromatosis of the thoracic aorta and its relation with mortality and cerebrovascular and coronary events. Material and Methods Between 2005 and 2007, 601 patients (ps) were referred for evaluation with transesophageal echocardiography (TEE). Age: 64.53±13.61 years Male gender: 337ps. The following variables were included: Reason for ordering the study: embolic source (37.7%), endocarditis (22.1%), previous to cardioversion (11.5%), mitral valve disease (9.8%), other reasons (18.95%). Risk factors: diabetes, smoking habits, hypertension, dyslipidemia. Presence of atrial fibrillation. The patients were divided into two groups: With uncomplicated aortic plaques < 4 mm: ps = 465. With complex aortic atheromatosis (CAA): aortic plaques ≥ 4 mm, with ulcers, thrombi or aortic debris: ps = 136. Follow-up: 1596 days (mean: 759 days). A total of 520 ps (86.52%) were contacted; the following events were considered: transient ischemic attack or stroke, AMI, angina, revascularization and/or cause of mortality during that period. Multivariate analysis was used to identify independent predictors. A p value < 0.01 was considered statistically significant. Results Cardiovascular mortality: 3.2% (13/407 ps) in group a and 18.6% (21/113 ps) in group b (p<0.01). Combined vascular events: 91/407 ps (22.4%) in group a and 45/113 ps (39.8%) in group b (p<0.01). Multivariate analysis showed that CAA was an independent predictor of cardiovascular mortality (OR 4.54, 95% CI 1.52-13.58, p<0.01) and of cerebrovascular and/or coronary events (OR 3.33, 95% CI 1.66-6.67, p<0.01). Conclusions In this population, CAA was an independent predictor of cardiovascular mortality and combined vascular events.