Relationship Between Brugada Syndrome and Ischemic Stroke: A Case Report and Comprehensive Literature Review.

BACKGROUND Brugada syndrome is characterized by specific electrocardiographic changes predisposing individuals to ventricular arrhythmias and sudden cardiac death. Cases of coexisting Brugada syndrome and ischemic stroke are seldom documented, and an underlying pathophysiological link is yet unknown. This article presents a case in which a patient exhibited both Brugada syndrome patterns and an ischemic stroke, prompting a comprehensive literature review to explore the potential association between Brugada syndrome and ischemic stroke. CASE REPORT A 49-year-old man, previously healthy, was admitted to the hospital after being discovered unconscious at his workplace. Physical exam showed low oxygen saturation, fever, and abnormal neurological findings. Head computed tomography revealed a significant posterior circulation ischemic stroke. An electrocardiogram revealed Brugada syndrome type II initially, progressing to type III pattern. Despite efforts, the patient's condition rapidly deteriorated, leading to death within 24 hours. As far as we're aware, Brugada patterns following a posterior circulation ischemic stroke have only been documented in 1 other instance, in which the patient was also diagnosed with atrial fibrillation. CONCLUSIONS Both our literature review and the presented case indicate that Brugada patterns may coexist with and even be associated with ischemic stroke. More extensive research is required to shed light on this potential association. The question of whether Brugada syndrome is a precursor to or a result of ischemic stroke remains unanswered. We propose that patients with ischemic stroke should undergo an evaluation for electrocardiographic signs indicative of Brugada syndrome, particularly if no clear causes, like cardioembolism, are evident.

Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report.

BACKGROUND Right ventricular (RV) failure can result from acute or chronic cardiac or pulmonary conditions, or both, resulting in increased afterload, reduced contractility, changes in preload, ventricular interdependence, or dysrhythmias. Notably, increased afterload, particularly among previously healthy individuals, is often the primary cause of RV failure in cases of pulmonary and cardiac origin. Massive pulmonary thromboembolism is a common cause of impending RV failure, and chronic conditions like atrial septal defects can also contribute to pulmonary hypertension. CASE REPORT A 72-year-old patient, with no known past medical history, presented to the emergency department in profound shock, rapidly progressing to cardiorespiratory arrest. Bedside ultrasound revealed marked right chambers dilatation, severe mitral and tricuspid insufficiency, a large atrial septal defect, mild pericardial effusion, and global hypokinesia. This case illustrates how multiple mechanisms of RV dysfunction can converge, leading to fulminant RV failure and subsequent cardiac arrest, including increased afterload, decreased contractility, dysrhythmias, and ventricular interdependence. CONCLUSIONS This article emphasizes the usefulness of bedside ultrasound in diagnosing and elucidating the causes of circulatory collapse. In this patient, ultrasound played an important role in identifying 3 contributing factors: chronic RV overload from an extensive atrial septal defect, left ventricular impact due to ventricular interdependence, and acute pulmonary thromboembolism. Being aware of these factors, along with the practicality of bedside ultrasound, allowing emergency physicians to make prompt diagnoses and effectively manage RV failure-related emergencies.

Angiographic description of the anatomy and clinical aspects of the anterior interventricular artery in a group of Colombians individuals / Descripción angiográfica de los aspectos anatómicos y clínicos de la arteria interventricular anterior en un grupo de personas colombianas

Introduction: The anterior interventricular artery originates from the left coronary artery and irrigates the anterior surface of the ventricles, apex, and interventricular septum, making it the second most relevant artery of the heart. Objective: To describe the anatomical and clinical aspects of the anterior interventricular artery through angiography. Materials and methods: A descriptive study was conducted using 200 angiographic reports of Colombian individuals. The anterior interventricular artery's origin, course, patency, and coronary dominance were evaluated. Data related to chest pain, acute myocardial infarction, dyslipidemia, and electrocardiographic abnormalities were included. Statistical tests could not be performed due to this artery's low prevalence of anatomical variations. Results: One anterior interventricular artery was found to have originated from the left coronary sinus without a myocardial bridge, with no alteration in permeability, and with left dominance. The frequency of bridges was 2%, and the most frequent dominance was right in 86%; permeability alterations occurred in 43% mainly affecting S13. Twentyfive per cent presented chest pain; 40%, echocardiographic alterations; 5%, ischemic heart disease, and 59%, electrocardiographic alterations. Conclusions: Variations of origin of the anterior interventricular artery have a low prevalence according to reports from Chile, Colombia, and Spain. anterior interventricular artery myocardial bridges were scarce compared to other studies, suggesting better specificity of computed tomography angiography or direct dissection for these findings. The assessment of coronary permeability is graded with the thrombolysis in myocardial infarction scale; values 0 and 1 indicate occlusive lesion associated with ischemic heart disease. According to various techniques, the most frequent coronary dominance the right, followed by the left in men and balanced circulation in women.

Introducción: La arteria interventricular anterior se origina en la coronaria izquierda, irriga la cara anterior de los ventrículos, el ápex y el tabique interventricular; es la segunda arteria más relevante del corazón. OBJETIVO: Describir las características anatómicas y clínicas de la arteria interventricular anterior mediante angiografía. Materiales y métodos: Se realizó un estudio descriptivo con 200 reportes angiográficos de personas colombianas; se valoraron el origen, el trayecto y la permeabilidad de la arteria interventricular anterior, así como la dominancia coronaria. Se incluyeron datos relacionados con dolor precordial, infarto agudo de miocardio, dislipidemia y alteración electrocardiográfica. No fue posible hacer pruebas estadísticas, debido a la escasa prevalencia de variaciones anatómicas de dicha arteria. RESULTADOS: Se encontró una arteria interventricular anterior con su origen en el seno aórtico izquierdo, sin puente miocárdico, sin alteración de la permeabilidad y con dominancia izquierda. La frecuencia de los puentes fue del 2 % y la dominancia más frecuente fue la derecha en el 86 %. Se presentaron alteraciones de permeabilidad en el 43 % de los casos, las cuales afectaron principalmente al S13. El 25 % de los pacientes presentó dolor precordial; el 40 %, alteraciones ecocardiográficas; el 5 %, cardiopatía isquémica, y el 59 %, alguna alteración electrocardiográfica. CONCLUSIONES: Las variaciones en el origen de la arteria interventricular anterior son poco prevalentes, según reportes de Chile, Colombia y España. Los puentes miocárdicos de esta arteria fueron escasos respecto a otros estudios, lo cual sugiere mejor especificidad de los hallazgos de la angiotomografía o de la disección directa. La permeabilidad coronaria se valora con la escala TIMI (Thrombolysis in Myocardial Infarction); puntajes de 0 y 1 indican una lesión oclusiva asociada con cardiopatía isquémica. La dominancia coronaria más frecuente, según diversas técnicas, es la derecha, seguida de la izquierda en hombres y de una circulación balanceada en mujeres.

Descripción angiográfica de los aspectos anatómicos y clínicos de la arteria interventricular anterior en un grupo de personas colombianas

Introducción. La arteria interventricular anterior se origina en la coronaria izquierda, irriga la cara anterior de los ventrículos, el ápex y el tabique interventricular; es la segunda arteria más relevante del corazón. Objetivo. Describir las características anatómicas y clínicas de la arteria interventricular anterior mediante angiografía. Materiales y métodos. Se realizó un estudio descriptivo con 200 reportes angiográficos de personas colombianas; se valoraron el origen, el trayecto y la permeabilidad de la arteria interventricular anterior, así como la dominancia coronaria. Se incluyeron datos relacionados con dolor precordial, infarto agudo de miocardio, dislipidemia y alteración electrocardiográfica. No fue posible hacer pruebas estadísticas, debido a la escasa prevalencia de variaciones anatómicas de dicha arteria. Resultados. Se encontró una arteria interventricular anterior con su origen en el seno aórtico izquierdo, sin puente miocárdico, sin alteración de la permeabilidad y con dominancia izquierda. La frecuencia de los puentes fue del 2 % y la dominancia más frecuente fue la derecha en el 86 %. Se presentaron alteraciones de permeabilidad en el 43 % de los casos, las cuales afectaron principalmente al S13. El 25 % de los pacientes presentó dolor precordial; el 40 %, alteraciones ecocardiográficas; el 5 %, cardiopatía isquémica, y el 59 %, alguna alteración electrocardiográfica. Conclusiones. Las variaciones en el origen de la arteria interventricular anterior son poco prevalentes, según reportes de Chile, Colombia y España. Los puentes miocárdicos de esta arteria fueron escasos respecto a otros estudios, lo cual sugiere mejor especificidad de los hallazgos de la angiotomografía o de la disección directa. La permeabilidad coronaria se valora con la escala TIMI (Thrombolysis in Myocardial Infarction); puntajes de 0 y 1 indican una lesión oclusiva asociada con cardiopatía isquémica. La dominancia coronaria más frecuente, según diversas técnicas, es la derecha, seguida de la izquierda en hombres y de una circulación balanceada en mujeres.

Introduction. The anterior interventricular artery originates from the left coronary artery and irrigates the anterior surface of the ventricles, apex, and interventricular septum, making it the second most relevant artery of the heart. Objective. To describe the anatomical and clinical aspects of the anterior interventricular artery through angiography. Materials and methods. A descriptive study was conducted using 200 angiographic reports of Colombian individuals. The anterior interventricular artery's origin, course, patency, and coronary dominance were evaluated. Data related to chest pain, acute myocardial infarction, dyslipidemia, and electrocardiographic abnormalities were included. Statistical tests could not be performed due to this artery's low prevalence of anatomical variations. Results. One anterior interventricular artery was found to have originated from the left coronary sinus without a myocardial bridge, with no alteration in permeability, and with left dominance. The frequency of bridges was 2%, and the most frequent dominance was right in 86; permeability alterations occurred in 43% mainly affecting S13. Twenty-five per cent presented chest pain; 40%, echocardiographic alterations; 5%, ischemic heart disease, and 59%, electrocardiographic alterations. Conclusions. Variations of origin of the anterior interventricular artery have a low prevalence according to reports from Chile, Colombia, and Spain. anterior interventricular artery myocardial bridges were scarce compared to other studies, suggesting better specificity of computed tomography angiography or direct dissection for these findings. The assessment of coronary permeability is graded with the thrombolysis in myocardial infarction scale; values 0 and 1 indicate occlusive lesion associated with ischemic heart disease. According to various techniques, the most frequent coronary dominance the right, followed by the left in men and balanced circulation in women.

Anthropometric measures as predictors of cardiovascular risk in a population of employees / Medidas antropométricas como predictores del riesgo cardiovascular en una población de empleados

Abstract Background: There are several scales to calculate the cardiovascular risk of patients at the outpatient level; however, most of them require the measurement of parameters that involve high costs or waiting time for the results. Objective: The objective of this study was to show the capacity of some anthropometric measures for the prediction of cardiovascular risk in an adult population of a Colombian State University. Materials and methods: Ninety-eight working individuals of a State university with an average age of 50.6 ± 7.5 years were evaluated in 2014. For each person, the variables gender, age, height, weight, percentage body fat (%BF), body mass index, blood pressure (BP), percentage of hand grip strength (%HGS), midline level waist circumference (MLW), waist-to-hip ratio, waist-to-height ratio, fruit and vegetable portions ingested per day, and cigarette smoking were recorded. Subsequently, in 2018, the participants were contacted and were asked about new medical diagnoses of cardiovascular type that they would have had in the time elapsed since the evaluation. Results: Eighty-three individuals participated in the new evaluation (2018). The MLW was an independent risk factor associated with type 2 diabetes mellitus (DM) OR: 1214 (95% CI, p = 0.010) and the %BF associated with high BP (HBP) OR: 1137 (95% CI, p = 0.028). Conclusion: MLW and %BF are economic anthropometric measurements techniques that can help predict the risk of developing DM and HBP at 4 years.

Resumen Antecedentes: Existen varias escalas para calcular el riesgo cardiovascular de los pacientes a nivel ambulatorio; sin embargo, la mayoría requieren de la medición de parámetros que implican altos costos o un tiempo de espera para obtener los resultados. Objetivo: Demostrar la capacidad de algunas medidas antropométricas para predecir el riesgo cardiovascular en una población adulta de una universidad pública en Colombia. Metodología: 98 empleados de una universidad pública con una edad media de 50.6 ± 7.5 años fueron evaluados en el año 2014. Para cada persona, se registraron las variables de género, edad, estatura, peso, porcentaje de grasa corporal (% GC), índice de masa corporal (IMC), tensión arterial (TA), porcentaje de fuerza de agarre (% FA), circunferencia de la cintura a nivel de la línea media (CCM), índice cintura-cadera (ICC), índice cintura-estatura (ICE), porciones de frutas y verduras (PFV) ingeridas al día, y tabaquismo. Después, en el 2018, se contactaron los participantes y se les preguntó por nuevos diagnósticos médicos de tipo cardiovascular que hubieran tenido en el lapso desde la evaluación. Resultados: 83 individuos participaron en la nueva evaluación (2018). La CCM fue un factor de riesgo independiente asociado a la diabetes tipo 2 (DM), OR = 1,214 (IC 95%, p = 0.010) y el %GC asociado a la tensión arterial alta (TAA), OR = 1,137 (IC 95%, p = 0.028). Conclusión: La CCM y el %GC son técnicas de medidas antropométricas económicas que pueden ayudar a predecir el riesgo de desarrollar DM y TAA a 4 años.

Abordaje percutáneo transgástrico en la disrupción ductal del páncreas: serie de casos / Percutaneous transgastric approach in pancreatic ductal disruption: Case series

Resumen Se presentan 6 pacientes con disrupción ductal del páncreas (DDP) tratados mediante drenaje percutáneo guiado por imágenes con apoyo de la endoscopia. Inicialmente, los pacientes presentaron necrosis pancreática infectada tratada con drenaje percutáneo transgástrico y luego de resolver la infección desarrollaron DDP. En el estudio por imágenes se diagnosticaron 4 pacientes con disrupción ductal parcial y 2 con disrupción total, a quienes se les indicó la colocación de una prótesis transgástrica percutánea para lograr el drenaje del líquido pancreático hacia el estómago. La duración promedio de la prótesis fue de 183 días; no hubo casos de mortalidad. Se pudo evidenciar que esta opción terapéutica mínimamente invasiva tiene baja morbimortalidad, por lo que se plantea el abordaje percutáneo transgástrico apoyado por la endoscopia como posible tratamiento de la DDP.

Abstract A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD.

Description of the Etiologies, Clinical Characteristics, and Outcomes in Patients with Hyperferritinemia in a Colombian Tertiary Hospital.

BACKGROUND: This study analyzes the clinical characteristics, outcomes, and conditions associated with hyperferritinemia (≥5000 ng/mL) in a high-complexity center in Colombia. METHODS: This retrospective and descriptive study was performed between 2011 and 2020, at the Fundación Valle del Lili, Cali, Colombia, by reviewing medical charts from patients who had serum ferritin measurements equal to or greater than 5000 ng/mL. RESULTS: We found 350 reports of ferritin values ≥5000 ng/mL, corresponding to 317 patients, with a median ferritin value of 8789 (6001-15 373) ng/mL. The most frequent etiologies were infection (n = 198, 56.57%), hematologic disorders (n = 104, 29.71%), and blood transfusion (n = 98, 28.00%). These last 2 etiologies cooccurred in 37 (10.57%) cases. The main clinical signs accompanying hyperferritinemia were fever in 199 (56.86%) cases, multiorgan involvement in 125 (35.71%), and hepatomegaly in 95 (27.14%) cases. Ninety-four (29.65%) patients died in the hospital, and 11 (3.47%) died within 30 days after medical discharge, mainly due to infection (n = 51, 48.57%). Intrahospital mortality was associated with significantly higher ferritin levels (10 846, IQR: 6425-23 459) than survival (8452, IQR: 5980-13 932) (P = 0.018). CONCLUSIONS: Hyperferritinemia is related to many underlying causes, with infection being the principal cause in our cohort, followed by hematologic disorders. Additionally, in-hospital mortality was related to higher ferritin levels.