RESUMO
Peripheral arterial disease is a frequent under-diagnosed and poorly recognized clinical entity that can affect a great number of patients. Recognition of risk factors is crucial and a through evaluation of symptoms and use of diagnostic tools to better decide when an intervention is warranted. Lower extremity bypass surgery is one alternative method for treatment of PAD. It is indicated for type D and C lesions with low cardiac risk according to the TASC classification system. Preoperative assessment is imperative for every vascular procedure since it has been associated with major postoperative cardiovascular events; myocardial infarction being the most common. After excluding active disease, functional capacity and clinical risk predictors must be determined via METs and the Revised Cardiac Risk Index (RCRI), respectively. If a patient is considered to have a high cardiac risk, then noninvasive studies should be performed. Aspirin and a statin should be administrated preoperatively and postoperatively. Clopidogrel can be utilized as an alternative if a contraindication to aspirin exists. Periodic follow up consisting of clinical evaluations assessing and return or progression of symptoms of claudication, presence of pulses, ankle-brachial index (ABI) measurement, and smoking cessation counseling should be performed in every patient after vascular surgery.
Assuntos
Doença Arterial Periférica/cirurgia , Procedimentos Cirúrgicos Vasculares , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/classificação , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/uso terapêutico , Cuidados Pós-Operatórios , Pré-Medicação , Cuidados Pré-OperatóriosRESUMO
UNLABELLED: Peripheral artery disease (PAD) of the lower extremities is frequently underdiagnosed and undertreated. The results of screening for PAD in adults attending outpatient clinics at different sites in Puerto Rico from 2007 to 2010 are presented. METHODS: A total of 33 outpatients screening clinics were conducted at different sites throughout the Island. Following the ACC/AHA Guideline recommendations, asymptomatic patients who qualified were screened for PAD using the ankle-brachial index (ABI). An ABI < 0.9 was considered positive for PAD. We estimated the prevalence of PAD in the study population and used logistic regression models to assess factors associated with a positive screening test for PAD. RESULTS: A total of 933 patients were screened for PAD. Out of the 933 patients, the ABI was < 0.9 in 390 (41.8%) of them. Bivariate analysis showed a significant difference in PAD screening results by gender (P = 0.004) and history of arterial hypertension (P = 0.004). Regarding clinical characteristics, leg edema 44.7% (P = 0.001), intermittent claudication 40.3% (P = 0.002), distal extremity coldness 29.0% (P = 0.012), and weak lower extremity pulses 67.5% (P < 0.001) were more prevalent on patients with an ABI < 0.9. In the multivariate analysis, male gender (OR = 1.92, 95% CI: 1.18, 3.11) and arterial hypertension (OR = 2.16, 95% CI: 1.28, 3.65) were significantly associated with PAD after adjusting for specific confounders. CONCLUSIONS: Arterial hypertension, cigarette smoking, diabetes mellitus, and dyslipidemia are known key factors in development of PAD. Practicing physicians must be aware of the importance of an early diagnosis of PAD, particularly in the asymptomatic patient, so as to institute preventive and management measures.
Assuntos
Hipertensão , Doença Arterial Periférica , Humanos , Prevalência , Porto Rico , Fatores de RiscoRESUMO
The metabolic syndrome is one of the most discussed topics in the past 15 years. It is a collection of risk factors that includes insulin resistance, central obesity, arterial hypertension, and atherogenic dyslipidemia. The presence of these risk factors increases the probability of developing diabetes mellitus and cardiovascular disease, increasing coronary and cardiovascular mortality. The prevalence of the metabolic syndrome in the US has increased in the past years due to an increased incidence of obesity and physical inactivity. Diagnosis of the metabolic syndrome can be done with the use of established criteria by the NCEP-ATP III and the WHO. The principal treatment for this condition is to modify life styles, most importantly, diet and exercise. In many cases, this intervention alone is not sufficient to control these risk factors and a more aggressive intervention is required, including drugs directed to each risk factor independently to avoid complications due to the development of cardiovascular disease associated to the syndrome.
Assuntos
Doenças Cardiovasculares/etiologia , Síndrome Metabólica/complicações , Adulto , Idoso , Diabetes Mellitus Tipo 2/etiologia , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Resistência à Insulina , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Prevalência , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Organização Mundial da SaúdeRESUMO
Data of the transcatheter radio frequency ablations for patients with supraventricular tachycardia conducted in Puerto Rico is presented. One group includes the first 100 patients performed from September 1994 to March 1997 at the Cardiovascular Center of Puerto Rico and the Caribbean and the Second group includes 157 ablations done in the year 2003. Ablations performed in the different types of supraventricular tachycardias is analyzed including success rates and complications. Results are compared to those reported in the 1998 NASPE registry. The results obtained demonstrated a high successful rate of procedures with minimal complications in both series of patients. One procedure related death occurred in the 2003 year group and none in the earlier group.
Assuntos
Ablação por Cateter/métodos , Taquicardia Supraventricular/cirurgia , Adulto , Humanos , Porto Rico , Resultado do TratamentoRESUMO
Pulmonary embolism is a medical condition frequently overlooked in patients who present clinical symptoms that may suggest other more common cardiovascular conditions. As a result, missing such a diagnosis may unfortunately cost many lives. In this article the pathogenesis, etiologies and clinical features of this illness is reviewed. The diagnostic tools as well as the medical treatment available at hand today in the management of this condition is also discussed.