Subject(s)
Atrial Appendage/surgery , Bacteremia/diagnosis , Postoperative Complications/diagnosis , Prostheses and Implants/microbiology , Staphylococcal Infections/diagnosis , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Echocardiography, Transesophageal/methods , Female , Humans , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Positron Emission Tomography Computed Tomography/methods , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Staphylococcal Infections/drug therapy , Treatment OutcomeABSTRACT
INTRODUCCIÓN: La endocarditis infecciosa tiene una alta morbimortalidad y precisa un manejo médico-quirúrgico coordinado. El objetivo fue analizar la mortalidad en un hospital sin cirugía cardiaca. MATERIAL Y MÉTODOS: Evaluación de una cohorte prospectiva de pacientes con endocarditis infecciosa diagnosticada entre agosto de 2011 y enero de 2016 según los criterios de Duke modificados. RESULTADOS: Se incluyeron 64 pacientes, de los cuales fueron intervenido diecisiete (26,6%). La mortalidad fue 32,8% y se asoció con el antecedente de enfermedad pulmonar obstructiva crónica y la presencia de complicaciones, como la insuficiencia valvular y los embolismos en el sistema nervioso central; la cirugía cardiaca no fue un factor relacionado con la mortalidad. Cuatro pacientes (6,6%) no fueron intervenidos a pesar de tener indicación de cirugía cardiaca. El principal motivo para no ser intervenido fue el mal pronóstico prequirúrgico (44,7%). CONCLUSIONES: La mortalidad por endocarditis infecciosa en un hospital sin cirugía cardíaca es elevada. La complejidad de la patología fortalece la necesidad de equipos multidisciplinarios e interhospitalarios
BACKGROUND: Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery. MATERIAL AND METHODS: Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke's criteria. RESULTS: Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%). CONCLUSIONS: Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Endocarditis, Bacterial/mortality , Endocarditis, Bacterial/surgery , Hospital Mortality , Endocarditis, Bacterial/microbiology , Kaplan-Meier Estimate , Prospective Studies , Cohort Studies , Risk FactorsABSTRACT
BACKGROUND: Pulmonary hypertension (PH) is a common finding among patients with heart failure and preserved ejection fraction (HFpEF) and contributes to develop right ventricular systolic dysfunction (RVSD). AIMS: We evaluated the diagnostic accuracy of Flowers and Horan electrocardiographic criteria to detect significant right ventricular pressure overload. METHODS: 123 patients were prospectively included. We used the Flowers and Horan (FH) ECG criteria to define RV enlargement (score >10). Echocardiographic measurements were performed blinded to the electrocardiographic results. RESULTS: Severe PH was found in 51.5%. Seventeen patients (16.5%) had a FH score >10 points. This was associated to RVSD (RR 2.66; 1.51-4.67 CI 95%, p=0.002), with 90.5% specificity and 34.4% sensitivity and to severe PH (RR 1.70; 1.16-2.50 CI 95%, p=0.028) with 91.9% specificity and 27.5% sensitivity. CONCLUSIONS: The ECG is a useful tool to classify HFpEF patients with echocardiographic signs of right ventricular pressure overload, in the absence of RBBB.
Subject(s)
Electrocardiography/methods , Heart Failure/diagnosis , Hypertension, Pulmonary/diagnosis , Hypertrophy, Right Ventricular/diagnosis , Hypertrophy, Right Ventricular/etiology , Ventricular Dysfunction, Right/diagnosis , Aged, 80 and over , Algorithms , Diagnosis, Computer-Assisted/methods , Diagnosis, Differential , Echocardiography/methods , Female , Heart Failure/complications , Humans , Hypertension, Pulmonary/etiology , Male , Reproducibility of Results , Sensitivity and Specificity , Single-Blind Method , Stroke Volume , Ventricular Dysfunction, Right/etiologyABSTRACT
Revisión del manejo clínico del síndrome coronario agudo sin elevación del ST, a partir de las Guías Clínicas de la Sociedad Española de Cardiología, tanto en el ámbito intrahospitalario como el extrahospitalario, con especial énfasis en los temas de mayor controversia actual.
