Archivos de cardiologia de Mexico最新文献

Diastolic and systolic currents of injury are fundamental for understanding electrocardiographic alterations in acute myocardial ischemia. These currents result from electrical gradients between ischemic and healthy zones, driven by differences in depolarization and repolarization. The diastolic current, directed toward healthy tissue, and the systolic current, oriented toward the injured region, explain phenomena such as TQ depression (diastolic current of injury) and QRS complex modifications accompanied by ST-segment deviations (systolic current of injury). Historical and contemporary studies have elucidated the underlying pathophysiology of these currents, emphasizing changes in radial myocardial activation, alterations in electrical vectors, and the potential presence of intramural conduction blocks. Furthermore, precise correlations between these electrocardiographic findings and acute ischemic events have been demonstrated in both experimental and clinical models. Understanding these currents not only facilitates the diagnosis of myocardial ischemia but also enhances the capacity for prompt intervention. This knowledge underscores the central role of the electrocardiogram in clinical practice and cardiovascular research.

Objective: Intermediate blood pressure states, such as high-normal blood pressure and prehypertension, represent a continuous spectrum of cardiovascular risk. Their natural history in the working population has not been fully characterized. The objective of this study was to describe the transitions between different blood pressure states (normopressure, prehypertension, and hypertension) and to analyze their trajectories during a 7-year follow-up in an occupational cohort.

Method: Retrospective longitudinal study including 12,027 workers evaluated between 2013 and 2021. They were classified as normotension < 120/80 mmHg and hypertension ≥ 140/90 mmHg. Intermediate states were analyzed using two categories: prehypertension with 120-139/80-89 mmHg and high-normal blood pressure with 130-139/85-89 mmHg. Incidence rates were calculated and evolutionary trajectories were analyzed.

Results: The incidence of prehypertension was 25.80 per 1,000 person-years (95% CI: 25.05-26.55), higher than high-normal blood pressure (9.64; 95% CI: 9.25-10.03) and hypertension (9.86; 95% CI: 9.54-10.19). In the transition analysis, of the workers who started with normopressure, 60.1% progressed to prehypertension and 26.7% developed hypertension. Of those with initial prehypertension, 49.7% remained in their state and 43.8% progressed to hypertension. In the alternative classification, 21.2% progressed from normopressure to high-normal blood pressure, and of the latter, 55.9% developed hypertension.

Conclusions: Intermediate blood pressure states show distinctive patterns of progression, with significant transition rates toward hypertension. These findings underscore the importance of strengthening occupational surveillance and developing early preventive interventions in workers with intermediate blood pressure states.

El prolapso valvular mitral arrítmico es una condición implicada en casos de muerte súbita cardiaca inexplicable que recientemente ha tomado importancia debido a los métodos diagnósticos actuales. Sin embargo, ya que la presencia de prolapso valvular mitral se ha considerado un hallazgo benigno, sus implicaciones arrítmicas han sido subestimadas. La importancia de la presente revisión es destacar parámetros clínicos y de gabinete que permitan identificar individuos con riesgo arrítmico mediante una estratificación apropiada, para así poder aplicar medidas terapéuticas oportunas y evitar desenlaces fatales.

Objective: The implementation of heart failure (HF) guidelines in actual practice is rarely adequate and most patients do not receive optimal treatments. Our aim was to assess changes in attitudes, knowledge, confidence, and care pathways of HF patients among physicians in Argentina after a structured educational intervention.

Methods: Cross-sectional survey in 22 public and private health centers of physicians who participated in a comprehensive multi-module educational program (patient identification, classification/therapeutic options in advanced HF, structure/organization of the HF Day Hospital, education of patients in different stages/scenarios, and education of nursing staff in the management of patients at different stages/scenarios). Simple evidence-based roadmaps were created to address knowledge gaps.

Results: The intervention improved physicians' confidence in the diagnosis of HF with preserved ejection fraction (p < 0.001), and prioritization of quadruple therapy for outpatients (p = 0.01) and patients with acute HF (p < 0.001). The proportion of "confident"/"very confident" physicians in identifying HF patients with reduced ejection fraction who could benefit from an implantable cardioverter-defibrillator increased significantly (p = 0.01), as did the relevance of hypertonic saline administration and intravenous iron infusions. The use of discharge checklists increased significantly after the intervention.

Conclusions: This multifaceted, structured intervention was effective in improving physicians' confidence and attitudes, as well as their knowledge and care pathways of HF patients in Argentina.