RESUMEN
It is estimated that 5% of patients with heart failure (HF) will progress to end-stage disease refractory to medical therapy and might require prolonged hospitalisation with inotropic support. We present the case of a patient with end-stage HF who was admitted with cardiogenic shock. During his hospitalisation, he required prolonged intravenous vasopressor therapy due to refractory hypotension. He did not qualify for heart transplantation or left ventricular-assist device strategies. Midodrine was started as a last resort attempt to wean off vasopressors. After 5 days of therapy, the patient was weaned entirely off vasopressors and was discharged home for hospice care. By the time of discharge, he was tolerating low-dose carvedilol along with midodrine. We propose midodrine as a reasonable alternative for patients with end-stage HF with reduced ejection fraction and refractory hypotension, who are dependent on intravenous vasoactive drugs and are not candidates for advanced HF therapies.
Asunto(s)
Insuficiencia Cardíaca , Hipotensión , Midodrina , Masculino , Humanos , Midodrina/uso terapéutico , Vasoconstrictores/uso terapéutico , Hospitalización , Insuficiencia Cardíaca/tratamiento farmacológico , Hipotensión/tratamiento farmacológicoRESUMEN
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 RiesgoRESUMEN
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.