RESUMEN
Peripartum cardiomyopathy (PPCM) is a condition that affects women during the reproductive years in the late pregnancy period and/or early postpartum period. Although it is associated with several risk factors and various hypotheses exist of its etiology the cause of this disorder is still unknown. Standard therapy for PPCM is the same as for heart failure. Studies examining new therapeutic approaches are adding to the armamentarium available to physicians treating patients with PPCM. Despite all the current knowledge the mortality rates associated with PPCM remain relatively high. This article is a review of the current knowledge of etiology, diagnosis, treatment and prognosis of PPCM and attempts to present areas of need of further research.
Asunto(s)
Humanos , Femenino , Cardiomiopatías/etiología , Complicaciones Cardiovasculares del Embarazo/etiología , Periodo Posparto , Fármacos Cardiovasculares/uso terapéutico , Cardiomiopatías/diagnóstico , Cardiomiopatías/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Embarazo , Factores de RiesgoRESUMEN
Physicians are frequently concerned with the management of the surgical risk in patients with heart disease requiring non cardiac surgery. A preoperative evaluation helps to assess the cardiac risk for the planned surgery and helps to take measures to reduce that risk. We summarize the essentials in evaluating patients with coronary artery disease, valvular heart disease, arterial hypertension, arrhythmias, permanent pacemaker bearers, and those with congestive heart failure in order to prevent cardiac complications during the required surgery. Special attention has been given to the functional capacity, cardiac risk present, presence or absence of left ventricular dysfunction and the institution of protective measures. The usefulness of the ACC AHA guidelines has been summarized
Asunto(s)
Humanos , Anciano , Factores de Edad , Arritmias Cardíacas , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Procedimientos Quirúrgicos Operativos/efectos adversos , Medición de Riesgo , Enfermedad Coronaria , Electrocardiografía , Urgencias Médicas , Ejercicio Físico , Enfermedades de las Válvulas Cardíacas , Hipertensión/complicaciones , Insuficiencia Cardíaca , Marcapaso Artificial , Factores de Riesgo , Disfunción Ventricular IzquierdaRESUMEN
Peripheral arterial disease results from the atherosclerotic involvement of arteries of the upper and lower extremities as well as that of the renal and carotid arteries. In view of the importance of its early recognition we have summarized the clinical manifestations, diagnostic procedures and tests, and the current medical and surgical management including percutaneous revascularization. Algorithms that guide in the diagnostic steps and management decisions have been presented.
Asunto(s)
Humanos , Arteriopatías Oclusivas/diagnóstico , Enfermedades Vasculares Periféricas/diagnóstico , Arteriopatías Oclusivas/tratamiento farmacológico , Arteriopatías Oclusivas/cirugía , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Enfermedades Vasculares Periféricas/cirugía , Factores de Riesgo , Procedimientos Quirúrgicos Vasculares , Vasodilatadores/uso terapéuticoRESUMEN
The therapy for hypertension utilizing diuretics and beta-blockers induces metabolic and biochemical alterations that blunt the possible beneficial effects of blood pressure reduction in coronary artery disease risk. The utilization of other antihypertensive medications with the capacity of improving cardiovascular risk factors, like diabetes and dyslipidemias is recommended.
Asunto(s)
Hipertensión/tratamiento farmacológico , Antihipertensivos/uso terapéutico , Humanos , Hipertensión/mortalidad , Hipertensión/fisiopatologíaRESUMEN
Antihypertensive Therapy has been ineffective in reducing the incidence of coronary artery disease. It has been suggested that the metabolic and biochemical alterations induced by some antihypertensive drugs may be responsible for their failure to reduce cardiovascular mortality in patients with hypertension. Hypertension is only one of multiple coronary risk factors associated to insulin resistance. This cluster of risk factors is call "The Syndrome of Insulin Resistance" by some and "Syndrome X" by Reaven and others. Is important to know this information when pharmacological antihypertensive therapy is contemplated.
Asunto(s)
Antihipertensivos/farmacología , Hipertensión/metabolismo , Resistencia a la Insulina , Antihipertensivos/uso terapéutico , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/prevención & control , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Enfermedad Coronaria/prevención & control , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Incidencia , Modelos Biológicos , Obesidad/complicaciones , Factores de Riesgo , SíndromeRESUMEN
The efficacy and safety of enalapril and its effects on the quality of life were evaluated in 1017 Puerto Rican patients with uncomplicated mild to moderate essential hypertension. Enalapril was administered for 4 weeks in an open label, noncomparative study. Initially, patients received enalapril 5 mg and the dosage was titrated upwards, according to response, to a maximum of 20 mg/day. The goal of therapy was to achieve a diastolic blood pressure (DBP) less than 90 mm Hg. The study included 468 male and 545 female patients (mean age 52.6 +/- 11.9 years). A subgroup of 294 elderly patients was also evaluated (mean age 65.9 +/- 6.1 years). Mean blood pressure decreased from 157/99 mm Hg to 138/84 mm Hg (p less than 0.0001) in 966 patients who received enalapril as monotherapy. Mean blood pressure decreased from 164/99 mm Hg to 143/85 mm Hg (p less than 0.0001) in the elderly patients. After 4 weeks of enalapril monotherapy, 67% of the patients had a DBP less than 90 mm Hg. Enalapril was very well tolerated. Headache and dizziness were the most frequently reported side effects. Among the patients who completed a quality of life questionnaire, more than 70% reported feeling the same or better and less than 2% reported feeling worse after enalapril therapy. In conclusion, enalapril seems to be an excellent alternative as initial therapy in young and elderly Puerto Rican hypertensive patients.