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1.
Rev Port Cardiol ; 43(2): 67-74, 2024 Feb.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-37923244

RESUMEN

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is a common cause of morbidity and mortality in pregnant women. Arrhythmias are common complications during pregnancy; however, the data are limited. Our goal was to characterize the epidemiology, clinical presentation, and impact of cardiac arrhythmias on maternal-fetal outcomes. METHODS: A prospective cohort study from the Colombian Registry of Pregnancy and Cardiovascular Disease was carried out from 2016 to 2019. All patients with tachyarrhythmia or bradyarrhythmia and a minimum follow-up of six months after delivery were included. The primary outcome was a composite of cardiac events defined as pulmonary edema, symptomatic sustained arrhythmia requiring specific therapy, stroke, cardiac arrest, or maternal death. Secondary outcomes were other cardiac, neonatal, and obstetric events. RESULTS: Arrhythmias were the most common cause of referral to our dedicated cardio-obstetric clinic. A total of 92 patients were included, mean age 27±6 years; 8.7% had previous structural heart disease, and cardiology consultation was delayed in 79.4%. The most common arrhythmias were premature ventricular contractions (33%) and paroxysmal reentrant supraventricular tachycardias (15%); 11 patients (12%) had cardiac implantable electronic devices. Cardiac events occurred in 18.4% of patients, obstetric events occurred in 6.5%, and one caesarean was indicated in the context of symptomatic severe mitral stenosis. Adverse neonatal outcomes were observed in 24.3% of newborns. CONCLUSIONS: Arrhythmias were the most common cause of referral to a dedicated cardio-obstetric clinic; most had a benign course. Adverse maternal cardiovascular outcomes were significant and there was a high rate of obstetric and neonatal adverse events, underlining the importance of multidisciplinary care.


Asunto(s)
Estenosis de la Válvula Mitral , Complicaciones Cardiovasculares del Embarazo , Femenino , Recién Nacido , Humanos , Embarazo , Adulto Joven , Adulto , Mujeres Embarazadas , Estudios Prospectivos , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia
2.
Rev Colomb Obstet Ginecol ; 72(3): 298-306, 2021 09 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34851572

RESUMEN

Objective: To report the case of a pregnant woman with mirror syndrome associated with non-compaction cardiomyopathy in the mother and the fetus, in which antenatal medical treatment provided to the mother resulted in a favorable perinatal maternal outcome. Case presentation: A 16-year old primigravida with 33 weeks of gestation referred from a Level I institution to a private Level IV center in Medellín, Colombia, because of a finding of fetal hydrops on obstetric ultrasound. During hospitalization, the patient showed clinical and ultrasonographic signs of heart failure (dyspnea, edema and hypoxemia), with the diagnosis of hydrops fetalis (mirror syndrome) also confirmed. Diuretic treatment with furosemide was initiated in the mother, with subsequent improvement of the maternal condition as well as of the fetal edema. During the subacute postpartum period in the hospital, the presence of non-compaction cardiomyopathy was confirmed on cardiac nuclear magnetic resonance imaging in both the mother and the newborn. After discharge in adequated condition, they were included in the cardiovascular follow-up program for heart failure and congenital heart disease, respectively. Conclusion: A case of mirror syndrome associated with maternal and fetal non-compaction cardiomyopathy is presented. There is a limited number of reports on mirror syndrome due to cardiac anomalies (maternal and fetal), with weak treatment descriptions, pointing to the need for research in this area. It would be important to consider the diagnosis of non-compaction cardiomyopathy in fetuses with hydrops unrelated to isoimmunization or cardiac dysfunction, and approach these cases from a multi-disciplinary perspective.


Objetivo: reportar el caso de una gestante con síndrome en espejo asociada a miocardiopatía no compactada, tanto en la madre como el feto, en los que el tratamiento médico antenatal en la madre llevó a un resultado materno perinatal favorable. Presentación del caso: se describe el caso de una primigestante de 16 años, con 33 semanas de embarazo, remitida desde una institución de primer nivel de atención a una institución privada de cuarto nivel en la ciudad de Medellín, Colombia, por presentar feto con hidropesía en ultrasonido obstétrico de control. Durante la hospitalización, la paciente presentó signos clínicos y ecocardiográficos de falla cardiaca (disnea, edema e hipoxemia), a la vez que se confirmó el diagnóstico de Hydrops fetalis (síndrome en espejo). Se instauró tratamiento diurético con furosemida en la madre, logrando mejoría del cuadro materno y del edema fetal. En el puerperio mediato hospitalario se confirmaron la presencia de miocardiopatía no compactada en la resonancia magnética nuclear cardiaca, tanto de la madre como del recién nacido. Ambos egresaron en adecuadas condiciones y fueron vinculados al programa de seguimiento cardiovascular: falla cardiaca y de cardiopatía congénitas, respectivamente. Conclusión: se presenta un caso de síndrome en espejo asociado a miocardiopatía no compactada materna y fetal. Es limitado el número de reportes de síndrome en espejo por anomalías cardiacas (maternas y fetales) y pobre la descripción de los tratamientos realizados que surgen como temas a investigar. Sería importante considerar el diagnóstico de MNC en fetos con hidropesía no asociados a isoinmunización y con disfunción cardiaca, así como su atención por equipos multidisciplinarios.


Asunto(s)
Cardiomiopatías , Edema , Adolescente , Cardiomiopatías/diagnóstico por imagen , Femenino , Feto , Humanos , Hidropesía Fetal/diagnóstico por imagen , Recién Nacido , Madres , Embarazo
4.
Acta méd. colomb ; 46(4): 26-42, Oct.-Dec. 2021. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1374086

RESUMEN

Abstract Introduction: heart failure with reduced ejection fraction has a growing therapeutic arsenal. Thus, the indications for each therapy must be refined. Methods: a systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, to update the systematic search performed in the development of the "Clinical Practice Guidelines for Prevention, Diagnosis, Treatment and Rehabilitation" (CPG) of the Colombian Ministry of Health. Results: six new clinical trials were found which substantially modify the main recommendations of the CPG. Angiotensin receptor antagonists combined with neprilysin inhibitors (ARNI), sodium-glucose cotransporter 2 (SGLT2) inhibitors, betablockers and mineralocorticoid receptor antagonists (MRA) are now the main core of treatment for patients with heart failure with reduced ejection fraction. Other therapeutic options should be considered after beginning and titrating the doses of these four medications. Discussion: given the robustness of the evaluating studies, the proposed practical scheme, as the central core with four fundamental therapeutic strategies, will improve the treatment of patients with heart failure and allow the stepwise inclusion of other alternatives, plotted as orbits, to impact on other individual outcomes. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2108).

5.
Rev. colomb. obstet. ginecol ; 72(3): 298-306, July-Sept. 2021. graf
Artículo en Español | LILACS | ID: biblio-1351954

RESUMEN

Objetivo: reportar el caso de una gestante con síndrome en espejo asociada a miocardiopatía no compactada (MNC), tanto en la madre como el feto, en los que el tratamiento médico antenatal en la madre llevó a un resultado materno perinatal favorable. Presentación del caso: se describe el caso de una primigestante de 16 años, con 33 semanas de embarazo, remitida desde una institución de primer nivel de atención a una institución privada de cuarto nivel en la ciudad de Medellín, Colombia, por presentar feto con hidropesía en ultrasonido obstétrico de control. Durante la hospitalización, la paciente presentó signos clínicos y ecocardiográficos de falla cardiaca (disnea, edema e hipoxemia), a la vez que se confirmó el diagnóstico de Hydrops fetalis (síndrome en espejo). Se instauró tratamiento diurético con furosemida en la madre, logrando mejoría del cuadro materno y del edema fetal. En el puerperio mediato hospitalario se confirmaron la presencia de miocardiopatía no compactada en la resonancia magnética nuclear cardiaca, tanto de la madre como del recién nacido. Ambos egresaron en adecuadas condiciones y fueron vinculados al programa de seguimiento cardiovascular: falla cardiaca y de cardiopatía congénitas, respectivamente. Conclusión: se presenta un caso de síndrome en espejo asociado a miocardiopatía no compactada materna y fetal. Es limitado el número de reportes de síndrome en espejo por anomalías cardiacas (maternas y fetales) y pobre la descripción de los tratamientos realizados que surgen como temas a investigar. Sería importante considerar el diagnóstico de MNC en fetos con hidropesía no asociados a isoinmunización y con disfunción cardiaca, así como su atención por equipos multidisciplinarios.


ABSTRACT Objective: To report the case of a pregnant woman with mirror syndrome associated with noncompaction cardiomyopathy in the mother and the fetus, in which antenatal medical treatment provided to the mother resulted in a favorable perinatal maternal outcome. Case presentation: A 16-year old primigravida with 33 weeks of gestation referred from a Level I institution to a private Level IV center in Medellín, Colombia, because of a finding of fetal hydrops on obstetric ultrasound. During hospitalization, the patient showed clinical and ultrasonographic signs of heart failure (dyspnea, edema and hypoxemia), with the diagnosis of hydrops fetalis (mirror syndrome) also confirmed. Diuretic treatment with furosemide was initiated in the mother, with subsequent improvement of the maternal condition as well as of the fetal edema. During the subacute postpartum period in the hospital, the presence of non-compaction cardiomyopathy was confirmed on cardiac nuclear magnetic resonance imaging in both the mother and the newborn. After discharge in adequated condition, they were included in the cardiovascular follow-up program for heart failure and congenital heart disease, respectively. Conclusion: A case of mirror syndrome associated with maternal and fetal non-compaction cardiomyopathy is presented. There is a limited number of reports on mirror syndrome due to cardiac anomalies (maternal and fetal), with weak treatment descriptions, pointing to the need for research in this area. It would be important to consider the diagnosis of non-compaction cardiomyopathy in fetuses with hydrops unrelated to isoimmunization or cardiac dysfunction and approach these cases from a multidisciplinary perspective.


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Adolescente , Enfermedades Placentarias , Hidropesía Fetal , No Compactación Aislada del Miocardio Ventricular , Cardiomiopatías , Síndrome , Edema , Feto
7.
Rev. Fac. Med. (Bogotá) ; 64(1): 111-121, ene.-mar. 2016. ilus, tab
Artículo en Español | LILACS | ID: lil-779673

RESUMEN

Las taquicardias supraventriculares son un grupo de entidades clínicas prevalentes en la población general, pero que afectan con mayor frecuencia a la población adulta; son ritmos rápidos y generalmente regulares en los cuales se encuentra implicada alguna estructura por encima de la bifurcación del haz de His para formación o perpetuación. El diagnóstico de estas entidades requiere un abordaje clínico sistemático, siendo el electrocardiograma de superficie la principal herramienta para su adecuada clasificación. El tratamiento de las taquicardias supraventriculares dependerá del estado hemodinámico del paciente, el cual definirá el requerimiento de terapia eléctrica o tratamiento médico. Se debe hacer una selección adecuada de los pacientes que requieren estudio electrofisiológico y ablación.


Supraventricular tachycardias are a set of clinical entities prevalent in the general population, but it is the adult population the most frequently affected by them. They are fast and usually regular rhythms in which some structures involved over the bundle of His bifurcation for its formation or maintenance are found. The diagnosis of these entities requires a systematic clinical approach being the surface electrocardiogram the main tool for their proper classification. Treatment of supraventricular tachycardias depends on the patient´s hemodynamic status, which will define the need of electrical therapy or medical treatment. An appropriate selection of patients requiring electrophysiological study and ablation should be made.

8.
Iatreia ; 28(4): 456-471, oct.-dic. 2015. ilus, tab
Artículo en Español | LILACS, COLNAL | ID: lil-765527

RESUMEN

La endocarditis infecciosa es una enfermedad producida por la colonización y proliferación de agentes infecciosos en la superficie endotelial del corazón. Su presentación clínica es variable pues depende de condiciones propias del hospedero, tales como el estado inmunológico, la presencia de material protésico y el uso de drogas endovenosas, y del agente causal. El diagnóstico se establece, usualmente, mediante la suma de elementos como la historia clínica, el examen físico, los hemocultivos, el ecocardiograma y otras ayudas. Presentamos el caso de un hombre adulto que acudió al hospital con un cuadro clínico de fiebre e insuficiencia cardíaca aguda. Se documentó la presencia de soplo sistólico en el foco aórtico y el ecocardiograma reveló insuficiencia valvular grave y una lesión vegetante sobre la válvula aórtica bicúspide. Requirió reemplazo valvular y completó el tratamiento antibiótico, dirigido por la sensibilidad demostrada, luego de hemocultivos positivos para Streptococcus mitis.


Infective endocarditis is a disease caused by colonization and proliferation of infectious agents on the endothelial surface of the heart. Its clinical presentation is variable, depending upon conditions of the patient, such as immunosuppression, presence of prosthetic material, intravenous drug use, and the etiologic agent. Diagnosis is usually established through the addition of elements such as medical history, physical examination, results of blood cultures, echocardiography and other aids. We present the case of an adult male who came to the hospital with fever and symptoms and signs of acute heart failure. The presence of a systolic murmur was documented in the aortic area, and the echocardiogram revealed severe valve regurgitation and a vegetating lesion on the bicuspid aortic valve. He required valve replacement and completed antibiotic treatment based on the sensitivity of the Streptococcus mitis strain that was demonstrated in the blood cultures.


A endocardite infecciosa é uma entidade clínica produzida pela colonização e proliferação de agentes infecciosos, na superfície endotelial do coração. Sua apresentação clínica é variável pois depende de condições próprias do hospedeiro, tais como o estado imunológico, a presença de material protético e o uso de drogas endovenosas, e do agente causal. O diagnóstico se estabelece, usualmente, mediante a soma de elementos como a história clínica, o exame físico, os resultados de hemocultura, o ecocardiograma e outras ajudas. Apresentamos o caso de um homem adulto que foi ao hospital com quadro clínico de febre e insuficiência cardíaca aguda. Documentouse a presença de sopro sistólico no foco aórtico e o ecocardiograma revelou insuficiência valvular grave e uma lesão vegetante sobre a válvula aórtica bicúspide. Requereu substituição valvular e completou o tratamento antibiótico, dirigido pela sensibilidade demonstrada, depois de hemocultivos positivos para Streptococcus mitis.


Asunto(s)
Masculino , Persona de Mediana Edad , Endocarditis Bacteriana , Endotelio , Insuficiencia Cardíaca , Streptococcus
9.
Iatreia ; 28(1): 78-86, ene.-mar. 2015. ilus, tab
Artículo en Español | LILACS, COLNAL | ID: lil-734981

RESUMEN

Se presenta el caso clínico de una mujer de 26 años de edad, que acudió al Hospital Universitario San Vicente Fundación (Medellín) con síntomas y signos de falla cardíaca aguda y diagnóstico previo de falla cardíaca crónica con fracción de expulsión disminuida, de origen no claro, tromboembolismo pulmonar y ataque cerebrovascular isquémico, sin modulación neurohormonal óptima. Ingresó a la institución con hallazgos clínicos de sobrecarga hídrica y baja perfusión tisular, con requerimiento de soporte inotrópico y diuréticos parenterales; se logró estabilizarla e introducir progresivamente la terapia médica para la falla cardíaca. Para el estudio del origen de esta enfermedad, se hizo resonancia magnética de corazón, que demostró un área de realce tardío en el territorio de la arteria descendente anterior, sugestiva de necrosis, por lo que se le efectuó coronariografía, en la que no se hallaron lesiones en las arterias coronarias epicárdicas. Finalmente se logró la compensación de la falla cardíaca aguda y se decidió hacer anticoagulación crónica por la probable trombofilia de la paciente, en concordancia con los fenómenos trombóticos arteriales y venosos recurrentes.


We describe the clinical case of a 26 year-old woman who came to Hospital Universitario San Vicente Fundación (Medellín, Colombia) with symptoms and signs of acute heart failure. She had been previously diagnosed with chronic heart failure with reduced ejection fraction without clear origin, pulmonary thromboembolism and ischemic stroke, without optimal neurohormonal modulation. She was admitted with clinical findings of fluid overload and low tissue perfusion, with inotropic support requirement and parenteral diuretics; clinical stability was achieved with the progressive introduction of medical therapy for heart failure. For the study of the latter, heart MRI was done that showed a delayed enhancement area in the left anterior descending artery. Coronary angiography was carried out in which no significant lesions were found in the epicardial arteries. Finally, compensation of the acute heart failure was achieved, and chronic anticoagulation was started for probable thrombophilic disease, due to the recurring arterial and venous thrombotic events.


Se apresenta o caso clínico de uma mulher de 26 anos de idade, que foi ao Hospital Universitário San Vicente Fundación (Medellín) com sintomas e signos de falha cardíaca aguda e diagnóstico prévio de falha cardíaca crônica com fração de expulsão diminuída, de origem não clara, tromboembolismo pulmonar e ataque cerebrovascular isquêmico, sem modulação neuro-hormonal ótima. Ingressou à instituição com conclusões clínicas de sobrecarrega hídrica e baixa perfusão tissular, com requerimento de suporte inotrópico e diuréticos parenterais; conseguiu-se estabilizar e introduzir progressivamente a terapia médica para a falha cardíaca. Para o estudo da origem desta doença, fez-se ressonância magnética de coração, que demonstrou uma área de realce tardio no território da artéria descendente anterior, sugestiva de necroses, pelo que se lhe efetuou coronariografia, na que não se acharam lesões nas artérias coronárias epicárdicas. Finalmente se conseguiu a compensação da falha cardíaca aguda e se decidiu fazer anticoagulação crônica pela provável trombofilia da paciente, em concordância com os fenômenos trombóticos arteriais e venosos recorrentes.


Asunto(s)
Femenino , Adulto , Cardiopatías
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