159 results on '"Miocardiopatías"'
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2. Utilidad de la resonancia magnética cardíaca con mapas paramétricos en el diagnóstico y pronóstico de pacientes con miocardiopatías.
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Pérez Barreda, Aylen, Vázquez Hernández, Gleiny, Marcos Gutiérrez, Yamilé, Bencomo Rodríguez, Llimia, Martínez González, Aniley, Padrón García, Kenia, Pérez Mohamed, Reynel, Oro Cortina, Carlos, Rodríguez Nande, Lidia M., and Peix González, C. Amalia
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Introduction: Cardiomyopathies constitute a heterogeneous group of myocardial diseases with high morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) plays an essential role in their diagnosis and prognosis. Objective: To describe the usefulness of cMRI by applying parametric maps in the diagnosis and prognosis of patients with cardiomyopathies Method: An observational, descriptive, cross-sectional study was conducted with 40 patients suffering from cardiomyopathies, treated at the Instituto de Cardiología y Cirugía Cardiovascular of Havana, Cuba, in 2018, who underwent cMRI and were followed for 24 months. Results: Men (60%) and arterial hypertension (50%) were more frequent. cMRI confirmed the initial diagnosis in 47% of cases. The ejection fraction was significantly lower in the deceased (p=0.039), who also presented higher end-diastolic and endsystolic volumes. Patients with decreased ventricular function presented higher extracellular volumes (mean of 38.9 ms), and higher mortality at 24 months of followup. The native T1 and extracellular volume values were significantly higher in the deceased with mean of 1134.4 and 41.4 ms respectively. Conclusions: cMRI complements the noninvasive diagnosis and prognosis of cardiomyopathies by confirming, adding or refuting diagnoses through assessment of ventricular function and tissue characterization, where ejection fraction and extracellular volume are the most important prognostic variables. [ABSTRACT FROM AUTHOR]
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- 2022
3. Hypertrophic cardiomyopathy. Proposal for a new classification.
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Llamas-Esperón, Guillermo A. and Llamas-Delgado, Guillermo
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HYPERTROPHIC cardiomyopathy , *DISEASE progression , *MORPHOLOGY , *NOSOLOGY , *CARDIOLOGISTS , *ECHOCARDIOGRAPHY , *HEART function tests , *PROGNOSIS - Abstract
Hypertrophic cardiomyopathy (HCM) is a clinical condition, but its name has been subjected to frequent changes over the years, largely because of its morphological and functional heterogeneity, which leads the clinician who is focused on its study to have difficulty in understanding how to diagnose it and when and how to treat it. Regarding its name, it has been called in more than 75 different ways, and it has being classified with difficulty through echocardiography for more than 40 years. Today, it is necessary to understand that the diverse phenotypic behavior, as well as the evolutionary stages of the disease, must be approached in a practical and effective way, so that it easier to understand its clinical behavior and prognosis, as well as the therapeutic needs in each particular case. We review the aspects related to the name of the condition and propose a new classification that could provide the clinical and surgical cardiologist a better understanding of HCM in its various morphological and functional aspects. [ABSTRACT FROM AUTHOR]
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- 2022
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4. [Pheochromocytoma as a simulator of cardiac pathology].
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Vallejo Herrera MJ, Vallejo Herrera V, Márquez Pérez V, Serrano Puche F, and Vegas Vegas I
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Pheochromocytomas are rare neuroendocrine tumors that can present as hypertensive crises or serious cardiac and cerebrovascular complications that endanger the patient's life. Two unusual cases of adrenergic crises induced by pheochromocytoma with cardiovascular manifestations are presented, one with multiple complications/multiorgan failure, fatal outcome and definitive diagnosis in the post mortem autopsy, and another with a satisfactory evolution after diagnosis and appropriate treatment., (Copyright © 2024 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2024
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5. Impact of the creation of specialized units for patients with hypertrophic cardiomyopathy
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Martín Negreira-Caamaño, Jesús Piqueras-Flores, Inmaculada Vivo-Ortega, María Arántzazu-González-Marín, Manuel Muñoz-García, and Alberto Jiménez-Lozano
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Morte súbita ,Miocardiopatia hipertrófica ,Insuficiência cardíaca ,Miocardiopatias ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction and objectives: According to current international guidelines, hypertrophic cardiomyopathy (HCM) patients should be managed in specialized units. However, there is lack of data on the impact of the creation of these units in the management of HCM patients. Our goal was to assess the impact of the creation of an Inherited Inherited Diseases Cardiac Unit (ICDU) in the current management of patients with HCM. Methods: We analyzed 114 consecutive patients (62.6±8 years old, 70.2% males) with HCM. Variables related to optimal management of HCM patients and their family study were recorded, as well as guidance on the risk of sudden death. We analyzed whether patients were assessed by the ICDU or at a general cardiology consultation (GCC). Results: 50 patients were assessed in the IDCU and 64 in the GCC. Familial screening was more frequent in patients assessed by the IDCU (45.3% vs. 4%; p
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- 2021
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6. Sudden cardiac death in persons aged 50 years or younger: diagnostic yield of a regional molecular autopsy program using massive sequencing.
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Ripoll-Vera, Tomás, Pérez Luengo, Consuelo, Borondo Alcázar, Juan Carlos, García Ruiz, Ana Belén, Sánchez Del Valle, Nieves, Barceló Martín, Bernardino, Poncela García, Juan Luis, Gutiérrez Buitrago, Gloria, Dasi Martínez, Concepción, Canós Villena, Juan Carlos, Moyano Corvillo, Susana, Esgueva Pallarés, Raquel, Sancho Sancho, Juan Ramón, Guitart Pinedo, Gemma, Hernández Marín, Elena, García García, Estela, Vingut López, Albert, Álvarez Rubio, Jorge, Govea Callizo, Nancy, and Gómez Pérez, Yolanda
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Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2021
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7. Rentabilidad diagnóstica y seguridad de la biopsia endomiocárdica en corazón nativo en un centro español de referencia
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Eusebio García-Izquierdo Jaén, Juan Francisco Oteo Domínguez, Marta Jiménez Blanco, Cristina Aguilera Agudo, Fernando Domínguez, Jorge Toquero Ramos, Javier Segovia Cubero, Clara Salas Antón, Arturo García-Touchard, José Antonio Fernández-Díaz, Rodrigo Estévez-Loureiro, Francisco Javier Goicolea Ruigómez, and Luis Alonso-Pulpón
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Biopsia endomiocárdica ,BEM ,Miocardiopatías ,Miocarditis ,Amiloidosis ,Mapa electroanatómico ,Internal medicine ,RC31-1245 - Abstract
RESUMEN Introducción y objetivos: La biopsia endomiocárdica (BEM) es una técnica diagnóstica fundamental en el diagnóstico de distintas miocardiopatías, pero no está exenta de posibles complicaciones. Se presentan los resultados en términos de rentabilidad diagnóstica y seguridad de la serie de BEM realizadas en corazón no trasplantado en nuestro hospital, así como las consecuencias de la implementación de un protocolo de actuación y seguridad en BEM desarrollado en nuestro centro. Métodos: Se revisaron de forma retrospectiva todas las BEM en corazón no trasplantado realizadas desde septiembre de 2004 hasta julio de 2018. Se comparó la rentabilidad diagnóstica y seguridad en dos etapas: antes y después de la puesta en marcha del protocolo. Resultados: Se incluyeron 204 BEM realizadas en 190 pacientes. La indicación más frecuente fue el estudio de disfunción ventricular o sospecha de miocarditis (51,5%), seguida de estudio de miocardiopatía restrictiva o infiltrativa (44,6%). Se realizaron 172 BEM en cavidades derechas (84,3%) y 30 en cavidades izquierdas (14,7%); solo en 2 de los procedimientos se tomaron muestras de ambos ventrículos. La BEM permitió el diagnóstico definitivo en el 52% de los casos. Tras la implementación del protocolo se observó una mejoría en la rentabilidad diagnóstica (42,5 frente a 58,1%; p = 0,030) y una disminución en la tasa de complicaciones mayores (del 7,5% al 3,2%; p = 0,167), con una reducción estadísticamente significativa en la tasa de perforaciones cardiacas (6,3 frente a 0,8%; p = 0,025). Conclusiones: La BEM es una técnica con un gran potencial diagnóstico en pacientes con sospecha de miocardiopatía. Aunque puede presentar complicaciones potencialmente graves, la puesta en marcha de un protocolo de actuación y seguridad se asocia a una reducción en la tasa de complicaciones y a una mejoría en la rentabilidad diagnóstica.
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- 2019
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8. Cardiovascular system involvement in SARS-CoV-2 infection
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Jairo Jesus Gómez-Tejeda, Claudia Hernandez-Perez, and Yoandri Aguilera-Velazquez
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coronavirus ,covid-19 ,sars-cov-2 ,hipertensión ,arritmias ,miocardiopatías ,Medicine ,Medicine (General) ,R5-920 - Abstract
Introduction: COVID-19 is an emerging disease with global incidence, which exhibits a greater number of complications in patients with comorbidities, mainly in those with a history of cardiovascular disease. Objective: to describe the implications of COVID-19 in the cardiovascular system. Method: A review of the literature was conducted in the MEDLINE, SciELO, JAMA and Elsevier databases, recovering 35 articles, which were taken as the basis for the present review. The combination of terms using search formulas was used to retrieve articles. Development: COVID-19 can be variable in correspondence with the presentation form and accompanying symptoms, as well as the recipient's immune response. SARS-CoV-2 binds to cells through the viral spike structural protein that binds to the angiotensin-converting enzyme 2 receptor from viral receptors; therefore, hypertensive patients or those with other cardiovascular conditions have a higher risk of developing severe forms of COVID-19. Among the cardiovascular diseases associated with infection by a coronavirus, myocarditis, arrhythmias, acute myocardial infarction and heart failure stand out. Conclusions: the main cardiovascular implications in patients with COVID-19 are arrhythmia, thromboembolic disease, myocarditis, heart failure of acute onset and myocardial infarction, which condition a more serious picture of the disease. The inflammatory response, hemodynamic changes secondary to the viral process, as well as hypoxemia, constitute mechanisms of negative impact on cardiovascular health, leading to the development of acute cardiac injury.
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- 2020
9. RESONANCIA MAGNÉTICA CARDÍACA: NUEVOS DESARROLLOS Y PERSPECTIVAS FUTURAS
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Dr Diego Pérez de Arenaza
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Resonancia magnética cardiaca ,realce tardío con gadolinio ,miocardiopatías ,miocardiopatía hipertrófica y miocardiopatía dilatada ,Medicine - Abstract
La resonancia magnética cardiovascular (RMC) es una técnica de imágenes establecida en la evaluación de pacientes con miocardiopatías. El aspecto más relevante de la RMC es la caracterización tisular para la identificación de la fibrosis mediante las imágenes de realce tardío con gadolinio (RTG). El patrón de RTG es de utilidad para el diagnóstico de la etiología en miocardiopatías. Además, la presencia de RTG se asocia con pronóstico adverso. En este trabajo se evalúa el valor pronóstico del RTG en pacientes con miocardiopatía hipertrófica (MCPH) y en pacientes con miocardiopatías dilatada. En pacientes con MCPH, la cuantificación del RTG identifica pacientes con alto riesgo de muerte súbita y disfunción ventricular. En pacientes con miocardiopatía dilatada, el RTG se asocia con incremento de los eventos como muerte y hospitalización. Por otro lado, la presencia de RTG identifica pacientes que se beneficiarán con la colocación de cardiodesfibrilador implantable, sobre todo aquellos pacientes con fracción de eyección mayor a 35%, con miocardiopatía dilatada isquémica o no isquémica. En pacientes que se evalúa la terapia de resincronización, la ubicación del gadolinio identifica las área del sitio de implante del catéter para optimizar los resultados. Por último, el desarrollo del mapeo de T1 identifica formas incipientes de fibrosis difusa intersticial que podría tener impacto en identificar pacientes en riesgo en etapas más precoces.
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- 2018
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10. Mid-term Outcome of Patients with Diagnosis of Transthyretin Cardiac Amyloidosis.
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COSTABEL, JUAN P., LORENZO, CRISTINA, MONDRAGÓN, IGNACIO, MITRIONE, SOLEDAD, TALAVERA, LUJÁN, MERETTA, ALEJANDRO, DAQUARTI, GUSTAVO, VRANCIC, MARIANO, and DIEZ, MIRTA
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CARDIAC amyloidosis ,TRANSTHYRETIN ,AMYLOIDOSIS ,DISEASE risk factors ,CARDIOVASCULAR diseases - Abstract
Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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11. Afectación del sistema cardiovascular en la infección por SARS-CoV-2.
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Jesús Gómez-Tejeda, Jairo, Hernández-Pérez, Claudia, and Aguilera-Velázquez, Yoandri
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Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
12. Papel de la Resonancia Magnética en la Miocardiopatía Hipertrófica y Dilatada en Pacientes Críticos
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Buendia Gomez, Daniel Augusto, Díaz, Valentin, Jaimes Bautista, Jefferson David, Hernández Muñoz, Diana Marcela, Domínguez Olmos, Fabián José, Osorio Martínez, Leonardo Andrés, Hernández Ruiz, Ruth patricia, Romero., María de los Ángeles, Buendia Gomez, Daniel Augusto, Díaz, Valentin, Jaimes Bautista, Jefferson David, Hernández Muñoz, Diana Marcela, Domínguez Olmos, Fabián José, Osorio Martínez, Leonardo Andrés, Hernández Ruiz, Ruth patricia, and Romero., María de los Ángeles
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Cardiomyopathies are a diverse group of diseases. Among the most well-known cardiomyopathies is hypertrophic and dilated cardiomyopathy. In hypertrophic cardiomyopathy, we find ventricular hypertrophy, preferably of the left ventricle. Dilated cardiomyopathy, on the other hand, is characterized by dilation and impairment of left ventricular function or both ventricles. For its diagnosis, MRI has become the reference in the evaluation of left and right ventricular volumes and function, also allowing the identification of regional contractility and the identification of areas of non-viable myocardium with greater sensitivity than isotopic studies. For this reason, we have carried out a bibliographic search resulting in different case reports in which MRI has been very useful in the diagnosis of hypertrophic and dilated cardiomyopathy. Therefore, we can conclude that its usefulness in the area of cardiology allows a ..., Las miocardiopatías son un grupo variado de enfermedades. Entre las miocardiopatías más conocidas encontramos a la miocardiopatía hipertrófica y dilatada. En la miocardiopatía hipertrófica encontramos una hipertrofia ventricular preferiblemente del ventrículo izquierdo. En cambio, la miocardiopatía dilatada se caracteriza por una dilatación y deterioro de la función ventricular izquierda o de ambos ventrículos. Para su diagnóstico, la RM ha llegado a ser la referencia en la evaluación de los volúmenes y la función ventricular izquierda y derecha, permitiendo además identificar la contractilidad regional e identificar áreas de miocardio no viable con mayor sensibilidad que los estudios isotópicos. Por ello, hemos realizado una búsqueda bibliográfica dando como resultado diferentes reportes de casos en los que la RM ha resultado de gran utilidad en el diagnóstico de la miocardiopatía hipertrófica y dilatada. Por ende, podemos concluir que su utilidad en el área de cardiología permite una mayor precisión en cuanto a masa, volumen y función contráctil del ventrículo izquierdo en estos tipos de miocardiopatías.
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- 2023
13. Expectations of patients submitted to myocardial revascularization surgery at the time of hospital discharge
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Cibele Cielo, Éder Luís Arboit, Marlusse Silveira, and Silviamar Camponogara
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Enfermagem ,Cuidados de enfermagem ,Miocardiopatias ,Revascularização miocárdica ,Alta do Paciente. ,Medicine ,Nursing ,RT1-120 - Abstract
Objetivo: conhecer as expectativas de pacientes submetidos à cirurgia de revascularização do miocárdio no momento da alta hospitalar. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado com dez pacientes pós-cirúrgicos de revascularização miocárdica de um hospital universitário do sul do Brasil. Os dados foram coletados de julho a agosto de 2012, utilizando-se entrevista semiestruturada e analisados por meio de análise de conteúdo. Resultados: os resultados foram agrupados em uma categoria que versa sobre as expectativas dos pacientes frente ao processo de recuperação e retorno às atividades diárias. Evidenciou-se que essa fase mostra-se desafiadora para os sujeitos, sobressaindo-se sentimentos de ansiedade e preocupação com o futuro, além de terem fragilidades em relação ao conhecimento sobre as mudanças de hábitos impostas pelo processo de adoecimento. Conclusões: a cirurgia provoca um impacto significativo na vida dos pacientes, sendo necessária a intervenção efetiva da enfermagem, a fim de otimizar o processo de recuperação.
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- 2015
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14. Ventrículo izquierdo no compacto: panorámica y arritmogenia.
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Dorantes Sánchez, Margarita, Jerez Castro, Ana M., and Hechavarría Poymiró, Sheila
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Cardiomyopathies are an important and diverse group of myocardial diseases associated with mechanical, electrical, or both dysfunctions. The left ventricular (LV) non-compaction is a familial cardiomyopathy of uncertain etiology, whose exact incidence and prevalence are unknown. It is characterized by an increase in the trabecular mass of the LV in contrast to a thin compact epicardial layer that can be visualized with imaging techniques that confirm the diagnosis. In this article is described the classification of MOGE (S) for cardiomyopathies, electrocardiographic disorders that can be found in patients with left ventricular non-compaction, the role of programmed electrical stimulation of the heart and other aspects of interest of this disease. In addition, some demonstrative electrocardiographic disorders (Stollberger and Jenni criteria) found in affected patients are presented. [ABSTRACT FROM AUTHOR]
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- 2018
15. RESONANCIA MAGNÉTICA CARDÍACA: NUEVOS DESARROLLOS Y PERSPECTIVAS FUTURAS.
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DE ARENAZA, DIEGO PÉREZ
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Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2018
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16. Registro Nacional Argentino de Resonancia Cardíaca (RENAREC)
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Castillo, Santiago del, Jaimovich, Guillermo, Destefano, Luciano, Casas, Jorge, Cintora, Federico, Estofan, Mariano, Ricapito, María de la Paz, Zan, Macarena C. de, Sciancalepore, Agustina, Castillo, Santiago del, Jaimovich, Guillermo, Destefano, Luciano, Casas, Jorge, Cintora, Federico, Estofan, Mariano, Ricapito, María de la Paz, Zan, Macarena C. de, and Sciancalepore, Agustina
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Background: The usefulness of cardiac magnetic resonance imaging (MRI) has greatly increased in the last years. Different international registries have been published on its use; however, there is no data available from Argentina. Objective: The aim of this study was to evaluate different indications, protocols, safety and therapeutic consequences of cardiac MRI in Argentina. Methods: A prospective national registry was designed with collection of demographic data, indications for cardiac MRI, associated complications, diagnoses and therapeutic consequences. Results: A total of 34 centers from 10 provinces of Argentina (85% private and 59% with inpatient capacity) participated in the study, including 1131 patients (mean age 54±18 years and 61% males). The main indications for cardiac MRI were hypertrophic cardiomyopathy (13.9%), and ventricular arrhythmia (12.3%). In 99.7% of cases, no study complications were reported. The most frequent results of cardiac MRI were: normal (31.2%), non-ischemic cardiomyopathy (14.7%), ischemic-necrotic cardiomyopathy (11.6%) and hypertrophic cardiomyopathy (8.9%). Clinical suspicion was confirmed in 23.6% of cases and cardiac MRI generated an unsuspected new diagnosis in 48.7% of cases. The main therapeutic consequences were hospital discharge (31.6%) followed by change in medication (28.1%). Conclusions: Cardiac MRI is widely used in Argentina, mainly in private centers with a very low incidence of complications. Cardiomyopathies (hypertrophic and dilated) and ventricular arrhythmia are its main indication, and it provides a new unsuspected diagnosis in almost half of the cases. Further studies are required to assess its clinical and therapeutic impact., Introducción: La utilidad de la resonancia magnética cardíaca (RMC) ha crecido ampliamente en los últimos años, en los cuales se han publicado distintos registros internacionales sobre su uso e impacto clínico. Sin embargo, no contamos con este tipo de información en Argentina. Objetivo: Evaluar indicaciones, protocolos utilizados, seguridad y consecuencias terapéuticas de la RMC en la República Argentina. Material y métodos: Se diseñó un registro prospectivo a nivel nacional con recolección de datos demográficos, indicaciones de RMC, complicaciones asociadas, diagnósticos y consecuencias terapéuticas. Resultados: Participaron 34 centros de 10 provincias de Argentina (85% centros privados, 59% centros con internación). Se incluyeron 1131 pacientes (edad 54 ± 18 años, 61% varones). Las principales indicaciones para el estudio de RMC fueron la miocardiopatía hipertrófica (13,9%) y la arritmia ventricular (12,3%). El 99,7% de los estudios fueron reportados sin complicaciones. Los resultados más frecuentes de la RMC fueron: normal (31,2%), miocardiopatía no isquémica (14,7%), miocardiopatía isquémico-necrótica (11,6%) y miocardiopatía hipertrófica (8,9%). La sospecha clínica fue confirmada en el 23,6% de los casos y la RMC generó un diagnóstico nuevo no sospechado en el 48,7% de los casos. Las consecuencias terapéuticas más frecuentes fueron el alta hospitalaria (31,6%) seguida por el cambio en la medicación (28,1%). Conclusiones: La RMC es un estudio ampliamente utilizado en Argentina, principalmente en centros privados, con un número muy bajo de complicaciones. Las principales indicaciones son las miocardiopatías (hipertrófica y dilatada) y la arritmia ventricular, y provee un diagnóstico nuevo no sospechado en casi la mitad de los casos. Se requieren de otros estudios en el futuro para evaluar las implicancias clínicas y terapéuticas.
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- 2022
17. Complicaciones cardiovasculares en pacientes covid-19
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Guanipatin Gualpa, Carlos Andrés, Naranjo Perugachi, Jeaneth del Carmen, Guanipatin Gualpa, Carlos Andrés, and Naranjo Perugachi, Jeaneth del Carmen
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Cardiovascular involvement in patients with Covid-19, without a history of cardiac pathologies, is associated with disease severity and even higher mortality. The pathophysiological mechanisms most clearly described are direct myocardial damage and the process associated with systemic inflammation. Cardiovascular manifestations are diverse and include acute heart failure, myocarditis, cardiomyopathies, acute coronary syndromes, arrhythmias, thromboembolic events, cardiogenic shock. Methodology: This work will be a compilation of information that is based on already published literature, with the use of journals that remain current such as Intra Med, PubMed, The new journal of medicine, SciELO, WHO, PAHO and other journals that maintain publications with good scientific evidence from the last 3 years, from 2019 to the present, in the Spanish, Portuguese and English languages. All articles dealing with cardiovascular complications due to SARS-Cov-2 in patients without underlying chronic diseases will be considered. Patients with previous cardiac pathologies were excluded for this study. Conclusions And Discussion: The inflammatory response, the hemodynamic changes secondary to the viral process, as well as the hypoxemia caused by Covid-19; constitute mechanisms of negative repercussion on cardiovascular health. It is known that the best treatment is prevention, without neglecting home isolation measures, constant hand washing avoids these future complications., O comprometimento cardiovascular de pacientes com Covid-19, sem histórico de patologias cardíacas, está associado à gravidade da doença e mortalidade ainda maior. Os mecanismos fisiopatológicos mais claramente descritos são a lesão miocárdica direta e o processo associado à inflamação sistêmica. As manifestações cardiovasculares são diversas e incluem insuficiência cardíaca aguda, miocardite, cardiomiopatias, síndromes coronarianas agudas, arritmias, eventos tromboembólicos, choque cardiogênico. Metodologia: Este trabalho será uma compilação de informações que tem como base a literatura já publicada, com o uso de periódicos atuais como Intra Med, PubMed, The new journal of medicine, SciELO, OMS, OPAS e outros periódicos que mantêm publicações com boa evidências científicas dos últimos 3 anos, de 2019 até o presente, nos idiomas espanhol, português e inglês. Todos os artigos que tratam de complicações cardiovasculares devido ao SARS-Cov-2 em pacientes sem doenças crônicas subjacentes serão levados em consideração. Pacientes com patologias cardíacas prévias foram excluídos deste estudo. Conclusões e Discussão: A resposta inflamatória, as alterações hemodinâmicas secundárias ao processo viral, bem como a hipoxemia causada pela Covid-19; constituem mecanismos de repercussão negativa na saúde cardiovascular. Sabe-se que o melhor tratamento é a prevenção, sem descuidar das medidas de isolamento domiciliar, a lavagem constante das mãos previne essas complicações futuras desde a raiz, El compromiso cardiovascular de los pacientes con Covid-19, sin antecedentes de patologías cardiacas, se asocia a la severidad de la enfermedad e inclusive a una mayor mortalidad. Los mecanismos fisiopatológicos descritos con mayor claridad son el daño miocárdico directo y el proceso asociado a la inflamación sistémica. Las manifestaciones cardiovasculares son diversas e incluyen insuficiencia cardiaca aguda, miocarditis, miocardiopatías, síndromes coronarios agudos, arritmias, eventos tromboembólicos, shock cardiogénico. Metodología: Este trabajo será una recopilación de información que se basa en literatura ya publicada, con la utilización de revistas que se mantienen actuales como Intra Med, PubMed, The new journal of medicine, SciELO, OMS, OPS y otras revistas que mantienen publicaciones con buena evidencia científica de los últimos 3 años, desde el 2019 hasta la actualidad, en los idiomas español, portugués e inglés. Se tendrá en cuenta todos los artículos que traten sobre complicaciones cardiovasculares por SARS-Cov-2 en pacientes sin enfermedades crónicas de base. Se excluyo a pacientes con patologías cardiacas previas para este estudio. Conclusiones Y Discusión: La respuesta inflamatoria, los cambios hemodinámicos secundarios al proceso viral, así como la hipoxemia causada por Covid-19; constituyen mecanismos de repercusión negativa sobre la salud cardiovascular. Se sabe que el mejor tratamiento es la prevención, sin dejar de lado las medidas de aislamiento domiciliario, el constante lavado de manos se evita de raíz estas futuras complicaciones.
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- 2022
18. Caracterización clínica y genética de los pacientes pediátricos con miocardiopatía atendidos en una institución cardiovascular de la ciudad de Bogotá entre enero de 2015 y junio de 2021
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Beltrán Durán, Nathalie, Castro Oróstegui, Laura Jimena, Huertas Quiñones, Victor Manuel, Pedraza-Flechas, Ana María, and Restrepo Martínez, Carlos
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Disfunción miocárdica ,Miocardiopatías ,Genetic etiology of cardiomyopathies in children ,Falla cardíaca ,Heart failure ,Cardiac muscle ,Músculo cardíaco ,Cardiomyopathies ,Myocardial dysfunction ,Ciencias médicas, Medicina ,Etiología genética de las miocardiopatías en niños - Abstract
Introducción: Las miocardiopatías son un grupo heterogéneo de entidades que comprometen la función y estructura del músculo cardíaco, generando disfunción miocárdica, falla cardíaca e inclusive muerte súbita. La literatura Latinoamérica es limitada en cuanto a la etiología genética de las miocardiopatías en niños, lo que limita realizar medidas de promoción y prevención en los pacientes y sus familias. Métodos: Con el objetivo de describir las características clínicas y genéticas implicadas en el diagnóstico de miocardiopatía se realizó un estudio tipo serie de casos, en el que se incluyeron pacientes de 0 a 18 años con diagnóstico de miocardiopatía. Resultados: Se identificó la miocardiopatía dilatada (MCD) como el tipo más frecuente (37,1%), seguida de la miocardiopatía hipertrófica (MCH) representando el 20% del total de pacientes. El 30,6% cursó con disfunción sistodiastólica y el 57,5% requirió hospitalización general, 29,2% en la unidad de cuidados intensivos y el 7,14% recibió trasplante cardiaco. Se documentó antecedente familiar en el 19,7% de los pacientes, seis casos de consanguinidad en primer grado. Las manifestaciones predominantes fueron disnea, cianosis y tos. El 35,5% de los niños eran asintomáticos. Del total de los pacientes solo el 40,3% tenía estudio molecular en los cuales se evidenció variantes patogénicas y probablemente patogénicas para los genes MYH7, MYL2, TNNI3 y TPM. Conclusión: Se reafirma la importancia de realizar estudios moleculares genéticos en todos los pacientes pediátricos con diagnóstico de miocardiopatía. Este estudio retrospectivo sugiere que 1 de cada 6 niños puede ser poseedor de una variante patogénica o probablemente patogénica. Introduction: Cardiomyopathies are a heterogeneous group of entities that compromise the function and structure of the heart muscle, generating myocardial dysfunction, heart failure and even sudden death. The Latin American literature is limited in terms of the genetic etiology of cardiomyopathies in children, which limits the implementation of promotion and prevention measures in patients and their families. Methods: In order to describe the clinical and genetic characteristics involved in the diagnosis of cardiomyopathy, a case series study was carried out, which included patients from 0 to 18 years old with a diagnosis of cardiomyopathy. Results: Dilated cardiomyopathy (DCM) was identified as the most frequent type (37.1%), followed by hypertrophic cardiomyopathy (HCM), which represents 20% of all patients. Systodiastolic dysfunction was present in 30.6%, with 57.5% requiring general hospitalization, 29.2% in the intensive care unit, and 7.14% receiving a heart transplant. Family history was documented in 19.7% of the patients, six cases of consanguinity in the first degree. The predominant manifestations were dyspnea, cyanosis and cough. 35.5% of the children were asymptomatic. Of the total number of patients, only 40.3% underwent a molecular study that showed pathogenic and probably pathogenic variants for the MYH7, MYL2, TNNI3, and TPM genes. Conclusion: The importance of performing molecular genetic studies in all pediatric patients diagnosed with cardiomyopathy is reaffirmed. This retrospective study suggests that 1 in 6 children may have a pathogenic or probably pathogenic variant.
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- 2022
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19. Restrictive cardiomyopathy. Report of seven cases
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Fonseca Sánchez Luis Alfonso, Camacho Reyes Laura, and Bobadilla Aguirre Alfredo
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miocardiopatía restrictiva ,insuficiencia cardiaca ,miocardiopatías ,Medicine ,Pediatrics ,RJ1-570 - Abstract
Restrictive cardiomyopathy is a disease characterized by ventricular diastolic failure with elevation of end-dyastolic pressure and preserved systolic function. Materials and methods: retrospective study of patients with a diagnosis of restrictive cardiomyopathy. We carry out an analysis of demographic data, clinical presentation, and studies of patients diagnosed in the last 15 years at Instituto Nacional de Pediatría. Results: all included patients had clinical data of heart failure manifested mainly by medium-sized efforts dyspnea on schoolchildren and dyspnea by feeding in infants, as well as polypnea and diaphoresis. The most important signs were hepatomegaly, ascites, and gallop rhythm. Cardiomegaly by right atrial dilatation was the most frequent radiological data. The most frequent electrocardiographic data were dilatation of both atria, ST-segment depression and negative T waves. Echocardiogram showed in all cases binaural dilation and restrictive pattern. Conclusions: our patients were similar to those described in the specialized literature. Echocardiogram is still the best study for the diagnosis and the use of functional measurements as Doppler imaging can help to reveal early diastolic failure. In our country the heart transplant is just feasible; mortality remains 100%. Keywords: Restrictive cardiomyopathy, Heart failure, Cardiomyopathy.
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- 2014
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20. Clinical and Genetic Diagnosis of Nonischemic Sudden Cardiac Death.
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Jiménez-Jáimez, Juan, Alcalde Martínez, Vicente, Jiménez Fernández, Miriam, Bermúdez Jiménez, Francisco, Rodríguez Vázquez del Rey, María del Mar, Perin, Francesca, Oyonarte Ramírez, José Manuel, López Fernández, Silvia, de la Torre, Inmaculada, García Orta, Rocío, González Molina, Mercedes, Cabrerizo, Elisa María, Álvarez Abril, Beatriz, Álvarez, Miguel, Macías Ruiz, Rosa, Correa, Concepción, and Tercedor, Luis
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2017
- Full Text
- View/download PDF
21. Cardiac defibrillators: state of the art
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Olaya, Alejandro, Rojas-Montañez, Luis M., and Delgadillo-Velásquez, Jennifer
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Desfibriladores implantables ,Sudden cardiac death ,Miocardiopatías ,cardiovascular system ,Ventricular tachycardia ,Ventricular fibrillation ,Fibrilación ventricular ,Muerte súbita cardiaca ,Cardiomyopathies ,Implantable cardioverter-defibrillators ,Taquicardia ventricular - Abstract
Resumen La muerte súbita cardiaca es una consecuencia devastadora de las enfermedades estructurales del corazón y un problema de salud pública en todo el mundo; es responsable de alrededor del 50% de las muertes por causa cardiovascular. Su incidencia es mayor en personas por encima de los de 40 años, siendo en esta población la cardiopatía isquémica instaurada o durante la fase aguda del infarto al miocardio los factores de riesgo más importantes; sin embargo, hay otros factores no relacionados con isquemia, como la cardiomiopatía dilatada, hipertrófica o valvular. La fibrilación y la taquicardia ventricular son la causa más frecuente de muerte súbita cardiaca en adultos. Los cardiodesfibriladores implantables son ampliamente utilizados y recomendados por las sociedades de cardiología para la prevención primaria y secundaria de la muerte súbita cardiaca. Abstract Sudden cardiac death is a devastating consequence of structural heart disease and a global public health problem, accounting for close to 50% of cardiovascular deaths. Its incidence is greater in people over the age of 40, with the most important risk factors being: established ischemic heart disease or ischemia during the acute phase of a myocardial infarction. However, there are other factors, unrelated to ischemia, such as dilated, hypertrophic, or valvular cardiomyopathy. Ventricular fibrillation and tachycardia are the most frequent causes of sudden cardiac death in adults. Implantable cardioverter-defibrillators are widely used and recommended by cardiology societies for primary and secondary prevention of sudden cardiac death.
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- 2022
22. Investigating genetic and mechanistic interactors in familial cardoimyopathy through advanced disease modeling
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Escribá Piera, Rubén, Raya Chamorro, Ángel, Río Fernández, José Antonio del, and Universitat de Barcelona. Facultat de Biologia
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Ciències de la salut ,Miocardiopatías ,Myocardiopathies ,Ciencias biomédicas ,Células madre ,Genetics ,Miocardiopaties ,Stem cells ,Cèl·lules mare ,Medical sciences ,Genética ,Genètica - Abstract
[eng] Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease and a frequent cause of heart failure and sudden cardiac death. HCM is a highly complex condition defined by clinical and genetic heterogeneity. During last decades, our understanding of the diverse genetic landscape and the pathological molecular mechanisms underlying HCM has increased significantly. However, studying the effect of genetic modifiers of cardiomyopathies is limited by their complex genetic aetiology. A better understanding of the complex genetic mechanisms underlying cardiac diseases is an imperative hallmark for precision medicine. With this aim, we sought to investigate the differing molecular and genetic mechanisms of two siblings with an extensive family history of HCM but divergent clinical manifestations using patient-specific induced pluripotent stem cells (hiPSCs). For this purpose, we generated patient-specific iPSC from the male, diagnosed with a severe hypertrophic phenotype, and from the female, with mild hypertrophy, whose genetic testing revealed a common pathogenic mutation in the MYBPC3 gene (K600Nfs*2). Morphological characterization of iPSC-derived cardiomyocytes from mutant carriers revealed that sarcomeric alignment and structure was not compromised. However, MYBPC3 deficient iPSC-CMs showed reduced contractile force generation without cell shape remodelling. We then took advantage of the CRISPR/Cas9 gene-editing technology to generate MYBPC3-corrected isogenic controls in order to better ascribe genotype-phenotype correlations. Functional evaluation of mutant and isogenic iPSC-CMs revealed that cardiomyocytes from the symptomatic patient presented a hypercontractile phenotype as well as faster calcium transients. Further analysis on the mitochondrial bioenergetics indicated an inefficient ATP consumption in sarcomeres from both mutant carriers. In order to explore whether additional genetic variants were modifying the pathological outcomes in the symptomatic carrier, we performed a whole- exome sequencing of the mutant carriers. We identified a variant of unknown significance (VUS) in the MYH7 gene (I1927F), the second most common mutated gene in HCM, uniquely present in the severe HCM individual. Although the identified VUS has been previously described in HCM patients, there is not sufficient clinical and functional evidence to ascertain pathogenicity. To precisely evaluate the effect of the VUS, we generated a MYH7 I1927F corrected isogenic iPSC line using CRISPR/Cas9. Functional evaluation of double and single mutant iPSC-CMs revealed that the additional presence of the MYH7 variant was responsible for the faster cardiac contraction, strongly supporting a severe pathogenic contribution. Our study provides a unique platform to functionally assess the effect of genetic modifiers.
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- 2022
23. Análise transcriptómica comparativa de insuficiência cardíaca em casos de miocardiopatia hipertrófica e dilatada revela expressão génica diferencial
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Cainé, Laura, Fadoni, J., and Santos, Agostinho
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Miocardiopatias ,Ttranscriptoma ,Morte Subita - Abstract
Poster apresentado no 20º Congresso Nacional de Medicina Legal e Ciências Forenses, Coimbra, 2022 N/A
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- 2022
24. Miopericarditis posterior a infección leve por virus SARS COV 2
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Tilca, Gabriel, Alvarado, Sebastián, Vera, Celeste, and Vega, Gabriel
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Miocardiopatías ,Pericarditis - Abstract
La infección por COVID-19 se ha asociado con múltiples complicaciones cardiovasculares o exacerbación de enfermedades cardiovasculares pre-existentes que implica mayor riesgo de morbilidad y mortalidad. La lesión miocárdica puede ocurrir en distintas fases de la COVID-19 (p. ej., fases viral, pulmonar, inflamatoria y de recuperación), incluso tardíamente tras el inicio de los síntomas. Si bien no se conoce del todo su fisiopatología se sabe que esta mediada tanto por mecanismos directos como el daño inducido por receptor de enzima convertidora de angiotensina 2, lesión por hipoxia, cardiotoxicidad directa, daño microvascular e indirectos como la respuesta inflamatoria por la liberación de citoquinas, un estado de pro coagulabilidad, entre otros. La prevalencia de miocarditis se sitúa en alrededor del 7%, siendo esta mayor en pacientes cursando un cuadro grave. Se presenta el caso de un paciente de 29 años de edad, sin antecedentes de relevancia, cuya primera manifestación fue una miopericarditis, con gran elevación de biomarcadores de daño miocárdico, cuya evolución demostró trastornos sectoriales en la deformación miocárdica que revirtieron en el seguimiento. Myopericarditis after mild SARS COV 19 virus infection COVID-19 infection has been associated with multiple cardiovascular complications or exacerbation of pre-existing cardiovascular diseases that entail increased risk of morbidity and mortality. Myocardial injury can occur in different phases of COVID-19 (eg, viral, pulmonary, inflammatory, and recovery phases), even late after the onset of symptoms. Although its pathophysiology is not fully known, it is known that it is mediated both by direct mechanisms such as damage induced by angiotensin-converting enzyme 2 receptor, hypoxic injury, direct cardiotoxicity, microvascular damage, and indirect ones such as the inflammatory response due to the release of cytokines, a pro-coagulability state, among others. The prevalence of myocarditis is around 7%, this being higher in patients with severe symptoms. We present the case of a 29-year-old patient, with no relevant history, whose first manifestation was myopericarditis, with a high elevation of biomarkers of myocardial damage, whose evolution showed sectorial disorders in myocardial deformation that were reversed in the follow-up. Fil: Tilca, Gabriel. Hospital El Carmen (Mendoza, Argentina). Servicio de Cardiología Fil: Alvarado, Sebastián. Hospital El Carmen (Mendoza, Argentina). Servicio de Cardiología Fil: Vera, Celeste. Hospital El Carmen (Mendoza, Argentina). Servicio de Cardiología Fil: Vega, Gabriel. Hospital El Carmen (Mendoza, Argentina). Servicio de Cardiología
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- 2021
25. El aumento de la expresión del ARNm de la enzima convertidora de angiotensina I homóloga (ECA-2) inducido por atorvastatina se asocia a menor fibrosis e hipertrofia ventricular izquierda en un modelo de cardiomiopatía diabética Atorvastatin induced increase in homologous angiotensin i converting enzyme (ACE2) mRNA is associated to decreased fibrosis and decreased left ventricular hypertrophy in a rat model of diabetic cardiomyopathy
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Cristian Aguilar, Freddy Ventura, and Luis Rodríguez-Delfín
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Miocardiopatías ,Sistema renina-angiotensina ,Reacción en cadena de la polimerasa de transcriptasa inversa ,Cardiomyopathies ,Renin-angiotensin system ,Reverse transcriptase polymerace chain reaction ,Medicine ,Medicine (General) ,R5-920 - Abstract
Objetivos. Evaluar el efecto de atorvastatina sobre la progresión del remodelado cardiaco y la expresión de ECA-2 en el miocardio de ratas diabéticas. Materiales y métodos. La diabetes fue inducida en ratas Holtzman con una inyección intraperitoneal de estreptozotocina. Los animales fueron divididos en tres grupos: (1) ratas control, (2) ratas diabéticas y (3) ratas diabéticas tratadas con atorvastatina (50 mg/kg/día). Después de ocho semanas de tratamiento, los corazones fueron extraídos para el análisis morfométrico, la cuantificación de colágeno y la determinación de los niveles de ARNm de ECA y ECA-2. Resultados. El índice de hipertrofia ventricular y el depósito de colágeno se incrementaron significativamente en las ratas diabéticas. La administración de atorvastatina previno estos cambios sin modificar los niveles de colesterol. La hiperglicemia produjo un incremento significativo en los niveles del ARNm de ECA y una marcada disminución en la expresión de ECA-2 en el miocardio de ratas diabéticas. La administración de atorvastatina indujo la expresión del ARNm de ECA-2 e inhibió la sobreexpresión del ARNm de ECA en el miocardio de las ratas diabéticas. Conclusiones. Nuestros resultados indican que la atorvastatina, independientemente de su capacidad para disminuir el colesterol, normaliza la relación de la expresión de ECA/ECA-2 y atenúa el desarrollo del remodelado adverso en el corazón diabético.Objectives. This study has investigated the effect of atorvastatin on the progression of cardiac remodelling and ACE- 2 expression in diabetic myocardium in rats. Materials and Methods. Diabetes was induced in Holtzman rats with an intraperitoneal injection of streptozotocin. The animals were divided into 3 groups: (1) normal control rats, (2) diabetic rats and (3) diabetic rats treated orally with atorvastatin (50 mg/kg/day). After eight weeks of treatment, the hearts were removed for morphometric studies, collagen content assay and genetic expressions of ACE and ACE2 mRNA. Results. Myocardial hypertrophy index and collagen deposition were increased in diabetic rats, but not in the treated-diabetic rats, without producing changes in cholesterol levels. Myocardial ACE mRNA levels were increased while ACE2 mRNA levels were decreased in diabetic rats. Atorvastatin administration attenuated overexpression of ACE mRNA and overexpression of ACE-2 mRNA in diabetic rats. Conclusions. Our results indicate that atorvastatin, independently of its cholesterol-lowering capacity, lowers the ACE/ACE2 ratio to normal values and attenuates the development of adverse remodeling in the diabetic heart.
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- 2011
26. Choque cardiogênico associado à hemorragia subaracnóidea Cardiogenic shock associated with subarachnoid hemorrhage
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Glauco Adrieno Westphal, Gerson Costa, Sérgio Gouvêa, Keitiane Michele Kaefer, Rodrigo Soares da Silva, and Milton Caldeira Filho
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Hemorragia subaracnóidea ,Choque cardiogênico ,Insuficiência cardíaca ,Miocardiopatias ,Relatos de casos ,Subarachnoid hemorrhage ,Shock, cardiogenic ,Heart failure ,Cardiomyopathies ,Case reports ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Complicações sistêmicas são vistas frequentemente em indivíduos acometidos por hemorragia subaracnóidea. Dentre estas alterações podem ocorrer anormalidades eletrocardiográficas que simulam miocardiopatia isquêmica que podem ou não estar associadas com disfunção miocárdica. O objetivo deste é relatar um caso de associação de hemorragia subaracnóidea com disfunção miocárdica e choque cardiogênico. Mulher de 45 anos foi internada com quadro de coma secundário a hemorragia subaracnóidea. À admissão apresentava Glasgow = 7, Hunt-Hess = 5 e classificação tomográfica de Fisher = 3. O aneurisma cerebral de artéria comunicante anterior evidenciado pela arteriografia cerebral foi embolizado com sucesso no segundo dia de internação. Evoluiu com dispnéia e infiltrado pulmonar difuso. Havia alteração da repolarização ventricular em parede lateral, aumento da CK-MB (36 U/L) e hipotensão. O índice cardíaco de 2,03 L/min/m², a resistência vascular sistêmica 3728 dynes.seg/cm5/m², e a irresponsividade a volume evidenciavam o padrão hemodinâmico de choque cardiogênico. A fração de ejeção do ventrículo esquerdo era de 39%. A cineangiocoronariografia não apresentava lesões coronarianas obstrutivas. Após 6 dias a paciente foi extubada e ao oitavo dia foi possível a retirada completa da dobutamina. A fração de ejeção passou a 65%. Sucessivos exames de Doppler transcraniano não apresentaram vasoespasmo. A paciente recebeu alta da unidade de terapia intensiva no décimo quarto dia. Pacientes com hemorragia subaracnóidea podem apresentar disfunção ventricular e choque cardiogênico, aumentando o risco de isquemia cerebral. O diagnóstico e a otimização hemodinâmica são essenciais para minimizar os riscos de vasoespasmo e isquemia cerebral.Systemic complications are frequent in subarachnoid hemorrhage patients. Among these complications, electrocardiographic abnormalities simulating ischemic cardiomyopathy may occur, possibly associated with myocardial dysfunction. This manuscript aims to report a case of subarachnoid hemorrhage associated with myocardial dysfunction and cardiogenic shock. A 45 years old woman was admitted with subarachnoid hemorrhage and coma, showing Glasgow scale = 7, Hunt-Hess = 5 and Fischer computed tomography classification = 3. On the second day, the patient underwent anterior cerebral communicant artery aneurysm embolization. The clinical evaluation revealed diffuse pulmonary infiltration, dyspnea and hypotension. Additional tests showed electrocardiographic lateral wall repolarization changes and elevated creatine kinase-MB fraction (36U/L). The cardiac index was 2.03 L/minute/m², Vascular systemic resistance was 3728 dynes.sec/cm². The non-responsiveness to volume demonstrated a cardiogenic shock pattern. The ventricular ejection fraction was 39%. The coronariography was normal, showing no obstructive lesions. Six days later the patient was removed from respiratory support and after eight days the dobutamine infusion was discontinued. The ejection fraction recovered up to 65%. Serial transcranial Doppler evaluations did not show vascular spasm. After ten days the patient was discharged from the intensive care unit. Patients with subarachnoid hemorrhage may be complicated with ventricular dysfunction and cardiogenic shock, increasing the cerebral ischemia risk. Diagnosis optimization and hemodynamic stabilization are essential to minimize the risk of cerebral vasospasm and ischemia.
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- 2010
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27. Impact of the creation of specialized units for patients with hypertrophic cardiomyopathy
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Alberto Jiménez-Lozano, María Arántzazu-González-Marín, Martín Negreira-Caamaño, Jesús Piqueras-Flores, Manuel Muñoz-García, and Inmaculada Vivo-Ortega
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Pediatrics ,medicine.medical_specialty ,Insuficiência cardíaca ,Miocardiopatias ,Cardiology ,Sudden death ,Medical care ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Miocardiopatia hipertrófica ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Child ,General Environmental Science ,business.industry ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Morte súbita ,Optimal management ,Defibrillators, Implantable ,Death, Sudden, Cardiac ,030228 respiratory system ,Current management ,lcsh:RC666-701 ,Heart failure ,cardiovascular system ,General Earth and Planetary Sciences ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction and objectives: According to current international guidelines, hypertrophic cardiomyopathy (HCM) patients should be managed in specialized units. However, there is lack of data on the impact of the creation of these units in the management of HCM patients. Our goal was to assess the impact of the creation of an Inherited Inherited Diseases Cardiac Unit (ICDU) in the current management of patients with HCM. Methods: We analyzed 114 consecutive patients (62.6±8 years old, 70.2% males) with HCM. Variables related to optimal management of HCM patients and their family study were recorded, as well as guidance on the risk of sudden death. We analyzed whether patients were assessed by the ICDU or at a general cardiology consultation (GCC). Results: 50 patients were assessed in the IDCU and 64 in the GCC. Familial screening was more frequent in patients assessed by the IDCU (45.3% vs. 4%; p
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- 2021
28. Plan of Action for Inherited Cardiovascular Diseases: Synthesis of Recommendations and Action Algorithms.
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Barriales-Villa, Roberto, Gimeno-Blanes, Juan Ramón, Zorio-Grima, Esther, Ripoll-Vera, Tomás, Evangelista-Masip, Artur, Moya-Mitjans, Angel, Serratosa-Fernández, Luis, Albert-Brotons, Dimpna C., García-Pinilla, José Manuel, and García-Pavía, Pablo
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2016
- Full Text
- View/download PDF
29. Guías de manejo de enfermedad pericárdica y miocarditis Pericardial disease and myocarditis: management guide
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Jorge E Marín, Mauricio Duque, William Uribe, and Eduardo Medina
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pericarditis ,derrame pericárdico ,taponamiento cardiaco ,pericarditis constrictiva ,pericardiocentesis ,pericardiectomía ,miocardiopatías ,miocarditis ,pericardial effusion ,cardiac tamponade ,constrictive pericarditis ,pericardiectomy ,myocardiopathies ,myocarditis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
El pericardio es una estructura que se ve afectada, de forma primaria, por una serie de agentes de diversa índole, y de forma secundaria, por procesos sistémicos. Su respuesta es inespecífica y generalmente lo constituye un proceso inflamatorio que puede ser agudo, recurrente o crónico. El reconocimiento de estas patologías es de vital importancia para su correcto enfoque terapéutico. En estas guías se presentan algunas orientaciones básicas para la correcta clasificación, diagnóstico y terapia de los principales síndromes que afectan al pericardio, basados en los aspectos clínicos, etiológicos y de ayudas paraclínicas de los cuales se dispone en la actualidad. También se dan algunas recomendaciones de tratamiento específico para cada una de las principales entidades que normalmente afectan al pericardio. En la segunda parte del manuscrito se hace una breve mención de algunos aspectos fisiopatológicos de la miocarditis aguda, sus principales causas, y el tratamiento de la falla cardiaca que la enfermedad produce con sus diferencias puntuales, y se profundiza un poco sobre la controversia de su manejo con inmunosupresión y las medidas experimentales para su terapia. Metodológicamente se trató de seguir, hasta donde fue posible, las recomendaciones de medicina basada en evidencia, con grados de recomendación ya reconocidos en la literatura médica internacional.Pericardium is a structure that can be primarily affected by a series of different agents and in a secondary way by systemic processes. Its response is not specific and in general it corresponds to an inflammatory process that can be acute, chronic or recurrent. The recognition of these pathologies is of vital significance in the making of a right therapeutic approach. Some basic orientations for the correct classification, diagnosis and therapy of main pericardial syndromes, based on clinical and etiological aspects and paraclinical available aids are presented. Likewise, some recommendations for the specific treatment of each one of the main entities usually affecting the pericardium are given. Next, a brief mention of some physiopathological aspects of acute myocarditis, its main etiologies, and the treatment of the cardiac failure secondary to the disease with its specific differences, is made, and the controversy on its handling with immunosuppressors and the experimental therapy measures are studied in depth. We intended to follow until possible the recommendations of medicine based on evidence with grades already recognized in international medical literature.
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- 2005
30. Estudo da função ventricular na técnica de plicatura da parede livre do ventrículo esquerdo em cães Left ventricular function after plication of the left ventricular free wall in dogs
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James Newton Bizetto Meira de Andrade, Aparecido Antonio Camacho, Paulo Sérgio Patto Santos, Alexandra Pinheiro Fantinatti, Newton Nunes, Ângelo João Stopiglia, João Carlos Leal, and Domingo Marcolino Braile
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Miocardiopatias ,Miocardiopatia congestiva ,Ventrículos cardíacos ,Doxorrubicina ,Cães ,Myocardial diseases ,Cardiomyopathy, congestive ,Heart ventricles ,Doxorubicin ,Dogs ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJETIVO: Avaliar os efeitos da técnica na função ventricular esquerda em cães hígidos e com cardiomiopatia dilatada induzida pela doxorrubicina. MÉTODO: De 13 cães, oito receberam doxorrubicina até que a fração de encurtamento (FE) fosse menor que 20%. Destes, quatro animais e os cinco não induzidos foram submetidos à plicatura da parede livre do ventrículo esquerdo (PPLVE). Os demais cães não foram operados. Foram avaliados débito cardíaco (DC), pressão arterial, exame físico, eletrocardiografia, sistema "Holter" e ecocardiografia, por 180 dias. RESULTADOS: Houve redução do volume ventricular esquerdo. Os cães induzidos melhoraram após a operação e a fração de ejeção (FEj) retornou aos valores normais para a espécie. O DC e a FE aumentaram após a operação. Um cão foi a óbito. Nos cães não operados, a FE diminuiu e foram a óbito em torno de 40 dias após a indução; nos cães não induzidos, esta não se alterou. Houve extra-sístoles ventriculares, que se resolveram espontaneamente. CONCLUSÕES: A PPLVE sem circulação extracorpórea reduz o volume ventricular esquerdo e melhora a função cardíaca dos cães com cardiomiopatia dilatada induzida pela doxorrubicina, demonstrando baixa morbidade e mortalidade tardia.OBJECTIVE: We tested a new surgical technique, the plication of the left ventricular free wall, to reduce left ventricular area and volume and improve left ventricular systolic function, without using a cardiopulmonary bypass. METHODS: Dilated cardiomyopathy was induced in eight dogs by the injection of doxorubicin. Plication of the left ventricular free wall was performed in four dogs with induced cardiomyopathy and in five control dogs. Two dogs not submitted to surgery. The other two dogs died during the induction phase. Cardiac output, 2-dimensional and M-mode echocardiography, arterial blood pressure and electrocardiography were recorded over a 180 days period. Ambulatory electrocardiography of 24 hours was performed during the first postoperative day. RESULTS: The cardiomyopathy-induced group had significant improvements in cardiac output, ejection fraction, shortening fraction and reductions in the left ventricular end-systolic, end-diastolic area and volume after the surgery. One dog died. Electrocardiography and Holter revealed premature ventricular complexes, which improved spontaneously at the first week. The cardiomyopathy-induced dogs that did notundergo surgery deteriored and died about 40 days after the induction of cardiomyopathy. Hemodynamic values did not change in the normal dogs submitted to the surgery. CONCLUSION: The plication of the left ventricular free wall reduced the left ventricular area and volume and improved left ventricular systolic function in dogs with doxorubicin-induced cardiomyopathy giving low morbidity and mortality.
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- 2004
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31. Rentabilidad diagnóstica y seguridad de la biopsia endomiocárdica en corazón nativo en un centro español de referencia
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José Antonio Fernández-Díaz, Rodrigo Estévez-Loureiro, Fernando Domínguez, Cristina Aguilera Agudo, y Juan Francisco Oteo Domínguez, Jorge Toquero Ramos, Luis Alonso-Pulpón, Clara Salas Antón, Arturo García-Touchard, Eusebio García-Izquierdo Jaén, Marta Jiménez Blanco, Francisco Javier Goicolea Ruigómez, and Javier Segovia Cubero
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Gynecology ,medicine.medical_specialty ,Miocardiopatías ,business.industry ,BEM ,General Engineering ,RC31-1245 ,Both ventricles ,Endomyocardial biopsy ,Biopsia endomiocárdica ,Mapa electroanatómico ,Amiloidosis ,Cardiac Perforation ,medicine ,Miocarditis ,In patient ,Major complication ,Myocardial disease ,business ,Internal medicine - Abstract
espanolIntroduccion y objetivos: La biopsia endomiocardica (BEM) es una tecnica diagnostica fundamental en el diagnostico de distintas miocardiopatias, pero no esta exenta de posibles complicaciones. Se presentan los resultados en terminos de rentabilidad diagnostica y seguridad de la serie de BEM realizadas en corazon no trasplantado en nuestro hospital, asi como las consecuencias de la implementacion de un protocolo de actuacion y seguridad en BEM desarrollado en nuestro centro. Metodos: Se revisaron de forma retrospectiva todas las BEM en corazon no trasplantado realizadas desde septiembre de 2004 hasta julio de 2018. Se comparo la rentabilidad diagnostica y seguridad en dos etapas: antes y despues de la puesta en marcha del protocolo. Resultados: Se incluyeron 204 BEM realizadas en 190 pacientes. La indicacion mas frecuente fue el estudio de disfuncion ventricular o sospecha de miocarditis (51,5%), seguida de estudio de miocardiopatia restrictiva o infiltrativa (44,6%). Se realizaron 172 BEM en cavidades derechas (84,3%) y 30 en cavidades izquierdas (14,7%); solo en 2 de los procedimientos se tomaron muestras de ambos ventriculos. La BEM permitio el diagnostico definitivo en el 52% de los casos. Tras la implementacion del protocolo se observo una mejoria en la rentabilidad diagnostica (42,5 frente a 58,1%; p = 0,030) y una disminucion en la tasa de complicaciones mayores (del 7,5% al 3,2%; p = 0,167), con una reduccion estadisticamente significativa en la tasa de perforaciones cardiacas (6,3 frente a 0,8%; p = 0,025). Conclusiones: La BEM es una tecnica con un gran potencial diagnostico en pacientes con sospecha de miocardiopatia. Aunque puede presentar complicaciones potencialmente graves, la puesta en marcha de un protocolo de actuacion y seguridad se asocia a una reduccion en la tasa de complicaciones y a una mejoria en la rentabilidad diagnostica. EnglishIntroduction and objectives: Endomyocardial biopsy (EMB) is an established diagnostic tool in myocardial disease. However, this technique may carry major complications. We present the diagnostic and safety results of our experience in EMB in the non-transplant setting. We also present the results after the implementation of a technical and safety protocol developed at our center. Methods: We retrospectively analyzed the data of all EMBs conducted in non-transplant patients from September 2004 through July 2018. We compared the diagnostic yield and rate of major complications of EMB in two different periods: before and after implementing the protocol. Results: We included 204 EMBs performed in 190 patients. The most frequent indications were the evaluation of ventricular dysfunction or suspected myocarditis (51.5%) and the evaluation of restrictive cardiomyopathy or suspected infiltrative disease (44.6%). One hundred and seventy-two EMBs were performed in the right cardiac chambers (84.3%) and 30 EMBs in the left cardiac chambers (14.7%). The samples were taken from both ventricles on 2 cases only. Definite diagnosis was reached in 52% of the cases. After the implementation of the protocol, the diagnostic yield significantly improved (42.5% vs 58.1%; P = .030) and the rate of major complications decreased (from 7.5% to 3.2%; P = .167), with a statistically significant lower rate of cardiac perforation (6.3% vs 0.8%; P = .025). Conclusions: The EMB is a diagnostic tool with a great potential in patients with suspected cardiomyopathy. Our experience shows that a technical and safety protocol can help decrease the rate of complications and improve the diagnostic yield of EMB.
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- 2019
32. Fibroblast growth factor-2, but not the adipose tissue-derived stromal cells secretome, inhibits TGF-β1-induced differentiation of human cardiac fibroblasts into myofibroblasts
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Gabriel Romero Liguori, Martin C. Harmsen, Tácia Tavares Aquinas Liguori, Luiz Felipe P. Moreira, and Restoring Organ Function by Means of Regenerative Medicine (REGENERATE)
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EXPRESSION ,0301 basic medicine ,Stromal cell ,medicine.medical_treatment ,lcsh:Medicine ,Fibroblast growth factor ,Article ,MESENCHYMAL STEM-CELLS ,Transforming Growth Factor beta1 ,SIGNALING PATHWAYS ,03 medical and health sciences ,0302 clinical medicine ,TGF beta signaling pathway ,medicine ,Humans ,Myocytes, Cardiac ,COLLAGEN-SYNTHESIS ,Myofibroblasts ,Fibroblast ,lcsh:Science ,Cells, Cultured ,IN-VIVO ,Multidisciplinary ,Chemistry ,Growth factor ,HUMAN DERMAL FIBROBLASTS ,lcsh:R ,ISCHEMIC CARDIOMYOPATHY ,Cell Differentiation ,Mesenchymal Stem Cells ,TGF-BETA ,Fibroblasts ,Tissue inhibitor of metalloproteinase ,Extracellular Matrix ,030104 developmental biology ,medicine.anatomical_structure ,Culture Media, Conditioned ,030220 oncology & carcinogenesis ,PARACRINE ACTIONS ,Cancer research ,MMP14 ,MIOCARDIOPATIAS ,Fibroblast Growth Factor 2 ,lcsh:Q ,Myofibroblast ,CHRONIC MYOCARDIAL-INFARCTION ,Signal Transduction - Abstract
Transforming growth factor-β1 (TGF-β1) is a potent inducer of fibroblast to myofibroblast differentiation and contributes to the pro-fibrotic microenvironment during cardiac remodeling. Fibroblast growth factor-2 (FGF-2) is a growth factor secreted by adipose tissue-derived stromal cells (ASC) which can antagonize TGF-β1 signaling. We hypothesized that TGF-β1-induced cardiac fibroblast to myofibroblast differentiation is abrogated by FGF-2 and ASC conditioned medium (ASC-CMed). Our experiments demonstrated that TGF-β1 treatment-induced cardiac fibroblast differentiation into myofibroblasts, as evidenced by the formation of contractile stress fibers rich in αSMA. FGF-2 blocked the differentiation, as evidenced by the reduction in gene (TAGLN, p ACTA2, p = 0.0056) and protein (αSMA, p = 0.0338) expression of mesenchymal markers and extracellular matrix components gene expression (COL1A1, p COL3A1, p = 0.0029). ASC-CMed did not block myofibroblast differentiation. The treatment with FGF-2 increased matrix metalloproteinases gene expression (MMP1, p MMP14, p = 0.0027) and decreased the expression of tissue inhibitor of metalloproteinase gene TIMP2 (p = 0.0023). ASC-CMed did not influence these genes. The proliferation of TGF-β1-induced human cardiac fibroblasts was restored by both FGF-2 (p = 0.0002) and ASC-CMed (p = 0.0121). The present study supports the anti-fibrotic effects of FGF-2 through the blockage of cardiac fibroblast differentiation into myofibroblasts. ASC-CMed, however, did not replicate the anti-fibrotic effects of FGF-2 in vitro.
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- 2018
33. Dissecção da aorta após transplante cardíaco ortotópico: relato de 2 casos
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Noedir A. G. STOLF, Alfredo I. FIORELLI, Fernando BACAL, Viviane VEIGA, Ricardo BERNADIS, Edimar A. BOCCHI, Carlos ABREU FILHO, and Patrícia M. CURY
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Transplante de coração ,Miocardiopatias ,Aorta ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
No período de março de 1985 a setembro de 1999, 214 pacientes foram submetidos a transplante cardíaco em conseqüência de cardiomiopatia refratária ao tratamento farmacológico. Dois (0,9%) pacientes, com idades de 33 e 49 anos, desenvolveram dissecção da aorta torácica como complicação tardia fatal após o transplante cardíaco ortotópico. Na primeira paciente, com cardiomiopatia idiopática, esta complicação ocorreu no 93º mês de evolução, enquanto que no segundo, com cardiomiopatia isquêmica, a ocorrência foi mais precoce, no 11º mês. A hipertensão arterial sistêmica e o tabagismo estiveram presentes como fatores de risco em ambos os casos. As manifestações clínicas da dissecção ocorreram de forma aguda e catastrófica que impossibilitaram qualquer atitude cirúrgica e, possivelmente, maior atenção desta rara complicação possa modificar a sua péssima evolução natural.
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- 2000
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34. Expectativas de pacientes submetidos à cirurgia de revascularização do miocárdio no momento da alta hospitalar.
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Cielo, Cibele, Silveira, Marlusse, Luís Arboit, Éder, and Camponogara, Silviamar
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Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2015
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35. Anatomicosurgical segmentectomy of the left ventricle for systematized partial resection of the heart: an experimental study
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Liberato John Alphonse DI DIO, Fabio B. JATENE, Renato S. ASSAD, Antonio Carlos Palandri CHAGAS, Rosangela MONTEIRO, Rodrigo Ramos FREITAS, Maria Cristina Donadio ABDUCH, and Adib D. JATENE
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Ventrículo cardíaco ,Miocardiopatias ,Heart ventricle ,Myocardial diseases ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A surgical experimental investigation is being carried out in an attempt to provide a viable alternative to the current approaches to cardiac resection of the left ventricular myocardium in cases of cardiomyopathies with dilated ventricle. The experiments are based upon the presence of anatomicosurgical segments in the dog's heart similar to those existing in the atria and ventricles of humans. So far three mongrel dogs (weight 15 kg) were submitted to cardiac catheterism to evaluate the anatomy of the coronary arteries and their branches, the function and cavity of the left ventricle (LV). A lateral thoracotomy on the left side was performed to expose the heart. Cardiopulmonary bypass (CPB) of each animal was established through the right atrium and the femoral artery (4 mg/kg Heparin, at 32°C, intermittent aorta cross-clamping). The left marginal artery and veins were ligated, causing an area of acute myocardial infarction, showing well-defined sharp limits. Such an area was then resected and the left ventricle was reconstructed. The animals were weaned from CPB, one dog having remained in a stable condition during a 7-day period of observation. The second was sacrificed after 4-day period of observation and the third dog died four hours after CPB owing to an excessive reduction of the LV chamber related to an anatomical variation. Pre and post operation transthoracic echocardiograms were obtained after undergoing cardiac catheterism. The echocardiogram revealed discrete mitral insufficiency, reduction of the diameter of the left ventricle with approximation of the papillary muscles, a dysfunction and an impressive reduction of the cavity of the left ventricle. Peri-sutural areas of infarction were not observed. The orientation given by the anatomicosurgical segmentation of the coronary circulation is an important alternative to the present surgical treatment of cardiomyopathies with dilated ventricle.Uma investigação experimental cirúrgica está sendo realizada, numa tentativa de fornecer uma alternativa viável às atuais abordagens para ressecção cardíaca do ventrículo esquerdo em casos de cardiomiopatias com dilatação ventricular. Os experimentos são baseados na presença de segmentos anatomocirúrgicos em corações de cães, similares aos existentes nos átrios e ventrículos humanos. Três cães (peso 15kg) foram submetidos a cateterismo cardíaco, para avaliar a anatomia das artérias coronárias e de seus ramos, a função e cavidade do ventrículo esquerdo (VE). Toracotomia lateral esquerda foi realizada para expôr o coração. Circulação extracorpórea (CEC) de cada animal foi estabelecida através do átrio direito e da artéria femoral (4 mg/kg Heparina, 32°C, clampeamento intermitente da aorta). Artéria e veias marginais esquerdas foram ligadas, causando uma área de infarto agudo do miocárdio, exibindo limites de corte bem definidos. Desta forma, uma área foi ressecada e o ventrículo esquerdo foi reconstruído. Os animais foram desconectados da CEC. Um cão permaneceu em condição estável durante um período de 7 dias de observação. O segundo foi sacrificado após 4 dias de observação e o terceiro cão morreu 4 horas após CEC, devido a uma redução excessiva da câmara do VE relacionada a uma variação anatômica. Os ecocardiogramas transtorácicos pré e pós-operatórios foram obtidos após cateterismo cardíaco. O ecocardiograma revelou insuficiência mitral discreta, redução do diâmetro do ventrículo esquerdo com aproximação dos músculos papilares, uma disfunção e uma redução significativa da cavidade do ventrículo esquerdo. Áreas peri-suturais de infarto não foram observadas. A orientação dada pela segmentação anatomocirúrgica da circulação coronariana é uma alternativa importante ao tratamento cirúrgico atual de cardiomiopatias com ventrículo dilatado.
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- 1998
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36. Detecção e análise do potencial de ação monofásico do miocárdio em pacientes com miocardiopatia e transplante cardíaco
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Alfredo I. FIORELLI, Noedir A. G. STOLF, Fábio GAIOTTO, Fernando Campos G. PINTO, Fernando BACAL, Idágine CESTARI, Carlos NUNES, Adolfo LEIRNER, and Adib D. JATENE
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Potenciais de ação ,Miocárdio ,Miocardiopatias ,Transplante do coração ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A técnica do potencial de ação monofásico (MAP) é um método de obtenção de potencial in vivo, por meio de cateteres especiais, muito semelhante ao potencial de ação celular, porém, com a vantagem de não exigir o emprego de microeletrodos transmembrana in vitro na célula miocárdica. Este trabalho apresenta detalhes da construção de um cateter-eletrodo para aquisição de MAP endocárdico in vivo, bem como o desempenho do algorítmo desenvolvido para aquisição e análise automática dos sinais captados. Vários fatores afetam a fase de repolarização miocárdica, sendo pouco visíveis ao eletrocardiograma, porém, podem ser melhor identificados pelo MAP. As miocardiopatias e o transplante são situações que podem modificar o estado morfo-funcional da fibra miocárdica. O algorítmo desenvolvido para análise do MAP baseia-se na discriminação de características morfológicas e temporais dos potenciais. Inicialmente foram estudados 23 pacientes com indicação para realização de biópsia endomiocárdica, sendo que em 8 (34,8%) deles a biópsia foi indicada para complementar a avaliação da miocardiopatia idiopática e em 15 (65,2%) para controle de rejeição após transplante cardíaco ortotópico. Foram constituídos dois grupos de 5 pacientes, um com portadores de miocardiopatia (excluindo-se miocardite em atividade) e outro com transplante (estudados em duas situações distintas, sem e com rejeição em grau 3A ou superior). Com base nos resultados obtidos desta investigação, pode-se concluir que: 1) o cateter-eletrodo ora apresentado confirmou, na investigação clínica, o bom desempenho apresentado em pesquisa experimental para aquisição do MAP; 2) o algorítmo computadorizado mostrou-se adequado e com igual desempenho apresentado em estudo experimental; 3) as interferências que o MAP sofre nos corações com miocardiopatia ou transplantados, sem ou com rejeição, determinam alterações proporcionais de tal forma que conservam a morfologia da onda de repolarização; 4) durante os episódios de rejeição a velocidade de despolarização do miócito dobra ou triplica.
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- 1997
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37. Ventriculectomia parcial: um novo conceito no tratamento cirúrgico de cardiopatias em fase final Partial ventriculectomy: a new concept for surgical treatment of end stage cardiopathies
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Randas J. V Batista, José Luiz Verde dos Santos, Marcos Franzoni, A. C. F Araujo, Noriaki Takeshita, Murilo Furukawa, Lise Bochino, Dalton Precoma, Paulo Neri, Lisias Thome, Eduardo Oliveira, Rosane Carvalho, and Marco A Cunha
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Ventriculectomia parcial ,Miocardiopatias ,Ventriculectomy, partial ,Myocardiopathies ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A melhora clínica da função cardíaca pós aneurismectomia de ventrículo esquerdo e/ou cardiomioplastia com o músculo grande dorsal parece ser, ao menos parcialmente, devida ao remodelamento do ventrículo esquerdo. Através de pesquisa em nosso laboratório experimental com carneiros, demonstramos que o aumento do diâmetro do ventrículo é mais importante que a perda de massa muscular para a deterioração da função ventricular. Sabendo-se que em miocardiopatia dilatada não ocorre aumento de massa muscular, reduzimos o diâmetro do ventrículo para o normal, em uma série consecutiva de pacientes com esta lesão. No período de 1984 a 1995, foram operados com esta nova técnica, denominada, então, "Ventriculectomia Parcial", 103 pacientes portadores de miocardiopatias complexas e insuficiência cardíaca congestiva (NYHA IV). A operação é baseada na lei de Laplace (T=P.11.D) e consistiu na remoção de uma fatia de músculo da parede lateral do ventrículo esquerdo, iniciando-se na ponta deste, estendendo-se entre os músculos papilares e terminando próximo ao anel mitral. A cirurgia é realizada sob circulação extracorpórea normotérmica e não se utiliza cardioplegia. "Todos os pacientes foram avaliados pré-operatoriamente com ecodopplercardiografia e ventriculografia digital, os quais revelaram fração de ejeção < 20%, confirmando estes pacientes como candidatos ao transplante cardíaco. A maioria era do sexo masculino (n=73) e a idade variou de 19 a 74 anos. As doenças foram: miocardite a virus (n=12); pós miocardioplastia (n=1); doença de Chagas (n=15); doença valvar (n=38); doença isquémica (n=16); idiopática (n=21). Óbitos hospitalares (ocorridos nos primeiros 30 dias da cirurgia) (n=13): embolia pulmonar (n=4); insuficiência renal (n=5); sangramento (n=4). Óbitos tardios (ocorridos depois do 30º dia de cirurgia) (n=10): arritmia (n=6); "insuficiência cardíaca" (n=2); causa desconhecida (n=2); 8 pacientes precisaram ser reoperados por sangramento. Não houve infecção e nenhum paciente precisou balão intra-aórtico. Todos saíram com nitroprussiato e 19 pacientes, com inotrópicos. A ventriculografia e a ecocardiografia pós-op mostraram melhora acentuada da FE (de 100% a 300%). Em conclusão, a nova técnrca "Ventriculectomia Parcial", com o objetivo de reduzir o diâmetro do ventrículo esquerdo, pode beneficiar pacientes em estágio final de cardiopatia dilatada. Este novo conceito pode, na nossa experiência, proporcionar ao paciente melhora clínica significativa e prolongamento de sua vida.The clinical improvement of cardiac function post left ventricular aneurysmectomy and/or cardiomyoplasty with the latissimus dorsi muscle seems to be due to the remodeling of the left ventricle. We did some experiments with sheep in our laboratory and we concluded that the increment of ventricular diameter is more deleterious than loss of muscle mass to the ventricular function. Since there is no increment in muscle mass to the dilated hearts, we reduced their diameter to accomplish a better ventricular function in a series of very sick patients with dilated hearts. From 1984 to 1995, 103 patients with complex cardiac problems and end stage congestive heart failure (NYHA IV) with dilated cardiomyopathy underwent "Partial Ventriculectomy". The operation was based on Laplace's law (T-P.II.D) and consisted of removal of a large wedge of muscle from the lateral wall of the left ventricle beginning at the apex and extending between the papillary muscles, ending proximal to the mitral annulus. The operation was performed under normothermic cardiopulmonary bypass and no cardioplegia was used. Pre-operative left ventriculography and echocardiography showed global hypocontractility of the hearts with ejection fraction lower than 20% in all patients who were considered candidates for cardiac transplantation. Males were predominant (n=73) and the age varied from 19 to 74 years. The pathologies were: viral miocarditis (n=12); post miocardioplasty (n=1); Chagas' disease (n=15); valvular disease (n=38); ischemic disease (n=16); idiopathic (n=21). Hospital mortality (30 days post operative) (n=13): pulmonary embolus (n=4); renal failure (n=5); bleeding (n=4). Late deaths (after 30 days post-operative) (n=10): arhythmia (n=6); "cardiac failure" (n=2); unknown (n=2); 8 patients required reoperation for bleeding. There were no infection and none required IAPB. All patients had nipride and 19 needed inotropics. Post-op ventriculographies and echocardiographies showed improvement of EF (from 100% to 300%). In conclusion, this new technique "Partial Ventriculectomy", with it's purpose of reducing the ventricular diameter, may benefit patients with end stage heart failure. And this new concept may, in our experience, give the patient improvement in his clinical status and increase life span.
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- 1996
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38. Evolução clínica e comportamento da função ventricular no pós-operatório tardio da cardiomioplastia Clinical and ventricular function in the late follow-up of dynamic cardiomyoplasty
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Luiz Felipe P Moreira, Noedir A. G Stolf, Edimar A Bocchi, Fernando Bacal, Paulo M Pêgo-Fernandes, Alfredo I Fiorelli, Henry Abensu, José C Meneghetti, Paulo S Gutierrez, Geraldo Verginelli, and Adib D Jatene
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Cardiomioplastia ,Insuficiência cardíaca ,Miocardiopatias ,Cardiomyoplasty ,Heart failure ,Cardiomyopathies ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A cardiomioplastia tem sido proposta, como uma alternativa ao transplante cardíaco, no tratamento de pacientes com insuficiência miocárdica em fase avançada. O objetivo deste trabalho é estudar a evolução clínica e o comportamento da função ventricular no pós-operatório tardio desse procedimento em 34 pacientes portadores de cardiomiopatia dilatada, que foram operados no período de maio de 1988 a setembro de 1994. Vinte e sete pacientes estavam em classe funcional III e 7 pacientes em classe IV no preoperatorio, apesar do uso de terapêutica clínica otimizada. A mortalidade hospitalar foi de 2,9% e 1 paciente que evoluiu em choque cardiogênico foi submetido a transplante cardíaco 42 dias após a cardiomioplastia. O tempo de seguimento pós-operatório variou entre 2 e 73 meses, com média de 27,4 meses. Aos 6 meses de pós-operatório, 12 pacientes estavam em classe funcional 1,15 pacientes em classe 11 e 3 pacientes em classe III (p=0,001) em relação ao pré-operatório. Quatorze pacientes faleceram até 5 anos de pós-operatório e os índices de sobrevida foram 84,7% em 1 ano, 67,7% em 2 anos e 39,6% aos 5 anos de seguimento, sendo que, em 9 pacientes, os óbitos ocorreram por progressão da insuficiência cardíaca, e 5 pacientes faleceram subitamente. A análise de regressão de Gox mostrou que a mortalidade nos pacientes operados em classe funcional IV foi 5,5 vezes maior do que nos pacientes operados em classe III (p=0,006), cuja sobrevida foi de 52,7% aos 5 anos de pós-operatório. O estudo sistemático da função ventricular através da angiografia com radioisótopos, da ecocardiografia com Doppler e do cateterismo cardíaco direito documentou a melhora da fração de ejeção do ventrículo esquerdo (V E) de 19,8 ± 3 para 23,9 ± 7,2% (pDynamic cardiomyoplasty has been proposed as an alternative to heart transplantation in the treatment of severe cardiomyopathies. In this investigation, its results were investigated in 34 patients with idiopathic dilated cardiomyopathy submitted to this procedure from May 1988 to September 1994. Twenty seven patients were in New York Heart Association functional class III and 7 were in class IV before the operation, despite the use of maximal medical therapy. Hospital mortality was 2.9% and 1 patient presenting heart failure progression was submitted to urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed-up from 2 to 73 months (mean, 27.4 months). At 6 months of follow-up, 12 patients were in functional class 1,15 patients in class II and 3 patients in class III (p=0.001, in relation to preoperative data). Similar findings were observed from one to four years of follow-up. On the other hand, 14 patients died up to 5 years after the operation and the survival rates were 84.7% at 1 year, 67.7% at 2 years and 39.9% at 5 years of follow-up. The cause of death was progression of heart failure in 9 patients and 5 patients died suddenly. By stepwise Cox regression method, patients operated in functional class IV had relative risk of death 5.5 times higher than class III patients (p=0.006), whose survival rate was 52.7% at 5 years of followup. Regarding cardiomyoplasty influence on ventricular function, radioisotopic left ventricular (LV) ejection fraction improved from 19.8 + 3.1% to 23.6 + 6.2%, at 6 months of follow-up. Doppler-echocardiography documented similar changes in LV wall shortening. Also, right heart catheterization showed significant increases in mean arterial pressure, stroke index and LV stroke work index, which were associated with the decrease of mean pulmonary wedge pressure. On the other hand, it was not found any significant postoperative change in ventricular arrhythmia and atrial fibrillation incidence. At the late postoperative period, the hemodynamic improvement was maintained up to 5 years of follow-up, while LV ejection fraction and wall shortening tended to decrease after the second postoperative year returned to the preoperative levels. Finally, 3 of the 5 patients who completed 5 years of follow-up died due to heart failure progression and other died suddenly up to 73 months after the operation. Furthermore, histological examinations showed important fat tissue infiltration in the skeletal muscle flap of 9 patients submitted to necropsy studies from 20 to 73 months of follow-up. These histological changes were more severe in patients with longer follow-up. In conclusion, dynamic cardiomyoplasty improves congestive heart failure and LV function in patients with idiopathic dilated cardiomyopathy. However, long-term survival after this procedure is limited in patients operated upon in functional class IV. Furthermore, the cardiomyoplasty benefits on left ventricular function appear to be limited to a midterm period and this fact may be associated with late muscle flap degeneration.
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- 1995
39. Miocardiopatía restrictiva. Presentación de siete casos.
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Fonseca-Sánchez, Luis Alfonso, Camacho-Reyes, Laura, and Bobadilla Aguirre, Alfredo
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CARDIOMYOPATHIES , *HEART failure , *DYSPNEA , *ECHOCARDIOGRAPHY , *RADIOLOGY , *DOPPLER effect - Abstract
Restrictive cardiomyopathy is a disease characterized by ventricular diastolic failure with elevation of end-dyastolic pressure and preserved systolic function. Materials and methods: retrospective study of patients with a diagnosis of restrictive cardiomyopathy. We carry out an analysis of demographic data, clinical presentation, and studies of patients diagnosed in the last 15 years at Instituto Nacional de Pediatría. Results: all included patients had clinical data of heart failure manifested mainly by medium-sized efforts dyspnea on schoolchildren and dyspnea by feeding in infants, as well as polypnea and diaphoresis. The most important signs were hepatomegaly, ascites, and gallop rhythm. Cardiomegaly by right atrial dilatation was the most frequent radiological data. The most frequent electrocardiographic data were dilatation of both atria, ST-segment depression and negative T waves. Echocardiogram showed in all cases binaural dilation and restrictive pattern. Conclusions: our patients were similar to those described in the specialized literature. Echocardiogram is still the best study for the diagnosis and the use of functional measurements as Doppler imaging can help to reveal early diastolic failure. In our country the heart transplant is just feasible; mortality remains 100%. [ABSTRACT FROM AUTHOR]
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- 2014
40. Compromiso cardiovascular en COVID-19
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Germán, Valenzuela-Rodríguez and Amado-Tineo, Percy
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cardiomyopathies ,arritmias ,miocarditis ,SARS-CoV-2 ,cardiovascular ,COVID-19 ,heart failure ,thromboembolism ,insuficiencia cardíaca ,síndromes coronarios agudos ,tromboembolismo ,miocardiopatías ,myocardial injury ,acute coronary syndromes ,myocarditis ,arrhythmias ,injuria miocárdica - Abstract
Cardiovascular compromise among COVID-19 patients, especially in the subpopulation with cardiovascular risk factors, is associated with severity of disease and a higher mortality in some case-series.The most clearly described pathophysiological mechanisms are direct myocardial injury and the process associated with systemic inflammation. Cardiovascular manifestations are diverse and include myocardial injury, myocarditis, cardiomyopathies, heart failure, acute coronary syndromes, arrhythmias, thromboembolic events. Moreover, we must consider the adverse effects of medications used to treat the viral infection. El compromiso cardiovascular de los pacientes con COVID-19, especialmente en la subpoblación con factores de riesgo cardiovasculares, se asocia a la severidad de la enfermedad e inclusive a una mayor mortalidad en algunas series de casos. Los mecanismos fisiopatológicos descritos con mayor claridad son la injuria miocárdica directa y el proceso asociado a la inflamación sistémica. Las manifestaciones cardiovasculares son diversas e incluyen injuria miocárdica, miocarditis, miocardiopatías, insuficiencia cardíaca, síndromes coronarios agudos, arritmias, eventos tromboembólicos. Adicionalmente, debemos considerar los efectos adversos de los medicamentos utilizados para tratar la infección viral.
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- 2020
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41. Amiloidose Cardíaca
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Lopes, Julien Oliveira and Ferreira, Ana Catarina Moutinho
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Ciências Médicas::Ciências da Saúde::Medicina [Domínio/Área Científica] ,Tratamento ,Miocardiopatias ,Diagnóstico ,Etiologia ,Amiloidose Cardíaca - Abstract
Made available in DSpace on 2020-12-17T16:45:21Z (GMT). No. of bitstreams: 1 7547_16006.pdf: 871707 bytes, checksum: 5fb7749b866f309aa5649a5914946f46 (MD5) Previous issue date: 2020-07-13
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- 2020
42. Functional performance and muscular strength in symptomatic female carriers of Duchenne muscular dystrophy
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Caromano, Fatima Aparecida
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MIOCARDIOPATIAS - Published
- 2020
43. Abordaje de las cardiopatías familiares desde la Medicina genómica
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Ivonne J. Cárdenas-Reyes, Julián Palomino-Doza, Juan Pablo Trujillo-Quintero, Juan Pablo Ochoa, and Lorenzo Monserrat
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Miocardiopatías ,Massive sequencing ,Asociación genotipo-fenotipo ,030204 cardiovascular system & hematology ,Genotype-phenotype association ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Secuenciación masiva ,RC666-701 ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Muerte súbita cardiaca ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine - Abstract
Resumen: Las cardiopatías familiares son un grupo de enfermedades con alta heterogeneidad clínica y genética. Debido a que pueden heredarse y a su asociación con la muerte súbita, se recomienda efectuar un estudio clínico y genético del individuo afectado y su familia a través de una unidad especializada. Con la implementación de la secuenciación masiva se ha facilitado el acceso a los estudios genéticos en la práctica clínica de forma más rutinaria. Sin embargo, dada la gran cantidad de información obtenida se hacen necesarios el análisis y la interpretación adecuada de los resultados para garantizar un diagnóstico correcto. Este nuevo modelo de medicina amplía nuestra comprensión sobre estas patologías, gracias a que optimiza el diagnóstico, da una mejor aproximación pronóstica de los pacientes e identifica individuos asintomáticos en riesgo. Este artículo pretende realizar una revisión de la arquitectura genética de las enfermedades cardíacas hereditarias y proporcionar un enfoque práctico acerca de la utilidad de la Medicina genómica en el diagnóstico, la estratificación del riesgo y el estudio familiar en pacientes con este tipo de patologías. Abstract: The familial heart diseases are a group of diseases with high clinical and genomic heterogeneity. As they can be inherited and are associated with sudden death, it is recommended to perform a clinical and genetic study of the individual affected, as well as the family, in a specialised unit. The implementation of massive sequencing has meant that access to genetic studies is available in the most routine clinical practice. However, due to the large amount of information obtained, the results have to analysed and interpreted to ensure a correct diagnosis. This new medicine model widens the understanding of these diseases, as due to the diagnosis being optimised, it provides a more accurate prognosis for the patients, and identifies asymptomatic individuals at risk. A review is presented on the genetic architecture of heritable heart disease and provides a practical approach on the usefulness of Genomic Medicine in the diagnosis, risk stratification, and the familial study in patients with these types of heart diseases. Palabras clave: Miocardiopatías, Muerte súbita cardiaca, Asociación genotipo-fenotipo, Secuenciación masiva, Keywords: Cardiomyopathies, Sudden cardiac death, Genotype-phenotype association, Massive sequencing
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- 2018
44. RESONANCIA MAGNÉTICA CARDÍACA: NUEVOS DESARROLLOS Y PERSPECTIVAS FUTURAS
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Diego Perez de Arenaza
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03 medical and health sciences ,Resonancia magnética cardiaca ,0302 clinical medicine ,miocardiopatías ,Medicine ,realce tardío con gadolinio ,030212 general & internal medicine ,General Medicine ,miocardiopatía hipertrófica y miocardiopatía dilatada ,030204 cardiovascular system & hematology - Abstract
RESUMEN La resonancia magnetica cardiovascular (RMC) es una tecnica de imagenes establecida en la evaluacion de pacientes con miocardiopatias. El aspecto mas relevante de la RMC es la caracterizacion tisular para la identificacion de la fibrosis mediante las imagenes de realce tardio con gadolinio (RTG). El patron de RTG es de utilidad para el diagnostico de la etiologia en miocardiopatias. Ademas, la presencia de RTG se asocia con pronostico adverso. En este trabajo se evalua el valor pronostico del RTG en pacientes con miocardiopatia hipertrofica (MCPH) y en pacientes con miocardiopatias dilatada. En pacientes con MCPH, la cuantificacion del RTG identifica pacientes con alto riesgo de muerte subita y disfuncion ventricular. En pacientes con miocardiopatia dilatada, el RTG se asocia con incremento de los eventos como muerte y hospitalizacion. Por otro lado, la presencia de RTG identifica pacientes que se beneficiaran con la colocacion de cardiodesfibrilador implantable, sobre todo aquellos pacientes con fraccion de eyeccion mayor a 35%, con miocardiopatia dilatada isquemica o no isquemica. En pacientes que se evalua la terapia de resincronizacion, la ubicacion del gadolinio identifica las area del sitio de implante del cateter para optimizar los resultados. Por ultimo, el desarrollo del mapeo de T1 identifica formas incipientes de fibrosis difusa intersticial que podria tener impacto en identificar pacientes en riesgo en etapas mas precoces.
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- 2018
45. Limitações da cardiomioplastia no tratamento das cardiomiopatias Cardiomyoplasty limitations in the treatment of severe cardiomyopathies
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Luiz Felipe P Moreira, Edimar A Bocchi, Noedir A. G Stolf, Pedro Seferian Jr, Paulo M Pego - Fernandes, Antônio Carlos Pereira-Barreto, Fúlvio Pileggi, and Adib D Jatene
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cardiomioplastia ,miocardiopatias ,cardiomyoplasty ,cardiomyopathies ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A cardiomioplastia melhora a função ventricular esquerda e a sobrevida de pacientes portadores de cardiomiopatias severas. O objetivo deste estudo é identificar os fatores que influenciaram os resultados da cardiomioplastia em 22 pacientes operados entre maio de 1988 e dezembro de 1991. Todos os pacientes estavam em classe funcional III ou IV, apesar do uso de terapêutica clínica otimizada. Dezoito pacientes tinham diagnóstico de cardiomiopatia idiopática, a cardiomiopatia era chagásica em 2 e isquémica em 2. Não houve óbitos no período pós-operatório imediato e os pacientes foram seguidos por um período médio de 20,5 meses. Nove pacientes faleceram tardiamente e a sobrevida atuarial foi 76,1 % no primeiro ano e 63,8% no segundo ano de seguimento. Seis pacientes estão, atualmente, em classe funcional I, e 7 em classe II. A mortalidade e a manutenção dos sintomas, no primeiro ano pós cardiomioplastia, foi relacionada a ocorrência de tromboembolismo pulmonar e a progressão da insuficiência cardíaca em pacientes com alterações isquémicas do enxerto muscular, no pós-operatório imediato (pico de liberação plasmática da creatinoquinase > 1500 U.I.) (p=0,03). Paralelamente, aelevaçáo da fração de ejeção do ventrículo esquerdo, documentada aos seis meses de seguimento, foi mais importante em pacientes que apresentaram valores menores de liberação da creatinoquinase após a operação (p=0,02). Já o tamanho da cavidade ventricular esquerda pareceu influenciar a variação da fração de ejeção apenas quando foram retirados da análise os pacientes com comprometimento importante do enxerto muscular (p=0,06). Apesar de não ter havido influência da classe funcional pré-operatória sobre esse parâmetro e sobre a evolução clínica, no primeiro ano de seguimento, os pacientes operados em classe funcional IV apresentaram uma sobrevida, no segundo ano de pós-operatório, significativamente inferior à dos pacientes operados em classe III (33,3% versus 78,1%, p=0,04). Em conclusão, a melhora da função ventricular esquerda e a melhor evolução clínica após a cardiomioplastia podem ser limitadas pela ocorrência de lesão isquémica do enxerto muscular. A condição clínica pré-operatória, bem como o grau de dilatação das câmaras ventriculares, são, também, fatores importantes para o sucesso deste procedimento no tratamento das cardiomiopatias.Dynamic cardiomyoplasty improves left ventricular function and survival of patients with severe cardiomyopathies. The purpose of this study was to investigate the factors influencing cardiomyoplasty results in 22 patients operated upon at the Heart Institute. All patients were in New York Heart Association class III or IV, despite the use of maximal medical therapy. Eighteen patients had idiopathic dilated cardiomyopathy, in two patients the cardiomyopathy was due to Chagas' disease and in two due to ischemic ethiology. There were no operative death and patients were followed up for a mean of 20.5 months. Nine patients died at late follow-up period, and actuarial survival rates were 76.1% at 1 year and 63.8% at 2 years of follow-up. Six patients are presently in functional class I and six in class II. The mortality and the absence of functional improvement at 1 year were associated to episodes of pulmonary thromboelbolysm and to heart failure progression in patients with severe muscle flap ischemic compromise at the immediate postoperative period (creatinokinase peak level > 14001. U.) (p=0.03). In addition, the improvement of left ventricular ejection fraction at 6 months of follow-up was more significant in patients who presented lower values of creatinokinase after the surgical procedure (p=0.02). Otherwise, the influence of left ventricular dimension on ejection fraction changes was documented only when patients with severe muscle flap compromise were withdrawn from the analysis (p=0.06). Despite the absence of functional class influence on 1 year results of cardiomyoplasty, patients operated upon in class IV presented a less significant survival than patients operated upon in class III at 2 years of follow-up (33.3% versus 78.1 %, p= 0.04). In conclusion, quality of life and left ventricular function improvement after cardiomyoplasty may be limited by muscle flap ischemic compromise. Patient's condition prior to surgery and the degree of left ventricular dilation may also influence cardiomyoplasty results in patients with severe cardiomyopathies.
- Published
- 1992
46. Características ecocardiográficas da cardiomiopatia não-compactada: diagnóstico perdido ou errôneo Características ecocardiográficas de la miocardiopatía no compactada: diagnóstico perdido o erróneo Echocardiographic features of non-compaction cardiomyopathy: missed and misdiagnosed disease
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Francisco Martínez-Baca López, Rosa Marisol Alonso Bravo, and Domingo Arturo Rodríguez Huerta
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Miocardiopatías ,disfunción ventricular izquierda ,arritmias cardíacas ,embolia ,muerte súbita cardíaca ,Cardiomiopatias ,Disfunção Ventricular Esquerda ,Arritmias Cardíacas ,Embolia ,Morte Súbita Cardíaca ,Cardiomyopathies ,Ventricular Dysfunction ,Left ,Arrhythmias ,Cardiac ,Embolism ,Death ,Sudden ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A cardiomiopatia não-compactada é uma doença rara, anatomicamente caracterizada por um padrão trabecular proeminente e recessos intra-trabeculares profundos. Suas manifestações clínicas incluem disfunção ventricular grave arritmias, embolismo sistêmico e morte súbita. Nesse estudo, dois casos de pacientes de idades diferentes com cardiomiopatia não-compactada são descritos: uma criança do sexo masculino em idade escolar, cuja patologia estava associada com estenose mitral e regurgitação e um paciente adulto do sexo feminino, com 50 anos de idade e histórico de hipertensão arterial e insuficiência cardíaca.La miocardiopatía no compactada es una enfermedad rara, anatómicamente caracterizada por un patrón trabecular prominente y recesos intertrabeculares profundos. Sus manifestaciones clínicas incluyen disfunção ventricular gravem arritmias, embolismo sistémico y muerte súbita. En este estudio se describen dos casos de pacientes de edades diferentes con miocardiopatía no compactada: un niño de sexo masculino en edad escolar, cuya patología estaba asociada a estenosis mitral y regurgitación, y un paciente adulto del sexo femenino, con 50 años de edad e historia de hipertensión arterial e insuficiencia cardíaca.Non-compaction cardiomyopathy is a rare disease, anatomically characterized by a prominent trabecular pattern and deep intertrabecular recesses. Its clinical manifestations include severe left ventricular dysfunction, arrhythmias, systemic embolism, and sudden death. In this report, two cases of patients of different ages with non-compaction cardiomyopathy are described: a male schoolboy whose pathology was associated with mitral stenosis and regurgitation and a 50-year-old female with history of high blood pressure and cardiac failure.
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- 2009
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47. Resultados da cardiomioplastia no tratamento da cardiomiopatia dilatada Cardiomyoplasty results in the treatment of dilated cardiomyopathy
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Luiz Felipe P Moreira, Noedir A. G Stolf, Edimar A Bocchi, Pedro Seferian Jr, Paulo M Pêgo-Fernandes, Antônio Carlos Pereira-Barreto, Henry Abensur, José C Meneghetti, and Adib D Jatene
- Subjects
cardiomioplastia ,miocardiopatias ,cardiomyoplasty ,cardiomyopathies ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A cardiomioplastia tem sido proposta como uma alternativa ao transplante cardíaco no tratamento das cardiomiopatias isquémicas ou dilatadas. No período de maio de 1988 a outubro de 1990, 16 pacientes portadores de cardiomiopatia dilatada foram submetidos à cardiomioplastia no Instituto do Coração. Dez pacientes estavam em classe funcional III e seis em classe IV. Não houve óbitos no período de pós-operatório imediato. O tempo médio de seguimento foi de 16,9 ± 2,5 meses e a sobrevida atuarial foi 74% no 1º ano e 64,8% no 2º ano após a cardiomioplastia, sendo influenciada pela má evolução dos pacientes operados com diâmetro de ventrículo esquerdo maior do que 80 mm. Esses valores foram superiores, contudo, à sobrevida de um e dois anos de 39,5 e 29,6%, respectivamente, apresentada pelo grupo controle de 20 pacientes mantidos clinicamente (p = 0,06). Cinco dos 11 pacientes em seguimento após a cardiomioplastia, retornaram à classe funcional I e seis estão em classe II. Aos seis meses de pós-operatório, foi documentada a elevação da fração de ejeção do ventrículo esquerdo de 20,1 ± 3,8 para 26 ± 7,8% pelo estudo radioisotópico (p < 0,01), sendo que esse parâmetro se alterou principalmente em pacientes com menor dilatação da câmara ventricular esquerda. A Doppler-ecocardiografia mostrou que o encurtamento segmentar do ventrículo esquerdo se elevou de 12 ± 3,1 para 17,8 ± 2,3% (p < 0,01), enquanto que o volume sistólico aumentou de 23,6 ± 5,2 para 32,3 ± 7,9 ml (p < 0,01). Elevações semelhantes do índice sistólico, associados à queda da pressão em território pulmonar, foram também observadas pelo cateterismo cardíaco. O estudo ergoespirométrico documentou o aumento do consumo máximo de oxigênio de 14,9 ± 3,9 para 18,2 ± 3,4 ml/kg/min (p < 0,05). Um ano e aos 18 meses após a operação, as alterações decorrentes da cardiomioplastia permaneceram essencialmente as mesmas. Em conclusão, a cardiomioplastia melhora a função ventricular esquerda, reverte o quadro congestivo e melhora a sobrevida de pacientes portadores de cardiomiopatia dilatada. Fatores como a existência de grande cardiomegalia podem, contudo, influenciar a evolução tardia dos pacientes submetidos a este procedimento.Dynamic cardiomyplasty has been proposed as an alternative surgical treatment for severe cardiomyopathies. From May 1988 to October 1990, dynamic cardiomyoplasty was performed in 16 patients with dilated or chagasic cardiomyopathy at the Heart Institute. Ten patients were in New York Heart Association (NYHA) Class III and six in Class IV. There were no operative deaths. During a men follow-up of 16.9 ± 2.5 months, the actuarial survival was 74% at 1 year and 64.8% at 2 years of follow-up. This survival was influenced by the worse evolution of patients with left ventricular internal diameter more than 80 mm. These results were, however, better than the survival of 39.5 and 29.6%, presented at the same periods, respectively, by 20 patients maintained under medical therapy. Five of the 11 surviving patients in cardiomyoplasty group are in NYHA Class I and six in Class II. At 6 months of follow-up, radioisotopic left ventricular (LV) ejection fraction increased from 20.1 ± 3.8 to 26 ± 7.8% (p < 0.01). Doppler-echocardiography demonstrated that LV segmental wall shortening improved from 12 ± 3.1 to 17.8 ± 2.3% (p < 0.01), while LV stroke volume increased from 23.6 ± 5.2 to 32.3 ± 7.9 ml (p < 0.01). Similar increases in cardiac index, associated with decreases in pulmonary artery and wedge pressures, were also demonstrated by cardiac catheterization. Cardiopulmonary exercise test showed the improvement of maximal oxygen consumption from 14,9 ± 3.9 to 18.2 ± 3.4 ml/kg/min (p < 0.05). One year and 18 months after the cardiomyoplasty, these data remained essentially unchanged. In conclusion, dynamic cardiomyoplasty improves left ventricular function, reverses congestive heart failure and may improve survival of patiens with dilated cardiomyopathies. Factors as the existence of severe left ventricular dilation may, however, limited the late results of this procedure.
- Published
- 1991
48. Endomiocardiofibrose: resultados do tratamento cirúrgico com conservação das valvas atrioventriculares Endomyocardial fibrosis: results of the surgical treatment with atrioventricular valve preservation
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Sérgio Almeida de Oliveira, Luís Alberto Dallan, Antônio Carlos Pereira-Barreto, Charles Mady, Fúlvio Pileggi, and Adib D Jatene
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endomiocardiofibrose ,valvas cardíacas ,miocardiopatias ,endomyocardial fibrosis ,heart valves ,cardiomyopathies ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Entre abril de 1988 e janeiro de 1991, foram operados 25 pacientes consecutivos, para correção de endomiocardiofibrose, com técnica conservadora das valvas atrioventriculares. Dezenove pacientes eram do sexo feminino e seis do masculino. As idades variaram de 11 a 59 anos, com média de 40,6 anos. Dezesete pacientes apresentavam acometimento biventricular, seis com comprometimento do ventrículo esquerdo e apenas dois pacientes com lesão isolada do ventrículo direito. Todos estavam em grupos avançados de insuficiência cardíaca, sendo 19 em grupo IV da NYHA e seis no grupo III. No pré-operatório, 24 apresentavam insuficiência da valva tricúspide e 22 apresentavam insuficiência da valva mitral. Todos os pacientes foram operados com o auxílio de circulação extracorpórea e hipotermia sistêmica de 28ºC e pinçamento aórtico intermitente, para melhor exposição das cavidades ventriculares. A fibrose ventricular direita foi sempre ressecada através da valva tricúspide, enquanto que a fibrose do ventrículo esquerdo foi removida através de pequena ventriculotomia esquerda apical. Em todos os pacientes com insuficiência tricúspide, foi feita plástica anular do tipo DeVega. Dos pacientes com insuficiência mitral, sete tiveram correção espontânea após a ressecção da fibrose, e os outros 15 receberam anuloplastia. Houve apenas um (4%) óbito no pós-operatório imediato e nenhum óbito tardio. A recuperação funcional foi boa, estando atualmente 16 pacientes em grupo funcional I e 8 em grupo II.Between April 1988 and January 1991 we operated on 25 consecutive patients with endomyocardial fibrosis (EMF) with an approach to preserve the atrioventricular valves. Nineteen patients were females and six males. Their ages ranged from 11 to 5 years, with an average of 40.6 years. Seventeen patients had biventricular involvement, six had involvement of the left ventricle and only two patients had an isolated lesion of the right ventricle. All of them were in advanced stage of heart failure, 19 of which were in class IV of the NYHA, and six were in class III. Prior to the operation, tricuspid insufficiency was present in 24 patients and mitrai insufficiency was present in 22 patients. All the patients were operated on with the support of extracorporeal circulation and systemic hipothermia of 28ºC. Intermitent aortic cross-clamping was used so as to permit better exposition of the ventricular cavities. The fibrosis of the right ventricle was always removed through the tricuspid valve, while the fibrosis of the left ventricle was removed through a small apical left ventriculotomy in all the patients. An DeVega's annuloplasty of the tricuspid valve was necessary in all the patients with tricuspid insuffiency. On the other hand, seven patients had spontaneous correction of the ventricle insufficiency after the removal of the fibrosis of the left ventricle, while fifteen needed an annuloplasty. There was one (4.0%) in-hospital death and no late deaths. All patients experienced clinical improvement and are in NYHA functional class I or II.
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- 1991
49. Rentabilidad diagnóstica y seguridad de la biopsia endomiocárdica en corazón nativo en un centro español de referencia
- Author
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García-Izquierdo Jaén, Eusebio, Oteo Domínguez, Juan F., Jiménez Blanco, Marta, Aguilera Agudo, Cristina, Domínguez Rodríguez, Fernando, Toquero Ramos, Jorge, Segovia Cubero, Javier, Salas Antón, Clara, García Touchard, Arturo, Fernández Díaz, José Antonio, Estévez Loureiro, Rodrigo, Goicolea Ruigómez, Javier, Alonso Pulpón Rivera, Luis, García-Izquierdo Jaén, Eusebio, Oteo Domínguez, Juan F., Jiménez Blanco, Marta, Aguilera Agudo, Cristina, Domínguez Rodríguez, Fernando, Toquero Ramos, Jorge, Segovia Cubero, Javier, Salas Antón, Clara, García Touchard, Arturo, Fernández Díaz, José Antonio, Estévez Loureiro, Rodrigo, Goicolea Ruigómez, Javier, and Alonso Pulpón Rivera, Luis
- Abstract
Introduction and objectives: Endomyocardial biopsy (EMB) is an established diagnostic tool in myocardial disease. However, this technique may carry major complications. We present the diagnostic and safety results of our experience in EMB in the non-transplant setting. We also present the results after the implementation of a technical and safety protocol developed at our center. Methods: We retrospectively analyzed the data of all EMBs conducted in non-transplant patients from September 2004 through July 2018. We compared the diagnostic yield and rate of major complications of EMB in two different periods: before and after implementing the protocol. Results: We included 204 EMBs performed in 190 patients. The most frequent indications were the evaluation of ventricular dysfunction or suspected myocarditis (51.5%) and the evaluation of restrictive cardiomyopathy or suspected infiltrative disease (44.6%). One hundred and seventy-two EMBs were performed in the right cardiac chambers (84.3%) and 30 EMBs in the left cardiac chambers (14.7%). The samples were taken from both ventricles on 2 cases only. Definite diagnosis was reached in 52% of the cases. After the implementation of the protocol, the diagnostic yield significantly improved (42.5% vs 58.1%; P = .030) and the rate of major complications decreased (from 7.5% to 3.2%; P = .167), with a statistically significant lower rate of cardiac perforation (6.3% vs 0.8%; P = .025). Conclusions: The EMB is a diagnostic tool with a great potential in patients with suspected cardiomyopathy. Our experience shows that a technical and safety protocol can help decrease the rate of complications and improve the diagnostic yield of EMB., Introducción y objetivos: La biopsia endomiocárdica (BEM) es una técnica diagnóstica fundamental en el diagnóstico de distintas miocardiopatías, pero no está exenta de posibles complicaciones. Se presentan los resultados en términos de rentabilidad diagnóstica y seguridad de la serie de BEM realizadas en corazón no trasplantado en nuestro hospital, así como las consecuencias de la implementación de un protocolo de actuación y seguridad en BEM desarrollado en nuestro centro. Métodos: Se revisaron de forma retrospectiva todas las BEM en corazón no trasplantado realizadas desde septiembre de 2004 hasta julio de 2018. Se comparó la rentabilidad diagnóstica y seguridad en dos etapas: antes y después de la puesta en marcha del protocolo. Resultados: Se incluyeron 204 BEM realizadas en 190 pacientes. La indicación más frecuente fue el estudio de disfunción ventricular o sospecha de miocarditis (51,5%), seguida de estudio de miocardiopatía restrictiva o infiltrativa (44,6%). Se realizaron 172 BEM en cavidades derechas (84,3%) y 30 en cavidades izquierdas (14,7%); solo en 2 de los procedimientos se tomaron muestras de ambos ventrículos. La BEM permitió el diagnóstico definitivo en el 52% de los casos. Tras la implementación del protocolo se observó una mejoría en la rentabilidad diagnóstica (42,5 frente a 58,1%; p = 0,030) y una disminución en la tasa de complicaciones mayores (del 7,5% al 3,2%; p = 0,167), con una reducción estadísticamente significativa en la tasa de perforaciones cardiacas (6,3 frente a 0,8%; p = 0,025). Conclusiones: La BEM es una técnica con un gran potencial diagnóstico en pacientes con sospecha de miocardiopatía. Aunque puede presentar complicaciones potencialmente graves, la puesta en marcha de un protocolo de actuación y seguridad se asocia a una reducción en la tasa de complicaciones y a una mejoría en la rentabilidad diagnóstica.
- Published
- 2019
50. EL AUMENTO DE LA EXPRESIÓN DEL ARNm DE LA ENZIMA CONVERTIDORA DE ANGIOTENSINA I HOMÓLOGA (ECA-2) INDUCIDO POR ATORVASTATINA SE ASOCIA A MENOR FIBROSIS E HIPERTROFIA VENTRICULAR IZQUIERDA EN UN MODELO DE CARDIOMIOPATíA DIABÉTICA.
- Author
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Aguilar, Cristian, Ventura, freddy, and Rodríguez-Delfín, Luis
- Subjects
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ATORVASTATIN , *ANGIOTENSIN converting enzyme , *MESSENGER RNA , *LEFT heart ventricle , *CARDIAC hypertrophy , *LABORATORY rats , *PEOPLE with diabetes , *CARDIOMYOPATHIES , *DISEASE progression - Abstract
Objectives. This study has investigated the effect of atorvastatin on the progression of cardiac remodelling and ACE-2 expression in diabetic myocardium in rats. Materials and Methods. Diabetes was induced in Holtzman rats with an intraperitoneal injection of streptozotocin. The animals were divided into 3 groups: (1) normal control rats, (2) diabetic rats and (3) diabetic rats treated orally with atorvastatin (50 mg/kg/day). After eight weeks of treatment, the hearts were removed for morphometric studies, collagen content assay and genetic expressions of ACE and ACE2 mRNA. Results. Myocardial hypertrophy index and collagen deposition were increased in diabetic rats, but not in the treated-diabetic rats, without producing changes in cholesterol levels. Myocardial ACE mRNA levels were increased while ACE2 mRNA levels were decreased in diabetic rats. Atorvastatin administration attenuated overexpression of ACE mRNA and overexpression of ACE-2 mRNA in diabetic rats. Conclusions. Our results indicate that atorvastatin, independently of its cholesterol-lowering capacity, lowers the ACE/ACE2 ratio to normal values and attenuates the development of adverse remodeling in the diabetic heart. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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