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In December 2019, several cases of pneumonia were reported, whose etiological agent would be named SARS-CoV-2 causing coronavirus disease (COVID-19). Even though the main symptomatic characteristic is respiratory, affectations have been reported in other systems, cardiovascular being one of the main ones. Cardiovascular disorders, which are less common, and conditioned by a pathophysiological process of systemic inflammation, are mainly represented by acute myocardial damage, followed by arrhythmias, with no specified classification by the authors. Cardiogenic shock, heart failure, venous or systemic thromboembolism, and acute coronary syndrome have also been described; all this in male sex predominant populations, in older ages, and with poor prognosis. An understanding of cardiological manifestations is necessary, through research that allows us to also know their relationship with other risk factors and the middle and long-term repercussions, in order to not only have the appropriate clinical suspicion in these patients but offering also timely and comprehensive care and management. [ABSTRACT FROM AUTHOR]

Insulin is an essential hormone for the control of glucose. Its pleyotropic effects are mediated by a series of intracellular signaling pathways. Cardiovascular effects of insulin include the action upon the energetic metabolism, inotropic and vasodilator effects as well as the ionic transport and cardiac protection. The inotropic effect of an insulin infusion at high doses (1-10 u/kg/h) is secondary to the increased supply of glucose to the myocytes, decreased levels of free fatty acids, effect on Na/K-ATPase pump, improvement in the intracellular movement of calcium and the activation of the phosphatidylinositol-3-phosphate pathway. The aim of this paper is to report a case of refractory right ventricular failure which responded to the infusion of insulin at high doses, and review the literature related to the inotropic effect of insulin. Case report: 44 year old patient with a history of non-Hodgkin large B-cell lymphoma and cardiomyopathy secondary to anthracycline. Admitted to the Intensive Care Unit (ICU) for severe sepsis and septic shock. During her stay in the ICU she developed right-sided heart failure that led her to cardiogenic shock that was refractory to treatment with inotropic and vasopressor agents. We started a treatment consisting of insulin infusion at a dose of 1 u/kg/h, showing a significant improvement in the right ventricular dysfunction, reversing shock and improving systemic perfusion. The diminishment of inotropic and vasopressor agents was achieved. Conclusion: The inotropic effect of insulin is mediated by different mechanisms. The implementation of insulin infusions at high doses in different clinical scenarios associated with cardiac dysfunction is a promising new therapeutic alternative. [ABSTRACT FROM AUTHOR]

Antecedents: The cardiogenic shock (CCH) occurs in about 5 to 15% of patients with acute myocardial infarction (AMI) with high mortality. The power-cardiac (CP) is to haemodynamic parameter that represents the ability of the heart ace to pump, according chronotropism predictor of morbidity and mortality. Objective: To determine the usefulness of the (PC) in patients with CCH as factors of mortality at 6, 24 hours and 30 day. Design: retrospective, longitudinal, observational, descriptive. Instead of carrying out the study: Unidad de Cuidados Coronarios, Unidad Médica de Alta Especialidad 71, Torreón, Coahuila, México. Material and Methods: Cardiac power calculation (CP = MAP x OC / 451) to 47 subjects of 128 carriers of AMI having haemodynamic monitoring and using a bivariate analysis was analyzed the degree of association between CP and mortality at 6 hours, 24 hours and 30 days. Results: Of 128 patients with AMI, 26 (20.3%) were of HCC. The mortality of the sample examined was 20.31% (n = 128). The mortality of the group with a diagnosis of cardiogenic shock was 57.69% (n = 26). The association of CP and mortality at 30 days was OR 1.46 CI 0.98-2.17 (p = 0.58), mortality to 24 hours OR 2.61 CI 0.99-6.8 (p = 0.004). Conclusions: The CP is an independent variable predicting mortality at 30 days and 24 hours. [ABSTRACT FROM AUTHOR]