Cardiac complications of COVID-19: Incidence and outcomes

Background: Coronavirus disease-2019 (COVID-19) has been associated with pre-existing cardiac conditions as well as cardiovascular complications. The incidence rates of cardiac complications, age, and gender differences in this population are unknown. Objectives: We wanted to study the incidence of cardiac complications and mortality in patients with COVID-19. Methods: Data from the TriNetX COVID-19 global research network platform was used to identify COVID19 patients. We compared patients with and without cardiac complications in patients with COVID-19 and obtained survival data. Results: The final cohort was composed of 81,844 patients with COVID-19. Cardiac complications occurred in 9.3% of patients as follows: acute coronary syndromes in 1.3%, heart failure in 4.4%, atrial fibrillation in 4.5%, sinus bradycardia 1.9%, ventricular tachycardia in 0.5% and complete heart block in 0.01%. Mortality was significantly higher in patients with the cardiac complications mentioned (20%) than in those without them (2.9%) (odds ratio 7.2, 95% CI, 6.7e7.7; p < 0.0001). Older males seem to have higher incidence of cardiac complications and mortality. Conclusions: Patients with COVID-19 who have cardiac complications have a higher risk of mortality when compared to those without cardiac complications.

Prevalence of Atrial Fibrillation in Pacemaker Patients

Abstract Background: Current pacemakers allow for the continuous recording of the occurrence of arrhythmic events. One of the most frequent arrhythmias after implantation of a device is atrial fibrillation (AF), an important risk factor for embolic events. The frequency of this arrhythmia in pacemaker patients has not been widely studied. Objectives: This study aimed to evaluate the prevalence, incidence, and predictors of the occurrence of AF in patients with double-chamber pacemakers and without a history of atrial fibrillation prior to implantation. Methods: A dynamic, retrospective, and prospective cohort study was carried out with 186 patients undergoing biannual follow-up of the double-chamber pacemaker, without previous AF, in a single service, between 2016 and 2018. Clinical data were collected from the medical records and the telemetry of the device and the prevalence, incidence rate, relative risk by univariate analysis (by chi-square), and risk ratio were calculated by multivariate analysis (by Cox regression); values of p<0.05 were considered significant. Results: There was a prevalence of 25.3% FA, with an incidence of 5.64 cases / 100 persons-year. The median time for the development of arrhythmia was 27.5 months. Multivariate analysis identified 5 statistically significant predictors: male gender, OR: 2.54 [1.04-6.15]; coronary artery disease, OR: 2.98 [1.20-7.41]; hypothyroidism, OR: 3.63 [1.46-9.07]; prior heart surgery, OR: 2.67 [1.01-7]; and left atrial enlargement, OR: 2.72 [1.25-5.92]. Conclusions: The prevalence and incidence of AF in this population are high. Risk factors for AF were: male gender, coronary artery disease, hypothyroidism, prior heart surgery, and left atrial enlargement.

Aborted Sudden Death Due to Severe Ventricular Arrhythmia in Timothy Syndrome

Abstract Timothy Syndrome is a rare autosomal dominant multisystem genetic condition. The CACNA1C gene, codifier of the CaV1.2 calcium channel, is affected, resulting in the loss of voltage-dependent calcium channel inactivation. Relevant clinical characteristics: (1) corrected QT interval greater than 480ms; (2) syndactyly. Death often occurs during childhood, and results from ventricular tachyarrhythmias. This study presents the case of a female newborn who suffered a cardiorespiratory arrest, secondary to ventricular arrhythmia. A prolonged QT interval, combined with 2:1 AV block, was also identified, requiring a definitive cardiac pacemaker implant that, during inpatient care, developed pulmonary sepsis, followed by death.

RACCOVID-19: primer Registro Argentino de Complicaciones Cardiovasculares en pacientes con COVID-19 / RACCOVID-19: First Argentine Registry of Cardiovascular Complications in COVID-19 Patients

RESUMEN Introducción: La enfermedad por coronavirus (COVID-19) ha causado una de las mayores pandemias conocidas al día de la fecha. La Sociedad Argentina de Cardiología (SAC) y la Federación Argentina de Cardiología (FAC) elaboraron el primer Registro Argentino de Complicaciones Cardiovasculares en pacientes con COVID-19 (RACCOVID-19), con el propósito de relevar, a nivel nacional, su impacto en la evolución hospitalaria de estos pacientes. Objetivos: Documentar la aparición de complicaciones cardiovasculares en pacientes internados por COVID-19 y evaluar predictores de riesgo de dichas complicaciones y su impacto pronóstico. Material y Métodos: Se incluyen datos de 2750 pacientes en 50 centros de 11 provincias del país, desde el 18 de mayo hasta el 31 de octubre de 2020. Resultados: La edad promedio fue de 57±18 años y hubo predominio de sexo masculino (60,2%). La tasa de complicaciones cardiovasculares fue del 15,3%. La insuficiencia cardíaca (43,5%), las arritmias (33,5%) y el daño miocárdico (31,1%) fueron las complicaciones más frecuentes. La mortalidad fue del 19,3%. Un modelo de predicción de sobrevida en la etapa hospitalaria incluyó las siguientes variables: edad, sexo masculino, valores de hematocrito y creatinina al ingreso, existencia de antecedentes patológicos, formas de presentación de COVID-19 graves y presencia de complicaciones cardiovasculares. Conclusiones: El registro RACCOVID-19 mostró una tasa de complicaciones cardiovasculares del 15,3%. La mortalidad total del registro fue del 19,3% y las complicaciones cardiovasculares junto con otras variables de presentación, así como la gravedad del cuadro clínico de COVID-19, forman parte de un perfil de riesgo clínico asociado a mayor mortalidad.

ABSTRACT Background: Coronavirus disease (COVID-19) has caused one of the largest pandemics known to date. The Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC) have developed the First Argentine Registry of Cardiovascular Complications in COVID-19 patients (RACCOVID-19) with the purpose of performing a nationwide review of their impact in the in-hospital evolution of these patients. Objectives: The aim of this study was to record cardiovascular complications in hospitalized patients for COVID-19, and to evaluate risk predictors of these complications and their prognostic impact. Methods: A total of 2750 patients from 50 centers in 11 provinces of the country were included from May 18 to October 31, 2020. Results: Mean age was 57±18 years, with a prevalence of male gender (60.2%). Cardiovascular complications occurred in 15.3% of cases. Heart failure (43.5%), arrhythmias (33.5%) and myocardial injury (31.1%) were the most relevant complications. Mortality was 19.3%, and a predictive model of in-hospital survival included age, male gender, admission hematocrit and creatinine, history of previous diseases, severe forms of COVID-19 presentation and cardiovascular complications. Conclusions: The RACCOVID-19 registry showed 15.3% of cardiovascular complications. Overall mortality was 19.3% and cardiovascular complications together with other presentation variables as well as the clinical severity of COVID-19, are part of a clinical risk profile associated with higher mortality.

Role of Preoperative Rehabilitation in Hip Surgeries: A Narrative Review

Hip trauma is a significant cause of morbidity and mortalityamong elderly patients. In the United States approximately30lakhs hip fractures occur each year and this number isincreasing each year along with the increased number ofelderly population. The management of hip trauma usuallydepends on the surgical management. However evidencesuggests that even with prompt surgical interventions, thepost operative complications are common and patient face agreat difficulty in post operative rehabilitation. Recently, someof the randomized trials have suggested that preoperativerehabilitation in the form of exercise or the physiotherapyis associated with improved postoperative pain score anddecreased hospital stay in elderly frail patients and in patientswith associated co morbidities such as diabetes, cardiovascular,or respiratory complications. In this present review wewill outline the importance of preoperative rehabilitationin management of different types of hip trauma based onprevious study summaries. We will also try to evaluate theimportance of such rehabilitation therapy in final outcome ofthe patients after surgery

Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

Abstract Background: Postoperative atrial fibrillation (POAF) is a common complication associated with undesirable outcomes; hence, the provision of appropriate tools is important to help identify patients at risk. Objectives: To evaluate the predictive capacity of the CHADS2 and CHA2DS2-VASc scores, alone and combined with left atrial (LA) size, for the onset of POAF in patients undergoing coronary artery bypass grafting and/or valvular surgery. Methods: We performed a retrospective cohort study on 144 patients. A decision tree was used to identify the cut-off values of the CHADS2 and CHA2DS2-VASc scores and LA size in order to calculate sensitivity, specificity, predictive-value positive (PVP), and predictive-value negative (PVN), in addition to regression models. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of the models. The level of significance adopted was 5%. Results: Patients who developed POAF were older (p = 0.050), had reduced left ventricular ejection fraction (p = 0.045), longer hospital length of stay (p = 0,018), but their mean CHADS2 (p = 0.077) and CHA2DS2-VASc (p = 0.109) scores were similar to those of patients with no arrhythmia. LA size improved the predictive capacity of the CHADS2 score, in terms of specificity and PVP, and of the CHA2DS2-VASc score, in terms of sensitivity and PVN. However, the CHADS2 (OR = 1.198; CI95% = 0.859-1.156) and CHA2DS2-VASc (OR = 1.047; CI95% = 0.784-1.401) scores were not predictors of POAF, either alone or in combination with LA size (OR = 1.163; CI95% = 0.829-1.648 and OR = 1.065; CI95% = 0.795-1.433). Conclusion: The CHADS2 and CHA2DS2-VASc scores alone or in combination with LA size did not show good predictive capacity for POAF.

Hemoglobina glucosilada como predictor de mortalidad y complicaciones en pacientes con infarto agudo del miocardio con elevación del segmento ST / Glycated hemoglobin as predictor of mortality and complications in patients with acute myocardial infarction with st-segment elevation

Introducción: La hemoglobina glucosilada pudiera convertirse en una herramienta en la estratificación inicial de pacientes infartados según el balance metabólico previo. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada para muerte y complicaciones cardíacas mayores en el período intrahospitalario en pacientes con diagnóstico de infarto agudo del miocardio con elevación del segmento ST. Métodos: Se realizó un estudio observacional analítico de cohorte prospectivo en pacientes atendidos en la Unidad de Cuidados Coronarios del Hospital Universitario Arnaldo Milián Castro entre noviembre de 2018 y marzo de 2019 por presentar diagnóstico de infarto del miocardio agudo con elevación del segmento ST (N=73), de los cuales se seleccionó una muestra de 62 pacientes. Se realizó un análisis de conglomerados de K-medias y se valoró el área bajo la curva ROC de la hemoglobina glucosilada para predecir mortalidad y complicaciones mayores. Resultados: Existieron diferencias estadísticamente significativas entre los diferentes cluster en las variables estado al egreso (p=0,001; V=0,489) y ocurrencia de complicaciones cardíacas mayores (p=0,050; V=0,307). El análisis del estadístico C de la hemoglobina glucosilada demostró su capacidad predictiva para mortalidad tanto en diabéticos (C=0,810; p=0,014) como en no diabéticos (C=0,817; p=0,006), así como para complicaciones cardíacas mayores en diabéticos (C=0,799; p=0,015) y no diabéticos (C=0,683; p=0,052). Se estableció el punto de corte en 7,8 por ciento, por encima del cual la hemoglobina glucosilada constituyó un factor pronóstico de mortalidad y complicaciones cardíacas mayores. Conclusiones: Se determinó que la hemoglobina glucosilada posee capacidad para predecir mortalidad y complicaciones cardíacas mayores en el período intrahospitalario. Su valor por encima del punto de corte constituyó un predictor independiente(AU)

Introduction: Glycated hemoglobin could become a tool in the initial stratification of infarcted patients according to the previous metabolic balance. Objective: To determine the prognostic value of death glycated hemoglobin and major cardiac complications in the in-hospital period in patients diagnosed with acute myocardial infarction with ST-segment elevation. Methods: A prospective cohort analytical observational study was conducted in patients treated in the Coronary Care Unit at Arnaldo Milián Castro University Hospital from November 2018 to March 2019. They presented diagnosis of acute myocardial infarction with ST segment elevation ( N = 73); a sample of 62 patients was selected. Cluster analysis of K-means was performed and the area under ROC curve of glycated hemoglobin was assessed to predict mortality and major complications. Results: There were statistically significant differences between the clusters in the variables such as state at discharge (p = 0.001; V = 0.489) and occurrence of major cardiac complications (p = 0.050; V = 0.307). The analysis of C statistic of glycated hemoglobin established the predictive capacity for mortality in both diabetics (C = 0.810; p = 0.014) and non-diabetics (C = 0.817; p = 0.006), as well as for major cardiac complications in diabetics ( C = 0.799; p = 0.015) and non-diabetics (C = 0.683; p = 0.052). The cut-off point was established at 7.8 percent, above which glycated hemoglobin was a prognostic factor for mortality and major c. Conclusions: Glycosylated hemoglobin was stablished to have the ability to predict mortality and major cardiac complications in the in-hospital period. Its value above the cut-off point was an independent predictor(AU)

Genetic Syndromes and Associated Cariovascular Anomalies in Adults: A Singapore Perspective

@#Children with genetic syndromes are increasingly surviving to adulthood in Singapore. This is due to early detection and significantly improved multi-dimensional care. Congenital heart disease is one of the characteristic abnormalities in patients. However, the cardiac anomalies of some of these patients may only manifest later in early adulthood. A significant number of such patients are not on regular medical follow-ups to monitor for future complications. This article describes based on the common syndromic conditions that are present in Singapore. Advanced genetic tests like chromosomal microarray analysis can help diagnose these syndromes that are not obvious clinically, thus instituting appropriate management and treatment for such patients. Creating awareness of such syndromes and its cardiac complications will translate to them being referred to the cardiologists to prevent further morbidity and mortality. Timely counselling regarding fertility, prenatal testing and complications due to pregnancy are also discussed in this article.

Association between Microvolt T-Wave Alternans and Malignant Ventricular Arrhythmias in Chagas Disease / Associação entre Microalternância de Onda T e Arritmias Ventriculares Malignas na Doença de Chagas

Abstract Background: Sudden cardiac death is the most frequent death mechanism in Chagas disease, responsible for 55% to 65% of the deaths of patients with chronic Chagas cardiomyopathy (CCC). The most often involved electrophysiological mechanisms are ventricular tachycardia and ventricular fibrillation. The implantable cardioverter defibrillator (ICD) has a beneficial role in preventing sudden death due to malignant ventricular arrhythmias, and, thus the correct identification of patients at risk is required. The association of microvolt T-wave alternans (MTWA) with the appearance of ventricular arrhythmias has been assessed in different heart diseases. The role of MTWA is mostly unknown in patients with CCC. Objectives: To evaluate the association between MTWA and the occurrence of malignant ventricular arrhythmias in patients with CCC. Method: This is a case-control study including patients with CCC and ICD, with history of malignant ventricular arrhythmias (case group), and patients with CCC and no history of those arrhythmias (control group). The MTWA test results were classified as negative and non-negative (positive and indeterminate). The significance level adopted was a = 0.05. Results: We recruited 96 patients, 45 cases (46.8%) and 51 controls (53.1%). The MTWA test was non-negative in 36/45 cases (80%) and 15/51 controls (29.4%) [OR = 9.60 (95%CI: 3.41 - 27.93)]. After adjustment for known confounding factors in a logistic regression model, the non-negative result continued to be associated with malignant ventricular arrhythmias [OR = 5.17 (95%CI: 1.05 - 25.51)]. Conclusion: Patients with CCC and history of malignant ventricular arrhythmias more often have a non-negative MTWA test as compared to patients with no history of arrhythmia.

Resumo Fundamento: A morte súbita cardíaca é o mecanismo de morte mais comum na doença de Chagas, responsável pelo óbito de 55% a 65% dos pacientes com cardiomiopatia chagásica crônica (CCC). Os mecanismos mais frequentemente envolvidos são as taquiarritmias ventriculares. O cardioversor-desfibrilador implantável (CDI) apresenta impacto na redução da mortalidade por arritmias ventriculares e faz-se necessária a correta identificação de pacientes sob risco. A associação de microalternância de onda T (MTWA) com o aparecimento de arritmias ventriculares foi avaliada em diferentes cardiopatias através de um teste. O papel da MTWA na identificação de pacientes sob risco na CCC permanece incerto. Objetivo: Avaliar a associação entre MTWA e a ocorrência de arritmias ventriculares malignas na CCC. Método: Trata-se de um estudo caso-controle, que incluiu pacientes com CCC em uso de CDI, com história prévia de arritmias ventriculares malignas (casos) ou sem história prévia (controles). Os resultados do teste foram classificados em negativo e não negativo (positivo e indeterminado). O nível de significância foi a = 0,05. Resultado: Foram recrutados 96 pacientes, 45 no grupo caso (46,8%) e 51 no grupo controle (53,1%). O teste de MTWA apresentou resultado não negativo em 36/45 pacientes no grupo caso (80%) e 15/51 no grupo controle (29,4%), OR = 9,60 (IC95%: 3,41 - 27,93). Após ajuste para fatores de confusão num modelo de regressão logística, o resultado não negativo continuou associado à presença de arritmias ventriculares malignas, com OR = 5,17 (IC95%: 1,05 - 25,51). Conclusão: Na CCC, pacientes com história de arritmia ventricular maligna apresentam maior frequência de teste de MTWA não negativo quando comparados a pacientes sem ocorrência prévia de arritmias.

Manifestaciones cardiacas en la etapa aguda de la enfermedad de Kawasaki en un hospital pediátrico de tercer nivel en la Ciudad de México / Cardiac manifestations in the acute phase of Kawasaki disease in a third level children's hospital in Mexico City

Resumen Objetivo: Describir las manifestaciones cardiacas en la etapa aguda de la enfermedad de Kawasaki en pacientes atendidos en un hospital de tercer nivel de la Ciudad de México, México. Métodos: Estudio retrospectivo, descriptivo en pacientes con diagnóstico de enfermedad de Kawasaki de agosto de 1995 a diciembre del 2016 en el Instituto Nacional de Pediatría, México. Se estudio la demografía de los pacientes, características clínicas, tratamiento empleado y desarrollo de complicaciones cardiacas en la etapa aguda de la enfermedad. Resultados: Se estudiaron 508 casos de enfermedad de Kawasaki. La edad media al diagnóstico fue de 37.64 ± 35.56 meses. Predominio de pacientes masculinos del 65.4%, con una relación masculino/femenino de 1.88:1. La mayoría de los casos (79.2%) tuvo una presentación completa. La gammaglobulina intravenosa fue administrada en 92.4% de los casos. Veintiocho pacientes (5.5%) desarrollaron arritmias, se presentaron cambios en el segmento ST en 29 pacientes (5.6%) y 5 pacientes desarrollaron isquemia miocárdica. En el ecocardiograma inicial, 51 pacientes (9.9%) presentaron datos de miocarditis, 72 pacien- tes (14%) datos de pericarditis y 77 casos tuvieron derrame pericárdico (15%). Se detectaron alteraciones en las arterias coronarias en 169 casos (32.9%). Cuatro pacientes fallecieron en la etapa aguda de la enfermedad por complicaciones cardiacas de la enfermedad de Kawasaki. Conclusiones: En México cada vez existen más casos de enfermedad de Kawasaki con un alto porcentaje de manifestaciones cardiacas al diagnóstico. Se requiere de un mayor conocimiento de la enfermedad en México, para poder establecer cuál es la evolución cardiológica de los pacientes en el país.

Abstract Objectives: To describe the cardiac manifestations in the acute phase of patients with Kawasaki disease treated in a third level Children's hospital in Mexico City, Mexico. Methods: A cross-sectional study was conducted in patients with a diagnosis of Kawasaki disease treated in this hospital from August 1995 to December 2016. Information included patient demographics, clinical features, treatment used, electrocardiographic findings, extra-coronary echocardiographic findings, and the development of coronary artery aneurysms in the acute phase of the disease. Results: The study included 508 cases of Kawasaki disease, with a mean age at diagnosis of 37.64 ± 35.56 months (range from 2 to 200 months). Almost two-thirds (65.4%) of the patients were male, with a male/female ratio of 1.88:1. Complete Kawasaki disease was diagnosed in 79.2% of cases. Almost all cases (92.4%) received intravenous immunoglobulin. Twenty-eight patients (5.5%) developed arrhythmias, ST changes developed in 29 patients (5.6%), and 5 patients presented with ischaemic changes. In the initial echocardiographic evaluation, 51 patients (9.9%) were diagnosed with myocar- ditis, 72 patients (14.0%) with pericarditis and 77 cases (15.0%) developed pericardial effusion. Coronary artery anomalies were detected in 169 cases (32.9%). 32 cases were diagnosed as giant coronary aneurysms. Four patients died from cardiac complications in the acute phase of the disease. Conclusions: There has been an increase in the diagnosis of Kawasaki disease in Mexico. They presented with more cardiac complications than reported in literature. An increased knowledge of Kawasaki disease is required in Mexico in order to establish the cardiac outcomes of this group of patients.

Cardiac complications associated with the influenza viruses A subtype H7N9 or pandemic H1N1 in critically ill patients under intensive care

Abstract Background and objective: The clinical presentations and disease courses of patients hospitalized with either influenza A virus subtype H7N9 (H7N9) or 2009 pandemic H1N1 influenza virus were compared in a recent report, but associated cardiac complications remain unclear. The present retrospective study investigated whether cardiac complications in critically ill patients with H7N9 infections differed from those infected with the pandemic H1N1 influenza virus strain. Methods: Suspect cases were confirmed by reverse transcription polymerase chain reaction assays with specific confirmation of the pandemic H1N1 strain at the Centers for Disease Control and Prevention. Comparisons were conducted at the individual-level data of critically ill patients hospitalized with H7N9 (n = 24) or pandemic H1N1 influenza virus (n = 22) infections in Suzhou, China. Changes in cardiac biochemical markers, echocardiography, and electrocardiography during hospitalization in the intensive care unit were considered signs of cardiac complications. Results: The following findings were more common among the H7N9 group relative to the pandemic H1N1 influenza virus group: greater tricuspid regurgitation pressure gradient, sinus tachycardia (heartbeat ≥ 130 bpm), ST segment depression, right ventricular dysfunction, and elevated cardiac biochemical markers. Pericardial effusion was more often found among pandemic H1N1 influenza virus patients than in the H7N9 group. In both groups, most of the cardiac complications were detected from day 6 to 14 after the onset of influenza symptoms. Those who developed cardiac complications were especially vulnerable during the first four days after initiation of mechanical ventilation. Cardiac complications were reversible in the vast majority of discharged H7N9 patients. Conclusions: Critically ill hospitalized H7N9 patients experienced a higher rate of cardiac complications than did patients with 2009 pandemic H1N1 influenza virus infections, with the exception of pericardial effusion. This study may help in the prevention, identification, and treatment of influenza-induced cardiac complications in both pandemic H1N1 influenza virus and H7N9 infections.

Cystatin C: An Early Marker of Cardiac Complications in Diabetics.

Introduction: Cardiovascular disease is one of the common complications of Diabetes mellitus. Serum Cystatin C level has been suggested as a marker for cardiac complications in diabetes. Material and Methods: We studied serum Cystatin C level in Diabetics to fi nd if correlation exists between cardiac complications and elevated Cystatin C levels. Results: A total of 50 diabetics were studied out of whom 25 had cardiac complications and the rest did not have cardiac complications. No signifi cant diff erence was observed between Serum Cystatin C levels of diabetics with cardiac complications (mean 1∙5±0∙45) and diabetics without cardiac complications (1∙4±0∙46) although Cystatin C levels were found to be elevated in diabetic cases. Conclusion: Keeping in view the signifi cant diff erence (p=0∙000) in Cystatin C levels of healthy and diabetic patients, it is reasonable to accept the importance of Cystatin C as an indicator of diabetes and its associated complications.

Betabloqueadores perioperatorios en cirugía no cardiaca: recomendaciones basadas en la evidencia / Preoperative Betablockers in non cardiac surgery: recommendations base don evidence

Introducción: los eventos cardiacos perioperatorios son desórdenes frecuentes y asociados a un incremento de la mortalidad. Los b- bloqueadores se han utilizado para la prevención de estas complicaciones. Objetivo: determinar el valor de la evidencia actual, sobre la eficacia/seguridad del uso perioperatorio de b- bloqueadores en cirugía no cardiaca, para la prevención de complicaciones cardiacas. Métodos: se buscó en MEDLINE, Cochrane Library y CINAHL los ensayos clínicos controlados (2000-actualidad) y los meta-análisis (2008- actualidad) recientes, que evaluaron la eficacia de los b- bloqueadores perioperatorios en cirugía no cardiaca, en términos de eventos cardiacos y eventos adversos. Resultados: los b-bloqueadores perioperatorios disminuyen el riesgo de infarto miocárdico, aunque su eficacia en la reducción de otros eventos cardiacos, la mortalidad cardiaca y la mortalidad general, es contradictoria. Estos resultados dependen del riesgo clínico y quirúrgico de los pacientes incluidos. Con excepción del esmolol, todos los b-bloqueadores estudiados se asocian a un incremento del riesgo de eventos adversos (bradicardia, hipotensión). Conclusiones: la administración perioperatoria de b-bloqueadores ajustados a la frecuencia cardiaca y presión arterial, es razonable en pacientes con riesgo quirúrgico alto, independientemente de la categoría de riesgo clínico. En el resto de los pacientes, se debe considerar su uso, especialmente si se encuentran taquicardicos de manera prolongada. En los pacientes que previamente consumen b- bloqueadores, se debe continuar el tratamiento en el post- operatorio.

Introduction: preoperative cardiac events are frequent disorders associated to the increase of mortality. b- blockers have been used for the prevention of these complications. Objective: determine the value of present evidence about the efficacy/security of the use of b- blockers in the preoperative period in non cardiac surgery for the prevention of cardiac complications. Methods: it was looked up in MEDLINE, Cochrane Library and CINAHL controlled clinical trials (2000-today) and the recent meta- analysis (2008- today) which evaluated the efficacy of preoperative b- blockers in non cardiac surgery, in terms of cardiac events and side events. Results: preoperative b-blockers diminish the risk of myocardial infarction, though the reduction of other cardiac events, the cardiac mortality and mortality in general is contradictory. The results depend on the clinical and surgical risks of the patients included. With the exception of esmolol, all b-blockers studied are associated to an increase of side events risks (bradichardia, hypotension). Conclusion: the preoperative administration of b-blockers adjusted to the hear rate and blood pressure is reasonable in patients with high surgical risk, apart from the category of clinical risk. Its use must be considered in the rest of the patients, especially if they are tachicardic in a prolonged way. In patients who previously takeb- blockers, the treatment must continue Hill the postoperative period.

Postinfarct Ventricular Septal Defect after Coronary Covered Stent Implantation

We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.

Complicações cardiopulmonares das doenças falciformes / Cardiopulmonary complications of sickle cell disease

O pulmão é um dos principais alvos de complicações agudas e crônicas nas doenças falciformes (DF). A síndrome torácica aguda é a segunda causa de internação hospitalar apresentando considerável morbimortalidade. O suporte clínico de alta qualidade é a base do tratamento bem sucedido. A administração adequada de fluidos, a analgesia, a oxigenioterapia, a fisioterapia respiratória ativa e o uso criterioso de transfusões sanguíneas são elementos essenciais do tratamento. A hipertensão pulmonar (HP), por sua vez, tem sido recentemente reconhecida como uma das complicações mais graves e freqüentes destes pacientes. A pressão de artéria pulmonar deve ser medida periodicamente por meio de ecocardiografia. Se o diagnóstico de HP for confirmado, o uso de hidroxiuréia, anticoagulação, transfusões e oxigênio deveriam ser considerados. As manifestações cardíacas nas DF incluem cardiomegalia, isquemia miocárdica, disfunção ventricular e cor pulmonale. O tratamento destas complicações deve seguir as recomendações das diretrizes atuais.

The lung is a major target organ for acute and chronic complications in sickle cell disease. Acute chest syndrome is the second most common cause of hospital admission resulting in considerable morbidity and mortality. The mainstay of successful treatment remains high quality supportive care. Fluid management, analgesia, oxygenation, bronchodilators, incentive spirometry and judicious use of transfusion therapy are essential elements of supportive care management. Pulmonary hypertension (PHT) has emerged as one of the most frequent and serious complications in these patients. The pulmonary artery pressure should be evaluated periodically by echocardiography. If the PHT diagnosis is positive the use of hydroxiurea, anticoagulation, transfusions and oxygen therapy should be considered. Cardiac manifestations are common including enlargement of the heart, myocardial ischaemia, ventricular dysfunction and cor pulmonale. The management of these complications follows the current guidelines.