Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Objective: To describe the perceptions of resident doctors about the development of their training program during the pandemic in the city of Lima - Peru.

Materials and methods: Through a cross-sectional study, a questionnaire was applied to seventy-eight cardiology residents in the last two years of training in the specialty. The perceptions about the accompaniment and support of the universities in the educational venues, for the development of the training program in cardiology during the pandemic, were evaluated.

Results: Regarding the support provided for their training, the items evaluated showed shortcomings above 60%, where permanent supervision was lacking in 90.0% of the residents. Regarding compliance with the rotations, the residents only received supervision in 24.4%, observing that they did not manage to carry out adequate rotations in 80.8% of the cases. The courses of the curricular plan were adequately developed in 92.5% of the cases, and the actions for the health of the resident were very low, highlighting that only in 9.0% of the cases did the university inquire about the state of health of the resident.

Conclusions: The development of the cardiology residency training program during the pandemic presented important shortcomings, showing that the deficiencies were accentuated compared to previous studies.

There are few reports on intracardiac fungal masses, especially in the pediatric population. We present the case of an extremely premature patient who, after being hospitalized since birth in an intensive care unit, developed fungal masses in the right atrium, which, due to their size, location and resistance to medical treatment, required surgical excision. For this reason, at the slightest suspicion of systemic candidiasis in pediatric patients, it is mandatory to include an echocardiogram in the defocalization examinations to rule out endocarditis and thus avoid the development of intracardiac fungal masses. Therefore, early detection for timely medical management may avoid the surgical approach associated with a high risk of morbidity and mortality in extremely premature patients.

Objective: To analyze the clinical and angiographic characteristics of patients with coronary ectasia found on coronary angiography.

Materials and methods: : Descriptive study of patients admitted to the cardiac catheterization laboratory of the Hospital Guillermo Almenara with coronary ectasia, during the years 2012 to 2020. The frequency of coronary ectasia, clinical, angiographic and coronary flow characteristics were determined.

Results: 7504 catheterizations were reviewed, and 91 patients were found to have coronary ectasia (1.21%). Of these patients, 71 cases were male (78%), and the mean age was 67.74 ± 9.9 years. The 38.5% of cases were obese or overweight; 39.6% were hypertensive; 11% diabetic; 13.2% smoked; 3.3% had chronic kidney disease and 3.3% had polyglobulia. Sixty-one percent of cases had a diagnosis of acute coronary syndrome, and 24% of cases had high-risk stable angina. The artery most frequently involved by ectasia was the right coronary artery (70%). The average diameter of the ectatic artery was 5.7 mm. Occlusive thrombus was found in 19.8% of cases. There was a significant association between TIMI flow and diameter of the ectatic artery (p=0.000), and there was also an association between coronary ectasia and acute coronary syndrome among patients living at an altitude of more than 2500 m (p=0.000).

Conclusions: coronary ectasia was an infrequent entity among patients who underwent coronary angiography, was predominantly male, mainly involved the right coronary artery, was associated with lower TIMI flow, and acute coronary syndrome among residents above 2500 m of altitude.

Background: The Global Registry of Acute Coronary Events (GRACE) prediction model stratifies patients with non-ST-segment elevation myocardial infarction (NSTEMI). Corrected QT interval (QTc) is not considered in this model.

Objective: To evaluate the relationship between the QTc interval and the GRACE score in patients with NSTEMI.

Materials and methods: An observational, retrospective study was carried between 2016 and 2019. We included patients with diagnosis of NSTEMI, QTc intervals were calculated with Bazett's formula, and they were classified into 2 groups: a normal QTc interval (<440 ms) and prolonged (≥440 ms). According to the GRACE score they were classified in three ranges: low risk (≤109 points), intermedium (110 - 139 points) and high (≥140 points), we determined if there were a correlation between QTc interval and the GRACE score.

Results: A total of 940 patients with a diagnosis of NSTEMI were admitted in our institution, 634 met the inclusion criteria, there were 390 patients with normal QTc interval and 244 with a prolonged QTc interval. Patients with prolonged QTc were older (65.5 vs 61, p=0.001) with a lower proportion of males (71.7% vs 82.8%, p=0.001). An association was found between the GRACE score and the QTC interval, subjects with a normal QTc had a greater proportion of low and intermediate risk than those with a prolonged QTc (p=0.001). Conclusions. In NSTEMI patients, a normal QTc interval (<440 ms) is associated with a GRACE risk score of low or intermediate risk.

The electrocardiogram (ECG) is a test that will allow making life-saving decisions. It has different patterns, and differential diagnoses, like the pattern of acute coronary syndrome with an elevation of the high lateral ST segment, which is called the sign of the flag of South Africa. We present the case of a 44-year-old patient presented with typical chest pain; the ECG showed ST-segment elevation in the DI, DII, AVL - V2, and ST depression in DIII, corresponding to an acute coronary occlusion with a compromise of the lateral segment of the heart. This ECG pattern is known as the flag sign of South Africa. The early recognition allowed the decision to perform immediately pharmacological reperfusion therapy and rescue angioplasty.

A 26-year-old pregnant woman with 29 weeks of gestational age reported two months of cough, dyspnea, orthopnea, and palpitations. Chest tomography revealed a 10x12cm solid mass in the right lung. Echocardiography showed that the tumor compromised the right atrium and ventricle, and was diagnosed by transcutaneous biopsy as Primary Mediastinal B-Cell Lymphoma (PMCBL). The patient presented 2:1 atrial flutter, sinus bradycardia, and ectopic atrial bradycardia. Due to the rapid poor evolution, it was decided to terminate the pregnancy by cesarean section and start chemotherapy, after which the cardiovascular complications resolved. PCML is a very rare lymphoma that can affect pregnant women in any trimester, its symptoms are related to its rapid growth and compromise of the heart, causing various cardiovascular manifestations (heart failure, pericardial effusion, cardiac arrhythmias). PCMLC is characteristically chemosensitive and has a good prognosis.

Objectives: To determine one-year survival and factors associated with mortality in patients with ST-segment elevation myocardial infarction in Peru.

Methods: An analysis was made of the cohort of patients included in the PERSTEMI-II registry during the year 2020, in whom survival at one year after the event and its risk factors were evaluated using Kaplan-Meier survival analysis and Cox regression.

Results: Of 374 patients in the PERSTEMI-II study, 366 (97.9%) completed follow-up up to one year after the event with a survival rate of 85%. Successful reperfusion was related to better survival at 1 year (hazard ratio [HR]=0.30, 95% CI: 0.14-0.62, p=0.001). Age (HR=1.04, 95% CI: 1.01-1.07, p=0.003), chronic kidney disease (HR=2.15, 95% CI: 1.04-4.39, p=0.037) and cardiogenic shock (HR=6.67, 95% CI: 3.72-11.97, p<0.001) were factors of higher mortality at 1-year follow-up.

Conclusion: The PERSTEMI-II registry is the first Peruvian registry that provides data on survival after ST-segment elevation myocardial infarction, which is 85% at one year. Successful reperfusion improves survival at one-year post infarction.

Amyloidosis is a multisystem disease caused by infiltration of misfolded proteins; cardiac involvement determines its prognosis. There are several types of precursor proteins capable of causing the disease; however, only two affect the heart, clonal immunoglobulin light chains (AL) and tetrameric transthyretin (TTR) protein. It is an underdiagnosed disease and, in late stages, it has a poor prognosis. We present the case of an older adult patient with progressive cardiac and extracardiac manifestations, as well as laboratory and echocardiographic criteria that brought us closer to the diagnosis of cardiac amyloidosis and also allowed us to assess the prognosis. The patient had a torpid evolution with a fatal outcome. The pathological anatomy studies allowed us to confirm our diagnostic presumption.