ABSTRACT
The aortic aneurysm is part of the acute aortic syndromes (AAS). Aortic aneurysms have a weakened tunica media. Acute aneurysm expansion may herald rupture with high morbility and mortality. Five percent of AAS are diagnosed as pentetrating atherosclerotic ulcer which is an ulceration of an atherosclerotic lesion of the aorta that penetrates the internal elastic lamina and allows hematoma formation within the tunica media of the aortic wall. Endovascular treatment is an alternative to surgery and has provided an adequate rate of successful repair. There is another type of treatment which combines surgery and endovascular repair (the hybrid open-endovascular repair) which provides adequate results. The afford mention case is about a patient with a penetrating atherosclerotic ulcer. The hematoma that results from this ulcer extends and self-contains the aneurysm, with a high risk of rupture. We will also describe the aneurysm treatment options.
Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic , Aortic Aneurysm, Thoracic , Aortic Aneurysm, Thoracic , Aortic Diseases , Aortic Diseases , Atherosclerosis , Atherosclerosis , Ulcer , Ulcer , Vascular Surgical Procedures/methodsABSTRACT
The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.
Subject(s)
Aged , Humans , Hypertension , Practice Guidelines as TopicABSTRACT
Propósito: A través de una Re-encuesta Nacional sobre Hipertensión Arterial Sistémica (HTAS) y Factores de Riesgo Cardiovascular, en población adulta con HTAS identificada en encuestas nacionales de salud del año 2000; Determinar: 1) Las tasas de morbilidad y mortalidad. 2) La incidencia e interrelación en el tiempo con otros factores de riesgo, tales como Obesidad, Dislipidemia, Diabetes y Tabaquismo. 3) Los principales factores de riesgo asociados a HTAS que influencian la aparición de complicaciones, necesidad y numero de días de hospitalización. 4) El grado de adherencia y tipo de medicación usada por el paciente hipertenso. Métodos: La Re-encuesta Nacional de Hipertensión (RENAHTA) fue realizada en el periodo 2003-2004. La encuesta es tipo III del método paso a paso descrito por la OMS. La población estudiada correspondió en su mayoría (73%) a individuos detectados en encuestas nacionales previas. El muestreo fue ponderado a priori tomando en cuenta una prevalencia nacional promedio de HTAS de 30.05% y su correspondiente para cada estado de la República. Error máximo permisible en la estimación = 0.28, Efecto de diseño = 4.5; y, Tasa de respuesta esperada (0.70). Resultados: De 14 567 como muestra inicial, 1165 (8%) sujetos fueron considerados como no hipertensos o falsos positivos en el año 2000. De los 13,402 pacientes restantes se informaron 335 muertes ocurridas en los primeros 2 años de seguimiento (2000-2002), lo que implicó una mortalidad anual de ˜1.15% en la población hipertensa. Así, 13,067 sobrevivientes, fueron sujetos a análisis. La edad al momento de la re-encuesta fue 45.6 ± 12.6. El (40.5%) fueron hombres (n=5,295), hubo diferencia estadísticamente significativa en la talla, pero no en el peso entre ambos géneros. El control de la HTAS subió de 14.6% en el 2000 a 19.2% en el 2004. Se duplicó la cifra de diabéticos de 16% a 30% (p < .001). El 54% de la población estudiada requirió de hospitalización al menos ...
Objective: Based on a National Re-survey on Hypertension (HTA) and other cardiovascular risk factors performed in Mexico during 2003 and 2004 in the adult population with HTA, as identified in the 2000 National Survey of Health, this study was planed to determine: 1) morbidity and mortality rates; 2) the incidence and interrelation with other risk factors, such as overweight, obesity, dyslipidemia, nephropathy and diabetes; 3) the main risk factors associated to HTA involved in its complications, need for hospitalization and number of days; and, 4) the degree of therapeutical adhesion and the type of antihypertensive drugs used. Methods: The survey was of type III using the step by step method described by WHO. Sampling was weighed a priori taking into account a national prevalence average of HTA of 30.05% and its corresponding rate for each federal state. Permissible maximum error in the estimation = 0.28. Effect of design = 4.5; and, Rate of awaited answer (0.70). Results: From the initial 14,567 interviewed patients, 1,165 (8%) subjects were considered non-hypertensive or false positives at the 2000 survey. From the 13,402 remaining patients, 335 died during the first 2 years of pursuit, which implies an annual mortality of ˜1.15% in the hypertensive population. Thus, 13,067 survivors were subjected to the final analysis. The mean age at the re-survey was 45.6 ± 12.6; 40.5% were men (n = 5,295). There was a statistically significant difference in height, but not in weight between both genders. The control HTAwas raised 14.6% in the year 2000 and 19.2% in 2004. The prevalence of diabetes was duplicated from 16% to 30% (< .001). Fifty four percent of the whole population required hospitalization at least once during the period of study. The rates of overweight, obesity, and dyslipidemia rose significantly (p < 0.05) independently from age, federal state, and gender. Conclusion: RENAHTA shows the impact of hypertension on the morbidity and mortality during the 3.1 ± 1.5 years of follow-up in Mexico. It alerts us on the need to reinforce the strategies of attention and prevention of this crucial risk factor and of screening the dynamic nonlinear interaction between the main cardiovascular risk factors in Mexico. New hypotheses are proposed forthe metabolic syndrome.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hypertension/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Health Surveys , Hypertension/complications , Mexico/epidemiology , Prevalence , Risk FactorsABSTRACT
El incremento en la explosión demográfica, el aumento en la esperanza de vida y el desarrollo tecnológico vertiginoso, han hecho que el número de pacientes con padecimientos cardiacos y necesidad de tratamiento quirúrgico se haya venido incrementando en las últimas dos décadas. Esto ha obligado a numerosas instituciones a tener que dar prioridad a los casos avanzados o de mayor gravedad, haciéndose un rezago en el caso de padecimientos cuya naturaleza no implique tanta urgencia operatoria. Con el objeto de conocer, si el establecimiento de una vía de internamiento, diferente a la habitual, que incluyese pacientes con padecimientos con escaso deterioro y poca posibilidad de complicación quirúrgica, pudiese mejorar esta situación, se realizó un estudio prospectivo, contrastando los costos de tratamiento quirúrgico de 70 enfermos, con otros 70 enfermos con patologías similares pero con diferente grado de avance del padecimiento, internados por la vía habitual y operados en el mismo periodo de tiempo. La mortalidad se redujo en un 5.71 por ciento, la morbilidad en un 18.2 por ciento y los costos se abatieron en un 48.7 por ciento. Se señala además la enorme frecuencia entre la comunicación interauricular y la enfermedad de Von Willebrand en nuestro medio. Se propone el mantenimiento y aumento de número de operaciones por esta vía y se señalan las limitaciones de la misma