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2.
Arch Cardiol Mex ; 91(4): 453-457, 2021 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-33601404

RESUMO

Objective: To determine the incidence of undiagnosed atrial fibrillation in patients with an ischemic cerebral vascular event. Methods: A descriptive cross-sectional design was carried out in patients older than 18 years with a diagnosis of ischemic cerebral vascular event, attended in the emergency department. The sample size was made up of the total clinical records of patients with a diagnosis of ischemic cerebral vascular event (n = 199). All patients who underwent electrocardiogram were included. Age and sex were studied; history of diabetes mellitus and history of hypertension. The cerebral vascular event was diagnosed with a computerized axial tomography endorsed by a radiologist; atrial fibrillation was considered when an irregular R-R wave, absence of P wave, and irregular atrial activity were identified on the electrocardiogram. The reading and interpretation was performed by the emergency physician. Statistical analysis included percentages, confidence intervals for percentages and calculation of probability of occurrence of binomial event. Results: The average age of the patients with a cerebral vascular event is 72.37 years (95% CI: 70.91-73.82), the male sex predominates with 57.7% (95% CI: 50.8-64.7). The diagnosis of arterial hypertension is present in 74.8% (95% CI: 68.8-80.9) of the patients. The incidence of first-time atrial fibrillation is 72.36% (95% CI: 66.0-78.6). Conclusion: In the studied population, the incidence of previously undiagnosed atrial fibrillation in patients with ischemic cerebrovascular event is high.


Objetivo: Determinar la incidencia de fibrilación auricular no diagnosticada en pacientes con evento vascular cerebral tipo isquémico. Métodos: Diseño transversal descriptivo en pacientes mayores de 18 años con diagnóstico de evento vascular cerebral de tipo isquémico, atendidos en el servicio de urgencias. El tamaño de la muestra lo integraron el total de expedientes clínicos de pacientes con diagnóstico de evento vascular cerebral isquémico (n = 199). Se incluyeron todos los pacientes a los que se les realizó electrocardiograma. Se estudió edad, sexo, antecedente de diabetes mellitus y antecedente de hipertensión arterial. El evento vascular cerebral se diagnosticó con tomografía axial computarizada avalada por médico radiólogo; se consideró fibrilación auricular cuando en el electrocardiograma se identificó onda R-R irregular, ausencia de onda P y actividad auricular irregular; la lectura e interpretación fue realizada por el médico urgenciólogo. El análisis estadístico incluyó porcentajes, intervalos de confianza para porcentajes y cálculo de probabilidad de ocurrencia de evento binomial. Resultados: El promedio de edad de los pacientes con evento vascular cerebral es 72.37 años (IC 95%: 70.91-73.82), predomina el sexo masculino con un 57.7% (intervalo de confianza del 95% [IC 95%]: 50.8-64.7). El diagnóstico de hipertensión arterial está presente en el 74.8% (IC 95%: 68.8-80.9) de los pacientes. La incidencia de fibrilación auricular de primera es el 72.36% (IC 95%: 66.0-78.6). Conclusión: En la población estudiada la incidencia de fibrilación auricular no diagnosticada previamente en pacientes con evento vascular cerebral isquémico es alta.


Assuntos
Fibrilação Atrial/epidemiologia , Hipertensão/epidemiologia , AVC Isquêmico/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Hipertensão/diagnóstico por imagem , AVC Isquêmico/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Rev. sanid. mil ; 72(5/6): 359-362, sep.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1020888

RESUMO

Resumen El factor de riesgo más importante para presentar una enfermedad cerebrovascular (EVC) es la edad. El ictus es la causa más frecuente de discapacidad adquirida en la edad adulta. De acuerdo con la Organización Mundial de la Salud, se estima que en el año 2050, casi la mitad de la población mayor de 65 años podría sufrir o haber sufrido un EVC. Debido a la gran incidencia y al impacto negativo que tiene esta enfermedad, presentamos el caso clínico de una trombólisis exitosa en una paciente con ictus isquémico y crisis hipertensiva en el Servicio de Urgencias. Ponemos de manifiesto la adecuada evaluación con las diferentes escalas existentes, clínicas, radiológicas y pronósticas (NIHSS, Dragon Score, ASPECT, HAT score), así como los criterios de inclusión y exclusión, los cuales son indispensables para administrar una terapia de repercusión intravenosa. Conclusiones En México, los casos reportados con trombólisis exitosa son sólo el 5%. En este caso de éxito, la adecuada actuación en el Servicio de Urgencias de primer contacto impactó de manera positiva en el pronóstico de la paciente, ya que el diagnóstico oportuno y la administración de rTPA (activador tisular del plasminógeno) evitó secuelas importantes y consiguió una mejor calidad de vida -la cual se ve disminuida hasta en 70% de los pacientes que sufren un EVC (según estudios realizados en los EUA)-.


Abstract The most important risk factor for presenting a cerebrovascular disease (CVA) is age. Stroke is also the most frequent cause of disability acquired in adulthood. According to the World Health Organization, it is estimated that by the year 2050, almost half of the population over 65 could suffer or have suffered a CVA. Due to the high incidence and negative impact of this disease, we present a clinical case of successful thrombolysis in a patient with ischemic stroke and hypertensive crisis in the emergency department. We emphasize the adequate evaluation with the different existing clinical, radiological and predictive scales (NIHSS, Dragon Score, ASPECT, HAT score), as well as the inclusion and exclusion criteria, which are indispensable to administer an intravenous reperfusion therapy. Conclusions In Mexico, the cases reported with successful thrombolysis are only 5%. In this successful case, the proper performance in the emergency service impacted positively on the prognosis of the patient, since the timely diagnosis and administration of rTPA avoided important sequelae and provided a better quality of Life, which is decreased in up to 70% of patients suffering from a CVA (according to studies conducted in the USA).

4.
Rev. mex. cardiol ; 27(1): 34-43, ene.-mar. 2016. ilus, tab
Artigo em Inglês | LILACS-Express | LILACS | ID: lil-782712

RESUMO

Objective: To describe gender differences in adult patients undergoing carotid angioplasty and its relation to morbidity and mortality at 30 days and 6 months. Material and methods: An observational study from the WHO database comprehending all patients underwent carotid angioplasty in the Department of Hemodynamics Coronary and Peripheral Artery Intervention, Cardiology Hospital 34, IMSS, Monterrey, was conducted in order to ASSESS the differences between genders and their relationship to primary end points within 30 days after the intervention, which were defined as the presence of death related to the procedure, major cerebrovascular event, or myocardial infarction. Results: 279/341 patients/lesions were included for analysis. Within baseline characteristics, women had significantly higher prevalence of type 2 diabetes mellitus (61.4 versus 45.4%, p = 0.006), prior renal angioplasty (21.9 versus 11.5%, p = 0.015), right carotid condition (65.8 versus 53.7%, p = 0.03), prior stroke (20.2 versus 34.4%, p = 0.007) and higher EuroSCORE (3.13 ± 1.72 versus 2.4 ± 1.26, p < 0.001). The masculine gender was only associated with smoking (69.2 versus 35.1%, p < 0.001). In univariate analysis, the female gender was associated with major fatal and non-fatal stroke (4.4 versus 0.9%, p = 0.031). According to symptomatology and subgroups, we found a significant association between women with asymptomatic Increased risk of major cardiovascular events when compared to asymptomatic diseases (9.5 versus 1.4%, p = 0.004). Conclusions: In our center, women who underwent carotid angioplasty present more comorbidities and higher risk in comparison with the male gender. However, these differences do not impact on most adverse cardiovascular events (MACVE) at 30 days. In the subgroup of asymptomatic patients, the risk of major cardiovascular events is significantly higher in the female gender.


Objetivo: Describir las diferencias de género en pacientes adultos sometidos a angioplastia carotídea y su relación con la morbimortalidad a 30 días y seis meses. Material y métodos: Estudio observacional de la base de datos que comprende los casos sometidos a angioplastia carotídea en el Departamento de Hemodinámica e Intervención Coronaria Periférica del Hospital de Cardiología No. 34, IMSS, Monterrey. Se analizaron las diferencias entre géneros y su relación con los puntos finales primarios dentro de los 30 días posteriores a la intervención, los cuales fueron definidos como la presencia de muerte relacionada con procedimiento, evento vascular cerebral o infarto agudo de miocardio. Resultados: Se incluyeron 279/341 pacientes/lesiones. Dentro de las características basales se encontró que las mujeres presentaban una mayor prevalencia de diabetes mellitus tipo 2 (61.4 versus 45.4%, p = 0.006), angioplastia renal previa (21.9 versus 11.5%, p = 0.015), afección de carótida derecha (65.8 versus 53.7%, p = 0.03), evento vascular cerebral (EVC) previo (34.4 versus 20.2%, p = 0.007) y EuroSCORE más alto (3.13 ± 1.72 versus 2.4 ± 1.26, p < 0.001). El género masculino sólo se asoció con mayor tabaquismo (69.2 versus 35.1%, p < 0.001). En el análisis univariado, el género femenino se asoció significativamente con EVC (fatal y no fatal) (4.4 versus 0.9%, p = 0.031). Al dividir en subgrupos de acuerdo con la sintomatología, se encontró una fuerte asociación entre las mujeres asintomáticas con más elevado riesgo de eventos cardiovasculares mayores en comparación con el grupo masculino asintomático (9.5 versus 1.4%, p = 0.004). Conclusiones: En nuestro centro, las mujeres sometidas a angioplastia carotídea presentan más comorbilidades y se encuentran en un riesgo mayor en comparación con el género masculino. Sin embargo, estas diferencias no impactan en la incidencia de eventos adversos cardiovasculares mayores (EACVM) a 30 días. En el subgrupo de pacientes asintomáticos el riesgo de eventos cardiovasculares mayores es significativamente más alto en el género femenino.

5.
Cir Cir ; 81(1): 60-3, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-23461923

RESUMO

INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Idoso , Transtornos Cerebrovasculares/complicações , Feminino , Fraturas do Colo Femoral/etiologia , Humanos , Paresia/complicações , Paresia/etiologia
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