Violence and aggression against nurses during the COVID-19 pandemic in Latin America. From the emerging leaders program of the Interamerican Society of Cardiology (SIAC).

INTRODUCTION: During the Coronavirus (COVID-19) pandemic, healthcare providers have overcome difficult experiences such as workplace violence. Nurses are particularly vulnerable to workplace violence. The objective of this study was to characterize violence and aggression against nurses during the COVID-19 pandemic in Latin America. METHODS: An electronic cross-sectional survey was conducted in 19 Latin American countries to characterize the frequency and type of violent actions against front-line healthcare providers. RESULTS: Of the original 3544 respondents, 16% were nurses (n = 567). The mean age was 39.7 ± 9.0 years and 79.6% (n = 2821) were women. In total, 69.8% (n = 2474) worked in public hospitals and 81.1% (n = 2874) reported working regularly with COVID-19 patients. Overall, about 68.6% (n = 2431) of nurses experienced at least one episode of workplace aggression during the pandemic. Nurses experienced weekly aggressions more frequently than other healthcare providers (45.5% versus 38.1%, p < .007). Nurses showed a trend of lower reporting rates against the acts of aggression suffered (p = .076). In addition, nurses were more likely to experience negative cognitive symptoms after aggressive acts (33.4% versus 27.8%, p = .028). However, nurses reported considering changing their work tasks less frequently compared to other healthcare providers after an assault event (p = .005). CONCLUSION: Workplace violence has been a frequent problem for all healthcare providers during COVID-19 pandemic in Latin America. Nurses were a particularly vulnerable subgroup, with higher rates of aggressions and cognitive symptoms and lower rate of complaints than other healthcare providers who suffered from workplace violence. It is imperative to develop strategies to protect this vulnerable group from aggressions during their tasks.

Blood pressure telemonitoring and telemedicine, a Latin America perspective.

PURPOSE: To share a Latin-American perspective of the use of telemedicine, together with blood pressure measurements outside the medical office, as a potential contribution to improving access to the health system, diagnosis, adherence, and persistence in hypertension treatment. MATERIAL AND METHODS: A document settled by a Writing Group of Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Epidemiology and Cardiovascular Prevention Council of the Interamerican Society of Cardiology, and National Cardiologist Association of Mexico. RESULTS: In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. The clinical practitioner has seen increased evidence that the use of out-of-office blood pressure (BP) measurement and telemedicine are helpful tools to keep patients and physicians in contact and promote better pharmacological adherence and BP control. A survey carried out by medical and scientific institutions showed that practitioners are up-to-date with telemedicine, had internet access, and had hardware availability. CONCLUSIONS: A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension.

What is the context?In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality.What is new?Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension.What is the impact?Needs are always infinite, and resources are finite, so according to the World Health Organisation (WHO), advances in electronic, information, and communication technology point to more significant equity in the provision of services, considering the effectiveness, possibility of refining the rationalisation of health spending, and improving health care for remote populations.A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension.

Blood pressure telemonitoring and telemedicine for hypertension management-positions, expectations and feasibility of Latin-American practitioners. SURVEY carried out by several cardiology and hypertension societies of the Americas.

PURPOSE: To assess the opinion of Latin-American physicians on remote blood pressure monitoring and telehealth for hypertension management. MATERIAL AND METHODS: Cross-sectional survey of physicians residing in Latin-America. The study was conducted by the Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Interamerican Society of Cardiology Epidemiology and Cardiovascular Prevention Council, and National Cardiologist Association of Mexico. An online survey composed of 40 questions using Google Forms was distributed from 7 December 2021, to 3 February 2022. The survey was approved by the GREHTA Ethics Committee and participation was voluntary and anonymous. Multiple logistic regression models were constructed to identify the challenges of telehealth. RESULTS: 1753 physicians' responses were gathered. The responses came from physicians from different Latin-American countries, as follows: 24% from Mexico, 20.6% from Argentina, 14.7% from Colombia, 10.9% from Brazil, 8.7% from Venezuela, 8.2% from Guatemala and 3.2% from Paraguay. Responders with a high interest in carrying out their assistance task through remote telemonitoring reached 48.9% (821), while 43.6% are already currently conducting telemonitoring. A high number, 62%, claimed to need telemonitoring training. There is a direct relation between higher interest in telemonitoring and age, medical specialty, team working, residence in the biggest cities, expectations regarding telemedicine and reimbursement. CONCLUSIONS: Remote monitoring is feasible in Latin-America. General practitioners and specialists from bigger cities seem eager and are self-perceived as well-trained and experienced. Facilities and resources do not seem to be a challenge but training reinforcement and telemedicine promotion is necessary for those physicians less motivated.PLAIN LANGUAGE SUMMARYWhat is the context?Hypertension is one of the leading worldwide modifiable risk factors for premature death. Strong evidence supports that effective treatment of this condition results in a significant reduction of hard outcomes.Only 20%-30% of hypertensive patients are within the blood pressure targets recommended by guidelines in Latin-America. There is an urgent need to implement innovative strategies to reverse this alarming health situation.What is new?Latin-American physicians were highly predisposed to telemonitoring practice. This high motivation was not influenced by hardware or software availability, technological knowledge or experience, by volume of monthly consultations, or by area (private-public) where the care activity is carried out.This high motivation may be supported by the conviction that this practice could be very useful as a complement to face-to-face assistance and a highly effective tool to improve adherence even though respondents considered that just 10% of the patients would prefer telemonitoring over office consultation.What is the impact?Facilities and resources do not seem to be a challenge but training reinforcement and telemedicine promotion is necessary for those physicians less motivated. The general perception is that it is necessary to move forward to resolve legal gaps and financial aspects.Physicians must adapt to changes and develop new communication strategies in a world where the unrestricted access to teleinformation makes patients self-perceived as experts.

Chikungunya and the Heart.

INTRODUCTION: Neglected tropical diseases are a group of communicable diseases that occur in tropical and subtropical conditions and are closely related to poverty and inadequate sanitation conditions. Among these entities, chikungunya remains one of the most widely spread diseases. Although the main symptoms are related to a febrile syndrome, cardiovascular (CV) involvement has been reported, with short- and long-term implications. As part of the "Neglected Tropical Diseases and other Infectious Diseases involving the Heart" (NET-Heart) Project, the aim of this review is to compile all the information available regarding CV involvement of this disease, to help healthcare providers gain knowledge in this field, and contribute to improving early diagnosis, treatment, and prevention strategies. METHODS: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in conducting and reporting this systematic review. The search was conducted using MEDLINE/PubMed, SciELO, and LILACS databases to identify any relevant studies or reviews detailing an association between chikungunya and cardiac involvement published from January 1972 to May 31, 2020. RESULTS: Despite its mechanism not being fully understood, CV involvement has been described as the most frequent atypical presentation of chikungunya (54.2%). Myocarditis is the most prevalent CV complication. Different rhythm disturbances have been reported in 52% of cases, whereas heart failure was reported in 15% of cases, pericarditis in 5%, and acute myocardial infarction in 2%. Overall estimated CV mortality is 10%, although in patients with other comorbidities, it may increase up to 20%. In the proper clinical setting, the presence of fever, polyarthralgia, and new-onset arrhythmia suggests chikungunya virus-related myocarditis. CONCLUSION: Although most cases are rarely fatal, CV involvement in chikungunya infection remains the most frequent atypical presentation of this disease and may have severe manifestations. Timely diagnosis and appropriate management are necessary to improve patient outcomes.

Zika & heart: A systematic review.

Zika virus infection affects more than 80 countries in the world, mainly those with a tropical climate. Although the most frequent clinical presentation is characterized by rash, conjunctivitis, myalgia, arthralgia and fever, in some cases it is associated with cardiovascular manifestations, such as myocarditis, pericarditis, heart failure and arrhythmias. Furthermore, maternal transmission of the virus generates congenital Zika syndrome, which is associated with cardiac septal defects. Early recognition and treatment of Zika's cardiovascular complications are essential to reduce morbidity and mortality in these patients. There is no specific antiviral treatment or vaccine in humans, so the development of public health strategies to prevent its transmission is of paramount importance. The "Neglected Tropical Diseases and other Infectious Diseases" (NET-Heart project) is an initiative to systematically review all these devastating endemic conditions affecting the heart to spread knowledge and propose algorithms for early diagnosis and treatment.

Dietary Patterns in Pregnancy and Biomarkers of Oxidative Stress in Mothers and Offspring: The NELA Birth Cohort.

Background: Although adherence to the Mediterranean and antioxidant-rich diets during pregnancy is suggested to improve maternal-fetal health by reducing oxidative stress, yet there is no study available. Objective: We examined whether maternal dietary patterns in pregnancy impact the biomarkers of oxidative stress in mothers and their offspring. Methods: Study population included 642 mothers and 335 newborns of the "Nutrition in Early Life and Asthma" (NELA) birth cohort. Maternal diet during pregnancy was assessed by a validated food frequency questionnaire and a priori-defined dietary indices (relative Mediterranean Diet [rMED], alternative Mediterranean Diet [aMED], Dietary Approach to Stop Hypertension [DASH], Alternate Healthy Index [AHEI], and AHEI-2010) were calculated. Biomarkers measured were: hydroperoxides, carbonyl groups, and 8-hydroxydeoxyguanosine (8OHdG) determined in maternal blood and newborn cord blood, and urinary maternal and offspring 15-F2t-isoprostane. Multivariate linear regression models were performed. Results: Maternal rMED score was inversely associated with the maternal levels of 8OHdG at mid-pregnancy (beta per 1-point increase = -1.61; 95% CI -2.82, -0.39) and the newborn levels of hydroperoxides (beta per 1-point increase = -4.54; 95% CI -9.32, 0.25). High vs. low maternal rMED score was marginally associated with the decreased levels of 8OHdG in newborns (beta = -9.17; 95% CI -19.9, 1.63; p for trend 0.079). Maternal DASH score tended to be inversely associated with maternal urinary 15-F2t-isoprostane (beta per 1-point increase = -0.69; 95% CI, -1.44, 0.06). High vs. low maternal AHEI score was associated with reduced offspring urinary levels of 15-F2t-isoprostane (beta = -20.2; 95% CI -38.0, -2.46; p for trend 0.026). Conclusion: These results suggest that maternal adherence to healthy dietary patterns during pregnancy may reduce DNA damage and lipid oxidation in mothers and offspring.

Endocarditis de Libman-Sacks / Libman-Sacks endocarditis

La endocarditis de Libman-Sacks es una manifestación cardiaca bien reconocida del lupus eritematoso sistémico en la que se observan vegetaciones valvulares estériles, con predominio en el lado izquierdo del corazón, especialmente en la válvula mitral. La mayoría de los pacientes son asintomáticos; sin embargo, en la presentación clínica la forma aguda puede imitar a la de una endocarditis infecciosa (endocarditis pseudoinfecciosa) y complicar tanto el diagnóstico diferencial como el tratamiento. Se reporta el caso de un paciente de género masculino, de 63 años, quien manifestó signos y síntomas compatibles con endocarditis infecciosa, y cuyos diferentes estudios demostraron una endocarditis de Libman-Sacks que respondió de forma favorable al tratamiento inmunosupresor.

The Libman-Sacks endocarditis is a well-recognized systemic lupus erythematosus manifestation in which cardiac valvular sterile vegetations are observed predominantly in the left side of the heart, especially in the mitral valve. Most patients are asymptomatic; however, the acute clinical presentation may mimic an infectious endocarditis (pseudo-infectious endocarditis) and complicate both the differential diagnosis and treatment. The case of a 63 year-old male patient, who presented signs and symptoms consistent with infectious endocarditis and whose several studies demonstrated Libman-Sacks endocarditis and who responded favorably to immunosuppressive therapy, is reported.

Mesotelioma pericárdico primario manifestado como derrame pericárdico severo / Primary pericardial mesothelioma presenting as severe pericardial effusion

Introducción y objetivos:El mesotelioma pericárdico primario es un tumor extremadamente raro con pobre pronóstico, cuya etiología permanece desconocida. Se manifiesta clínicamente por disnea y derrame pericárdico. Se describe el caso de un paciente joven con derrame pericárdico severo como manifestación inicial del mesotelioma pericárdico. Caso clínico: Hombre de 34 años de edad con cuadro clínico de tres meses consistente en edema de las extremidades, disnea y aumento del perímetro abdominal. La ecocardiografía transtorácica documentó derrame pericárdico severo, obteniéndose por pericardiocentesis 2.660 ml de líquido cetrino. La resonancia magnética cardiaca evidencia engrosamiento, nodularidad del pericardio y signos de fibrosis. Se realizó biopsia del pericardio que concluye mesotelioma maligno. Se definió manejo con quimioterapia sistémica por oncología. Discusión: El mesotelioma pericárdico corresponde a menos del tres por ciento de los tumores cardiacos y del pericardio. Los factores de riesgo asociados son desconocidos, presentándose más en hombres. El diagnóstico usualmente es tardío con metástasis en más del 50% de los pacientes. No tiene una terapia estándar y usualmente es solo paliativa. El pronóstico es pobre con una sobrevivencia media de seis meses. Conclusiones: El derrame pericárdico severo y recurrente puede ser la primera manifestación de un mesotelioma primario pericárdico y deberá considerarse como diagnóstico diferencial en esta presentación clínica.

Introduction and objectives: Primary pericardial mesothelioma is an extremely rare tumor with poor prognosis whose etiology remains unknown. It is expressed clinically as dyspnea and pericardial effusion. The case of a young patient who presented with severe pericardial effusion as the initial manifestation of pericardial mesothelioma is described. Case report: 34 year-old man with 3-month symptoms of consistent in limb edema, dyspnea and increased abdominal girth. Transthoracic echocardiography documented severe pericardial effusion; 2,660 ml of citrine liquid was obtained by pericardiocentesis. Cardiac magnetic resonance imaging evidenced thickening, nodularity of the pericardium and signs of fibrosis. Pericardial biopsy was diagnostic of malignant mesothelioma. Systemic chemotherapy was initiated by oncology. Discussion: Pericardial mesothelioma accounts for less than 3% of cardiac tumors and pericardium. Associated risk factors are unknown, occurring more often in men. The diagnosis is usually delayed with metastases present in more than 50% of patients. There is no standard therapy and it is usually only palliative. The prognosis is poor, with a median survival of only 6 months. Conclusions: Severe and recurrent pericardial effusion may be the first manifestation of primary pericardial mesothelioma and should be considered as a differential diagnosis in this clinical presentation.

Una causa poco frecuente de hipertrabeculación exclusiva del ventrículo derecho: ventrículo derecho no compacto / An unusual cause of right ventricular hypertrabeculation exclusive of the right ventricle: non compaction of right ventricle

La cardiopatía por falta de compactación ventricular es una entidad infrecuente, que generalmente compromete el ventrículo izquierdo ocasionando falla cardíaca, arritmias ventriculares, embolismo periférico y muerte súbita. Hasta el momento, se han descrito muy pocos casos de ventrículo derecho no compacto, por lo cual no hay criterios diagnósticos establecidos y se desconoce como es la evolución clínica y la respuesta al tratamiento de este grupo de pacientes. Se describe el caso de un paciente con hipertrabeculación marcada del ventrículo derecho en quien se descartó un origen estructural de la misma, haciéndose diagnóstico de ventrículo derecho no compacto.

Non compaction cardiomyopathy is a rare entity which usually involves the left ventricle causing heart failure, ventricular arrhythmias, peripheral embolism and sudden death. So far, very few cases of right ventricular non compaction have been described, for which no established diagnostic criteria exist and the clinical course as well as the response to treatment of these patients remain unknown. We describe the case of a patient with marked right ventricular hypertrabeculation in whom a structural origin of it was discarded, whereby the diagnosis of right ventricular non-compactation was made.

Endocarditis por Coxiella burnetii: fiebre Q / Coxiella burnetii endocarditis: Q fever

La fiebre Q es una zoonosis causada por Coxiella burnetii; más frecuente en Europa pero reportada en otros continentes, puede cursar en forma aguda o crónica. La endocarditis es una forma de presentación crónica con curso insidioso y se asocia frecuentemente a fenómenos embólicos, representa 1% de todos los casos de endocarditis en el mundo. El diagnóstico se realiza por la sospecha clínica, cultivos negativos para patógenos convencionales y la confirmación serológica. Este artículo describe el caso clínico de un paciente con endocarditis causada por Coxiella burnetii y se revisa la literatura. (Acta Med Colomb 2012: 37: 31-33).

Q fever is a zoonosis caused by Coxiella burnetii. Q fever may present as subacute or chronic endocarditis, has a high incidence of embolic phenomena and is often fatal, representing 1% of all cases of endocarditis worldwide. Q fever most commonly presents an insidious course. The diagnosis is made by clinical suspicion after serial blood cultures for conventional pathogens are negative and by serological confirmation. This article describes the clinical case of a patient with endocarditis caused Coxiella burnetii and updated review of the literature. (Acta Med Colomb 2012: 37: 31-33).

Enfoque de la paciente embarazada con enfermedad valvular cardiaca / Abordagem da paciente grávida com doença valvular cardíaca / Pregnant patient with heart valve disease, a methodological approach

Las mujeres con enfermedad valvular que están embarazadas o planean embarazarse requieren cuidadosa evaluación y manejo. El embarazo se asocia con cambios fisiológicos que pueden agravar muchas enfermedades valvulares. La mayoría de mujeres toleran bien el embarazo y el parto sin complicaciones mayores; sin embargo, algunos tipos de enfermedad valvular son mal tolerados y requieren manejo intensivo. Además las pacientes con riesgo de tromboembolismo y aquellas con prótesis valvulares requieren anticoagulación y la decisión respecto al tipo e intensidad de la anticoagulación, requiere un cuidadoso balance entre el riesgo individual de trombosis y sangrado en la madre y los peligros para el feto. La clave para optimizar los buenos resultados en las pacientes con enfermedad valvular cardiaca consiste en un diagnóstico exacto de la etiología, en la clasificación del riesgo, en la adecuada evaluación y consejería antes de la gestación y la referencia de las mujeres de alto riesgo a centros con experiencia. El manejo de estas pacientes debe ser multidisciplinario con un equipo que incluya especialistas en las áreas de obstetricia, cardiología, neonatología y anestesiología entre otros...

Women with valvular disease who are pregnant or plan to become pregnant require careful evaluation and management. Pregnancy is associated with physiological changes that can aggravate many valvular diseases. Most women tolerate well pregnancy and childbirth without major complications, but some types of valvular disease are poorly tolerated and require intensive management. In addition, patients who are at risk of thromboembolism and those with prosthetic valves required anticoagulation. The decision regarding the type and intensity of anticoagulation requires a careful balance between the individual risk of thrombosis, bleeding in the mother and the dangers to the fetus. The key to optimize good results in patients with valvular heart disease consists of a precise diagnosis of the etiology, classification of risk, appropriate evaluation and counseling before pregnancy and reference of high-risk women to centers with experience. The management of these patients should be multidisciplinary including specialists in the areas of obstetrics, cardiology, neonatology and anesthesiology, among others...

As mulheres com doença valvular que estão grávidas ou pretendem engravidar necessitam de uma avaliação cuidadosa e manejo. A gravidez associa se com mudanças fisiológicas que podem piorar muitas doenças valvulares. A maioria das mulheres toleram bem a gravidez e o parto sem complicações maiores; porém alguns tipos de doença valvular são mal toleradas e precisam manejo intensivo. Alem disso as doentes com risco de tromboembolismo e aquelas com prótese valvulares precisam anticoagulação e a decisão respeito ao tipo e intensidade da anticoagulação, precisam um equilíbrio cuidadoso entre o risco individual de trombose e hemorragia na mãe e os perigos para o feto. A chave para otimizar os bons resultados nas doentes com doença valvular cardíaca consistem num diagnóstico exato da etiologia, uma classificação do risco, na avaliação adequada e conselheira antes da gravidez e encaminhamento de mulheres de alto risco aos centros experientes. O manejo destas doentes debe ser multidisciplinar com uma equipe que inclui especialistas nas áreas de obstetrícia, cardiologia, neonatologia e anestesiologia entre outras...

Terapia de resincronización cardiaca: experiencia, seguimiento clínico y ecocardiográfico, y optimización del dispositivo con ecocardiografía / Heart resynchronization therapy: experience, clinical follow-up and optimization of the device with echocardiography

Antecedentes: en pacientes con falla cardiaca avanzada, clase funcional III-IV, la mortalidad alcanza el 50 porciento a un año y el 80 porciento a dos años. Algunos permanecen sintomáticos y tienen pobre estado funcional a pesar del tratamiento farmacológico. La terapia de resincronización cardiaca es una alterativa terapéutica que mejora la hemodinámica y los síntomas en estos pacientes. Objetivo: analizar la experiencia en el manejo de la falla cardiaca con dispositivos de terapia de resincronización cardiaca con o sin cardiodesfibrilador. Diseño metodológico: se realizó un estudio de intervención, sin asignación aleatoria de los pacientes, con evaluación antes y después de la intervención...

Antecedents: in patients with advanced heart failure, functional class III-IV, mortality reaches 50% at one year and 80% at two years. Some remain asymptomatic and have a poor functional state, regardless of the pharmacologic treatment. Heart resynchronization therapy is a therapeutic alternative that improves hemodynamic and symptoms in these patients. Objective: to analyze the experience in the management of heart failure with heart resynchronization therapy devices with or without cardio defibrillator. Methodologic design: an intervention study without aleatory patients' assignment, with evaluation before and after the intervention. Results: the cohort was constituted by 82 patients. 73% were men. Mean age was 65.4 ± 11.9 years. The etiology was non-ischemic in 50 patients and ischemic in 32. Mean initial ejection fraction was 19.4% ± 11.7%. Initial functional class was class III - IV in 85% of cases and all patients received optimal medical treatment. During the follow-up, it was observed improvement of functional class, diastolic function, diastolic diameter of left ventricle, ejection fraction, mitral insufficiency, left atrial area, systolic lung pressure, synchrony parameters and myocardial function index with statistical significant difference in relation to the initial value (p<0.05). Survival at 44 months was 72%. Conclusion: the experience with heart resynchronization therapy and clinical and echocardiographic follow-up of the studied patients is similar to that found in other studies described in the literature.

Ecocardiografía de contraste: historia, características de las microburbujas y técnicas instrumentales / Contrast echocardiography: history, micro bubble characteristics and instrumental techniques

Este artículo describe la historia de la ecocardiografía de contraste, las características físicas de las microburbujas de los agentes de contraste, las principales herramientas instrumentales (índice mecánico, foco y enfoque, número de imágenes por segundo) y las técnicas ecocardiográficas (segunda armónica, armónica de fusión, segunda armónica de pulso invertido, imagen intermitente, angio y densitometría acústica) actualmente disponibles para uso clínico.

Miocardiopatía por estrés (miocardiopatía tipo takotsubo): presentación de un caso clínico y revisión de la literatura / Stress cardiomyopathy (Takotsubo): case presentation and literature review

La miocardiopatía por estrés o tipo takotsubo es un síndrome de aturdimiento miocárdico intenso, precipitado por situaciones de estrés agudo asociado con liberación suprafisiológica de catecolaminas. La disfunción ventricular izquierda es severa, característicamente reversible y de muy buen pronóstico. La arteriografía coronaria no demuestra lesiones coronarias significativas y la elevación de las enzimas de daño miocárdico es leve. También se conoce como miocardiopatía tipo takotsubo o como abombamiento apical transitorio del ventrículo izquierdo. Afecta con mayor frecuencia a mujeres ancianas y rara vez al hombre. Se presenta el caso clínico de una paciente con este tipo de miocardiopatía en el que se hace una revisión de la literatura, con énfasis en su forma de presentación clínica, hallazgos del electrocardiograma, enzimas cardiacas, alteraciones características de la contractilidad, fisiopatología, pronóstico y tratamiento.

Stress cardiomyopathy -Takotsubo cardiomyopathy- is a syndrome of intense myocardial stunning, resulting from acute stress situations accompanied by high catecholamine release. It is also known as Takotsubo cardiomyopathy or as transient apical left ventricular ballooning. Left ventricular systolic dysfunction is severe, reversible and has a good prognosis. Coronary arteriography doesn’t show significant coronary lesions and the serum enzymes elevation is minor. It affects predominantly old women and is very rare in men. A case of an old patient with this type of cardiomyopathy is presented and a review of literature is made, emphasizing its clinical manifestations, electrocardiographic findings, cardiac serum enzymes, characteristic contractility alterations, physiopathology, prognosis and treatment.

Utilidad de la atropina en pacientes bajo efecto beta-bloqueador durante la ecocardiografía de estrés con ejercicio / Utility of atropine in patients under beta-blocker effect during exercise stress echocardiography

Objetivo: evaluar la utilidad de adicionar atropina, 0,5 a 1,0 mg vía intravenosa (IV), durante el ejercicio máximo, en pacientes sometidos a ecocardiografía de estrés con ejercicio y que están bajo efecto beta-bloqueador.Población: se realizó ecocardiografía de estrés con ejercicio a setenta y tres pacientes consecutivos que recibían beta-bloqueadores y tenían frecuencia cardiaca basal menor de 60 latidos por minuto (LPM). De manera aleatoria se establecieron dos grupos: grupo I (18 pacientes.que no recibieron atropina durante el ejercicio máximo) y grupo II (50 pacientes, de los cuales 28 recibieron 0,5 mg de atropina intravenosa 30 seg a un minuto antes de concluir el ejercicio y 22 pacientes que recibieron 1,0 mg de atropina intravenosa 30 seg a un minuto antes de concluir el ejercicio).Resultados: entre los dos grupos no hubo diferencias en las características demográficas. La edad promedio fue de 59 ± 10,8 años (57 porciento hombres). La mayoría de los pacientes recibieron metoprolol (87 porciento), sin diferencias estadísticamente significativas en las dosis entre los grupos. Al momento de terminar el ejercicio, los pacientes alcanzaron en promedio el 84,7 porciento de la frecuencia cardiaca máxima (FCM). Post-ejercicio los valores fueron: a 30 segundos 76 porciento, a 60 segundos 68 porciento, a 90 segundos 62 porciento y a 120 segundos 59 porciento de la frecuencia cardiaca máxima. Al comparar el porcentaje de la frecuencia cardiaca máxima alcanzada en el máximo ejercicio y la observada en los primeros 120 segundos post-ejercicio, no se encontró diferencia estadísticamente significativa entre los grupos (p > 0,05).Conclusión: durante la realización de una ecocardiografia estrés con ejercicio, la administración de atropina no fue útil para incrementar la frecuencia cardiaca pico ni post-ejercicio en pacientes con efecto beta-bloqueador significativo (frecuencia cardiaca basal < 60 LPM).

Aneurismas y seudoaneurismas de injertos venosos coronarios / Aneurysms and pseudo aneurysms from coronary venous grafts

Los aneurismas y seudoaneurismas de injertos de vena safena aortocoronarios, son una complicación inusual de la cirugía de revascularización miocárdica. En este reporte se presenta el caso de un paciente de género masculino de 61 años de edad, quien sufrió un infarto del miocardio de la pared inferior 14 años atrás. La angiografía coronaria mostró enfermedad severa de dos vasos. Se realizó anastomosis de la arteria mamaria interna izquierda, al tercio medio de la descendente anterior e injerto de vena safena al tercio distal de la arteria coronaria derecha. En marzo de 2003, consultó por dolor anginoso. La radiografía de tórax reveló una masa paracardiaca derecha. La arteriografía coronaria mostró aneurisma del puente venoso a la arteria coronaria derecha. Durante la evolución presentó hemoptisis masiva; se hizo cirugía y se halló fístula de aneurisma de puente venoso coronario al lóbulo medio del pulmón derecho. En este artículo se hace una revisión de la etiología, los hallazgos clínicos, la metodología diagnóstica y el tratamiento actual de esta entidad. Hasta la fecha de esta publicación se reportan aproximadamente 60 casos en la literatura inglesa.

Evaluacion de la presion pulmonar en los pacientes sometidos a trasplante cardiaco / Evaluation of pulmonary preassure in patient who undergo cardiac transplantation

Se realizó un estudio analítico, retrospectivo de los pacientes sometidos a trasplante cardíaco en el Centro Cardiovascular Colombiano Clínica Santa María (CCSM) en el período comprendido entre 1985 - 2000. El objetivo del estudio fue determinar si la presencia de presión pulmonar elevada antes del trasplante cardíaco constituyó un riesgo para la mortalidad postoperatoria. Se revisó la base de datos e historias clínicas de los 139 pacientes trasplantados. La población se dividió en dos grupos según los valores de Resistencia Vascular Pulmonar (RVP): Grupo A (n = 59) denominado Hipertensos pulmonares; constituido por los pacientes con RVP >240 dinas.seg.cm'5 (3 unidades Wood) y Grupo B (n = 80) No hipertensos; constituido por los pacientes con RVP < 240 dinas.seg.cm'5. En el Grupo A se analizaron los valores de presión arterial pulmonar, gradiente traspulmonar y respuesta a vasodilatadores y se relacionaron con la mortalidad. Se realizó la distribución de frecuencia y análisis con Chi cuadrado y valor de p. En los resultados se observó tendencia a mayor mortalidad en el grupo de pacientes con presión pulmonar elevada, especialmente si ésta era no reactiva a vasodilatadores, pero sin encontrar diferencia estadísticamente significativa. Conclusión: La presencia de presión pulmonar elevada, pero dentro de los límites aceptados para realizar un trasplante cardíaco, no constituyó un factor de riesgo para la mortalidad postoperatoria. La explicación más probable a lo anterior se debe al estudio sistemático de la presión pulmonar y la exclusión de los pacientes que no cumplieron con los criterios de reactividad pulmonar para ser sometidos a un trasplante cardíaco en nuestra institución

Requerimientos mínimos esenciales en la formación del especialista en ecocardiografía del adulto en Colombia: propuesta presentada al ICFES/ASCOFAME / Minimal essential standards required for the training of a specialist in adult echocardiography in Colombia: a proposal presented to ICFES/ASCOFAME

En abril de 2003, la Asociación Colombiana de Facultades de Medicina (ASCOFAME) y el Instituto Colombiano para el Fomento de la Educación Superior (ICFES), convocaron a varios especialistas del país para discutir y escribir los estándares mínimos esenciales en la formación del especialista en ecocardiografía del adulto en Colombia. En este artículo se discuten entre otros, el perfil deseado del ecocardiografista, los requisitos para el ingreso a la especialidad, los objetivos generales y específicos de la especialidad, los contenidos teóricos básicos para la formación del especialista, la duración mínima del programa y los niveles de entrenamiento de acuerdo con el tipo de examen ecocardiográfico, como ecocardiografía Doppler, de estrés, perioperatoria y transesofágica. Estas recomendaciones siguen en términos generales, las guías de la Sociedad Americana de Ecocardiografía y de la Sociedad Colombiana de Cardiología.

Reporte de un adulto con doble tracto de salida del ventriculo derecho / Adult with double outlet right ventricle

Se describe el caso clínico de una paciente de 22 años. Con diagnóstico de cardiopatía congénita desde la infancia. Clase funcional I N.Y.H.A Consulta por palpitaciones. Se diagnostica por ecocardiografía, angiografía y resonancia magnética doble tracto de salida del ventrículo derecho. Es intervenida quirúrgicamente creando un túnel para unir el ventrículo izquierdo a la aorta ascendente a través del defecto interventricular