Ecocardiografía clínica básica en Medicina Interna / Focused cardiac ultrasound in Internal Medicine

La ecocardiografía clínica básica es una técnica no invasiva, que puede dominar y ser muy útil para el internista. La ecocardiografía ofrece una información útil, rápida y precisa acerca de la estructura y función cardiaca que complementa a la anamnesis y a la exploración física a la cabecera del paciente. Tras un período de formación teórica y práctica breve, el internista puede determinar la dimensión y función de ambos ventrículos, detectar la presencia de derrame pericárdico significativo, orientar el diagnóstico de valvulopatías severas y estimar la presión venosa central mediante el diámetro y colapsabilidad de la vena cava inferior con una elevada fiabilidad. El objetivo de la ecocardiografía clínica básica no es la realización de un ecocardiograma reglado sino agilizar el diagnóstico y optimizar el manejo de gran parte de los enfermos con afección cardiovascular(AU)

Focused cardiac ultrasound is a noninvasive technique which can be performed by the internist. It is capable of providing useful, rapid and accurate information about the structure and function of the heart. It can be used to complement anamnesis and physical examination at the bedside. Clinicians may be able to determine left and right ventricular diameter and function, detect the presence of significant pericardial effusion, identify important valvular defects and estimate the central venous pressure by measuring the diameter and collapsibility of inferior vena cava with good accuracy after a short training period. The aim of focused cardiac ultrasound is not to perform a complete echocardiogram but using previous mentioned data, it is possible to expedite diagnosis and optimize the management of patients with cardiovascular diseases(AU)

[Focused cardiac ultrasound in internal medicine]. / Ecocardiografía clínica básica en medicina interna.

Focused cardiac ultrasound is a noninvasive technique which can be performed by the internist. It is capable of providing useful, rapid and accurate information about the structure and function of the heart. It can be used to complement anamnesis and physical examination at the bedside. Clinicians may be able to determine left and right ventricular diameter and function, detect the presence of significant pericardial effusion, identify important valvular defects and estimate the central venous pressure by measuring the diameter and collapsibility of inferior vena cava with good accuracy after a short training period. The aim of focused cardiac ultrasound is not to perform a complete echocardiogram but using previous mentioned data, it is possible to expedite diagnosis and optimize the management of patients with cardiovascular diseases.

[Strategic orientation of the Spanish Society of Internal Medicine]. / Orientación estratégica de la Sociedad Española de Medicina Interna.

The council of the Spanish Society of Internal express its position within the general society, origins, objectives, and strategies. The Spanish Foundation of Internal Medicina promotes scientific research and continued education within Internal Medicine, by means of the 17 working groups. Taking into account the actual situation, the authors analyze this situation and formulate the strategy objectives for the upcoming years. These contents are summarized in 10 message decalogue that express the essence and future of Internal Medicine.

Orientación estratégica de la Sociedad Española de Medicina Interna / Strategic orientation of the Spanish Society of Internal Medicine

La Junta Directiva de la Sociedad Española de Medicina Interna (SEMI) expone su ideario, naturaleza de ser, objetivos, y estrategias. La Fundación Española de Medicina Interna promueve la investigación científica y formación continuada en el ámbito de la medicina interna, a través de los 17 grupos de trabajo. Partiendo de la situación actual, se realiza un análisis de esta situación y se trazan los objetivos estratégicos para los próximos años. Estos contenidos se resumen en un decálogo de mensajes que comprenden la esencia y futuro de la medicina interna(AU)

The council of the Spanish Society of Internal express its position within the general society, origins, objectives, and strategies. The Spanish Foundation of Internal Medicina promotes scientific research and continued education within Internal Medicine, by means of the 17 working groups. Taking into account the actual situation, the authors analyze this situation and formulate the strategy objectives for the upcoming years. These contents are summarized in 10 message decalogue that express the essence and future of Internal Medicine(AU)

Influence of admission blood pressure on mortality in patients with acute decompensated heart failure.

OBJECTIVES: To determine the relationship between admission blood pressure (BP) and prognosis in patients hospitalized for acute decompensated heart failure (HF). BACKGROUND: The relationship between BP admission blood pressure and outcomes in decompensated HF is controversial. It has been suggested that this presentation may be a specific disorder, but their mechanisms and clinical relationships are poorly defined. METHODS: We evaluated the association between initial BP (systolic, diastolic and mean BP) with readmission and mortality, as well as potential interactions with age, clinical characteristics, renal function, left ventricular dysfunction, comorbidities and treatment. By using Cox regression models the association between each outcome and BP was tested. RESULTS: A total of 581 patients (77.5-years-old, range 51-100) were included. At admission, mean BP in quartiles was 77.09 mm Hg (53.3-85.0) (Q1); 91.46 mm Hg (85.0-96.7) (Q2); 103.41 mm Hg (96.7-109.9) (Q3) and 124.79 mm Hg (109.9-209.0) (Q4). Median duration of follow-up was 8 months [95% confidence interval (CI) 5.2-11.1]. Mortality was 15.5% (Q1), 9.2% (Q2), 12.6% (Q3) and 7.3% (Q4). Interquartile hazard ratio (95% CIs) for mortality was 0.40 (0.19-0.85) P=0.017. Body mass index (BMI) was higher in Q4 29.59 k/m2 than in Q1 28.25 k/m2 (P=0.018). There were no differences in age, clinical antecedents, renal function, comorbidities or severity of HF between groups. CONCLUSION: Higher mean BP at admission is associated with significantly lower mortality during follow-up, in patients hospitalized for HF. With the exception of BMI, positively correlated with blood pressure, this relationship is independent of other clinical factors and medications.

Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna / Morbidity from patients admitted for heart failure in the departaments of internal medicine

Antecedentes y objetivosLos pacientes con insuficiencia cardiaca (IC) presentan con frecuencia patologías asociadas. Se desconoce en toda su extensión la influencia de estas comorbilidades en la mortalidad y otras variables clínicas. Hemos analizado la comorbilidad de los pacientes ingresados por IC en los servicios de medicina interna de hospitales de España y su relación con diversas variables sociodemográficas y clínicas.Pacientes y métodosEstudiamos de forma prospectiva 2.127 pacientes (desde el 1 de octubre del año 2000 al 28 de febrero del año 2001) con IC, ingresados en 51 hospitales de diferentes categorías (comarcales–hospitales universitarios), en los que un internista se ofreció a colaborar. La comorbilidad se calculó con el índice de Charlson.ResultadosLa edad media fue de 77 años (mujeres, el 57%). El 45% había tenido al menos un ingreso en el último año. El 41% tenía una clase funcional iii/iv de la New York Heart Association. La fracción de eyección se halló conservada en el 53% de los enfermos. Se indentificaron patologías asociadas en el 60% de los pacientes (diabetes mellitus, el 39%; enfermedad pulmonar obstructiva crónica, el 31%). El índice de Charlson medio fue de 5,4 puntos (rango: 2–11 puntos). La mortalidad intrahospitalaria global fue del 6,1%. Durante el ingreso hospitalario fallecieron más pacientes en el grupo de mayor comorbilidad (Charlson ≥3 puntos, el 8,4%) que entre los enfermos con menor índice de Charlson (1–2 puntos, el 5,2%; p<0,01). Los tratamientos prescritos fueron similares en ambos grupos. En el análisis multivariante, la comorbilidad se asoció de forma independiente con enfermos del sexo masculino, de edad mayor de 75 años, clase funcional iii/iv de la New York Heart Association y grado de incapacidad física...(AU)

Background and objetivesHeart Failure (HF) patients present frecuently comorbidities. Little is known about the impact of these comorbidities in morbimortality. We analized the comorbidities of HF patients admitted in Spanish internal medicine units and its relation with different socio-demografics and clinical variables.Patients and methodsWe studied prospectivaly 2127 patients (admitted from 01.10.2000–28.02.2001) with HF in 51 Hospitals of different categories (from local hospitals to universitary hospitals) in which an internist was available to collaborate in the study. Comorbidities were estimated by the Charlson index.ResultsMean age was 77 years (women 57%). 45% of patients have had a previous admission in the last year. 41% had a functional stage NYHA iii/iv.ResultsEyection fraction was preserved in 53% of patients. Comorbidities were identified in 60% of patients (diabetes mellitus, 39%; chronic lung disease 31%). The average Charlson index was 5.4 points (range 2–11 points). Global inhospital mortality was 6.1%. During the admission more patients died in the Group with higher comorbidities (Charlson, >3 points; 8.4%) than in the Group with low Charlson index (1–2, 5.2%; p<0.01). Treatments prescribed were similar in both groups. In a multivariant analisis comorbidities was associated independently with masculin gender, age superior to 75 years, functional status NYHA iii/iv and disfunctional physical capacity.ConclusionsComorbidities determined by Charlson index were associated with more frequent admission, longer stay in hospital, higher discapacity and higher mortality. These results enhance the importance of comorbidities in prognosis of heart failure patients admitted in internal medicine units in Spain(AU)

[Morbidity from patients admitted for heart failure in the departments of internal medicine]. / Comorbilidad de los pacientes ingresados por insuficiencia cardiaca en los servicios de medicina interna.

BACKGROUND AND OBJECTIVES: Heart Failure (HF) patients present frequently comorbidities. Little is known about the impact of these comorbidities in morbimortality. We analyzed the comorbidities of HF patients admitted in Spanish internal medicine units and its relation with different socio-demographics and clinical variables. PATIENTS AND METHODS: We studied prospectively 2127 patients (admitted from 01.10.2000-28.02.2001) with HF in 51 Hospitals of different categories (from local hospitals to university hospitals) in which an internist was available to collaborate in the study. Comorbidities were estimated by the Charlson index. RESULTS: Mean age was 77 years (women 57%). 45% of patients have had a previous admission in the last year. 41% had a functional stage NYHA iii/iv. Eyection fraction was preserved in 53% of patients. Comorbidities were identified in 60% of patients (diabetes mellitus, 39%; chronic lung disease 31%). The average Charlson index was 5.4 points (range 2-11 points). Global inhospital mortality was 6.1%. During the admission more patients died in the Group with higher comorbidities (Charlson, >3 points; 8.4%) than in the Group with low Charlson index (1-2, 5.2%; p<0.01). Treatments prescribed were similar in both groups. In a multivariant analysis comorbidities was associated independently with masculine gender, age superior to 75 years, functional status NYHA iii/iv and dysfunctional physical capacity. CONCLUSIONS: Comorbidities determined by Charlson index were associated with more frequent admission, longer stay in hospital, higher discapacity and higher mortality. These results enhance the importance of comorbidities in prognosis of heart failure patients admitted in internal medicine units in Spain.

Manejo de la insuficiencia cardíaca en pacientes ancianos a través de la implantación de un hospital de día multidisciplinar / Multidisciplinary management of elderly patients with heart failure in a day hospital

Introducción. Evaluar la utilidad de un hospital de día llevado por un equipo multidisciplinar integrado por enfermería especializada en insuficiencia cardíaca (IC), un geriatra y médicos internistas en la reducción de ingresos de pacientes ancianos con IC no preseleccionados por fracción de eyección (FEVI). Material y métodos. Se incluyeron 182 pacientes con una edad media de 76 años con IC descompensada que requirieron ingreso en Medicina Interna y Geriatría. Cincuenta y un pacientes recibieron seguimiento en el hospital de día, donde se realiza educación, optimización del tratamiento, acceso telefónico y tratamiento diurético parenteral ante descompensaciones. Se midió el reingreso por IC a los 3 meses posthospitalización. Se realizó un análisis bivariante usando pruebas paramétricas (p < 0,05) y el análisis de Kaplan Meier. Resultados. El 61% de los pacientes eran mujeres. La clase funcional media de los pacientes según la New York Heart Association (NYHA) fue de 2,75 ± 0,44 y la FEVI era < 45% en el 40% de los casos. La tasa de prescripción de bloqueante beta fue más alta en el grupo de intervención (n = 51) que en el grupo control (93% frente a 24%; p < 0,001), igualmente ocurrió con la prescripción de inhibidores de la enzima convertidora de la angiotensina o antagonistas de los receptores de angiotensina II (96% frente a 72%; p = 0,002). Los pacientes del grupo de intervención tuvieron menor frecuencia de reingreso por IC a los 90 días de seguimiento (28% frente a 11%; p = 0,020). El tiempo libre de reingreso fue superior en estos pacientes que en aquéllos seguidos convencionalmente (85,12 días frente a 76; log rank; p = 0,026). Discusión. La intervención multidisciplinar de enfermeras junto con médicos generalistas en un hospital de día constituye una opción válida en el manejo de pacientes ancianos no preseleccionados por FEVI pues reduce el reingreso hospitalario por IC (AU)

Introduction. To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). Material and methods. 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. Results. A total of 61% were women. Mean NYHA class was 2.75 ± 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). Discussion. Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF (AU)

[Multidisciplinary management of elderly patients with heart failure in a day hospital]. / Manejo de la insuficiencia cardíaca en pacientes ancianos a través de la implantación de un hospital de día multidisciplinar.

INTRODUCTION: To evaluate the utility of a day hospital managed by a multidisciplinary heart failure (HF) team composed of nurses, geriatricians and internal physicians in the reduction of hospital readmission of elderly patients with HF who are not selected by their left ventricular ejection fraction (LVEF). MATERIAL AND METHODS: 182 patients with mean age of 76 years and decompensated HP who required admission in internal medicine and geriatric wards were included. A total of 51 patients were followed up in a day hospital, where education, phone access, drug titration and use of parenteral diuretics were performed. Readmission due to HF at 3 months post-hospitalization was measured. A bivariate analysis was performed in both groups using parametrics test (p < 0.05) and a Kaplan Meier analysis using log rank. RESULTS: A total of 61% were women. Mean NYHA class was 2.75 +/- 0.44. LVEF < 45% was found in 40%. Prescription rate of beta blockers was significantly higher in the intervention group (93% vs 24%; p < 0.001) as well as ACE-inhibitors and ARB prescription rates (96% vs 72%, p = 0.002). Readmission rate due to HF in the first 90 days after discharge was lower in the intervention group (11% vs 28%; p = 0.020). HF admission free time was longer for these patient than those managed with conventional care (85.12 days versus 76; log rank; p = 0.026). DISCUSSION: Multidisciplinary intervention carried out by generalist physicians and HF nurses in a day hospital is useful to reduce HF admission in elderly patients not selected by their LVEF.

[Prognostic factors in patients admitted with type 2 diabetes in Internal Medicine Services: hospital mortality and readmission in one year (DICAMI study)]. / Factores pronósticos en pacientes con diabetes mellitus tipo 2 ingresados en Servicios de Medicina Interna: mortalidad y reingreso hospitalario en un año (estudio DICAMI).

INTRODUCTION: Type II diabetes mellitus (T2DM) is a prevalent Public Health Care problem that causes an increase in morbidity, mortality and number of hospital admissions as well as increased costs in care services in this population group. The clinical indicator that determine readmission and/or death are analyzed in a 12 month follow-up period. METHODS: All T2DM patients admitted in Spanish Internal Medicine Services between two different periods (june 1-15, 2003 and november 1-15) were enrolled in a prospective cohort study. Primary endpoint were readmission and/or death in the year following the first admission. RESULTS: Population of the study (n = 482) was distributed in 229 males (47.5%) and 253 females (52.5%). Mean age was 73.48 +/- 8.86 years. A total of 210 (43.6%) were not readmitted to the hospital and/or died in the follow-up and 272 (56.4%) were readmitted and/or died. The latter 272 patients had a significantly greater percentage of heart failure (odds ratio [OR] 1.760; 1.073-2.886), atrial fibrillation (OR 1.747; 1.010- 3.022) and previous history of systolic blood pressure (OR 0.400; 0.241-0.666). They also showed increased levels of plasma glucose (OR 1.004; 1.001-1.007), and lower concentration of plasma hemoglobin (OR 0.756; 0.677-0.845) and creatinine clearance (OR 0.985; 0.976-0.994). CONCLUSIONS: T2DM patients who are admitted to the Internal Medicine Services in Spain are elderly patients with elevated indices of readmission and death in a short follow-up period (one year). The coexistence of heart failure, atrial fibrillation, renal dysfunction deterioration and decrease in hemoglobin levels may predict this worse outcome.

Factores pronósticos en pacientes con diabetes mellitus tipo 2 ingresados en Servicios de Medicina Interna: mortalidad y reingreso hospitalario en un año (estudio DICAMI) / Prognostic factors in patients admitted with type 2 diabetes in Internal Medicine Services: hospital mortality and readmission in one year (DICAMI study)

Introducción. La diabetes mellitus tipo 2 (DMT2) constituye un problema de Salud Pública que determina un incremento de la mortalidad y del número de ingresos hospitalarios, con un aumento de los costes sanitarios en este grupo de población. Se analizan los indicadores clínicos que determinan el reingreso y/o muerte en un año de seguimiento. Métodos. Estudio de cohorte prospectivo de pacientes ingresados en Servicios de Medicina Interna con el diagnóstico de DMT2 en dos períodos diferentes (1-15 de junio y 1-15 de noviembre de 2003). Como variable resultado se consideraron el reingreso hospitalario y/o la muerte en un año de seguimiento. Resultados. El grupo de estudio lo constituyen 482 pacientes, 229 varones (47,5%) y 253 mujeres (52,5%) con 73,48 ± 8,86 años de edad. Doscientos diez (43,6%) no reingresaron y/o fallecieron en el seguimiento y 272 (56,4%) reingresaron y/o fallecieron. Estos 272 pacientes presentaron de forma significativa un porcentaje mayor de insuficiencia cardíaca (odds ratio [OR] 1,760; 1,073-2,886), fibrilación auricular (OR 1,747; 1,010-3,022), historia previa de presión arterial sistólica (PAS) > 130 mmHg (OR 0,400; 0,241-0,666), niveles superiores de glucemia al ingreso (OR 1,004; 1,001-1,007), niveles más bajos de hemoglobina (OR 0,756; 0,677-0,845) y aclaramiento de creatinina (OR 0,985; 0,976-0,994). Conclusiones. La DMT2 que ingresa en los Servicios de Medicina Interna se da en pacientes de edad avanzada y elevados índices de reingreso hospitalario y/o muerte en períodos de seguimiento cortos (un año). La coexistencia de insuficiencia cardíaca, fibrilación auricular, deterioro de función renal y descenso de cifras de hemoglobina pudiera predecir está peor evolución (AU)

Introduction. Type II diabetes mellitus (T2DM) is a prevalent Public Health Care problem that causes an increase in morbidity, mortality and number of hospital admissions as well as increased costs in care services in this population group. The clinical indicator that determine readmission and/or death are analyzed in a 12 month follow-up period. Methods. All T2DM patients admitted in Spanish Internal Medicine Services between two different periods (june 1-15, 2003 and november 1-15) were enrolled in a prospective cohort study. Primary endpoint were readmission and/or death in the year following the first admission. Results. Population of the study (n = 482) was distributed in 229 males (47.5%) and 253 females (52.5%). Mean age was 73.48 ± 8.86 years. A total of 210 (43.6%) were not readmitted to the hospital and/or died in the follow-up and 272 (56.4%) were readmitted and/or died. The latter 272 patients had a significantly greater percentage of heart failure (odds ratio [OR] 1.760; 1.073-2.886), atrial fibrillation (OR 1.747; 1.010- 3.022) and previous history of systolic blood pressure (OR 0.400; 0.241-0.666). They also showed increased levels of plasma glucose (OR 1.004; 1.001-1.007), and lower concentration of plasma hemoglobin (OR 0.756; 0.677-0.845) and creatinine clearance (OR 0.985; 0.976-0.994). Conclusions. T2DM patients who are admitted to the Internal Medicine Services in Spain are elderly patients with elevated indices of readmission and death in a short follow-up period (one year). The coexistence of heart failure, atrial fibrillation, renal dysfunction deterioration and decrease in hemoglobin levels may predict this worse outcome (AU)

[Heart failure, malnutrition and inflammation. Prevalence and relevant aspects in its assessment]. / Insuficiencia cardíaca, malnutrición e inflamación. Prevalencia y aspectos relevantes en su valoración.

UNLABELLED: Heart failure is associated to alterations in the nutritional status that contributes to a worse prognosis of the disease. OBJECTIVE: To study protein-calorie malnutrition (PEM) prevalence, micronutrient deficits and increase of inflammatory parameters in patients with cardiac failure (CF). MATERIAL AND METHODS: Cross-sectional, observational study in 98 heart failure patients of Internal Medicine Service have been evaluated. We have analyzed biomedical, anthropometric variables (weight, size, BMI, tricipital fold), search of treatments, echocardiogram valuation and determination of albumin, pre-albumin, A and E group vitamins, ESR and C-reactive protein. We have defined protein malnutrition (PN) as albumin values RESULTS: Average age was 76.6 +/- 7.5. A total of 77.7% showed a functional class II-III/IV. Prevalence of PEM was 40%. Low albumin and prealbumin was found in 12.8% and 38.3% respectively (p < 0.05). Using BMI, 5.3% of patients had malnutrition. Nevertheless, if tricipital fold is used, EM was found in the 25.3% of the cases (p < 0.05). Iron iron, vitamin A and C-reactive protein levels were different in heart failure patients with PM (p < 0.05). The percentage of protein malnutrition in patients with LVEF < 45% was 16.4% versus 5.5% in diastolic dysfunction (p = 0.01). Treatment with ACE-inhibitors was 42.2%; in this group the malnutrition for any criterion was 13% vs 26% in the group of patients without ACE-inhibitors (p = 0.08). CONCLUSIONS: There is a high prevalence of nutritional and inflammatory disturbances (low in diastolic dysfunction) in patients with moderate status of heart failure. Treatment with an ACE-inhibitor improves the nutritional parameters.

Insuficiencia cardíaca, malnutrición e inflamación. Prevalencia y aspectos relevantes en su valoración / Heart failure, malnutrition and inflammation. Prevalence and relevant aspects in its assessment

La insuficiencia cardíaca (IC) se asocia a alteraciones en el estado nutricional que contribuyen a empeorar el pronóstico de la enfermedad. Objetivo. Evaluar la prevalencia de malnutrición proteico-calórica (MPC), déficit de micronutrientes y aumento de parámetros inflamatorios en pacientes con IC. Material y métodos. Estudio observacional transversal de 98 pacientes (< 60 años) con IC ingresados en Medicina Interna. Se han analizado variables biomédicas, ecocardiográficas, antropométricas (peso, talla, índice de masa corporal [IMC], pliegue tricipital), registro de tratamientos específicos para la IC y determinación de albúmina, prealbúmina, hierro, magnesio, fósforo, vitaminas del grupo A y E, velocidad de sedimentación globular (VSG) y proteína C reactiva (PCR). Hemos definido desnutrición proteica como albúmina < 3 g/dl o prealbúmina < 13 mg/dl y desnutrición calórica como IMC < 20 o pliegue tricipital por debajo del percentil 50. Resultados. Edad media: 76,6 ± 7,5. El 77,7% presentaba una clase funcional II-III/IV. La prevalencia de MPC fue del 40%. Se encontró albúmina y prealbúmina bajas en el 12,8% y el 38,3%, respectivamente (p < 0,05). Con el IMC se detectó desnutrición en el 5,3% y con el pliegue tricipital en el 25,3% (p< 0,05). Los niveles de hierro y vitamina A fueron menores y la PCR más elevada, de forma significativa, en pacientes con desnutrición proteica (p < 0,05). El porcentaje de malnutrición proteica en pacientes con fracción de eyección del ventrículo izquierdo (FEVI) < 45% fue del 16,4% frente al 5,5% en disfunción diastólica (p = 0,01). El porcentaje de pacientes que tomaba inhibidores de la enzima conversora de la angiotensina (IECA) fue del 42,2%. Se constataron diferencias casi significativas (p = 0,08) en el número de enfermos malnutridos por cualquier criterio entre los que tomaban IECA y los que no (el 13% frente al 26%). Conclusiones. Existe una alta prevalencia de malnutrición por distintos criterios (menor en pacientes con disfunción diastólica) y elevación de PCR en pacientes con estadios no muy avanzados de IC. Los pacientes que reciben tratamiento con IECA presentan mejores parámetros nutricionales

Heart failure is associated to alterations in the nutritional status that contributes to a worse prognosis of the disease. Objective. To study protein-calorie malnutrition (PEM) prevalence, micronutrient deficits and increase of inflammatory parameters in patients with cardiac failure (CF). Material and methods. Cross-sectional, observational study in 98 heart failure patients of Internal Medicine Service have been evaluated. We have analyzed biomedical, anthropometric variables (weight, size, BMI, tricipital fold), search of treatments, echocardiogram valuation and determination of albumin, pre-albumin, A and E group vitamins, ESR and C-reactive protein. We have defined protein malnutrition (PN) as albumin values < 3 g/dl or prealbumin < 13 mg/dl; and energy malnutrition (EM) as BMI < 20 or tricipital fold values lower than percentile 50. Results. Average age was 76.6 ± 7.5. A total of 77.7% showed a functional class II-III/IV. Prevalence of PEM was 40%. Low albumin and prealbumin was found in 12.8% and 38.3% respectively (p < 0.05). Using BMI, 5.3% of patients had malnutrition. Nevertheless, if tricipital fold is used, EM was found in the 25.3% of the cases (p < 0.05). Iron iron, vitamin A and C-reactive protein levels were differenct in heart failure patients with PM (p < 0.05). The percentage of protein malnutrjiton in patients with LVEF < 45% was 16.4% versus 5.5% in diastolic dysfunction (p = 0.01). Treatment with ACE-inhibitors was 42.2%; in this group the malnutrition for any criterion was 13% vs 26% in the group of patients without ACE-inhibitors (p = 0.08). Conclusions. There is a high prevalence of nutritional and inflammatory disturbances (low in diastolic dysfunction) in patients with moderate status of heart failure. Treatment with an ACE-inhibitor improves the nutritional parameters

La insuficiencia cardíaca de origen hipertensivo e isquémico: características clínicas y pronósticas / Hypertensive and ischemic heart failure: clinical characteristics and prognoses

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Tratamiento general y seguimiento en el paciente con insuficiencia cardíaca estable

En el presente artículo nos centraremos en el mantenimiento y la monitorización de esquema terapéutico básico en el paciente con insuficiencia cardíaca. Tratar adecuadamente al paciente con esta afección depende inicialmente de realizar un correcto diagnóstico clínico preciso de la insuficiencia cardíaca, pero también del tipo de fallo diastólico o sistólico, de los factores causales y precipitantes de la situación de la insuficiencia cardíaca y también de la comorbilidad que con frecuencia acompaña a los pacientes con esta afección (AU)

Insuficiencia cardíaca en la mujer. Rasgos diferenciales

El cuadro clínico y los factores de riesgo de insuficiencia cardíaca sugieren que pueden existir diferentes mecanismos fisiopatológicos en el varón y la mujer. Mientras que el varón la cusa más frecuente de insuficiencia cardíaca es la cardiopatía isquémica, en la mujer es más frecuente la asociada a diabetes mellitus e hipertensión arterial. Sin embargo, la complejidad del desarrollo y la progresión de la insuficiencia cardíaca parecen ser similares en ambos sexos. Pero aunque a menudo varones y mujeres tienen diferente cuadro clínico, no existe información disponible por la que la insuficiencia cardíaca crónica deba ser tratada de forma diferente en ambos sexos, lo que debe ser tenido en cuenta por los médicos que tratan a pacientes con insuficiencia cardíaca (AU)

El tratamiento de la insuficiencia cardíaca / Therapy of heart failure

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