Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

[Control of arterial hypertension: a pending issueControle da hipertensão arterial: um assunto inacabado]. / El control de la hipertensión arterial, una asignatura pendiente.

Adequate diagnosis, treatment, and control of arterial hypertension (AHT) continues to be a pending issue in the attempt to reduce the incidence of premature mortality and disability due to cardiovascular disease, which is a reality worldwide and in the region of the Americas in particular.Despite having adequate diagnostic algorithms and efficient treatment schemes, the gap between medical knowledge and reality reveals the great difficulty in ensuring that patients follow recommendations. Adherence to treatment is a great challenge and a proper understanding of its dimensions is essential when designing strategies to improve control of AHT.It is clear that part of the solution is having adequate information and disseminating it, but actions that guarantee implementation are no less important. That is why clinical practice guidelines that try to address this problem are welcome. The recent publication of the World Health Organization's guidance on arterial hypertension is a clear example of this type of initiative.Implementation programs are arguably one of the biggest challenges in contemporary medicine. The development of multimodal interventions aimed at improving response capacity at the first level of care and promoting the development of integrated health services networks appears to be the most appropriate way to achieve adequate control of AHT.Scientific societies clearly play an important role in these initiatives by providing support and coordinating interactions among the different actors involved.

O diagnóstico, tratamento e controle adequados da hipertensão arterial sistêmica (HAS) continua sendo uma questão pendente em nossa tentativa de reduzir a incidência de mortalidade cardiovascular prematura e a incapacidade. Essa é a realidade no nível mundial e, particularmente, na região das Américas.Apesar de algoritmos de diagnóstico adequados e esquemas de tratamento eficientes, a lacuna entre o conhecimento médico e a realidade nos mostra como é difícil que nossas recomendações sejam adotadas por nossos pacientes. A adesão representa um grande desafio, e uma compreensão adequada de suas dimensões é essencial ao se projetar estratégias para melhorar o controle da HAS.Claramente, a disponibilidade e a divulgação de informações adequadas é parte da solução, mas não menos importantes são as ações para garantir sua implementação. Portanto, acolhemos de bom grado as diretrizes de prática clínica que visam abordar esta questão. A recente publicação das diretrizes da Organização Mundial da Saúde sobre hipertensão arterial é um claro exemplo de tais iniciativas.Os programas de implementação são indiscutivelmente um dos maiores desafios da medicina contemporânea. O desenvolvimento de intervenções multimodais na atenção primária com o objetivo de melhorar sua resolutividade e promover o desenvolvimento de redes integradas de serviços de saúde parece ser a forma mais apropriada para atingir níveis adequados de controle da HAS.Estamos convencidos do importante papel que nossas sociedades científicas desempenham nestas iniciativas ao prestar apoio, suporte e articulação aos diferentes atores envolvidos.

El control de la hipertensión arterial, una asignatura pendiente

[RESUMEN]. El adecuado diagnóstico, tratamiento y control de la hipertensión arterial (HTA) continúa siendo una asignatura pendiente en nuestro intento de reducir la incidencia de mortalidad cardiovascular prematura y discapacidades, siendo esta una realidad a nivel mundial y particularmente cierta en la región de las Américas. A pesar de contar con adecuados algoritmos diagnósticos y eficientes esquemas de tratamiento, la brecha entre el conocimiento médico y la realidad nos muestra la gran dificultad para que nuestras recomendaciones sean adoptadas por nuestros pacientes. La adherencia representa un gran desafío y la adecuada comprensión de sus dimensiones resulta básico al momento de diseñar estrategias para mejorar el control de la HTA. Es claro que disponer y diseminar información adecuada es una parte de la solución, pero no menos importante son las acciones que garanticen su implementación. Es por lo que damos la bienvenida a guías de práctica clínica que intenten abordar esta problemática. La reciente publicación de guía de la Organización Mundial de la Salud en hipertensión arterial es un claro ejemplo de este tipo de iniciativas. Los programas de implementación posiblemente sean uno de los mayores desafíos de la medicina contemporánea. El desarrollo de intervenciones multimodales en el primer nivel de atención con el objetivo de mejorar su capacidad resolutiva y promover el desarrollo de redes integradas de servicios de salud, impresiona ser el camino mas adecuado para alcanzar niveles adecuados de control de la HTA. Estamos convencidos del importante rol que nuestras sociedades científicas tienen con estas iniciativas dando apoyo, soporte y articulando la interacción con los diferentes actores involucrados.

[ABSTRACT]. Adequate diagnosis, treatment, and control of arterial hypertension (AHT) continues to be a pending issue in the attempt to reduce the incidence of premature mortality and disability due to cardiovascular disease, which is a reality worldwide and in the region of the Americas in particular. Despite having adequate diagnostic algorithms and efficient treatment schemes, the gap between medical knowledge and reality reveals the great difficulty in ensuring that patients follow recommendations. Adherence to treatment is a great challenge and a proper understanding of its dimensions is essential when designing strategies to improve control of AHT. It is clear that part of the solution is having adequate information and disseminating it, but actions that guarantee implementation are no less important. That is why clinical practice guidelines that try to address this problem are welcome. The recent publication of the World Health Organization's guidance on arterial hypertension is a clear example of this type of initiative. Implementation programs are arguably one of the biggest challenges in contemporary medicine. The development of multimodal interventions aimed at improving response capacity at the first level of care and promoting the development of integrated health services networks appears to be the most appropriate way to achieve adequate control of AHT. Scientific societies clearly play an important role in these initiatives by providing support and coordinating interactions among the different actors involved.

[RESUMO]. O diagnóstico, tratamento e controle adequados da hipertensão arterial sistêmica (HAS) continua sendo uma questão pendente em nossa tentativa de reduzir a incidência de mortalidade cardiovascular prematura e a incapacidade. Essa é a realidade no nível mundial e, particularmente, na região das Américas. Apesar de algoritmos de diagnóstico adequados e esquemas de tratamento eficientes, a lacuna entre o conhecimento médico e a realidade nos mostra como é difícil que nossas recomendações sejam adotadas por nossos pacientes. A adesão representa um grande desafio, e uma compreensão adequada de suas dimensões é essencial ao se projetar estratégias para melhorar o controle da HAS. Claramente, a disponibilidade e a divulgação de informações adequadas é parte da solução, mas não menos importantes são as ações para garantir sua implementação. Portanto, acolhemos de bom grado as diretrizes de prática clínica que visam abordar esta questão. A recente publicação das diretrizes da Organização Mundial da Saúde sobre hipertensão arterial é um claro exemplo de tais iniciativas. Os programas de implementação são indiscutivelmente um dos maiores desafios da medicina contemporânea. O desenvolvimento de intervenções multimodais na atenção primária com o objetivo de melhorar sua resolutividade e promover o desenvolvimento de redes integradas de serviços de saúde parece ser a forma mais apropriada para atingir níveis adequados de controle da HAS. Estamos convencidos do importante papel que nossas sociedades científicas desempenham nestas iniciativas ao prestar apoio, suporte e articulação aos diferentes atores envolvidos.

Alteraciones del embarazo como factores de riesgo cardiovascular / Pregnancy alterations as cardiovascular risk factors

Resumen La enfermedad cardiovascular es la principal causa de muerte en el mundo. Las complicaciones del embarazo y el parto se han identificado como factores de riesgo cardiovascular específicos de la mujer, lo cual resalta la importancia del enfoque de riesgo cardiovascular teniendo en cuenta las diferencias de género. Es necesario reconocer los riesgos cardiovasculares futuros de las mujeres que experimentaron un trastorno hipertensivo asociado al embarazo o un parto prematuro. Se proporciona, por tanto, una revisión completa de estos factores de riesgo específicos de la mujer, con énfasis en las alternativas de manejo para impactar en estos “nuevos factores de riesgo”.

Abstract Cardiovascular diseases are the leading cause of death in the world. Complications of pregnancy and childbirth have been identified as specific cardiovascular risk factors for women, which highlights the importance of the cardiovascular risk approach taking into account gender differences. It is necessary to recognize the future cardiovascular risks of women who have experienced a hypertensive disorder associated with pregnancy or premature delivery. Therefore, a complete review of these risk factors specific to women is proposed, with a review of the management alternatives to impact on these “new risk factors”.

Desempeño del método de suma de discos comparado con el método bidimensional en la estimación cuantitativa del derrame pericárdico / Performance of the method of disks compared to the bidimensional method in the quantitative estimation of pericardial effusion

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

Antecedentes, hábitos, características de género y escalas de riesgo cardiovascular en trabajadores hospitalarios / Medical history, habits, gender characteristics and cardiovascular risk scores in health care workers

Introducción: La enfermedad cardiovascular es la principal causa de morbilidad y mortalidad. Contribuye a la muerte de 1 por cada 3 mujeres. En los trabajadores hospitalarios no se encuentra información acerca de los factores de riesgo que influyen en eventos cardiovasculares. Material y Métodos: Se realizó un estudio de corte transversal. Se realizaron registros de aquellos trabajadores hospitalarios sometidos a tamizaje de riesgo cardiovascular. Se documentan 4 escalas de riesgo cardiovascular y se analiza su relación con variables sociodemográficas y laborales. Resultados: Se obtuvieron 179 registros de trabajadores hospitalarios. Los principales factores de riesgo cardiovascular fueron hipertensión arterial en 17% y diabetes mellitus en 5.6%, historia familiar de enfermedad cardiovascular en 27.4%. Al evaluar la estratificación del riesgo cardiovascular en la mujer el 8.5% tiene salud cardiovascular ideal, 82% en riesgo y el 7.7% en riesgo alto. Al comparar relaciones entre hipertensión arterial con otros factores de riesgo en las mujeres se encontró que las pacientes con diabetes mellitus tiene más proporción de hipertensión arterial (P = 0.028). Conclusiones: Los factores de riesgo cardiovascular son altamente prevalentes en la población, incluso en trabajadores hospitalarios y pacientes jóvenes. La población femenina se ve más afectada comparado con la población masculina. La identificación temprana de estos factores es clave para la prevención de eventos cardiovasculares. (AU)

Introduction: cardiovascular disease is the principal cause of Mortality in the world. It causes 1 in 3 women´s death. In health workers, there is no information about the risk factors that can affect cardiovascular events. Material and Methods: a cross-sectional study was performed. Medical history, habits, gender characteristics, and cardiovascular risk scores were screened out in health workers and then analysed their cardiovascular health relationship. Results: a total of 179 records of health workers were obtained. The main cardiovascular risk factors were hypertension in 17%, and diabetes mellitus in 5.6%, family history of cardiovascular disease were in 27.4% of patients. In women, cardiovascular disease was classified in ideal cardiovascular health in 8.5%, at risk in 82%, and high risk in 7.7%. We found women with diabetes have higher proportion of hypertension (P = 0.028). Conclusions: cardiovascular risk factors are highly prevalent in people, even in health workers and young patients. Women are more affected compared with men. Early recognition of cardiovascular risk factors is a fundamental factor to cardiovascular disease prevention. (AU)

El control de la hipertensión arterial, una asignatura pendiente / Control of arterial hypertension: a pending issue / Controle da hipertensão arterial: um assunto inacabado

RESUMEN El adecuado diagnóstico, tratamiento y control de la hipertensión arterial (HTA) continúa siendo una asignatura pendiente en nuestro intento de reducir la incidencia de mortalidad cardiovascular prematura y discapacidades, siendo esta una realidad a nivel mundial y particularmente cierta en la región de las Américas. A pesar de contar con adecuados algoritmos diagnósticos y eficientes esquemas de tratamiento, la brecha entre el conocimiento médico y la realidad nos muestra la gran dificultad para que nuestras recomendaciones sean adoptadas por nuestros pacientes. La adherencia representa un gran desafío y la adecuada comprensión de sus dimensiones resulta básico al momento de diseñar estrategias para mejorar el control de la HTA. Es claro que disponer y diseminar información adecuada es una parte de la solución, pero no menos importante son las acciones que garanticen su implementación. Es por lo que damos la bienvenida a guías de práctica clínica que intenten abordar esta problemática. La reciente publicación de guía de la Organización Mundial de la Salud en hipertensión arterial es un claro ejemplo de este tipo de iniciativas. Los programas de implementación posiblemente sean uno de los mayores desafíos de la medicina contemporánea. El desarrollo de intervenciones multimodales en el primer nivel de atención con el objetivo de mejorar su capacidad resolutiva y promover el desarrollo de redes integradas de servicios de salud, impresiona ser el camino mas adecuado para alcanzar niveles adecuados de control de la HTA. Estamos convencidos del importante rol que nuestras sociedades científicas tienen con estas iniciativas dando apoyo, soporte y articulando la interacción con los diferentes actores involucrados.

ABSTRACT Adequate diagnosis, treatment, and control of arterial hypertension (AHT) continues to be a pending issue in the attempt to reduce the incidence of premature mortality and disability due to cardiovascular disease, which is a reality worldwide and in the region of the Americas in particular. Despite having adequate diagnostic algorithms and efficient treatment schemes, the gap between medical knowledge and reality reveals the great difficulty in ensuring that patients follow recommendations. Adherence to treatment is a great challenge and a proper understanding of its dimensions is essential when designing strategies to improve control of AHT. It is clear that part of the solution is having adequate information and disseminating it, but actions that guarantee implementation are no less important. That is why clinical practice guidelines that try to address this problem are welcome. The recent publication of the World Health Organization's guidance on arterial hypertension is a clear example of this type of initiative. Implementation programs are arguably one of the biggest challenges in contemporary medicine. The development of multimodal interventions aimed at improving response capacity at the first level of care and promoting the development of integrated health services networks appears to be the most appropriate way to achieve adequate control of AHT. Scientific societies clearly play an important role in these initiatives by providing support and coordinating interactions among the different actors involved.

RESUMO O diagnóstico, tratamento e controle adequados da hipertensão arterial sistêmica (HAS) continua sendo uma questão pendente em nossa tentativa de reduzir a incidência de mortalidade cardiovascular prematura e a incapacidade. Essa é a realidade no nível mundial e, particularmente, na região das Américas. Apesar de algoritmos de diagnóstico adequados e esquemas de tratamento eficientes, a lacuna entre o conhecimento médico e a realidade nos mostra como é difícil que nossas recomendações sejam adotadas por nossos pacientes. A adesão representa um grande desafio, e uma compreensão adequada de suas dimensões é essencial ao se projetar estratégias para melhorar o controle da HAS. Claramente, a disponibilidade e a divulgação de informações adequadas é parte da solução, mas não menos importantes são as ações para garantir sua implementação. Portanto, acolhemos de bom grado as diretrizes de prática clínica que visam abordar esta questão. A recente publicação das diretrizes da Organização Mundial da Saúde sobre hipertensão arterial é um claro exemplo de tais iniciativas. Os programas de implementação são indiscutivelmente um dos maiores desafios da medicina contemporânea. O desenvolvimento de intervenções multimodais na atenção primária com o objetivo de melhorar sua resolutividade e promover o desenvolvimento de redes integradas de serviços de saúde parece ser a forma mais apropriada para atingir níveis adequados de controle da HAS. Estamos convencidos do importante papel que nossas sociedades científicas desempenham nestas iniciativas ao prestar apoio, suporte e articulação aos diferentes atores envolvidos.

Clinical, laboratory, microbiological and echocardiographic characteristics of infective endocarditis in a tertiary care hospital

Abstract Objectives: infective endocarditis (IE) is a potentially fatal disease. This study analyzed the clinical, laboratory, microbiological and echocardiographic characteristics of IE in a population of patients at a tertiary care hospital in Medellín, Colombia, over a three-year period. Methods: a retrospective observational study. The patients were classified according to the modified Duke criteria. Clinical and echocardiographic data, laboratory results and cultures were gathered from the clinical charts. Factors associated with the prognosis were determined. Results: a total of 48 cases were included, 29 (60.4%) of which involved males. The mean age was 53.8±19.2 years. Fever and fatigue were the most common clinical signs. No heart murmur was reported on admission in 52.1% of the patients. Most of the patients (62.5%) had no underlying predisposing heart condition. The IE occurred in a native valve in 36 patients (75%), with the mitral valve being the most frequently affected site. Transthoracic and/or transesophageal echocardiography showed vegetations in 45 cases (93.7%); these were mostly mobile, with an average size of 17.6±11.3 mm. Staphylococcus aureus was the main causal organism (33%). The prevalence of IE with negative blood cultures was 37.5%. The most frequent complication was embolism in 21 patients (43.7%), followed by heart failure (41.7%). On multivariate analysis, septic shock, kidney failure, Staphylococcus infection and the use of immunosuppressants were predictors of higher inpatient mortality. Conclusions: most cases occur in elderly patients with no underlying predisposing heart condi tion, in a native valve, with a predilection for the mitral valve. Staphylococcus aureus is the most frequent causal organism. Several factors predict greater inpatient mortality, including the presence of septic shock, kidney failure, Staphylococcus infection and the use of immunosuppressants. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1930)

Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation.

Background: Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective: The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods: A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results: An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions: There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them.

Características clínicas, demográficas y epidemiológicas de una cohorte de pacientes con síndrome de Takotsubo entre 2011 y 2016 en Medellín, Colombia / Clinical, demographic and epidemiological characteristics of a cohort of patients with Takotsubo's syndrome from 2011 to 2016 in Medellin, Colombia

Resumen Introducción: El síndrome de Takotsubo es una disfunción ventricular aguda de carácter temporal, usualmente reversible, secundaria a eventos estresantes que comprometen el eje cerebro-corazón. Objetivo: describir las características clínicas, epidemiológicas y desenlaces de una cohorte de pacientes con síndrome de Takotsubo en Medellín-Colombia. Materiales y métodos: Estudio observacional, descriptivo, ambispectivo, realizado en una cohorte de pacientes. Se revisaron las historias clínicas de pacientes que ingresaron al servicio de urgencias de una institución de tercer nivel de complejidad de la ciudad de Medellín entre enero de 2011 y diciembre de 2016 con diagnóstico de síndrome de Takotsubo. Se diseñó un cuestionario para recolectar variables demográficas, clínicas, de laboratorio e imagenológicas. Se obtuvieron medidas de frecuencia y análisis estadístico con el programa SPSS versión 21. Resultados: El 66,7% de los pacientes fueron mujeres, la mortalidad fue del 11,1% y la recurrencia del 5,6%. La mayoría de los casos tuvieron un desencadenante conocido (94,5%), siendo la infección el más frecuente (44,4%). El 77,8% de los pacientes presentó disnea al ingreso y el 27,8% requirió uso de algún vasopresor. El promedio de la fracción de eyección del ventrículo izquierdo inicial fue del 34.17+7.8 con evidencia de mejoría en el control, promedio luego del control= 54,81+10.2. Discusión y conclusiones: El síndrome de Takotsubo es una condición infrecuente, las mujeres son la población más afectada y la mayoría de los casos obedece a un factor desencadenante. La mortalidad reportada está dentro de lo esperado y se evidenció un buen pronóstico a mediano plazo. MÉD.UIS. 2020;34(1):27-33.

Abstract Introduction: Takotsubo syndrome is an acute, usually reversible, temporal ventricular dysfunction secondary to stressful events that compromise the brain-heart axis. The study's objective is to describe the clinical, epidemiological characteristics and outcomes of a cohort of patients with Takotsubo syndrome in Medellin-Colombia. Methods: Observational, descriptive, ambispective study performed in a cohort of patients. We reviewed the medical records of patients who entered the emergency department of a third-level complex institution of Medellin between January 2011 and December 2016 with Takotsubo syndrome diagnosis. A questionnaire was designed to collect demographic, clinical, laboratory, and imaging variables. Frequency measures and statistical analyses were obtained with the SPSS version 21 program. Results: 66.7% of the patients were women, mortality was 11.1%, and recurrence was 5.6%. The majority of the cases had a known trigger (94.5%), being the infection the most frequent (44.4%), 77.8% of the patients presented dyspnea on admission, and 27.8% required the use of vasopressor. The mean baseline left ventricular ejection fraction was 34.17 + 7.8 with evidence of improvement in control, average after control = 54.81 + 10.2. Discussion and conclusions: Takotsubo syndrome is an uncommon condition. Women are the most affected population and most cases are due to a secondary cause. The reported mortality is within expectations, and a good medium-term cardiac prognosis was evidenced. MÉD.UIS. 2020;34(1):27-33.

Hipertensión arterial y embarazo / High blood pressure and pregnancy

Resumen Los trastornos hipertensivos asociados al embarazo son una complicación frecuente y causa importante de morbimortalidad materno-fetal. Realizar un diagnóstico oportuno, definir la necesidad de inicio de terapias farmacológicas orales o intravenosas, así como las indicaciones de cuidado en centros de referencia, es el papel fundamental de los diferentes médicos que pueden verse enfrentados a este tipo de pacientes. Se propone una revisión completa de la clasificación, el enfoque diagnóstico y los aspectos fundamentales del tratamiento durante el embarazo, el parto y el posparto de los trastornos hipertensivos asociados al embarazo, así como las consecuencias futuras en el riesgo cardiovascular de la mujer con este tipo de enfermedades.

Abstract Hypertensive disorders associated with pregnancy are a frequent complication and an actual cause of maternal-fetal morbidity and mortality. Perform a timely diagnosis, defining the need to start oral or intravenous pharmacological therapies and the indications for care in referral centers is the different physicians’ fundamental role. They can meet with this type of patient. A complete review of the classification, the diagnostic approach, and the fundamental aspects of the treatment during pregnancy, childbirth, and postpartum of the hypertensive disorders associated with pregnancy is reviewed and the future consequences in the woman’s cardiovascular risk.

Desenlaces materno-fetales en embarazadas con categoría de riesgo III - IV según la Organización Mundial de la Salud en un centro de tercer nivel durante 2006 a 2017 / Maternal-fetal outcomes in pregnant women with World Health Organisation risk category III - IV in a tertiary care centre from 2006 to 2017

Resumen Objetivo: describir los desenlaces materno-fetales en embarazadas con categoría de riesgo III-IV según la Organización Mundial de la Salud (OMS). Métodos: se revisaron las historias clínicas de 41 embarazadas con categoría de riesgo III-IV según la OMS, atendidas en un hospital de tercer nivel en Medellín, Colombia. Se recolectaron variables demográficas, clínicas y ecocardiográficas en un formulario diseñado para tal fin. Las variables primarias están orientadas a la evaluación de los desenlaces maternos y fetales. Los análisis estadísticos se realizaron con el software IBM-SPSS versión 23. Resultados: la tasa de eventos neonatales fue mayor que la tasa de eventos maternos (68.3 vs. 31.7%). Los desenlaces maternos primarios y secundarios ocurrieron en un 31.7 y 12.2% respectivamente. La distribución según la categoría de riesgo de la OMS fue del 7.3% en el grupo III y del 92.7% en el grupo IV. Solo hubo una muerte materna no relacionada con enfermedad cardiovascular. La presencia de insuficiencia tricuspídea moderada/severa se asoció con prematuridad (p 0.006) y las gestantes con presión sistólica pulmonar ≥ 50 mm Hg tuvieron mayor número de neonatos con distrés respiratorio (p 0.010). La falla cardiaca derecha se relacionó con muerte materna (p 0.014) y prematuridad (p 0.019), mientras que la de falla cardiaca izquierda se asoció con muerte neonatal (p 0.003). Conclusiones: la enfermedad cardiovascular materna es causa frecuente de alta morbilidad y mortalidad materno-fetal. Este estudio identificó los principales desenlaces maternos y fetales, sin embargo, se requieren estudios con mayor tamaño de muestra.

Abstract Objective: To describe the maternal-fetal outcomes in pregnant woman with risk classification of III-IV according to the World Health Organization (WHO). Methods: A review was carried out on the medical records of 41 pregnant women with WHO risk classification of III-IV, treated in a tertiary hospital in Medellin, Colombia. Demographic, clinical, and cardiac ultrasound variables were recorded on a form designed for this purpose. The primary variables were directed at evaluating the fetal and maternal outcomes. The statistical analysis was performed using IBM-SPSS software version 23. Results: The neonatal events rate was greater than the maternal events rate (68.3% vs. 31.7%). Primary and secondary outcomes occurred in 31.7% and 12.2%, respectively. The distribution according to WHO risk category was 7.3% in risk group III, and 92.7% in group IV. There was only one maternal death unrelated to cardiovascular disease. The presence of moderate-severe tricuspid insufficiency was associated with prematurity (P=.006), and the mothers with a pulmonary systolic pressure ≥ 50 mm Hg had a greater number of newborns with respiratory distress (P=.010). Right heart failure was associated with maternal death (P=.014) and prematurity (P=.019), whilst left heart failure was associated with neonatal death (P=.003). Conclusions: Maternal cardiovascular disease is a frequent cause of high maternal-fetal morbidity and mortality. Although this study identified the main maternal and fetal outcomes, studies with a greater sample size are required.

Reporte de un caso de ruptura del músculo papilar anterior debido a infarto agudo de miocardio / Anterior papillary muscle rupture due to an acute myocardial infarction: A case report

Resumen La ruptura del músculo papilar anterolateral es una complicación del síndrome coronario agudo poco frecuente, en especial porque este músculo usualmente tiene doble irrigación sanguínea al comparar con el músculo papilar posteromedial que, por lo general, solo tiene una irrigación. Se presenta el caso de un paciente que consultó por signos y síntomas de falla cardiaca aguda precedidos de dolor de pecho, en quien se documentó insuficiencia mitral grave por ruptura del músculo papilar anterolateral debido a enfermedad coronaria isquémica de múltiples vasos.

Abstract The rupture of the anterior-lateral papillary muscle is an uncommon complication of acute coronary syndrome. This is particularly relevant as this has double blood irrigation compared to that of the posteromedial papillary muscle that generally only has single irrigation. The case is presented on a patient that consulted due to having signs and symptoms of acute heart failure preceded by chest pains. Severe mitral insufficiency was observed due to a rupture of the anterior-lateral papillary muscle caused by a multiple vessel ischaemic coronary disease.