RESUMEN
In the countries of Central America, South America and the Caribbean, there has been a dramatic rise in obesity, the metabolic syndrome, hypertension and other cardiovascular risk factors in the last few decades. Epidemiological evidence highlights a consistent correlation between obesity and hypertension, and the presence of obesity predisposes an individual to a greater risk of hypertension although the mechanisms remain unclear. Obesity and hypertension are two key drivers of the cardio-renal disease continuum, and patients with uncontrolled cardiovascular risk in their mid-life will likely have an increased risk of clinical cardiovascular and renal outcomes in old age. This article summarizes the current status for the prevalence and consequences of obesity and hypertension in Latin America, with the aim of initiating a call to action to all stakeholders for greater implementation of primary prevention strategies, particularly in the young (AU)
En los países centroamericanos, sudamericanos y caribeños se ha producido un incremento alarmante en cuanto a obesidad, síndrome metabólico, hipertensión y otros factores de riesgo cardiovascular en las últimas décadas. La evidencia epidemiológica destaca una correlación consistente entre obesidad e hipertensión, y la presencia de obesidad predispone al individuo a un mayor riesgo de hipertensión, aunque los mecanismos siguen siendo inciertos. La obesidad y la hipertensión son claros impulsores esenciales de las cifras reales de las enfermedades cardio-renales, y los pacientes con riesgo cardiovascular descontrolado en la mediana edad tendrán, con toda probabilidad, un riesgo incrementado de resultados clínicos cardiovasculares y renales en la vejez. Este artículo resume el estatus actual de la prevalencia y consecuencias de la obesidad e hipertensión en Latinoamérica, con el objetivo de iniciar una llamada a la acción a todos los participantes, de cara a implementar unas mayores estrategias de prevención primaria, especialmente en los jóvenes (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Obesidad/diagnóstico , Obesidad/etiología , Hipertensión/epidemiología , Síndrome Metabólico/epidemiología , Presión Arterial , Enfermedades Cardiovasculares/epidemiología , América Latina/epidemiología , Síndrome Metabólico/complicaciones , Hipertensión/complicaciones , Dislipidemias/epidemiología , Diabetes Mellitus Tipo 2/epidemiologíaRESUMEN
In the countries of Central America, South America and the Caribbean, there has been a dramatic rise in obesity, the metabolic syndrome, hypertension and other cardiovascular risk factors in the last few decades. Epidemiological evidence highlights a consistent correlation between obesity and hypertension, and the presence of obesity predisposes an individual to a greater risk of hypertension although the mechanisms remain unclear. Obesity and hypertension are two key drivers of the cardio-renal disease continuum, and patients with uncontrolled cardiovascular risk in their mid-life will likely have an increased risk of clinical cardiovascular and renal outcomes in old age. This article summarizes the current status for the prevalence and consequences of obesity and hypertension in Latin America, with the aim of initiating a call to action to all stakeholders for greater implementation of primary prevention strategies, particularly in the young.
Asunto(s)
Hipertensión/epidemiología , Obesidad/epidemiología , Adolescente , Adulto , Edad de Inicio , Síndrome Cardiorrenal/epidemiología , Síndrome Cardiorrenal/etiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Niño , Terapia Combinada , Comorbilidad , Manejo de la Enfermedad , Estudios Epidemiológicos , Femenino , Humanos , Hipertensión/prevención & control , Hipertensión/terapia , América Latina/epidemiología , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/terapia , Persona de Mediana Edad , Morbilidad/tendencias , Obesidad/prevención & control , Obesidad/terapia , Obesidad Infantil/epidemiología , PrevalenciaRESUMEN
An aneurysm of the left anterior descending coronary artery with thrombosis in its lumen in a 36-year-old woman who had an acute myocardial infarction is described. Although the aneurysm was detected by angiography, a transesophageal study provided new specific details of the exact site of origin of the aneurysm, as well as vascular thrombosis.
Asunto(s)
Aneurisma Coronario/diagnóstico por imagen , Trombosis Coronaria/diagnóstico por imagen , Ecocardiografía Transesofágica , Adulto , Aneurisma Coronario/complicaciones , Trombosis Coronaria/complicaciones , Femenino , Humanos , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiologíaRESUMEN
Our purpose was to investigate the long term outcome of Hancock bioprostheses at our Hospital. There were 128 bioprostheses, with histopathological study on 17 of them. The 12.8 years follow-up disclosed dysfunction on 48.18% with an annual dysfunction rate of 3.34 +/- 1.3. One half of the patients with prosthetic dysfunction were re-operated. A comparison of our results is made with those of the literature, either with biological or mechanical prostheses.
Asunto(s)
Bioprótesis , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Análisis Actuarial , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de PrótesisRESUMEN
To establish the prevalence and characteristics of silent myocardial ischemia in patients with unstable angina and acute myocardial infarction and its possible correlation with coronary artery lesions; two groups patients were studied, fifteen with unstable angina and fifteen with acute myocardial infarction. In all patients a continuous 24 hours ECG recording was made with a solid state microprocessor for ST variation analysis, and all underwent coronary arteriography and ventriculography, the severity of coronary heart disease was determined by Gensini scoring system and the coronary angiography morphology was studied. In 86% patients with unstable angina ischemic ST changes were found, 90% of these episodes were silent. There were 66% of the patients with acute myocardial infarction and ST ischemic changes of these 75% were silent. There was no correlation with the ischemic myocardium score index, nor with the angiographic morphology or the heart rate. Therefore it can be said that myocardial ischemia is a result not only of anatomic factors but of many others such as vasoconstriction, endothelial, myocardial, systemic and hemorheological alterations.
Asunto(s)
Angina Inestable/complicaciones , Enfermedad Coronaria/complicaciones , Infarto del Miocardio/complicaciones , Anciano , Angina Inestable/fisiopatología , Angiocardiografía , Enfermedad Coronaria/fisiopatología , Electrocardiografía , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Infarto del Miocardio/fisiopatología , Estudios ProspectivosRESUMEN
The clinical files from the National Institute of Cardiology "Ignacio Chávez" were reviewed, we found 26 corroborated cases of ruptured aneurysms Valsalva's sinus. There is predominance of the male sex in proportion 3:1 and the median age when the diagnosis was made was 22 years. 77% of these cases were in N.Y.H.A. clinical class I or II and the main symptom was dyspnoea on exertion. On the physical examination a continuous murmur or sistolo-diastolic murmur was heard over precordium in 92% of the cases and a hyperkinetic circulatory regimen. Only in 23% of these patients the diagnosis was suspected and the more common confusion was with the V.S.D. associated with aortic incompetence. On the E.K.G. we found data with volumetric overload of the right heart in 15 cases. The hemodynamic study confirmed the diagnosis only in 60%. The aortic valve was substituted for associated incompetence in 12 cases and the pathological study revealed fibromixoid degeneration in 9 cases and only fibrosis in the remaining 3. The sinus of Valsalva more affected was the right coronary and the chamber where the rupture was more frequent was the right ventricle in 73% of the cases. We conclude that the ruptured aneurysms of the Valsalva's sinus is rather frequent among the congenital heart diseases and has particular clinical data and special features in making a precise diagnosis.
Asunto(s)
Rotura de la Aorta/diagnóstico , Seno Aórtico , Adolescente , Adulto , Rotura de la Aorta/epidemiología , Insuficiencia de la Válvula Aórtica/diagnóstico , Niño , Estudios Transversales , Diagnóstico Diferencial , Disnea/etiología , Femenino , Defectos del Tabique Interventricular/diagnóstico , Humanos , Masculino , México/epidemiología , Seno Aórtico/anomalíasRESUMEN
High Altitude Pulmonary Edema (HAPE) generally appears in persons who climb over 2,500 meters (8,300 feet) above sea level, or in residents at altitudes beyond 3,000 meters (10,000 feet) who go down to sea level for a short period of time and return to their place of residence. Although dozens of cases have been reported, their etiopathogenesis is unknown, although both hydrostatic and permeability factors have been implied in its genesis. In this paper we describe the first HAPE case reported in the national literature and the factors implied in its physiopathology are reviewed.
Asunto(s)
Altitud , Edema Pulmonar/etiología , Adulto , Humanos , Masculino , Edema Pulmonar/fisiopatologíaRESUMEN
Seventeen patients with diagnosis of acute myocardial infarction with right ventricular extension were studied. All of them had evidence of contractile impairment of the right ventricle as shown by elevated filling pressure of the right ventricle, low systolic pulmonary pressure and low left ventricular filling pressure and cardiac output. These patients were treated with fluid infusion into the pulmonary artery besides other treatment measures for myocardial infarction in order to improve the filling pressure of the left ventricle and the cardiac output without stressing the right ventricle. The results obtained with this approach, which was maintained for 22 hours, showed a significant improvement in the stroke work indices of both ventricles and also in the cardiac output with a decrease in peripheral resistence without ever loading the ventricles. We analyze the physiological basis for using this procedure and also the complications that can occur. Our results show that the infusion of fluid into the pulmonary artery improves the hemodynamic situation of these patients and protects a damaged right ventricle.
Asunto(s)
Glucosa/uso terapéutico , Infarto del Miocardio/terapia , Arteria Pulmonar , Anciano , Presión Sanguínea , Resistencia Capilar , Gasto Cardíaco , Femenino , Glucosa/administración & dosificación , Insuficiencia Cardíaca/prevención & control , Ventrículos Cardíacos/fisiopatología , Humanos , Infusiones Intraarteriales , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Volumen SistólicoRESUMEN
Twenty six cases of inferior vena cava interruption for the treatment of recurrent pulmonary embolism are reviewed. Ten patients were treated with inferior vena cava ligation while in the other 16 a Mobin-Uddin umbrella was placed. The recent and late complications of both groups were analyzed. The most common complication of the inferior vena cava ligation was edema of the lower extremities in 40% of the patients. In the Mobin-Uddin group, the most frequent complication was the recurrence of thrombophlebitis in lower limbs, that appeared in 50% of the cases studied. We conclude that inferior vena cava ligation may be more beneficial to these patients because the long term complications are fewer in number and severity.
Asunto(s)
Filtración/instrumentación , Embolia Pulmonar/cirugía , Vena Cava Inferior/cirugía , Edema/etiología , Femenino , Humanos , Pierna , Ligadura , Masculino , México , Complicaciones Posoperatorias , Embolia Pulmonar/mortalidad , Recurrencia , Tromboflebitis/etiologíaRESUMEN
Se estudiaron los expedientes de 26 enfermos que se sometieron a interrupcion del drenaje de la vena cava inferior para tratamiento de embolismo pulmonar repetitivo a pesar de terapia anticoagulante. Diez de los pacientes se sometieron a ligadura de vena cava inferior y los otros diez y seis a colocacion de filtro de Mobin-Uddin; se analizaron las complicaciones de ambos procedimientos tanto en el periodo hospitalario como durante su evolucion a largo plazo. Los resultados indican que la complicacion mas frecuente en los casos de la ligadura de la vena cava inferior es el edema de miembros inferiores que llega hasta un 40% de los pacientes. En los casos de filtros de Mobin-Uddin es muy llamativa la recurrencia de fenomenos de tromboflebitis hasta en un 50% de los casos. Se concluye que en relacion a las complicaciones tardias, es preferible la ligadura de vena cava inferior en estos pacientes, ya que tienen un numero menor de complicaciones a largo plazo. Se hace un analisis de los mecanismos fisiopatologicos que pueden tener efecto sobre los resultados encontrados
Asunto(s)
Humanos , Masculino , Femenino , Ligadura , Embolia Pulmonar , Vena Cava InferiorRESUMEN
Se estudiaron 17 pacientes con diagnostico de infarto agudo del miocardio con extension al ventriculo derecho y que tuvieron datos de falla mecanica de este ultimo, caracterizada por presion de llenado del ventriculo derecho elevada, presion sistolica pulmonar disminuida, junto con datos de bajo gasto cardiaco. A estos enfermos se les infundieron liquidos en la arteria pulmonar como parte del tratamiento del infarto con el fin de mejorar el llenado del ventriculo izquierdo y el gasto cardiaco, sin sobrecargar volumetricamente al ventriculo derecho. Los resultados obtenidos con este sistema de tratamiento por un lapso promedio de 22 horas indican una mejoria significativa en los indices de trabajo de ambos ventriculos y en el gasto cardiaco con una disminucion de las resistencias perifericas, sin evidencia de sobrecarga ventricular. Se analizan los mecanismos fisiologicos que justifican este procedimiento y tambien las complicaciones atribuibles al mismo. Nuestros resultados indican que la infusion de liquidos en la arteria pulmonar mejora las condiciones hemodinamicas de los pacientes y protege a un ventriculo derecho lesionado
Asunto(s)
Humanos , Infusiones Intraarteriales , Infarto del Miocardio , Arteria Pulmonar , Ventrículos CardíacosRESUMEN
In order to ascertain myocardial damage secondary to D.C. cardioversion, we studied 20 patients from the National Institute of Cardiology Ignacio Chávez, in whom an elective electric countershock was applied because of rythm abnormalities. We studied the patients before and after the procedure with E.C.G., enzyme levels (SGOT, LDH, CKMB), and myocardial scintigraphy to detect possible myocardial lesions. Only in two patients the CKMB rose to a significant level. The ECG changes were significant in 40 per cent, and myocardial scintigraphy was positive in a diffuse pattern in 50 per cent of the cases. The interpretation of the three studies as a whole, showed an absolute lack of correlation between them. We conclude that DC countershock is a safe and innocuous procedure, to which no myocardial damage can be attributed, if it is used within the normal limits of clinic.
Asunto(s)
Cardioversión Eléctrica/efectos adversos , Traumatismos por Electricidad/etiología , Lesiones Cardíacas/etiología , Adulto , Anciano , Arritmias Cardíacas/terapia , Pruebas Enzimáticas Clínicas , Creatina Quinasa/sangre , Electrocardiografía , Femenino , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , TecnecioRESUMEN
En el Servicio de Urgencias y Unidad Coronaria del Instituto Nacional de Cardiologia Ignacio Chavez, se estudio un lote de 20 enfermos a quienes se les hizo electroversion electiva. Se hicieron determinaciones de enzimas sericas, centelleografia del miocardio y electrocardiogramas tratando de demonstrar lesion miocardica imputable al procedimiento terapeutico. En ningun enfermo habia datos de patologia que pudiese alterar los resultados de laboratorio. Los resultados obtenidos permiten aseverar que la electroversion es un procedimiento eficaz, seguro e inocuo ya que no encontramos datos que sugiriesen dano sobre la fibra miocardica atribuible al uso de corriente electrica