[Correlación de variables ecocardiográficas y biomarcadores en pacientes graves con COVID-19].

Objetivo: Describir las variables ecocardiográficas de los pacientes con COVID-19 y su correlación con biomarcadores y mortalidad. Método: Estudio observacional, descriptivo, longitudinal y retrospectivo. Resultados: El 70% (n = 21) eran de sexo masculino, el promedio de edad fue de 59 (46-67) años y el índice de masa corporal fue de 30.1 (27.3-32.4) kg/m2. En la evaluación de la función sistólica del ventrículo izquierdo se observó una adecuada correlación entre la excursión sistólica del plano del anillo mitral (MAPSE) y la fracción de eyección del ventrículo izquierdo (r2 = 0.508, p = 0.004). La evaluación de la función sistólica del ventrículo derecho indicó una óptima correlación entre la excursión sistólica del plano del anillo tricuspídeo (TAPSE) y la fracción de acortamiento del ventrículo derecho (r2 = 0.649, p = ≤ 0.0001). No hubo correlación de los biomarcadores y las variables ecocardiográficas entre los pacientes sobrevivientes y no sobrevivientes, a excepción del MAPSE y las concentraciones séricas de deshidrogenasa láctica (r2 = -0.427, p = 0.019). La tasa de mortalidad fue del 16% (n = 5). Conclusión: Existe una adecuada correlación entre las variables ecocardiográficas de la función sistólica del ventrículo izquierdo y del ventrículo derecho, así como también entre la MAPSE y los valores séricos de DHL.

Experience in the management of severe COVID-19 patients in an intensive care unit.

OBJECTIVE: To describe the clinical characteristics and management of severe COVID-19 patients. METHOD: Observational, descriptive, longitudinal, and retrospective study. RESULTS: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). CONCLUSION: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.

OBJETIVO: Describir las características clínicas y el manejo de pacientes graves con COVID-19. MÉTODO: Estudio observacional, descriptivo, longitudinal y restrospectivo. RESULTADOS: Ingresaron 56 pacientes, el 80.3% (n = 45) de sexo masculino, con un promedio de edad de 58 [46-67] años. Las principales condiciones de comorbilidad fueron obesidad, hipertensión y diabetes. El tiempo de inicio de los síntomas al ingreso fue de 9 [7-14] días, siendo los más frecuentes disnea, fiebre y tos seca. Los datos de laboratorio fueron linfopenia y elevación de deshidrogenasa láctica, fibrinógeno, dímero D, ferritina y proteína C reactiva. El 100% de los pacientes requirieron ventilación mecánica, con una mediana de tiempo de ventilación de 12 [6-17] días, y el 66% (n = 37) requirieron posición en prono. El tratamiento farmacólogico fue a base de azitromicina, hidroxicloroquina, tocilizumab y esteroides, principalmente. Las complicaciones más frecuentes fueron lesión renal aguda, enfermedad tromboembólica venosa e infarto agudo al miocardio. La tasa de mortalidad fue del 17.8% (n = 10). CONCLUSIÓN: Los pacientes graves en nuestro hospital fueron en su mayoría personas de la tercera edad y con obesidad, siendo las variables de mayor puntaje SOFA y lesión renal aguda las asociadas con mayor mortalidad.

Usefulness of qSOFA and ECOG Scores for Predicting Hospital Mortality in Postsurgical Cancer Patients without Infection.

BACKGROUND: The quick sequential organ failure assessment (qSOFA) and the Eastern Cooperative Oncologic Group (ECOG) scale are simple and easy parameters to measure because they do not require laboratory tests. The objective of this study was to compare the discriminatory capacity of the qSOFA and ECOG to predict hospital mortality in postsurgical cancer patients without infection. METHODS: During the period 2013-2017, we prospectively collected data of all patients without infection who were admitted to the ICU during the postoperative period, except those who stayed in the ICU for <24 hours or patients under 18 years. The ECOG score during the last month before hospitalization and the qSOFA performed during the first hour after admission to the intensive care unit (ICU) were collected. The primary outcome for this study was the in-hospital mortality rate. RESULTS: A total of 315 patients were included. The ICU and hospital mortality rates were 6% and 9.2%, respectively. No difference was observed between the qSOFA [AUC=0.75 (95% CI = 0.69-0.79)] and the ECOG scores [AUC=0.68 (95%CI =0.62-0.73)] (p=0.221) for predicting in-hospital mortality. qSOFA greater than 1 predicted in-hospital mortality with a high sensitivity (100%) but low specificity (38.8%); positive predictive value of 26.3% and negative predictive value of 93.1% compared to 74.4% of specificity, 55.1% of sensitivity%; positive predictive value of 18% and negative predictive value of 94.2% for an ECOG score greater than 1. Multivariable Cox regression analysis identified two independent predicting factors of in-hospital mortality, which included ECOG score during the last month before hospitalization (HR: 1.46; 95 % CI: 1.06-2.00); qSOFA calculated in the first hours after ICU admission (OR: 3.17; 95 % CI: 1.79-5.63). CONCLUSION: No difference was observed between the qSOFA and ECOG for predicting in-hospital mortality. The qSOFA score performed during the first hour after admission to the ICU and ECOG scale during the last month before hospitalization were associated with in-hospital mortality in postsurgical cancer patients without infection. The qSOFA and ECOG score have a potential to be included as early warning tools for hospitalized postsurgical cancer patients without infection.

Stress induced cardiomyopathy due to a Mexican earthquake / Cardiomiopatía por estrés inducida por el terremoto en México

Abstract Takotsubo Cardiomyopathy mainly occurs in postmenopausal women, with or with- out cardiovascular disease, and is commonly associated with emotional or physical stress. After nearly 27 years of extensive efforts towards a better understanding of this disorder, current knowledge remains limited. Many people suffer post-traumatic stress, and this situation can be associated to stress cardiomyopathy. The case is presented of a female who suffers stress asso- ciated with the earthquake of 19 September 2017 in Mexico City, and arrived in the Emergency Department in cardiogenic shock.

Resumen La miocardiopatía de Takotsubo ocurre principalmente en mujeres posmenopáusicas con o sin enfermedad cardiovascular, y se asocia comúnmente con estrés emocional o físico. Después de casi 27 an˜os de esfuerzos extensos para una mejor comprensión de este trastorno, el conocimiento actual sigue siendo limitado. Muchas personas sufren estrés postraumático y esta situación puede estar asociada a la cardiomiopatía por estrés. Presentamos el caso clínico de una mujer que sufrió estrés relacionado con el pasado terremoto del 19 de septiembre en la Ciudad de México y llegó al servicio de urgencias en choque cardiogénico.

The importance of intra-hospital pharmacovigilance in the detection of medication errors / La importancia de la farmacovigilancia intrahospitalaria en la detección oportuna de los errores de medicación.

Introduction: Hospitalized patients are susceptible to medication errors, which represent between the fourth and the sixth cause of death. The department of intra-hospital pharmacovigilance intervenes in the entire process of medication with the purpose to prevent, repair and assess damages. Objective: To analyze medication errors reported by Mexican Fundación Clínica Médica Sur pharmacovigilance system and their impact on patients. Method: Prospective study carried out from 2012 to 2015, where medication prescriptions given to patients were recorded. Owing to heterogeneity, data were described as absolute numbers in a logarithmic scale. Results: 292 932 prescriptions of 56 368 patients were analyzed, and 8.9% of medication errors were identified. The treating physician was responsible of 83.32% of medication errors, residents of 6.71% and interns of 0.09%. No error caused permanent damage or death. Conclusion: This is the pharmacovigilance study with the largest sample size reported.

Introducción: Los pacientes hospitalizados son susceptibles a errores de medicación, que representan entre la cuarta y sexta causa de muerte. El servicio de farmacovigilancia intrahospitalaria interviene en todo el proceso de medicación con el fin prevenir, corregir y evaluar los daños. Objetivo: Analizar los errores de medicación reportados por el sistema de farmacovigilancia de la Fundación Clínica Médica Sur, México, y su impacto en los pacientes. Método: Estudio prospectivo efectuado de 2012 a 2015, en el que se registraron las prescripciones de medicamente a los pacientes. Los datos se describieron como número absoluto en escala logarítmica debido a la heterogeneidad. Resultados: Se analizaron 292 932 prescripciones de 56 368 pacientes, entre las cuales se identificó 8.9 % errores de medicación. El médico tratante fue responsable de 83.32 %, los residentes de 6.71 % y los internos de 0.09 %. Ningún error causó daño permanente o muerte. Conclusión: El estudio de farmacovigilancia que se presenta constituye el de mayor tamaño de muestra informado.

Stress induced cardiomyopathy due to a Mexican earthquake.

Takotsubo Cardiomyopathy mainly occurs in postmenopausal women, with or without cardiovascular disease, and is commonly associated with emotional or physical stress. After nearly 27 years of extensive efforts towards a better understanding of this disorder, current knowledge remains limited. Many people suffer post-traumatic stress, and this situation can be associated to stress cardiomyopathy. The case is presented of a female who suffers stress associated with the earthquake of 19 September 2017 in Mexico City, and arrived in the Emergency Department in cardiogenic shock.

Pulmonary Ultrasound: A New Era in Critical Care Medicine.

Pulmonary ultrasonography is a complementary study that is easy to perform at the patient bedside with no need to transfer the patient to special areas. The technique provides information with high sensitivity and specificity for different pathologies. Pulmonary ultrasonography is a very important diagnostic tool in the assessment of lung, pleural, and chest wall diseases. Pulmonary ultrasound provides low-cost analysis, easy real-time reproduction, and safety, all of which have made it a beneficial tool in the diagnostic arsenal available to medical personnel. The purpose of this review was to describe the usefulness of pulmonary ultrasound in critical areas.

Outcome of Critically Ill Patients with Testicular Cancer.

PURPOSE: To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: This was a prospective observational study. There were no interventions. RESULTS: During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01-1.11, and P = 0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01-1.50, and P = 0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96-7.59, and P < 0.001) as independent predictors of death for up to 6 months. CONCLUSION: The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.

Clinical characteristics of critically ill cancer patients who are undergoing isolated limb perfusion.

The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.

Hypoxic hepatitis in cardiac intensive care unit: a study of cardiovascular risk factors, clinical course, and outcomes.

INTRODUCTION: Hypoxic hepatitis (HH) is observed frequently in intensive care units. Information in the cardiac intensive care unit (CICU) is limited. The aim of this study was to analyze the clinical course and outcomes of HH in the specific setting of the CICU. METHODS: We analyzed records of patients with HH admitted to the CICU (Group 1). Data were collected and compared with those of an intermediate group of patients with altered liver test results that did not meet the HH criteria who had a serum aminotransferase level of five to ≤20 times the upper-normal limit (Group 2), and with a control group who had an aminotransferase level less than five times the upper-normal limit (Group 3). RESULTS: PATIENTS WITH HH EXHIBITED A WORSE HEMODYNAMIC PROFILE AND MORE OF THESE PATIENTS WERE IN SHOCK: 17 (94.4%) in Group 1, 14 (77.8%) in Group 2, and seven (38.9%) in Group 3 (P=0.001). Cardiogenic shock was the most frequent event: 12 (66.7%) in Group 1, 13 (72.2%) in Group 2, and six (33.3%) in Group 3 (P=0.006). The mortality rate was 55.6%. Mechanical ventilation was an independent factor associated with death (odds ratio 12.25, 95% confidence interval 1.26-118.36). CONCLUSION: The mortality rate of patients with HH in CICU is high and is associated with ventilatory disturbances.

Acute liver failure associated with levetiracetam and lacosamide combination treatment for unspecified epileptic disorder.

Background and Aim. Levetiracetam is a second-generation antiepileptic drug. It is approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. Methods. We report a case of acute liver failure secondary to Levetiracetam in combination with Lacosamide documented with a liver biopsy. Results. Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. Conclusions. This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide.

Prophylactic activated recombinant factor VII in liver resection and liver transplantation: systematic review and meta-analysis.

BACKGROUND AND AIM: Intraoperative blood loss is a frequent complication of hepatic resection and orthotopic liver transplantation. Recombinant activated coagulation factor VII (rFVIIa) is a coagulation protein that induces hemostasis by directly activating factor X. There is no clear information about the prophylactic value of rFVIIa in hepatobiliary surgery, specifically in liver resection and orthotopic liver transplantation. The aim of this study was to assess the effect of rFVIIa prophylaxis to prevent mortality and bleeding resulting from hepatobiliary surgery. METHODS: Relevant randomized trials were identified by searching The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index. Randomized clinical trials comparing different rFVIIa prophylactic schemas against placebo or no intervention to prevent bleeding in hepatobiliary surgery were included. Adults undergoing liver resection, partial hepatectomy, or orthotopic liver transplantation were included. Dichotomous data were analyzed calculating odds ratios (ORs) and 95% confidence intervals (CIs). Continuous data were analyzed calculating mean differences (MD) and 95% CIs. RESULTS: Four randomized controlled trials were included. There were no significant differences between rFVIIa and placebo for mortality (OR 0.96; 95% CI 0.35-2.62), red blood cell units (MD 0.32; 95% CI -0.08-0.72) or adverse events (OR 1.55; 95% CI 0.97-2.49). CONCLUSIONS: The available information is limited, precluding the ability to draw conclusions regarding bleeding prophylaxis in hepatobiliary surgery using rFVIIa. Although an apparent lack of effect was observed in all outcomes studied, further research is needed.

Severe stunned myocardium after lightning strike.

OBJECTIVE: To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function. DESIGN: Case report. SETTING: Coronary care unit at Medica Sur Clinic, Mexico. PATIENT: A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium. CONCLUSIONS: Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.

[Levosimendan: a new strategy in the treatment of heart failure]. / Levosimendan: nueva estrategia en el manejo de la falla cardíaca.

Congestive heart failure is a long standing health issue. Traditionally, heart failure has been treated with a wide array of drugs such as diuretics, digitalis, catecholamine and non catecholamine inotropics, although treatment with these drugs bears adverse effects, such as the generation of arrhythmia and even death. A new class of drugs has recently exerted a positive impact on the treatment of patients with heart failure; these are the calcium sensitizers that enhance myocardial contractility without increasing cytosolic calcium. Levosimendan is a calcium sensitizer that, besides increasing contractility, has a vasodilating effect due to the activation of K(ATP) channels, being both mechanisms responsible for an advantageous therapeutic option. Different studies have proven the efficiency and safety profile of the drug on various scenarios and populations; thereby considering levosimendan a real and safe alternative treatment for patients with acute or chronic ventricular failure that need intravenous pharmacological support.

[Impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock secondary to acute myocardial infarction]. / Impacto del balón intra-aórtico de contrapulsación en la mortalidad por choque cardiogénico secundario a infarto agudo del miocardio.

OBJECTIVE: To determine the impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock post-acute myocardial infarction. METHODS: In a two-year period, 292 patients with acute myocardial infarction were admitted to the coronary intensive care unit, 40 were included in the study. Afterwards, patients were divided in two groups: early cardiogenic and late cardiogenic shock, and they were assigned randomly and blind to treatment with inotropics and inotropics plus intra-aortic balloon pump. RESULTS: There were significant differences in the measurements of pulmonary wedge pressure (20.4 +/- 1.6 vs 24.4 +/- 1.50, p = 0.0004) and the cardiac index (2.06 +/- 0.7 vs 1.65 +/- 0.18, p = 0.0002) between the two groups. The late cardiogenic shock group showed an increased mortality (25.9% vs 61.5%, p < 0.05). Patients treated with inotropics + balloon, in both early and late shock groups, showed a reduction in mortality of 66% and 69%, respectively. CONCLUSIONS: The use of the intra-aortic balloon pump in the treatment of cardiogenic shock post acute myocardial infarction reduces the mortality when associated with the use of inotropics and reperfusion.

Impacto del balón intra-aórtico de contrapulsación en la mortalidad por choque cardiogénico secundario a infarto agudo del miocardio / Impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock secondary to acute myocardial infarction

Propósito del trabajo: Determinar el impacto del balón intra-aórtico de contrapulsación en la mortalidad por choque cardiogénico postinfarto agudo del miocardio. Método: 292 pacientes con infarto agudo del miocardio ingresaron a la unidad de cuidados intensivos coronarios en el período comprendido de febrero de 2001 a febrero del 2003, de los cuales 40 cumplieron los criterios de inclusión y exclusión, posteriormente fueron divididos en 2 grupos: choque cardiogénico temprano y tardío, se les asignó al azar y de forma ciega a recibir tratamiento a base de inotrópicos aislados e inotrópicos más balón intra-aórtico de contrapulsación. Resultados: Se observaron diferencias significativas en ambos grupos en los valores de la presión en cuña de la pulmonar (20.4 ± 1.6 vs 24.4 ± 1.50, p = 0.0004) y el índice cardíaco (2.06 ± 0.7 vs 1.65 ± 0.18, p = 0.0002). El grupo de choque tardío presentó una mayor mortalidad (25.9% vs 61.5%, p < 0.05), los pacientes que recibieron apoyo con balón mostraron una disminución en la mortalidad del 66% y 69% en choque temprano y tardío respectivamente. Conclusiones: El uso del balón intra-aórtico de contrapulsación en los pacientes que desarrollan choque cardiogénico post IAM disminuye la mortalidad, como coadyuvante con el uso de inotrópicos y angioplastía primaria.

Objective: To determine the impact of the intra-aortic balloon pump in the mortality due to cardiogenic shock post-acute myocardial infarction. Methods: In a two-year period, 292 patients with acute myocardial infarction were admitted to the coronary intensive care unit, 40 were included in the study. Afterwards, patients were divided in two groups: early cardiogenic and late cardiogenic shock, and they were assigned randomly and blind to treatment with inotropics and inotropics plus intra-aortic balloon pump. Results: There were significant differences in the measurements of pulmonary wedge pressure (20.4 ± 1.6 vs 24.4 ± 1.50, p = 0.0004) and the cardiac index (2.06 ± 0.7 vs 1.65 ± 0.18, p = 0.0002) between the two groups. The late cardiogenic shock group showed an increased mortality (25.9% vs 61.5%, p < 0.05). Patients treated with inotropics + balloon, in both early and late shock groups, showed a reduction in mortality of 66% and 69%, respectively. Conclusions: The use of the intra-aortic balloon pump in the treatment of cardiogenic shock post acute myocardial infarction reduces the mortality when associated with the use of inotropics and reperfusion. (Arch Cardiol Mex 2005; 75: 260-266).

Levosimendan: Nueva estrategia en el manejo de la falla cardíaca / Levosimendan: A new strategy in the treatment of heart failure

La insuficiencia cardíaca congestiva se ha considerado como un grave problema de salud. De manera tradicional, la insuficiencia cardíaca ha sido manejada con diferentes fármacos, como son los diuréticos, digital, inotrópicos del tipo de las catecolaminas y no catecolaminas; sin embargo, el manejo de los mismos, también tienen efectos secundarios en donde se incluyen la génesis de las arritmias e incluso la muerte. Un nuevo grupo de drogas recientemente ha impactado en el manejo de los pacientes con insuficiencia cardíaca aguda y crónica, estos son los sensibilizadores de calcio, que actúan incrementando la contractilidad miocárdica, sin aumentar la liberación del calcio citosólico. El levosimendan, es un sensibilizador de calcio que además de aumentar la contractilidad, posee efecto vasodilatador por activación de los canales de K(ATP), siendo ambos mecanismos los que ofrecen una opción terapéutica en la falla cardíaca. Varios estudios han comprobado la eficacia y seguridad de la droga en diferentes estadios y poblaciones, por lo que se considera en la actualidad que el uso del levosimendan es una alternativa real y segura de tratamiento en aquellos pacientes con falla ventricular aguda o crónica que necesiten soporte farmacológico endovenoso.

Congestive heart failure is a long standing health issue. Traditionally, heart failure has been treated with a wide array of drugs such as diuretics, digitalis, catecholamine and non catecholamine inotropics, although treatment with these drugs bears adverse effects, such as the generation of arrhythmia and even death. A new class of drugs has recently exerted a positive impact on the treatment of patients with heart failure; these are the calcium sensitizers that enhance myocardial contractility without increasing cytosolic calcium. Levosimendan is a calcium sensitizer that, besides increasing contractility, has a vasodilating effect due to the activation of K(ATP) channels, being both mechanisms responsible for an advantageous therapeutic option. Different studies have proven the efficiency and safety profile of the drug on various scenarios and populations; thereby considering levosimendan a real and safe alternative treatment for patients with acute or chronic ventricular failure that need intravenous pharmacological support.

[Vasopressin: uses in cardiovascular practice]. / Vasopresina: usos en la práctica cardiovascular.

Vasopressin is secreted by the neurohypophysis influenced by many variables; among them the most important and known is the osmotic pressure (osmotic regulation) of body fluid. Other factors that modify this hormone's secretion are changes in blood volume and blood pressure, which contribute significantly to hemodynamic recovery. Vasopressin receptors are located in different sites, and their stimulation generate also generates different physiological responses. The receptors are of two types, V1 and V2. The usefulness of exogenous vasopressin has been proven in many clinical situations, refractory cardiac arrest, septic shock, vasodilator shock, postcardiotomy shock, and vasoplegic shock, with promising results. At present, enough scientific support exists for the use of this antidiuretic hormone (vasopressin) in clinical practice.