Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude.

OBJECTIVE: To determine the point prevalence of pulmonary hypertension (PH) and its relationship with respiratory disturbances in obese patients living at moderate altitude. SUBJECTS: A total of 57 obese patients comprised the final sample and consisted of 34 women and 23 men, with a mean age of 42.7+/-12.1 ys and a mean body mass index (BMI) 47.1+/-10.6 kg/m(2) (range from 30.1 to 76.1). The mean living altitude was 2248.7 m, range 2100-2400 m above sea level. MEASUREMENTS: Doppler echocardiography, pulmonary function tests, arterial blood gas analysis, and polysomnography were performed. RESULTS: Data showed that 96.5% of the studied sample had daytime PH defined as calculated systolic pulmonary artery pressure (PSAP) >30 mmHg (mean PSAP=50, s.d.=13 mmHg). The severity of diurnal PH was found to be related to the presence of alveolar hypoventilation and BMI. The main risk factor for severity of diurnal PH was hypoventilation with a significant odds ratio (OR) 7.96, 95% CI 1.35-46.84, BMI was (OR 1.12, 95% CI 1.02-1.25) and apnea/hypopnea index was not a predictor of pulmonary hypertension severity (OR 0.99, 95% CI 0.97-1.02). CONCLUSION: We concluded that prevalence of diurnal PH is high in obese patients living at moderate altitude, and that hypoventilation is the main risk factor associated with the severity of pulmonary hypertension.

Ebstein's anomaly, atrial paralysis and atrio-ventricular block: an uncommon association.

We report here the case of a 22-year-old female patient with an incomplete Ebstein's anomaly, complete heart block and atrial standstill. Atrial paralysis associated with Ebstein's anomaly is the most important feature, since there is a report of familial Ebstein's anomaly associated with atrial standstill but isolated cases have not been described. The patient presented with atypical chest pain and a symptomatic bradycardia of 37 beats per minute. A VVIR pacemaker was implanted. She has subsequently been symptom free.

[Carcinoid syndrome: report of a case with heart involvement and primary ovarian tumor]. / Síndrome carcinoide: reporte de un caso con afección cardiaco y tumor primario de ovario.

A patient with a primary ovarian carcinoid tumor with extensive carcinoid heart disease, without hepatic metastases is presents. Literature was revisited, emphasizing that carcinoid heart disease secondary to an ovarian tumor is quite rare. Surgical indications relative to this patient are discussed.

Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients.

OBJECTIVE: To determine the prevalence of sleep apnea in morbidly obese patients and its relationship with cardiac arrhythmias. RESEARCH METHODS AND PROCEDURES: Fifty-two consecutive morbidly obese (body mass index > or = 40 kg/m2) outpatients from the Obesity Clinic of the National Institute of Nutrition Salvador Zubirán underwent two nights of polysomnography with standard laboratory techniques. Electrocardiographic polysomnography signals (Lead II) were evaluated by two experienced cardiologists, and sleep complaints were measured with a standard sleep questionnaire (Sleep Disorders Questionnaire). In order to make comparisons between groups with different severities of sleep-disordered breathing, we classified the patients in four groups using the apnea-hypopnea index (AHI): Group 1, AHI 5 < 15 (n = 10); Group 2, AHI 15 < 30 (n = 10); Group 3, AHI 30 < 65 (n = 14); Group 4, AHI > or = 65 (n = 17). RESULTS: A wide range of sleep-disordered breathing, ranging from AHI of 2.5 to 128.9 was found. Ninety-eight percent of the sample (n = 51) had an AHI > or = 5 (mean = 51 +/- 37), and 33% had severe sleep apnea with AHI > or = 65 with a mean nocturnal desaturation time of <65% over 135 minutes. Electrocardiographic abnormalities were present in 31% of the patients. Cardiac rhythm alterations showed an association with the level of sleep-disordered breathing and oxygen desaturation. DISCUSSION: We conclude that there is a high prevalence of sleep apnea in morbidly obese patients and that the risk for cardiac arrhythmias increases in this population in the presence of a severe sleep apnea (AHI > or = 65) with severe oxygen desaturation (SaO2 < or = 65%).

Multiple recurring paragangliomas: a problem of diagnosis and location. Case report and review of the literature.

RATIONALE: Paragangliomas constitute a particular diagnostic challenge because of the difficulties involved in identifying new lesions. CASE REPORT: The findings in the case of a young woman with multiple recurring paragangliomas which reappeared eleven years after successful surgical treatment are presented. DISCUSSION: This case illustrates the diagnostic difficulties of this pathologic entity and the lack of a technique of sufficient sensitivity to reveal the existence of one or more tumors with or without hormonal secretion, their location and rate of growth and the number of neoplasias to avoid as many surgical interventions as possible. Inasmuch as an ideal technique for diagnosis and localization of this type of tumor remains to be developed, non-invasive methods, particularly 131I MIBG scintigraphy, play a significant role in evaluation because of their high sensitivity for detecting chromaffin tissue, especially in extra-adrenal locations. CONCLUSION: Periodic long-term radionuclide scanning should be recommended for all asymptomatic patients given the risk of residual and/or reactivating tumoral tissue with benign or metastatic behavior.

Kearns-Sayre syndromes an absolute indication for prophylactic implantation of definitive pacemaker?

Kearns-Sayre syndrome is a mitochondrial cytopathy characterized by chronic progressive external ophthalmoplegia, retinitis pigmentosa and heart block, the last of which determines the survival of these patients. The case of a 23 year old man with Kearns-Sayre syndrome, conduction disturbances and mitral valve prolapse is presented. The characteristics of this syndrome are described and the criteria for prophylactic installation of a pacemaker discussed.

Cardiac abnormalities associated with morbid obesity.

Morbidly obese patients are at increased risk for structural and functional abnormalities of the heart. This paper summarizes the effects of obesity on the heart, the effect of weight reduction on cardiac function, the impact of coronary artery disease on cardiac cardiomyopathy, and our experience in obesity heart disease at the Instituto Nacional de la Nutrición in Mexico.

Effect of major improvement in glycemic control on results of cardiovascular function tests in patients with insulin-dependent diabetes mellitus.

OBJECTIVE: To evaluate the effect of major improvement in glycemic control on cardiovascular function tests in patients with insulin-dependent diabetes mellitus (IDDM). METHODS: Eight men with chronic, poorly controlled IDDM (serum fructosamine >300 mmol/L and mean fasting blood glucose >200 mg/dL), who were 24 +/- 6 years of age and had a mean duration of diabetes of 8 +/- 1 years, were studied. No patient had microalbuminuria, was taking medication other than insulin, or had evidence of heart disease. Patients underwent baseline continuous ambulatory blood pressure monitoring, echocardiographic studies, and cardiovascular autonomic function tests, which were repeated after 4 weeks of an intensified insulin treatment program (IITP), during which they reached and maintained blood glucose concentrations and serum fructosamine levels in near-normal, nondiabetic ranges. RESULTS: Substantial changes in glycemic control had no significant influence on results of ambulatory blood pressure monitoring, cardiovascular autonomic function tests, and echocardiographic studies. CONCLUSION: Major improvement in glycemic control during a 1-month period in patients with IDDM had no significant influence on cardiovascular function tests. We cannot exclude the possibility that, after a longer duration of an IITP or in patients with clinically evident heart disease or evidence of major complications of diabetes, different responses might be observed.

Bicarbonate therapy in severe diabetic ketoacidosis. A double blind, randomized, placebo controlled trial.

Intravenous sodium bicarbonate has been used for a long time in the treatment of diabetic ketoacidosis. However, there are no clinical studies showing its effectiveness in improving arterial pH in this condition. We therefore designed this study to investigate if bicarbonate therapy improves the rate of increase of arterial pH and to find out its effects on the recovery rate of the other metabolic abnormalities. Twenty patients with severe diabetic ketoacidosis (pH less than 7.15) entered a double-blind, randomized, placebo controlled trial: nine were included in the bicarbonate group and eleven in the placebo group. All patients were studied during the first 24 hours of treatment. Their management was similar, except for the use of sodium bicarbonate in one group and 0.9% saline solution in the placebo group. Heart rate, respiratory rate, arterial pressure, mental status, blood gases, blood glucose, sodium, potassium, and urea were assessed at the beginning of treatment, and then at 2, 6, 12 and 24 hours. No clinical or metabolic differences were found between groups. Two hours after therapy was begun, the arterial pH rose in the bicarbonate group from 7.05 +/- 0.08 to 7.24 +/- 0.04, while it only rose from 7.04 +/- 0.08 to 7.11 +/- 0.09 in the placebo group (p less than 0.02). Simultaneously, arterial bicarbonate increased from 2.87 +/- 1.2 to 6.1 +/- 1.5 mEq/L in the bicarbonate group and from 2.55 +/- 0.81 to 3.6 +/- 2 mEq/L in the placebo group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)