RESUMEN

We report clinical and molecular mechanisms relating the process of inflammation involved in the progression of obesity and the metabolic syndrome, emphasizing the cardiovascular problems developed in Hispanic populations. Namely, the incidence, component characteristics and complications of obesity and metabolic syndrome in island Puerto Ricans are described and evidence is presented supporting the fact that the metabolic syndrome may be milder in Puerto Rico than in the mainland United States because it is characterized by less aggressive coronary artery disease and a relatively normal lipid profile. Moreover, data supports the fact that increased serum cholesterol levels produce less myocardial infarctions in Puerto Rico than in mainland Hispanics and Caucasians. In addition, the incidence of ventricular tachycardia, a complication caused by remodeling and ischemia of the heart, may be lower in Puerto Rico than in the United States, although the prevalence of the metabolic syndrome is higher in the island. On the other hand, there is evidence of a rising epidemic of obesity and vascular inflammation in Puerto Rico that suggests that cardiovascular morbidity and mortality in the island will continue to increase in the future decades.

Asunto(s)

Inflamación/epidemiología , Síndrome Metabólico/epidemiología , Obesidad/epidemiología , Colesterol/sangre , Hispánicos o Latinos , Humanos , Incidencia , Inflamación/etnología , Inflamación/patología , Síndrome Metabólico/etnología , Síndrome Metabólico/fisiopatología , Obesidad/etnología , Obesidad/fisiopatología , Puerto Rico/epidemiología , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/etnología , Estados Unidos/epidemiología

RESUMEN

Psoriasis is an immune disorder characterized by chronic activation of systemic inflammation. Morbidity and mortality in patients with psoriasis is attributed mainly to cardiovascular disease. There are studies in Caucasians and African- Americans, but little is known about how psoriasis is associated to coronary artery disease (CAD) in Hispanics. We intend to describe the angiographic findings of a group of Puerto Rican patients with psoriasis. Retrospective cohort study of 46 patients with psoriasis were studied. Coronary angiographic reports were reviewed, and collected data was statistically analized. Population median age was 56, and 72% were males. Of the 46 patients, 27 had CAD by angiographic criteria (58.7%). Twelve patients were referred to bypass graft surgery, 8 underwent coronary stent placement, and 7 were treated medically. Whether psoriasis can be considered a risk factor for developing CAD is still on debate. More than 50% of our patients with psoriasis had angiographic evidence of CAD. Adjusting for traditional cardiovascular risk factors, we found no significant association (p>0.05) with CAD. We believe that inflammation plays a contributing role in the increased risk of CAD in these patients. The importance of this study relies on being the first retrospective analysis in a group of Hispanics trying to determine an association between coronary artery disease and psoriasis when in Puerto Rico, coronary artery disease is 30% less than in the United States.

Asunto(s)

Enfermedad de la Arteria Coronaria/complicaciones , Hispánicos o Latinos , Inflamación/complicaciones , Psoriasis/etiología , Estudios de Cohortes , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/epidemiología , Femenino , Humanos , Inflamación/epidemiología , Masculino , Persona de Mediana Edad , Psoriasis/epidemiología , Puerto Rico/epidemiología , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

Two groups of patients were studied to find out the levels of angiotensin-II and endothelin-I in the coronary and peripheral circulation. Group A consisted of eight patients with diabetes mellitus type 2 and coronary artery disease; and Group B with diabetes mellitus without coronary artery disease. Significant differences were found between Group A and B in the levels of both peptides peripherally and intracoronary. This shows the importance of these peptides in the origin of coronary artery disease and progression of the disease in diabetics with coronary artery disease.

Asunto(s)

Angiotensina II/metabolismo , Enfermedad de la Arteria Coronaria/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Endotelina-1/metabolismo , Enfermedad de la Arteria Coronaria/complicaciones , Progresión de la Enfermedad , Humanos

RESUMEN

Higher doses and consumption of energy drinks leads to cardiovascular effects and potential consequences. Principal components found in energy drinks such as caffeine, guarana and taurine has been related to dilatation, aneurysm formation, dissection and ruptures. There is no evidence showing an integration of these components and its effects in endothelium and aortic walls due to higher levels of pressure during exercises. We report a case of a 44 years male with celiac trunk and branches dissection due to long-term consumption of energy drinks and intense exercise routine. Our proposition relates cell and vessel walls alterations including elasticity in endothelial wall due to higher blood pressure, resistance by intense exercise routine and long-term consumption of energy drinks.

Asunto(s)

Arteria Celíaca/patología , Bebidas Energéticas/efectos adversos , Ejercicio Físico/fisiología , Entrenamiento de Fuerza , Adulto , Presión Sanguínea/efectos de los fármacos , Cafeína/efectos adversos , Humanos , Masculino , Paullinia/efectos adversos , Taurina/efectos adversos , Factores de Tiempo

RESUMEN

The objective was to describe the metabolic outcomes 12 months after bariatric surgery (Roux-N-Y) in morbidly obese Hispanic patients, and evaluate the correlation between weight loss and the observed changes. Medical records from a hundred-and-two Hispanic obese patients who underwent bariatric surgery were identified at the University of Puerto Rico (UPR) Hospital. The following variables were obtained before and 12 months after surgery: Body Mass Index (BMI), body weight, total cholesterol (TC), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS). Ninety-seven percent of patients underwent Roux-N-Y surgery; 79.4% were females and 44% were diabetics. We observed statistically significant reductions (p < 0.05) 12 months after surgery in: BMI -14.3 (± 6.2) kg/m2, weight -86.1 (± 34.4) Ibs, TC -17.9 (± 32.4) mg/dL, triglycerides -28.7(± 40.6) mg/dL, LDL-15.4 (± 30.6) mg/dL, and FBS -11.3 (± 23.5) mg/dL. HDL, instead increased +5.22 (± 12.9) mg/dL (p < 0.0006). Gastric bypass surgery of the Roux-N-Y significantly improves the lipid profile and FBS levels in obese Hispanic patients. The poor correlation factor between weight loss and these variables suggests that other mechanisms, independent from weight loss, are responsible for these changes.

Asunto(s)

Glucemia/análisis , Derivación Gástrica , Hispánicos o Latinos , Lípidos/sangre , Adulto , Índice de Masa Corporal , Peso Corporal , Femenino , Humanos , Resistencia a la Insulina , Masculino , Síndrome Metabólico/metabolismo , Síndrome Metabólico/cirugía , Persona de Mediana Edad , Obesidad/metabolismo , Obesidad/cirugía , Periodo Posoperatorio , Puerto Rico/etnología , Estudios Retrospectivos , Estados Unidos , Pérdida de Peso

RESUMEN

UNLABELLED: Magnesium (Mg++), Potassium (K+) and Calcium (CA++) are important electrolytes in keeping a stable electrical status. The purpose of this study was to measure them in critically ill patients. METHODS: We evaluated the electrolytes in 28 consecutive patients. Eighteen were females and 10 males with mean age of 62 +/- 5 years. RESULTS: The admission diagnosis in 95% of the cases was congestive heart failure. Sixty-four percent of the patients had subnormal values of Mg++, 53% subnormal values of K+, and 28% subnormal values of CA++. Fourteen percent showed lower values of the three electrolytes and 35% only of Mg++ and K+ concomitantly. Twenty-eight percent showed prolonged QTC interval. All patients with prolonged QTC interval had low Mg++ and K+ levels. Twenty five percent of the patients showed atrial fibrillation, 25% ventricular tachycardia, and 3% junctional tachycardia. The ventricular tachycardia group had more electrolyte abnormalities than those with atrial fibrillation. None of the patients received Mg++ replacement during critical management while 50% received K+ replacement. CONCLUSION: This data shows physician overlook the Importance of Mg++ and K+ deficiency in critically ill patients.

Asunto(s)

Desequilibrio Ácido-Base/sangre , Enfermedad Crítica , Cardiopatías/sangre , Magnesio/fisiología , Desequilibrio Ácido-Base/etiología , Anciano , Cuidados Críticos/métodos , Complicaciones de la Diabetes/sangre , Pruebas Diagnósticas de Rutina , Electrocardiografía , Femenino , Cardiopatías/fisiopatología , Humanos , Hipertensión/sangre , Hipopotasemia/sangre , Hipopotasemia/etiología , Unidades de Cuidados Intensivos , Magnesio/sangre , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/sangre

RESUMEN

Metabolic syndrome is a cluster of risk factors for cardiovascular disease that affects an estimated 50 million Americans. The present article reviews the metabolic syndrome with respect to its definition, epidemiology, pathophysiology and management. A primary focus in research has been to elucidate the processes determined to cause insulin resistance, the fundamental mechanism underlying the metabolic syndrome. Namely, the incidence, component characteristics and complications of the metabolic syndrome in the island of Puerto Rico are described alongside the fact that the metabolic syndrome may be milder in Puerto Rico than in the mainland United States because it is characterized by less aggressive coronary disease and a relatively normal lipid profile. This suggests that the cardiovascular complications are more influenced by genetics and culture than diabetes mellitus and hypertension.

Asunto(s)

Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/complicaciones , Hispánicos o Latinos/genética , Hipertensión/complicaciones , Síndrome Metabólico/complicaciones , Fármacos Antiobesidad/uso terapéutico , Aterosclerosis/etiología , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/genética , Ritmo Circadiano , Terapia Combinada , Citocinas/metabolismo , Dieta Mediterránea , Terapia por Ejercicio , Predisposición Genética a la Enfermedad , Humanos , Inflamación , Resistencia a la Insulina , Síndrome Metabólico/etnología , Síndrome Metabólico/genética , Síndrome Metabólico/fisiopatología , Síndrome Metabólico/terapia , Puerto Rico/etnología , Sistema Renina-Angiotensina/fisiología , Factores de Riesgo , Tiazolidinedionas/uso terapéutico , Estados Unidos/epidemiología

RESUMEN

OBJECTIVE: There are extremely limited data on minority populations, especially Hispanics, describing the clinical epidemiology of acute coronary disease. The aim of this study is to examine the incidence rate of acute myocardial infarction (AMI), in-hospital case-fatality rate (CFR), and management practices among residents of greater San Juan (Puerto Rico) who were hospitalized with an initial AMI. METHODS: Our trained study staff reviewed and independently validated the medical records of patients who had been hospitalized with possible AMI at any of the twelve hospitals located in greater San Juan during calendar year 2007. RESULTS: The incidence rate (# per 100,000 population) of 1,415 patients hospitalized with AMI increased with advancing age and were significantly higher for older patients for men (198) than they were for women (134). The average age of the study population was 64 years, and women comprised 45% of the study sample. Evidence-based cardiac therapies, e.g., aspirin, beta blockers, ACE inhibitors/angiotensin receptor blockers, and statins, were used with 60% of the hospitalized patients, and women were less likely than men to have received these therapies (59% vs. 65%) or to have undergone interventional cardiac procedures (47% vs. 59%) (p<0.05). The in-hospital CFR increased with advancing age and were higher for women (8.6%) than they were for men (6.0%) (p<0.05). CONCLUSION: Efforts are needed to reduce the magnitude of AMI, enhance the use of evidence-based cardiac therapies, reduce possible gender disparities, and improve the short-term prognoses of Puerto Rican patients hospitalized with an initial AMI.

Asunto(s)

Infarto del Miocardio/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Cateterismo Cardíaco/estadística & datos numéricos , Fármacos Cardiovasculares/uso terapéutico , Comorbilidad , Manejo de la Enfermedad , Utilización de Medicamentos , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Infarto del Miocardio/terapia , Revascularización Miocárdica/estadística & datos numéricos , Factores de Riesgo , Distribución por Sexo , Sexismo , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos

RESUMEN

OBJECTIVE: Primary cardiac tumors are rare neoplasms in humans, of which the most common is the atrial Myxoma. The objective of this study was to find the incidence of these tumors at the Heart Center of Puerto Rico and the Caribbean. METHODS: This study was approved by the Institutional Review Board of the Medical Sciences Campus University of Puerto Rico to review the records at the Heart Center of patients with heart tumors in the last 14 years. RESULTS: The sample consists of 55 patients (78.9% were females and 24.1% were male) with a median age of 52 years. Sixty-five percent of patients lived in rural areas. Clinical presentations included shortness of breath (43.1%), chest pain (37.9%), asymptomatic (25%), palpitations (20.7%), neurologic symptoms (10.3%) and dizziness (6.9%). Electrocardiographic findings included normal sinus rhythm (53.4%), non-specific ST-T changes (32.8%), sinus tachycardia (20.7%), left atrial enlargement (10.3%) and atrial fibrillation (8.6%). A subgroup presenting with atrial fibrillation prior to diagnosis had left atrial myxoma. The tumors found, in descending order of frequency are: left atrial myxoma, right atrial myxoma, papillary fibroelastoma, hamartoma, lipoma and rhabdomyoma. We found a correlation between large left atrial myxoma and atrial fibrillation. CONCLUSION: The most frequent heart tumor was atrial myxoma. The larger myxomas were associated with atrial fibrillation.

Asunto(s)

Fibrilación Atrial/etiología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Neoplasias Cardíacas/diagnóstico , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Puerto Rico , Adulto Joven

RESUMEN

OBJECTIVE: The published literature suggests differences in presenting symptoms for acute myocardial infarction (AMI), management, and outcomes according to gender and age. However, limited information exists on this topic among Hispanics. METHODS: In Puerto Rican patients hospitalized with an initial AMI, we examined differences in presenting symptoms, effective cardiac therapies, and in-hospital mortality as a function of gender and age groups. We reviewed the medical records of patients hospitalized with a validated AMI in 12 greater San Juan, Puerto Rico hospitals during 2007. RESULTS: The average age of 1,415 patients hospitalized with a first AMI was 66 years and 45 % were women. Chest pain (81%) was the most prevalent acute presenting symptom with significant differences in its frequency between women (77%) and men (85%)(p<0.001). Right arm pain, shortness-of-breath/dyspnea, and sweating/ diaphoresis were most prevalent in patients 55-64 years old (45%), compared with patients 75 years and older (29%)(p<0.005). Relative to men and patients < 55 years old, coronary angiography/thrombolytic therapy and percutaneous coronary interventions were used less frequently in women and older patients (>75 years old). During hospitalization for AMI the in-hospital death rate was higher in women (8.6%) than men (6.0%), and increased with advancing age (p<0.05). CONCLUSION: These findings suggest significant gender and age differences in presenting symptoms, management, and early mortality in Puerto Ricans hospitalized with an initial AMI. It remains of considerable importance that health care personnel become aware of these gender and age differences to improve the management and outcomes of these patients.

Asunto(s)

Disparidades en Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Infarto del Miocardio/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico , Factores Sexuales

RESUMEN

Metabolic syndrome is a cluster of risk factors for cardiovascular disease that affects an estimated 50 million Americans. The present article reviews this syndrome with respect to its definition, epidemiology, pathophysiology, and management. A primary focus in research has been to elucidate the processes that have been determined to cause insulin resistance, the fundamental mechanism underlying metabolic syndrome; these processes are reviewed here along with the interplay of the syndrome with the renin-angiotensin system, circadian rhythm, and atherosclerosis. Lifestyle changes promoting exercise and a healthy diet can reduce the incidence and prevent the progression of metabolic syndrome; however, refractory cases may warrant drug therapy. Recent emphasis has been placed on targeting obesity and insulin resistance as new therapeutic modalities are developed. In this manuscript, the incidence, component characteristics, and complications of metabolic syndrome in island-living Puerto Ricans and other Hispanic populations are described. The fact that island patients suffering from the syndrome tend to have less aggressive coronary disease and relatively normal lipid profile compared to their stateside counterparts is also discussed.

Asunto(s)

Hispánicos o Latinos , Síndrome Metabólico/epidemiología , Humanos , Síndrome Metabólico/fisiopatología , Síndrome Metabólico/terapia , Puerto Rico/epidemiología

RESUMEN

UNLABELLED: The metabolic syndrome is probably one of the main medical problems in developing countries. Purpose of this investigation was to study the metabolic syndrome at the Puerto Rico and Caribbean Cardiovascular Center with emphasis on the cardiovascular complications. MATERIALS/METHODS: The medical charts in the last six years of the metabolic syndrome were evaluated at the PRCCC. RESULTS: One Hundred and Seventy-Three patients met the consensus criteria of the metabolic syndrome. The mean age was 60 years. Fifty-seven percent were males and 42% females. The mean body mass was 30 kg/m. The ejection fraction was subnormal (49 +/- 8%). The end systolic dimension of the left atrium was increased (45 +/- 10mm) when compared to normal. The incidence of atrial fibrillation was 16%. CONCLUSIONS: The metabolic syndrome in this sub-group of Hispanics, showed a higher incidence of atrial fibrillation without ventricular tachycardia. This is probably related to abnormal left ventricular and atrial function.

Asunto(s)

Fibrilación Atrial , Síndrome Metabólico , Hispánicos o Latinos , Humanos , Incidencia , Puerto Rico

RESUMEN

BACKGROUND: Induction immunotherapy in addition to standard triple therapy at the time of cardiac transplantation with cytolytic antibodies has been used in recipients with pre transplant renal impairment, and to prevent rejection. Recently, anti-interlukin-2 receptor monoclonal antibodies have been used for these purposes. A retrospective study of 58 heart transplant recipients was conducted to assess the effect of basiliximab, a chimeric anti-interlukin-2 receptor monoclonal antibody on biopsy proven acute rejection, serum creatinine, creatinine clearance, hospitalizations due to infection and mortality one year after transplantation. METHODS: A total of 58 heart transplant patient's charts were reviewed. All patients received triple immunosuppressive therapy with cyclosporine or tacrolimus, mycophenolate mofetil and prednisone post transplant. Basiliximab 20 mg on day 0 and day 4 was administered as induction therapy in a subgroup of patients. Both groups had similar pre transplant characteristics. Analysis was performed at intervals of 0-17 weeks, 18-34 weeks, 35-52 weeks, and one year overall. The incidence of acute rejection episodes, post-transplant renal function, patient survival and hospitalizations due to infection was analyzed. RESULTS: Twenty-seven patients received induction therapy with basiliximab and 31 patients did not. Basiliximab induction helped reduce acute rejection overall during the first year, with 22 episodes of rejection in the induction group, and 67 episodes in the no induction group. In the 0-17 weeks following transplantation there were 20 reported rejection episodes in the induction group versus 58 rejection episodes in the no-induction group, demonstrating also reduction of rejection by induction in this group. Basiliximab induction group had preserved renal function, with higher creatinine clearance at 1 year when compared to the no induction group. There were no differences between groups in terms of hospitalizations due to infections or mortality. CONCLUSION: Induction therapy with basiliximab significantly reduced the number of acute rejection within the first year after heart transplantation, without a negative impact on patient's renal function, risk of infection or mortality.

Asunto(s)

Anticuerpos Monoclonales/uso terapéutico , Trasplante de Corazón , Hispánicos o Latinos , Inmunosupresores/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Adulto , Basiliximab , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico , Estudios Retrospectivos

RESUMEN

Syncope is defined as a transient loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. Syncope is a prevalent disorder, accounting for 1-3% of emergency department visits and up to 6% of hospital admissions each year in the United States. The medical records of patients admitted at the Cardiovascular Center of Puerto Rico and the Caribbean after an episode of syncope were reviewed. The characteristics of this population and the etiologies of syncope were analyzed. One hundred and eighty six patients were identified with a primary diagnosis of syncope. A specific etiology was identified in 77.5% of the population studied whereas 22.6% had an unknown or unidentifiable cause. Cardiac syncope is associated with an increased mortality. Cardiac syncope was diagnosed in 60.8% of the evaluated patients. Although many etiologies for syncope exist, recent studies suggest categorization into cardiac, noncardiac, and unknown groupings for the purposes of future risk stratification.

Asunto(s)

Síncope , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico , Estudios Retrospectivos , Síncope/diagnóstico , Síncope/etiología

RESUMEN

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Asunto(s)

Anomalías de los Vasos Coronarios/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardiovasculares , Niño , Preescolar , Angiografía Coronaria , Anomalías de los Vasos Coronarios/epidemiología , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/cirugía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Puerto Rico/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female than in male recipients.

Asunto(s)

Trasplante de Corazón/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Femenino , Rechazo de Injerto/epidemiología , Trasplante de Corazón/mortalidad , Humanos , Incidencia , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Puerto Rico , Estudios Retrospectivos , Factores Sexuales , Análisis de Supervivencia , Factores de Tiempo

RESUMEN

Left ventricle (LV) cineventriculograms silhouettes in the right anterior oblique projection with simultaneous pressure micromanometry were assessed before and 10 min after administration of 1.25 mg enalaprilat intravenously to 10 patients with angina pectoris undergoing diagnostic cardiac catheterization. Cineventriculograms were divided into 20 areas using a modified Leighton's method for segmentalization of the LV and computed by the Janz's method for regional wall stress. Enalaprilat reduced preload and afterload in all cases. There was significant reduction in regional wall stress in 15 of the 20 segments after enalaprilat administration compared with baseline analysis. Segments without significant reduction in wall stress wee apical. There was significant reduction in global wall stress after enalaprilat. Thus, enalaprilat, in addition to improve hemodynamics decreasing both preload and afterload, reduces LV wall stress both regional and global. Clinical implications of these findings are in agreement with the wall stress reduction for prevention of ventricular remodeling with this agent in postinfarction patients.

RESUMEN

Twelve patients with ischemic heart disease had complete left and right catheterization before and after sublingual captopril. Hemodynamic measurements were ten (10) minutes apart and were monitored for thirty (30) minutes. The heart rate increased from 70 +/- 13 to 76 +/- 11 beats/minute (P = .04). There was no change in the arterial blood pressure, although the systemic vascular resistance decreased from 1500 +/- 400 to 1026 +/- 480 dynes-sec-cm-5 (P < .0001). The pulmonary artery pressure was increased 15 +/- 6 to 25 +/- 5mmHg (P = .005) and the pulmonary vascular resistance increased from 288 + 160 to 376 + 160 dynes-sec-cm-5 (P < .0001). The wedge pressure increased from 7 +/- 2 to 14 +/- 3 mmHg (P = .05). The cardiac output (CO) increased from 5.06 +/- 1.06 to 578 +/- 1.58 Lt/min. (P.05 =. The left ventricular end diastolic volume (LVEDV) increased from 128 +/- 40 to 145 +/- 37cc)P = .002), without change in the end systolic volume (ESV). The ejection fraction (EF) increased from 56 +/- 3 to 61 +/- 4 per cent (P = .02). These pressure changes appeared at two (2) minutes and disappeared after thirty (30) minutes. The study shows that, sublingual captopril produces a transient elevation of the pulmonary artery pressure and resistance

Asunto(s)

Humanos , Persona de Mediana Edad , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Isquemia Miocárdica/fisiopatología , Presión Arterial/efectos de los fármacos , Arteria Pulmonar/fisiopatología , Administración Sublingual , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Captopril/administración & dosificación , Captopril/farmacología , Cateterismo Cardíaco , Hemodinámica , Resistencia Vascular/efectos de los fármacos

RESUMEN

Ten elderly patientes each had a ventricular rate responsive pulse generator (Activitrax) placed in then to help correct severe conduction abnormalities; none had suspected ischemic heart disease. The pulse generator was programmed to a maximal pacing rate of 125 ppm, a medium activity threshold, and a rate response of 6. Six weeks after implantation of the pulse generator, the patients were evaluated before exercing and again when the pacing rate reached 125ppm. The evaluation protocol included an M-mode echocardiogram from which the following measurements were taken; the left ventricular end-diastolic volume (EDV), the end-systolic volume (ESV), the ejection fraction (EF), and the peak systolic pressure/end-systolic volume (PSP/ESV). The numerical values were recorded, clculated, and compared statically with the following results: the EDV increased from 91 ñ 10 to 125 ñ 20 cc (p < .05); the ESV decreased from 64 ñ 10 to 24 ñ 6cc (p < ..005); the EF increased from 41 ñ 5 to 61 ñ 10% (p < .05); and the PSP/ESV ratio increased from 1.70 ñ 1 to 4.10 ñ 2mm Hg/cc (p = 10). Also, during the maximal pacing rate, the septum of all patients showed paradoxical septal motion. All patients in our study have been asymptomatic and have shown an increase in their exercise capacity. We conclude that during exercise the left ventricular function ins influenced more by heart rate than by AV synchrony, as indicated by an elevated EDV in most patients

Asunto(s)

Humanos , Anciano , Arritmias Cardíacas/terapia , Técnicas Biosensibles , Frecuencia Cardíaca/fisiología , Marcapaso Artificial , Ventrículos Cardíacos/fisiología , Presión Arterial , Gasto Cardíaco , Ecocardiografía , Electrocardiografía , Volumen Sistólico , Función Ventricular Izquierda

Asunto(s)

Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Volumen Sistólico , Cateterismo Cardíaco , Válvula Mitral , Insuficiencia de la Válvula Mitral/fisiopatología , Estudios Retrospectivos