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Since the discovery of right ventricular infarction, interest in the characteristics of the right ventricle has been increasing. Right ventricular function is now known to be a predictor of mortality in different settings. The right ventricle is a low-pressure, high-compliance, high-volume chamber. To carry out its normal function, it is coupled to the pulmonary circulation and the left ventricle. In the face of acute changes in pressure, volume overload and ischemia, it dilates to adapt to its new load. Its manifestation may be ventricular dysfunction and/ or failure that will progress to cardiogenic shock due to right ventricular involvement. Various entities may be the cause of acute dysfunction: right ventricular infarction (alterations in contractility due to ischemia) and high-risk pulmonary thromboembolism (increased afterload). Both share a similar ventricular pathophysiology and high mortality without treatment. Understanding anatomy and physiology, dysfunction and acute ventricular failure are important to define a convenient diagnosis and treatment oriented towards pathophysiology. In this first part, the anatomy and physiology, acute right ventricular dysfunction/failure and cardiogenic shock are taken into consideration, from the perspective of these two entities. In another paper, treatment aimed at cardiogenic shock due to right ventricular involvement will be reviewed. [ABSTRACT FROM AUTHOR]

Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score = 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventri-cular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia. [ABSTRACT FROM AUTHOR]

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It has been acknowledged that medical life-threatening experiences such as an acute myocardial infarction (MI) often lead to acute stress disorder symptoms (ASS), which in turn can result in the development of post-traumatic stress symptoms (PTSS). Previous studies have suggested an association between various traumatic experiences and alexithymia. The association of alexithymia with ASS and PTSS in patients with MI is elusive. The aim of this study was to examine the association of alexithymia with MI-induced ASS and PTSS in patients at high risk of developing PTSD. Patients (N = 154) were examined twice, once within 48 hours, and then again three months after acute MI. All patients completed the self-rating Acute Stress Disorder Scale (ASDS) within 48 hours after the cardiac event. Three months after hospital discharge, all patients completed the Toronto Alexithymia Scale (TAS-20) and underwent the Clinician-Administered PTSD Scale (CAPS), a structured interview to assess the severity of PTSS. Descriptive statistics, correlations, multivariate linear regressions, and moderation analysis were conducted. The linear regression model explained 23% of the variance in MI-induced PTSS-symptoms (F(6.109) = 5.58, p < 0.001, R2 = 0.23. ASS was significantly related to PTSS severity (r (152) = p < 0.001). The scores of the TAS-20 subscale difficulties identifying feelings (DIF) were found to significantly moderate this relationship (R2 = 0.03, p = 0.04). The scores of TAS-20 subscales DDF and EOT as well as the TAS-20 total score had no influence on the relationship between ASS and PTSS (p > 0.05). In MI patients with high levels of DIF, ASS predicted the development of PTSS. If replicated, the finding may inform emotion-oriented interventions to investigate whether increasing the capacity to identify feelings following acute MI could be beneficial in preventing the development of PTSS. [ABSTRACT FROM AUTHOR]

La enfermedad cardiovascular es la principal causa de muerte a nivel mundial. De ella, el Infarto Agudo al Miocardio (IAM) y el Accidente Cerebrovascular (AVC) se encuentran fuertemente asociados a los cambios ambientales y sociales del último tiempo, tales como aumento de ingesta de comida rápida, sedentarismo, tabaquismo, entre otros. Algunos trastornos psiquiátricos que aparecen a corto y largo plazo posterior al evento coronario agudo tienen una implicancia directa en la morbimortalidad cardiovascular y global. De ellos, la depresión representa el trastorno psiquiátrico más frecuente, pudiendo encontrarse en 3 de cada 10 pacientes que tuvieron un IAM. La depresión aumenta las hospitalizaciones, disminuye la adherencia terapéutica y empeora el pronóstico cardiovascular a largo plazo. La fisiopatología en lo anterior es explicada en parte por alteraciones en el eje neuroendocrino y la respuesta al estrés, mientras que otros fenómenos permanecen aún desconocidos. Dentro de otros trastornos psiquiátricos asociados a un IAM se encuentran el delirium, ansiedad y trastornos de la personalidad. En función de lo anterior, se hace necesaria la incorporación de un sistema continuo de monitoreo y apoyo en salud mental en este grupo de pacientes para mejorar tanto su pronóstico como la calidad de vida.

Introducción: Este protocolo de investigación tiene la finalidad de intervenir con la familia y determinar la efectividad del Modelo de Cuidado de Enfermería para la Familia de Paciente con Infarto Agudo al Miocardio (IAM) en la Unidad de Cuidados Intensivos (UCI). Materiales y Métodos: Estudio descriptivo de intervención familiar. Resultados y Discusión: El 100% de las familias respondió afirmativamente que la enfermera familiar les informo sobre los cuidados a realizar en la familia según las necesidades detectadas, estableció un plan de intervención en la familia mismo que cumplió y se interesó para que dentro de lo posible la estancia en la familia sea agradable. Conclusiones: Los resultados de esta investigación de intervención a las familias de paciente con IAM en las UCI aporta resultados que apoyan la importancia de aplicar un Modelo de Cuidado de Enfermería Familiar en dichas unidades.Cómo citar este artículo: García DJ, Estrada MC, Gallegos M, Antuna AB. Efectividad del modelo de cuidado de enfermería para la familia de paciente con infarto agudo al miocardio en la unidad de cuidados intensivos. Rev Cuid. 2015; 6(1): 923-31. http://dx.doi.org/10.15649/cuidarte.v6i1.166

The Código Infarto (Infarction Code) strategy is part of the comprehensive care program "A Todo Corazón" (To All Heart), whose aim is to reinforce the prevention and health care of cardiovascular diseases. Mexico faces a big challenge, since it is the country with greater mortality secondary to acute myocardial infarction (AMI) in the first 30 days in patients of 45 years or older (28% compared with 7.9% of the average). In addition, Mexico's population has a high prevalence of risk factors (hypertension, diabetes, tobacco use, dyslipidemias, overweight, and obesity). It is for these reasons that 18 months ago the Instituto Mexicano del Seguro Social (IMSS) implemented the first care protocol for patients with AMI, called Código Infarto, whose main aim is to guarantee the diagnosis and treatment of patients with AMI, so that they can receive, once they are admitted at IMSS emergency rooms, primary angioplasty in less than 90 minutes, or fibrinolytic therapy in less than 30 minutes. The quality focus in the Código Infarto strategy has six main dimensions: security, effectiveness, its focus on the patient, opportune, efficient, and [it offers] equitable [treatment]. The implementation of Código Infarto in IMSS is the first institutional strategy to face the leading cause of death in our country and it has produced up until now very encouraging results. [ABSTRACT FROM AUTHOR]

En Chile, la prevalencia de tabaquismo en mayores de 15 años es 40,6%. El tabaquismo activo y pasivo provoca enfermedad cardiovascular como consecuencia del efecto del monóxido de carbono y nicotina a través de inducción de un estado de hipercoagulación, aumento del trabajo cardíaco, vasoconstricción coronaria, liberación de catecolaminas, alteración del metabolismo de los lípidos y alteración de la función endotelial. Se estima que en el mundo mueren 5.4 millones de personas prematuramente al año debido al uso de tabaco y subirá a 10 millones para el 2025. En Chile más de 41 personas mueren cada día por enfermedades asociadas al tabaco y el gasto anual en estas enfermedades es US$ 1.100 millones. Al analizar los datos chilenos del estudio INTERHEART el tabaco fue el factor de riesgo más importante, con un 42% (95%IC 33.2-51.4%) de los infartos atribuibles al hábito de fumar, lo que se explica por las altas tasas de consumo. Hay una importante reducción de riesgo al dejar de fumar.

OBJECTIVE: To estimate the incidence of myocardial infarction (MI) in a low-income Mexican population. MATERIAL AND METHODS: A total of 1 696 men and women aged 35 to 64 years from a longitudinal study were included. All subjects were free of MI at baseline. Incident MI was diagnosed during follow-up by electrocardiogram or by death certificate. Multiple logistic regression was used to estimate the risk of MI. RESULTS: Median follow-up was 6.2 years. Sixty-two of the participants developed MI. Age-adjusted incidence of MI was 6.6 in men and 4.8 in women per 1 000 person-years. The risk of developing MI was associated diabetes (OR= 2.42, p= 0.003), systolic blood pressure (OR= 1.28 per10 mm Hg, p= 0.013) and serum cholesterol (OR= 1.36 per 50 mg/dL, p= 0.038). CONCLUSIONS: Incidence of MI in this population may be explained by the rising prevalence of diabetes and hypercholesterolemia. It is necessary to implement preventive measures to address those risk factors.OBJETIVO: Estimar la incidencia de infarto al miocardio (IM) en población mexicana de nivel socioeconómico bajo. MATERIAL Y MÉTODOS.. Estudio longitudinal de 1696 hombres y mujeres de 35 a 64 años de edad y sin IM basal. IM fue definido por electrocardiograma o certificado de defunción. El riesgo de IM se evaluó con regresión logística múltiple. RESULTADOS: Durante el seguimiento (mediana de 6.2 años) 62 participantes desarrollaron IM o murieron por éste. La incidencia de IM ajustada por edad en hombres y mujeres fue de 6.6 y 4.8 por 1000 años-persona, respectivamente. El riesgo de IM estuvo asociado con diabetes (RM=2.42, p= 0.003), presión arterial sistólica (RM= 1.28 por cada 10 mm Hg, p= 0.013) y colesterol total (RM= 1.36 por cada 50 mg/dL, p=0.038). CONCLUSIONES: La incidencia de IM en esta población, puede ser debida a la alta prevalencia de diabetes y colesterol elevado. Es necesario tomar medidas preventivas para disminuir estos factores de riesgo.

Introduction. Coronary bypass grafting proved to reduce mortality in patients with extensive vascular disease. Patients undergoing this procedure using an extracorporeal circulation pump have a perioperative mortality of 2%. The incidence of complications such as myocardial infraction, cerebrovascular disease and acute kidney injury ranges from 5 to 7%. The presence of systemic inflammatory response syndrome (SIRS) may be a prognostic and diagnostic marker of postsurgical complications Material y Methods. This is a prospective and descriptive study. It used association tests between systemic inflammatory response syndrome and postsurgical complications arising from coronary bypass grafting in Hospital Christus Muguerza in Monterrey, Nuevo León, Mexico, from March to October 2014. Results. A total of 17 patients were included. Patients with one SIRS criterion registered one complication. The group of patients with four criteria registered four complications. The total number of days patients remained in UCI had a correlation coefficient of 0.71 with an internal consistence of 0.83 (p=.00042) according to the SIRS criteria. Discussion. Revascularization surgery causes great stress to the patients and it is reflected by systemic inflammatory response syndrome. With data obtained from this study we can infer that according to the patient's response we may estimate the number of ICU days and the risk of postsurgical complications. Nevertheless, due to the short duration of this sturdy, our results are not statistically significant. Therefore we may not assure a numerical value to the existent correlation or risk. [ABSTRACT FROM AUTHOR]

Introduction: This research protocol is intended to interfere with the family and to determine the effectiveness of the model of nursing care for the family of patient with acute infarction myocardium (AMI) in the intensive care unit (ICU). Materials and Methods: Descriptive study of family intervention Results and Discussion: 100% Of families responded affirmatively to the family nurse them informed about the care the family according to needs identified, established a plan of action in family same which met and it is interested for that as far as possible agreeable stay in the family. Conclusions: The results of this investigation of intervention with AMI in the ICU patient families brings results that support the importance of implementing a care model of nursing family in these units. [ABSTRACT FROM AUTHOR]

Objective. To estimate the incidence of myocardial infarction (MI) in a low-income Mexican population. Material and Methods. A total of 1 696 men and women aged 35 to 64 years from a longitudinal study were included. All subjects were free of MI at baseline. Incident MI was diagnosed during follow-up by electrocardiogram or by death certificate. Multiple logistic regression was used to estimate the risk of MI. Results. Median follow-up was 6.2 years. Sixty-two of the participants developed MI. Age-adjusted incidence of MI was 6.6 in men and 4.8 in women per 1 000 person-years. The risk of developing MI was associated diabetes (OR= 2.42, p= 0.003), systolic blood pressure (OR= 1.28 per10 mm Hg, p= 0.013) and serum cholesterol (OR= 1.36 per 50 mg/dL, p= 0.038). Conclusions. Incidence of MI in this population may be explained by the rising prevalence of diabetes and hypercholesterolemia. It is necessary to implement preventive measures to address those risk factors. [ABSTRACT FROM AUTHOR]

Se realiza un estudio sobre la actividad del bombeo derivado del catabolismo de ácidos grasos, glucosa y lactato. Además, se analiza a la oclusión coronaria que determina la recepción de sustratos oxidables y oxígeno en parte del tejido cardiaco y se realiza una observación del exceso de Ca+2 intercelular el cual provoca muerte celular.

Background: Child maltreatment is a major public problem, associated with enormous consequences on the individual and socioeconomic level. Studies show a clear impact of child maltreatment on long-term physical health. However, there is a lack of analyses comprising a wide variety of subtypes of maltreatment and addressing cumulative effects of different maltreatment subtypes experienced during childhood on physical health. Objective: The objective of this analysis was to assess the association of different subtypes and the intensity of child maltreatment with long-term physical health outcomes. Methods: In a cross-sectional observational approach, a representative sample of the German population (N=2510) was assessed regarding socioeconomic information, their current health status, and their experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ). Chi2-Tests were performed to compare differences of physical health conditions in adulthood in association with child maltreatment and binary regression analyses to assess the relationship of physical health and number of different subtypes of maltreatment experienced during childhood. Results: Odds increased significantly for obesity (1.8), diabetes (1.26), cancer (1.28), hypertension (1.16), chronic obstructive pulmonary disease (1.51), history of myocardial infarction (1.29) and stroke (1.31) with increasingenhancing number of experienced subtypes of child maltreatment. Growing intensity of each subtype of maltreatment was associated with higher rates of all assessed physical health conditions, which could point towards a dose-dependency of the relationship between maltreatment and long-term physical health. Conclusions: Child maltreatment is associated with increased odds for the leading morbidity and mortality causes in Germany. Interventions encompassing secondary and primary preventive strategies are critical to target this major public health problem and its devastating consequences. [ABSTRACT FROM AUTHOR]