Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators).

Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.

Tratamiento al alta en insuficiencia cardiaca ¿cumplimos con las guías? Subanálisis del registro ARGEN-IC / Heart Failure Treatment at Hospital Discharge. Do we Adhere to Guidelines? A Sub-analysis of the ARGEN-IC Registry

RESUMEN Introducción: La insuficiencia cardiaca (IC) se puede clasificar de diferentes maneras. La más utilizada, según la fracción de eyección ventricular izquierda (FEVI), distingue a grupos con opciones terapéuticas que impactan en la morbimortalidad. Existe información sobre adherencia a las recomendaciones de tratamiento específico al alta de la internación por IC en otros países, pero carecemos de ésta en el nuestro. Objetivos: Evaluar la prescripción de drogas específicas para IC con FEVI reducida (ICFER) al alta de pacientes internados por insuficiencia cardiaca aguda (ICA), así como los parámetros clínicos relacionados con la indicación. Materiales y métodos: Pacientes incorporados al registro prospectivo ARGEN-IC, con diagnóstico de ICA. Se definió FEVI deteriorada a la ≤40%; se analizó la prescripción de drogas recomendadas para ICFER al alta, y su relación con parámetros clínicos. Datos incorporados a la base Survey Monkey y analizados con el programa STATA 14. Se utilizó el test de t o chi cuadrado según la variable utilizada. Resultados: 871 pacientes incluidos, edad 68,1 años y 72,4% varones. FEVI reducida en el 53,3%. La estadía hospitalaria fue 8 días (RIC 5-12) y la mortalidad 7,32%. El 12,6% egresó con tensión arterial sistólica >130 mmHg y el 64,4% con frecuencia cardíaca >70 latidos por minuto. El 22,5% egresó sin betabloqueantes, el 29,1% sin vasodilatadores y el 43,7% sin antialdosterónicos. Entre las probables contraindicaciones, observamos 12,6% de enfermedad pulmonar obstructiva crónica (EPOC), 12,5% de índice de filtrado glomerular menor de 30 ml/min, 8,9% de creatinina mayor de 25 mg/dL y 0,44% hiperkalemia. Conclusiones: Constatamos prescripción subóptima y pobre cumplimiento de las recomendaciones; por ello es de vital importancia implementar estrategias para cambiar la realidad en nuestra región.

ABSTRACT Background: Heart failure (HF) can be classified in different ways. The most used classification is based on left ventricular ejection fraction (LVEF) and involves groups with therapeutic options that impact on morbidity and mortality. The information about adherence to the recommendation of specific treatment at hospital discharge for HF comes from other countries but not ours. Objectives: To evaluate the prescription of specific drugs for HF with reduced LVEF (HFrEF) at discharge in hospitalized patients for acute heart failure (AHF), as well as the clinical parameters related to the indication. Methods: Patients with diagnosis of AHF incorporated to the prospective ARGEN-IC registry were included. Reduced LVEF was defined as that ≤40%. Prescription rate of drugs recommended for HFrEF at discharge and its association with clinical parameters was analyzed. Data was incorporated to the Survey Monkey electronic database and analyzed using STATA® software package. The Student's t test or chi-square test were used, as applicable. Results: A total of 871 patients were included; mean age was 68.1 years and 72.4% were men. LEVF was reduced in 53.3%. Length of hospital stay was 8 days (IQR 5-12) and mortality rate was 7.32%. At discharge, systolic blood pressure was >130 mm Hg in 12.6% of the patients and 64.4% had heart rate >70 beats per minute; 22.5% were discharged without beta-blockers, 29.1% without vasodilators and 43.7% without aldosterone antagonists. Comorbidities included chronic obstructive pulmonary disease (COPD) in 12.6%, glomerular filtration rate <30 mL/min in 12.5 %, serum creatinine >2.5 mg/dL in 8,9% and hyperkalemia in 0.44%. Conclusions: We documented suboptimal prescription rate and poor adherence to the recommendations; thus, it is extremely important to implement strategies to change the reality in our region.

[Cardiac magnetic resonance and follow up of professional soccer players recovering from COVID-19]. / Resonancia magnética cardíaca y seguimiento de futbolistas profesionales post COVID-19.

The incidence of post-COVID-19 cardiac compromise is not well known. The eventual cardiac repercussions on a return to high-performance sport are unclear. A prospective observational study with evaluation by physical examination, electrocardiogram, Doppler echocardiogram and cardiac magnetic resonance imaging (CMR) was carried out in international level professional soccer players recovering from COVID-19 who had the disease asymptomatic or with mild symptoms. Four-month follow-up with participation in national and international competitions. Twenty-four soccer players were included, age 27.13 years (between 20 and 36). Nine (37.5%) had asymptomatic disease and 15 (62.5%) had mild symptoms. No athletes required hospitalization. Physical, electrocardiographic, and echocardiographic examinations did not reveal heart disease. CMRs showed ventricular thicknesses and volumes consistent with high-performance athletes. In T1, T2 and fat saturation signals, no fat infiltration or signs of edema were observed. No late enhancement after gadolinium injection. They began their training between 12 and 14 days after diagnosis. Eleven (45.8%) participated between 4 and 6 international matches of Libertadores de América International Cup. The remaining 13 completed high intensity training sessions and participated in local league competitions. At 4 months after diagnosis, none of the soccer players developed cardiac events and training and competitions were well tolerated. These findings suggest low cardiovascular impact of COVID 19 and excellent tolerance to early post-COVID high intensity exercise of young athletes recovering from the disease with no or mild symptoms.

La incidencia de compromiso cardíaco post COVID-19 en pacientes que cursaron la enfermedad asintomáticos o con síntomas leves no es bien conocida. Tampoco están claras las eventuales repercusiones cardíacas en el regreso al deporte de alto rendimiento. Se realizó un estudio observacional prospectivo con evaluación mediante electrocardiograma, ecocardiograma Doppler y resonancia magnética cardiaca (RMC) a hombres futbolistas profesionales de nivel internacional que habían cursado COVID-19 asintomáticos o con síntomas leves; seguimiento 4 meses con participación en competencias nacionales e internacionales. Se incluyeron 24 futbolistas, edad media 27, (20-36). Nueve (37.5%) cursaron la enfermedad asintomáticos y 15 (62.5%) con síntomas leves. Los exámenes físicos, electro y ecocardiográficos no evidenciaron cardiopatía. Las RMCs mostraron espesores y volúmenes ventriculares acordes a deportistas de alto rendimiento. En las señales de T1, T2 y saturación grasa no se observó infiltración grasa ni signos de edema; sin realce tardío post inyección de gadolinio. Comenzaron sus entrenamientos entre 12 y 14 días post diagnóstico. Once (45.8%) participaron entre 4 y 6 encuentros internacionales de la Copa Libertadores de América. Los restantes 13 cumplieron con entrenamientos de alta intensidad y participaron en competencias de liga local. A 4 meses del diagnóstico ninguno de los futbolistas desarrolló eventos cardíacos y los entrenamientos y competencias fueron bien tolerados. Estos hallazgos sugieren la escasa repercusión cardiovascular de COVID-19 y la excelente tolerancia al ejercicio de alta intensidad realizado en forma precoz post COVID de deportistas jóvenes que cursaron la enfermedad asintomáticos o con síntomas leves.

Resonancia magnética cardíaca y seguimiento de futbolistas profesionales post COVID-19 / Cardiac magnetic resonance and follow up of professional soccer players recovering from COVID-19

Resumen La incidencia de compromiso cardíaco post COVID-19 en pacientes que cursaron la enfermedad asintomáticos o con síntomas leves no es bien conocida. Tampoco están claras las eventuales repercusiones cardíacas en el regreso al deporte de alto rendimiento. Se realizó un estudio observacional pros pectivo con evaluación mediante electrocardiograma, ecocardiograma Doppler y resonancia magnética cardiaca (RMC) a hombres futbolistas profesionales de nivel internacional que habían cursado COVID-19 asintomáticos o con síntomas leves; seguimiento 4 meses con participación en competencias nacionales e internacionales. Se incluyeron 24 futbolistas, edad media 27, (20-36). Nueve (37.5%) cursaron la enfermedad asintomáticos y 15 (62.5%) con síntomas leves. Los exámenes físicos, electro y ecocardiográficos no evidenciaron cardiopatía. Las RMCs mostraron espesores y volúmenes ventriculares acordes a deportistas de alto rendimiento. En las señales de T1, T2 y saturación grasa no se observó infiltración grasa ni signos de edema; sin realce tardío post inyección de gadolinio. Comenzaron sus entrenamientos entre 12 y 14 días post diagnóstico. Once (45.8%) participaron entre 4 y 6 encuentros internacionales de la Copa Libertadores de América. Los restantes 13 cumplieron con entrenamientos de alta intensidad y participaron en competencias de liga local. A 4 meses del diagnóstico nin guno de los futbolistas desarrolló eventos cardíacos y los entrenamientos y competencias fueron bien tolerados. Estos hallazgos sugieren la escasa repercusión cardiovascular de COVID-19 y la excelente tolerancia al ejercicio de alta intensidad realizado en forma precoz post COVID de deportistas jóvenes que cursaron la enfermedad asintomáticos o con síntomas leves.

Abstract The incidence of post-COVID-19 cardiac compromise is not well known. The eventual cardiac repercussions on a return to high-performance sport are unclear. A prospective observational study with evaluation by physical examination, electrocardiogram, Doppler echocardiogram and cardiac magnetic resonance imaging (CMR) was carried out in international level professional soccer players recovering from COVID-19 who had the disease asymptomatic or with mild symptoms. Four-month follow-up with participation in national and international competitions. Twenty-four soccer players were included, age 27.13 years (between 20 and 36). Nine (37.5%) had asymptomatic disease and 15 (62.5%) had mild symptoms. No athletes required hospitalization. Physical, electrocardiographic, and echocardiographic examinations did not reveal heart disease. CMRs showed ventricular thicknesses and volumes consistent with high-performance athletes. In T1, T2 and fat saturation signals, no fat infiltration or signs of edema were observed. No late enhancement after gadolinium injection. They began their training between 12 and 14 days after diagnosis. Eleven (45.8%) participated between 4 and 6 international matches of Libertadores de América International Cup. The remaining 13 completed high intensity training sessions and participated in local league competitions. At 4 months after diagnosis, none of the soccer players developed cardiac events and training and competitions were well tolerated. These findings suggest low cardiovascular impact of COVID 19 and excellent tolerance to early post-COVID high intensity exercise of young athletes recovering from the disease with no or mild symptoms.

Electrocardiografía en chequeo médico precompetitivo: subanálisis de un registro unicéntrico prospectivo / Electrocardiography in pre-competitive medical fit: Subanalysis of a prospective single-center registry

Resumen Introducción: La interpretación del electrocardiograma del deportista muchas veces se ve complicada por los cambios producidos por el entrenamiento prolongado. Objetivos: Comparar la aplicación de los criterios de Seattle para valoración electrocardiográfica en deportistas en un grupo de cardiólogos del instituto de Cardiología y medicina del deporte, contra un profesional especializado en electrocardiografía del deportista, bajo los mismos criterios. Material y métodos: Sobre una base de datos prospectiva de pacientes que concurrieron al centro de medicina del deporte entre junio de 2017 y enero de 2018 para realización de apto físico, se incluyeron para el análisis 499 electrocardiogramas. Siete cardiólogos del Instituto de deportes (IW) valoraron los electrocardiogramas como "normales"; "alteraciones normales" o "alteraciones dudosas o anormales" (que requirieron más estudios en el seguimiento) conociendo los antecedentes del paciente al igual que los estudios realizados y la valoración cruzada de los electrocardiogramas dentro del instituto. Un cardiólogo del cuerpo médico de Boca Juniors especializado en electrocardiografía del deportista (FR) valoró los 499 electrocardiogramas de manera ciega (sin conocer los datos demográficos de los pacientes o los antecedentes patológicos) utilizando los mismos criterios. Resultados: De un total de 499 electrocardiogramas, 448 (89%) fueron interpretados como normales por el especialista en electrocardiografía del deporte vs. 459 (91%) por los cardiólogos del instituto de deporte. Respecto a alteraciones normales, 21 (4%) electrocardiogramas fueron considerados como alteraciones normales para el especialista en electrocardiografía vs. 23 (4%) por el instituto de deportes. 30 (6%) electrocardiogramas presentaron alteraciones dudosas o anormales para el especialista vs. 17 (3%) para el instituto de deporte. Conclusiones: La interpretación electrocardiográfica puede presentar variaciones de un centro a otro a pesar de utilizar criterios estandarizados. Es probable que la evaluación clínica influencie los resultados.

Abstract Introduction: The interpretation of the athlete's electrocardiogram is often complicated by the changes produced by prolonged training. Objective: To compare the application of Seattle criteria for electrocardiographic assessment in a group of cardiologists against a professional specialized in electrocardiography of the athlete under the same criteria. Material and methods: On a prospective database of recreational athletes who attended between June 2017 and January 2018 to perform physical fitness, 499 electrocardiograms were included for the analysis. Seven cardiologists from the Sports Institute (IW) rated the electrocardiograms as "normal"; "Normal alterations" or "dubious or abnormal alterations" knowing the patient's background as well as the studies performed. A cardiologist from the Boca Juniors medical team specialized in sportsman's electrocardiography (RF) assessed the 499 electrocardiograms blindly (without knowing the demographic data of the patients or the pathological background) using the same criteria. Results: Out of a total of 499 electrocardiograms, 448 (89%) were interpreted as normal by the sports electrocardiography specialist vs 459 (91%) by the cardiologists of the sports institute. Regarding normal alterations, 21 (4%) electrocardiograms were considered normal alterations for the electrocardiography specialist vs 23 (4%) by the sports institute. 30 (6%) electrocardiograms showed doubtful or abnormal alterations for the specialist vs 17 (3%) for the sports institute. Conclusions: The electrocardiographic interpretation can present variations from one center to another despite using standardized criteria. It is likely that the clinical evaluation.

Un caso exitoso de trasplante bipulmonar durante la pandemia por SARS CoV-2 en la Ciudad de Buenos Aires / A Successful Case of Double-Lung Transplant During the SARS CoV-2 Pandemic in the City of Buenos Aires

Paciente masculino portador de hipertesión pulmonar severa refractaria a tratamiento médico, sometido a trasplante bipulmonar durante la pandemia por SARS-CoV-2 en la ciudad de Buenos Aires. Para disminuir el riesgo de contagio se realizaron todas las medidas de prevención actualmente recomendadas, con especial énfasis en el uso del equipo de protección personal, contribuyendo de esta forma con el éxito terapéutico alcanzado.

Male patient with severe pulmonary hypertension refractory to medical treatment who underwent a double-lung transplant during the SARS-CoV-2 in the city of Buenos Aires. In order to reduce the risk of contagion all the currently recommended prevention measures were adopted, especially the use of personal protective equipment, thus contributing to the resultant therapeutic success.

Changes in cardiac Aquaporin expression during aortic valve replacement surgery with cardiopulmonary bypass.

OBJECTIVES: Cardiopulmonary bypass (CPB) use is an essential strategy for many cardiovascular surgeries. However, its use and duration have been associated with a higher rate of postoperative complications, such as low cardiac output syndrome due to myocardial oedema and dysfunction. Though Aquaporin water channels have been implicated in myocardial water balance, their specific role in this clinical scenario has not been established. METHODS: In a consecutive study of 17 patients with severe aortic stenosis undergoing aortic valve replacement surgery, 2 myocardial biopsies of the left ventricle were taken: 1 before and 1 after CPB use. Sociodemographic, clinical and laboratory data were collected. Western blot and immunohistochemistry studies were performed. RESULTS: After CPB use, there was a mean increase of ∼62% in Aquaporin 1 protein levels (P = 0.001) and a mean reduction of ∼38% in Aquaporin 4 protein levels (P = 0.030). In immunohistochemistry assays, Aquaporin 1 was found lining small blood vessels, while Aquaporin 4 formed a circular label in cardiomyocytes. There were no changes in the localization of either protein following CPB use. During the observed on-pump time interval, there was a 1.7%/min mean increase in Aquaporin 1 (P = 0.021) and a 2.5%/min mean decrease in Aquaporin 4 (P = 0.018). Myocardial interstitial oedema increased by 42% (95% confidence interval 31-54%) after CPB use. Patients who developed low cardiac output syndrome were in the upper half of the median percentage change of Aquaporin expression. CONCLUSION: Time-dependent changes in cardiac Aquaporin expression may be associated with myocardial oedema and dysfunction related to CPB use.

Combination treatment of autologous bone marrow stem cell transplantation and hyperbaric oxygen therapy for type 2 diabetes mellitus: A randomized controlled trial.

The objective of this study was to compare standard treatment versus the combination of intrapancreatic autologous stem cell (ASC) infusion and hyperbaric oxygen treatment (HBOT) before and after ASC in the metabolic control of patients with type 2 diabetes mellitus (T2DM). This study was a prospective, randomized controlled trial. The combined intervention consisted of 10 sessions of HBOT before the intrapancreatic infusion of ASC and 10 sessions afterwards. ASCs were infused into the main arterial supply of the pancreas to maximize the presence of the stem cells where the therapeutic effect is most desired. A total of 23 patients were included (control group = 10, intervention group = 13). Age, gender, diabetes duration, number of medications taken, body weight and height, and insulin requirements were recorded at baseline and every three months. Also, body mass index, fasting plasma glucose, C-peptide, and HbA1c, C-peptide/glucose ratio (CPGR) were measured every three months for one year. HbA1c was significantly lower in the intervention group compared with control throughout follow-up. Overall, 77% of patients in the intervention group and 30% of patients in the control group demonstrated a decrease of HbA1c at 180 days (compared with baseline) of at least 1 unit. Glucose levels were significantly lower in the intervention group at all timepoints during follow-up. C-peptide levels were significantly higher in the intervention group during follow-up and at one year: 1.9 ± 1.0 ng/mL versus 0.7 ± 0.4 ng/mL in intervention versus control groups, respectively, p = 0.0021. CPGR was higher in the intervention group at all controls during follow-up. The requirement for insulin was significantly lower in the intervention group at 90, 180, 270, and 365 days. Combined therapy of intrapancreatic ASC infusion and HBOT showed increased metabolic control and reduced insulin requirements in patients with T2DM compared with standard treatment.

Effects of Serelaxin in Patients with Acute Heart Failure.

BACKGROUND: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. METHODS: In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 µg per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. RESULTS: A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P = 0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P = 0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. CONCLUSIONS: In this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778.).

Hallazgos electrocardiográficos anormales en deportistas amateur: comparación de los criterios de Seattle 2013 y 2017 / Abnormal ECG Findings in Amateur Athletes: Comparison of the 2013 and 2017 Seattle Criteria

RESUMEN Introducción: La especificidad del electrocardiograma como método diagnóstico de causas de muerte súbita cardíaca en deportistas depende de los criterios utilizados para discernir entre alteraciones fisiológicas y patológicas. Objetivos: Evaluar la prevalencia de hallazgos electrocardiográficos anormales en deportistas amateur al comparar los Criterios de Seattle 2013 y 2017. Material y métodos: Fueron evaluados 853 deportistas. Se evaluaron género y edad como variables predictoras independientes. Se realizó un seguimiento mediante métodos complementarios de diagnóstico. Resultados: Presentaron electrocardiogramas anormales según criterios 2013 29 deportistas y 17, según criterios 2017, lo que constituyó el 3,4% y el 2%, respectivamente. No se encontraron diferencias significativas entre géneros ni por edad. Conclusiones: De los electrocardiogramas considerados anormales según los criterios 2013, el 41,4% pasó a considerarse normal al aplicarse los criterios redefinidos en 2017. Ni el género ni la edad constituyen variables predictoras independientes. En ningún evaluado, se pudo demostrar cardiopatía en el seguimiento.

ABSTRACT Introduction: The specificity of the electrocardiogram as a diagnostic method of causes of sudden cardiac death in athletes depends on the criteria used to discern between physiological and pathological alterations. Objectives: To assess the prevalence of abnormal electrocardiographic findings in amateur athletes when comparing the Seattle 2013 and 2017 Criteria. Material and methods: 853 athletes were evaluated. Gender and age were evaluated as independent predictor variables. Follow-up was carried out by means of complementary diagnostic methods. Results: 29 athletes presented abnormal electrocardiograms according to 2013 criteria, and 17 athletes according to 2017 criteria, constituting 3.4% and 2% respectively. No significant differences were found between genders or by age. Conclusions: Of the electrocardiograms considered abnormal according to the 2013 criteria, 41.4% came to be considered normal when applying the criteria redefined in 2017. Neither gender nor age are independent predictor variables. In none of the patients, heart disease could be demonstrated during follow-up.

Intoxicación por monóxido de carbono asociada a deterioro transitorio de la función sistólica del ventrículo izquierdo. Reporte de un caso / Carbon monoxide poisoning associated with transient deterioration of left ventricular systolic function. Case report

La intoxicación por monóxido de carbono (CO) es una forma común de envenenamiento en el mundo moderno. Sus consecuencias neurológicas están bien establecidas mientras que las manifestaciones cardiovasculares se limitan a la publicación de casos aislados o series de pacientes. Se presenta el caso de una mujer joven sin factores de riesgo ni antecedentes cardiovasculares conocidos que presentó deterioro transitorio de la función sistólica del ventrículo izquierdo tras una intoxicación severa por CO. Tras recibir el tratamiento convencional, la paciente evolucionó favorablemente y egresó sin presentar complicaciones.

Carbon monoxide poisoning associated with transient deterioration of left ventricular systolic function Case report Carbon monoxide (CO) poisoning is a common form of intoxication in the modern world. While the neurological effects of CO are well established, information on the cardiovascular features of this condition is limited to cases series or reports. We present the case of a young woman with no known risk factors or cardiovascular disease who presented with transient deterioration of left ventricular systolic function after severe CO intoxication. After receiving standard care for CO poisoning, the patient evolved favorably and was discharged without complications.

Envenenamento por monóxido de carbono associada com disfunção transitória da função sistólica do ventrículo esquerdo Relato de caso O envenenamento por monóxido de carbono (CO) é uma forma comum de intoxicação no mundo moderno. Embora os efeitos neurológicos do CO estejam bem estabelecidos, informações sobre as características cardiovasculares desta condição são limitada a casos de séries ou relatórios. Apresentamos o caso de uma jovem sem fatores de risco nem antecedentes cardiovasculares conhecidos ou com doença que apresentou deterioração transitória da função sistólica do ventrículo esquerdo após intoxicação por CO grave. Depois de receber tratamento padrão para intoxicação por CO, o paciente evoluiu favoravelmente e recebeu alta sem complicações.

Angioplastia con balón a arterias pulmonares en una paciente con hipertensión pulmonar tromboembólica crónica / Angioplastia com balão de artérias pulmonares em uma paciente com hipertensão pulmonar tromboembólica crônica / A case of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

La hipertensión pulmonar tromboembólica crónica presenta un tratamiento curativo, siendo la endarterectomía pulmonar (EP) la opción terapéutica establecida. Sin embargo, la angioplastia con balón a arterias pulmonares puede ser considerada una alternativa viable en pacientes inoperables o en aquellos que persisten con hipertensión pulmonar tras una EP. Se reporta a continuación el primer caso de angioplastia con balón a arterias pulmonares realizada en un centro de Argentina.

Chronic thromboembolic pulmonary hypertension presents a curative treatment, with pulmonary endarterectomy being the established therapeutic option. However, balloon angioplasty to pulmonary arteries may be considered an alternative therapeutic option for patients with inoperable or residual disease after surgery. Herewith, we report the first case of chronic thromboembolic pulmonary hypertension treated with balloon pulmonary angioplasty in Argentina.

A hipertensão pulmonar tromboembólica crônica tem um tratamento curativo, a endarterectomia pulmonar (EP), a opção terapêutica estabelecida. No entanto, angioplastia com balão de artérias pulmonares pode ser considerado uma alternativa viável em pacientes inoperáveis ou aqueles que persistem com a hipertensão pulmonar após EP. Relatamos o primeiro caso de angioplastia pulmonar com balão no centro da Argentina.

Heart transplantation in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome).

BACKGROUND: Heart involvement is the leading cause of death of patients with eosinophilic granulomatosis with polyangiitis (EGPA; formerly Churg-Strauss syndrome) and is more frequent in anti-neutrophil cytoplasm antibody (ANCA)-negative patients. Post-transplant outcome has only been reported once. METHODS: We conducted a retrospective international multicenter study. Patients satisfying the criteria of the American College of Rheumatology and/or revised Chapel Hill Consensus Conference Nomenclature were identified by collaborating vasculitis and transplant specialists, and the help of the Churg-Strauss Syndrome Association. RESULTS: Nine ANCA(-) patients who received transplants between October 1987 and December 2009 were identified. The vasculitis and cardiomyopathy diagnoses were concomitant for 5 patients and separated by 12 to 288 months for the remaining 4 patients. Despite ongoing immunosuppression, histologic examination of 7 (78%) patients' explanted hearts showed histologic patterns suggestive of active vasculitis. The overall 5-year survival rate was low (57%), but rose to 80% when considering only the 6 patients transplanted during the last decade. After survival lasting 3 to 60 months, 4 (44%) patients died sudden deaths. CONCLUSIONS: The search for EGPA-related cardiomyopathy is mandatory early in the course of this type of vasculitis. Indeed, prompt treatment with corticosteroids and cyclophosphamide may achieve restore cardiac function. Most patients in this series were undertreated. For patients with refractory EGPA, heart transplantation should be performed, which carries a fair prognosis. No optimal immunosuppressive strategy has yet been identified.

Antagonistas de los receptores de la endotelina para la hipertensión arterial pulmonar / Endothelin receptor antagonists for pulmonary arterial hypertension / Antagonistas dos receptores de endotelina para a hipertensão arterial pulmonar

La hipertensión arterial pulmonar (HAP) es consecuencia de una alteración aguda o crónica de la vasculatura pulmonar, que se caracteriza por el aumento de la presión arterial pulmonar como consecuencia del aumento de la resistencia vascular pulmonar. La fisiopatología de la HAP se caracteriza por la vasoconstricción pulmonar vascular, la proliferación de células musculares lisas, y la trombosis. Estos cambios son el resultado de un desequilibrio entre agentes vasodilatadores (prostaciclina, óxido nítrico, péptido intestinal vaso activo) y vasoconstrictores (tromboxano A2, endotelina, serotonina), los inhibidores de factores de crecimiento y mitógenos, y factores antitrombóticos y protrombóticos. Los recientes avances en el tratamiento están dirigidos a restablecer el equilibrio entre estos sistemas. Los antagonistas de los receptores de endotelina (bosentán, ambrisentán), inhibidores de la fosfodiesterasa tipo 5 (sildenafilo, tadalafilo), y prostaciclina (epoprostenol, iloprost, treprostinil, beraprost) representan las diferentes clases de medicamentos que se utilizan actualmente en monoterapia y en combinación para el tratamiento de la HAP. El propósito de esta revisión es proporcionar al lector una actualización del tratamiento de la HAP con antagonistas de los receptores de la endotelina.

Pulmonary arterial hypertension (PAH) is a consequence of acute or chronic disorder of the pulmonary vasculature, which is characterized by increased pulmonary artery pressure as a result of increased pulmonary vascular resistance. The pathophysiology of PAH is characterized by pulmonary vascular vasoconstriction, smooth muscle cell proliferation, and thrombosis. These changes are a result of an imbalance between vasodilators (prostacyclin, nitric oxide, vasoactive intestinal peptide) and vasoconstrictors (thromboxane A2, endothelin, serotonin), growth inhibitors and mitogenic factors, and antithrombotic and prothrombotic factors. Recent advances in treatment are directed at restoring the balance between these systems. Endothelin receptor antagonists (bosentan, ambrisentan), phosphodiesterase type 5 inhibitors (sildenafil, tadalafil), and prostacylin (epoprostenol, iloprost, treprostinil, beraprost) represent the different classes of medications that are currently used in monotherapy and in combination to treat PAH. The purpose of this review is to provide the reader with an update on the treatment of PAH with antagonists of endothelin receptors.

A hipertensão arterial pulmonar (HAP) é uma consequência da doença aguda ou crônica da vasculatura pulmonar, o que é caracterizado pelo aumento da pressão da artéria pulmonar, como um resultado da resistência vascular pulmonar aumentada. A fisiopatologia de HAP é caracterizada pela vasoconstrição pulmonar vascular, proliferação de células de músculo liso, e trombose. Estas alterações são um resultado de um desequilíbrio entre os vasodilatadores (prostaciclina, o óxido nítrico, o péptido intestinal vasoativo) e vasoconstritores (tromboxano A2, endotelina, serotonina), e inibidores de crescimento de fatores miogênicos, e fatores antitrombóticos e pró-trombóticos. Avanços recentes no tratamento são dirigidos para o restabelecimento do equilíbrio entre estes sistemas. Antagonistas do receptor da endotelina (bosentan, ambrisentan), inibidores da fosfodiesterasa tipo 5 (sildenafilo, tadalafilo) e prostaciclina (epoprostenol, iloprost, treprostinil, beraprost) representam as diferentes classes de medicamentos que são usados atualmente em monoterapia e em combinação para tratar HAP. O objetivo desta revisão é fornecer ao leitor uma atualização sobre o tratamento da HAP com os antagonistas dos receptores de endotelina.

Antagonistas de los receptores de la endotelina para la hipertensión arterial pulmonar / Endothelin receptor antagonists for pulmonary arterial hypertension / Antagonistas dos receptores de endotelina para a hipertensÒo arterial pulmonar

La hipertensión arterial pulmonar (HAP) es consecuencia de una alteración aguda o crónica de la vasculatura pulmonar, que se caracteriza por el aumento de la presión arterial pulmonar como consecuencia del aumento de la resistencia vascular pulmonar. La fisiopatología de la HAP se caracteriza por la vasoconstricción pulmonar vascular, la proliferación de células musculares lisas, y la trombosis. Estos cambios son el resultado de un desequilibrio entre agentes vasodilatadores (prostaciclina, óxido nítrico, péptido intestinal vaso activo) y vasoconstrictores (tromboxano A2, endotelina, serotonina), los inhibidores de factores de crecimiento y mitógenos, y factores antitrombóticos y protrombóticos. Los recientes avances en el tratamiento están dirigidos a restablecer el equilibrio entre estos sistemas. Los antagonistas de los receptores de endotelina (bosentán, ambrisentán), inhibidores de la fosfodiesterasa tipo 5 (sildenafilo, tadalafilo), y prostaciclina (epoprostenol, iloprost, treprostinil, beraprost) representan las diferentes clases de medicamentos que se utilizan actualmente en monoterapia y en combinación para el tratamiento de la HAP. El propósito de esta revisión es proporcionar al lector una actualización del tratamiento de la HAP con antagonistas de los receptores de la endotelina.(AU)

Pulmonary arterial hypertension (PAH) is a consequence of acute or chronic disorder of the pulmonary vasculature, which is characterized by increased pulmonary artery pressure as a result of increased pulmonary vascular resistance. The pathophysiology of PAH is characterized by pulmonary vascular vasoconstriction, smooth muscle cell proliferation, and thrombosis. These changes are a result of an imbalance between vasodilators (prostacyclin, nitric oxide, vasoactive intestinal peptide) and vasoconstrictors (thromboxane A2, endothelin, serotonin), growth inhibitors and mitogenic factors, and antithrombotic and prothrombotic factors. Recent advances in treatment are directed at restoring the balance between these systems. Endothelin receptor antagonists (bosentan, ambrisentan), phosphodiesterase type 5 inhibitors (sildenafil, tadalafil), and prostacylin (epoprostenol, iloprost, treprostinil, beraprost) represent the different classes of medications that are currently used in monotherapy and in combination to treat PAH. The purpose of this review is to provide the reader with an update on the treatment of PAH with antagonists of endothelin receptors.(AU)

A hipertensÒo arterial pulmonar (HAP) é uma consequÛncia da doenþa aguda ou cr¶nica da vasculatura pulmonar, o que é caracterizado pelo aumento da pressÒo da artéria pulmonar, como um resultado da resistÛncia vascular pulmonar aumentada. A fisiopatologia de HAP é caracterizada pela vasoconstriþÒo pulmonar vascular, proliferaþÒo de células de músculo liso, e trombose. Estas alteraþ§es sÒo um resultado de um desequilíbrio entre os vasodilatadores (prostaciclina, o óxido nítrico, o péptido intestinal vasoativo) e vasoconstritores (tromboxano A2, endotelina, serotonina), e inibidores de crescimento de fatores miogÛnicos, e fatores antitrombóticos e pró-trombóticos. Avanþos recentes no tratamento sÒo dirigidos para o restabelecimento do equilíbrio entre estes sistemas. Antagonistas do receptor da endotelina (bosentan, ambrisentan), inibidores da fosfodiesterasa tipo 5 (sildenafilo, tadalafilo) e prostaciclina (epoprostenol, iloprost, treprostinil, beraprost) representam as diferentes classes de medicamentos que sÒo usados atualmente em monoterapia e em combinaþÒo para tratar HAP. O objetivo desta revisÒo é fornecer ao leitor uma atualizaþÒo sobre o tratamento da HAP com os antagonistas dos receptores de endotelina.(AU)

Validity, reliability, feasibility and satisfaction of the Mini-Clinical Evaluation Exercise (Mini-CEX) for cardiology residency training.

AIMS: The purpose of the study was to determine the validity, reliability, feasibility and satisfaction of the Mini-CEX. METHODS AND RESULTS: From May 2003 to December 2004, 108 residents from 17 cardiology residency programs in Buenos Aires were monitored by the educational board of the Argentine Society of Cardiology. Validity was evaluated by the instrument's capability to discriminate between pre-existing levels of clinical seniority. For reliability, generalisability theory was used. Feasibility was defined by a minimum number of completed observations: 50% of the residents obtaining at least four Mini-CEX's. Satisfaction was evaluated through a one to nine rating scale from the evaluators, and residents' perspectives. The total number of encounters was 253. Regarding validity, Mini-CEX was able to discriminate significantly between residents of different seniority. Reliability analysis indicated that a minimum of ten evaluations are necessary to produce a minimally reliable inference, but more are preferable. Feasibility was poor: 15% of the residents were evaluated four or more times during the study period. High satisfaction ratings from evaluators' and residents' were achieved. CONCLUSION: Mini-CEX discriminates between pre-existing levels of seniority, requires considerable sampling to achieve sufficient reliability, and was not feasible within the current circumstances, but it was considered a valuable assessment tool as indicated by the evaluators' and residents' satisfaction ratings.

Tratamiento intervencionista de la hipertensión pulmonar / Interventional treatment of pulmonary hypertension

La hipertensión arterial pulmonar es una enfermedad rara que afecta a personas de mediana edad, predominando en el sexo femenino. La sobrevida es de 2,8 años, luego del diagnóstico. Desde el año 1980 (donde se realizó el primer trasplante pulmonar) hasta la fecha, el tratamiento médico presentó un gran progreso, lo que ha relegado a los tratamientos intervensionistas, como la septostomía, a un segundo plano.La primer septostomía fue realizada en el año1983 y hasta la actualidad sólo se realizaron aproximadamente 300 procedimientos en todo el mundo. Por este motivo presentamos un caso clínico donde el tratamiento intervencionista por medio de la septostomía auricular nos muestra una solución transitoria como puente hacia el trasplante pulmonar

The pulmonary hypertension is a rare disease that affects peoplein the third and fourth decade of life; the predominance is in female sex. Since the first pulmonary transplant, made in 1980, de medical treatment and the interventional procedures have had a great progress. The first septostomy was in 1983 and nowadays, there have been 300 septostomies around the world. We introduced a case report of a septostomy like a bridge to a pulmonary transplant

A hipertensão arterial pulmonar é uma doença rara que afeta a pessoas de meia idade, predominando o sexo feminino. Estudos epidemiológicos mostrarão que o diagnóstico realiza-se 2 anos depois do inicio dos sintomas e a sobrevida é de 2,8 anos logo do diagnóstico. Mas, em pacientes em classe funcional IV a mesma diminui a 6 meses. Desde o ano 1980 (onde se realizou o primeiro transplante pulmonar) até a data, o tratamento médico apresentou um grande progresso, o que há relegado aos tratamentos intervencionistas como a septostomía em um segundo plano e o seu desuso. A primeira septostomía foi realizada no ano 1983 e até hoje só foram realizados aproximadamente 300 procedimentos em todo o mundo. Por esse motivo nós apresentamos um caso clínico, onde o tratamento intervencionista pelo meio da septostomía auricular nos mostra uma solução transitória mas efetiva como ponte até o transplante pulmonar