Effects of Qilong Capsules on myocardial fibrosis and insufficient blood circulation in ischemic cardiomyopathy with Qi deficiency and blood stasis / 中国中药杂志

Protective effect of Qilong Capsules(QL) on the myocardial fibrosis and blood circulation of rats with coronary heart disease of Qi deficiency and blood stasis type was investigated. Sleep deprivation and coronary artery ligation were used to construct a disease-symptom combination model, and 60 SD rats were divided into sham operation(sham) group, syndrome(S) group, disease and syndrome(M) group and QL group randomly. The treatment group received administration of QL 0.4 g·kg~(-1)·d~(-1). Other groups were given the same amount of normal saline. The disease indexes of each group [left ventricular end diastolic diameter(LVESD), left ventricular end systolic diameter(LVEDD), left ventricular ejection fraction(LVEF), left ventricular axis shortening rate(LVFS), myocardial histopathology, platelet morphology, peripheral blood flow] and syndrome indexes(tongue color, pulse, grip power) were detected. In sham group, cardiomyocytes and myocardial fibers were arranged neatly and densely with clear structures. The tongues' color in sham were light red, and the pulse shape were regular. RGB is a parameter reflected the brightness of the image of the tongue. In the S group, the amplitude and frequency of the animal's pulse increased accompanied by decreasing R,G,B, however, the decreased R,G,B was accompanied by reduced pulse amplitude in M group. And in M group, we observed fuzzy cell morphology, hypertrophied myocytes, disordered arrangement of cardiomyocytes and myocardial fibers, reduced peripheral blood flow and increased collagen volume fraction(CVF). Increased LVESD and LVEDD, and decreased LVEF and LVFS represented cardiac function in S group was significantly lower than that in sham. In QL group, the tongue's color was red and the pulse was smooth. The myocardial fibers of the QL group were arranged neatly and secreted less collagen. It improved the blood circulation in the sole and tail, and reversed the increasing of LVEDD, LVESD and the decreasing of LVEF and LVFS of M group. Platelets in M and S group showed high reactivity, and QL could decrease aggregation risk. In conclusion, Qilong Capsules has an obvious myocardial protective effect on ischemic cardiomyopathy, which may inhibit the degree of myocardial fibrosis and reduce platelet reactivity.

Mesenchymal stem cells reduce left ventricular mass in rats with doxorubicin-induced cardiomyopathy / Las células madre mesenquimales reducen la masa ventricular izquierda en ratas con miocardiopatía inducida por doxorrubicina

SUMMARY: Doxorubicin is a drug that used by a majority in the treatment of carcinomas. The most obvious known side effect is cardiomyopathy. Many studies have been carried out to eliminate side effects of the doxorubicin, and stem cell studies have been added in recent years. In this study, it was aimed to investigate fetal-derived mesenchymal stem cells (F-MSCs) treatment of doxorubicininduced cardiomyopathy by morphological methods. A total of 24 rats which were divided into three separate groups (Control, sham, treatment), each consisting of 8 male rats were used. In sham and treatment group, Adriamycin was administered in a single dose by tail injection to perform cardiotoxicity. In the treatment group, F-MSCs were intra-peritoneally administrated. Then, rats were euthanized and their hearts were photographed at the level of papillary muscle. and thickness, diameters and surface area levels were measured. Left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated after measurement. The sham group, LVM and LVMI levels were found to significantly lower (p<0.05) than control and treatment group. In the one hand, LVMI levels of rats in treatment group was statistically similar (p>0.05) to control group. Similarly, LVM levels of control and treatment groups were close to each other while this level of sham group was lower. It has been shown that F-MSC administrations in rats with doxorubicin-induced cardiomyopathy have adverse effect on LVM and LVMI values. In addition, the intra-peritoneal MSC administrations may be an alternative to other injection routes such as intra-venous and intra-cardiac administrations.

RESUMEN: La doxorrubicina es un medicamento usado ampliamente en el tratamiento de carcinomas. El efecto secundario más conocido es la miocardiopatía. Se han llevado a cabo muchos estudios para eliminar los efectos secundarios de la doxorrubicina, y en los últimos años se han agregado estudios con células madre. mediante métodos morfológicos, se intentó investigar el tratamiento de las células madre mesenquimales (F-MSCs) derivadas del feto, de la miocardiopatía inducida por doxorrubicina. Se utilizó un total de 24 ratas que se dividieron en tres grupos (control, simulación, tratamiento), cada uno de las cuales consistía en 8 ratas macho. En el tratamiento simulado y en el grupo tratamiento, se administró doxorrubicina en una dosis única mediante inyección en la cola de la rata para realizar cardiotoxicidad. En el grupo tratamiento, las FMSC se administraron intraperitonealmente. Luego, las ratas fueron sacrificadas y sus corazones fueron fotografiados a nivel de los músculos papilares, y se midieron los espesores, los diámetros y los niveles de área superficial. Después de las mediciones se calcularon la masa ventricular izquierda (MVI) y el índice de masa ventricular izquierda (IMVI). En el grupo simulado, los niveles de MVI y IMVI se encontraron significativamente inferiores (p <0.05) que en los grupos control y tratamiento. Por un lado, los niveles de IMVI de las ratas en el grupo de tratamiento fueron estadísticamente similares (p> 0,05) al grupo de control. De forma similar, los niveles de MVI de los grupos control y tratamiento se aproximaban uno al otro, mientras que este nivel era más bajo en el grupo simulado. Se ha demostrado que la administracion de F-MSC en ratas con miocardiopatía inducida por doxorrubicina tiene un efecto adverso sobre los valores de MVI y IMVI. Además, la administracion de MSC intraperitoneal puede ser una alternativa a otras rutas de inyección tal como las administración intravenosa e intracardíaca.

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome / Tratamento da miocardiopatia periparto com agonista dopaminérgico e subsequente gestação com resultado satisfatório

Abstract Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Resumo Os mecanismos fisiopatológicos da miocardiopatia periparto ainda não são totalmente definidos, apesar de haver forte associação com vários fatores já conhecidos, incluindo a pré-eclâmpsia. O tratamento segue as mesmas recomendações para a insuficiência cardíaca com disfunção sistólica. Estudos clínicos e experimentais recentes sugerem que os produtos de degradação da prolactina podem induzir a miocardiopatia. A supressão farmacológica da produção de prolactina por agonista do receptor D2 da dopamina, bromocriptina ou cabergolina, vem demonstrando resultados satisfatórios na resposta terapêutica do tratamento. Apresentamos o relato de uma primigesta, adolescente, com miocardiopatia periparto que evoluiu para a normalização da função ventricular esquerda após a administração da cabergolina, utilizada como adjuvante na terapêutica da disfunção cardíaca. Subsequentemente, apesar do intervalo entre as gestações ser considerado curto, apresentou evolução satisfatória em uma nova gestação sem qualquer alteração cardíaca durante todo o período gestacional ou puerpério. Os agonistas dopaminérgicos, drogas de uso oral e de preço acessível para a maioria dos centros terciários, em particular em países subdesenvolvidos, não podem ser esquecidos frente a casos de miocardiopatia periparto.

Dyslipidemia in young patients with type 1 diabetes mellitus

Objective The association between type 1 diabetes mellitus (T1D) and dyslipidemia (DLP) increases the risk of cardiovascular disease (CVD). The aim of this study was to evaluate the presence of dyslipidemia in young T1D patients.Materials and methods The study design was cross-sectional and descriptive. We reviewed medical records of T1D patients followed at an endocrinology service, from 1998-2012. Data collected: gender, actual age and age at diagnosis, duration of T1D since diagnosis, body mass index (BMI), pubertal stage, glycemic control (GC) determined by glycated hemoglobin (HbA1c), total cholesterol (TC), HDL, LDL, triglycerides (TG). To analyze lipid profile and metabolic control, we used the Brazilian Society of Diabetes Guidelines.Results Were included 239 T1D patients, 136 (56.9%) females; mean ± SD: actual age 15.7 ± 5.0 years and at T1D diagnosis 7.3 ± 3.9; T1D duration 10.6 ± 6.4 years, 86.6% puberty, 15.1% overweight. The prevalence of DLP was 72.5%, 63.3% females, 86.6% puberty, mean ± SD: actual age 15.4 ± 4.8 years and at T1D diagnosis 7.2 ± 4.1 years, duration of T1D 10.7 ± 6.1 years. We found high-CT in 56.7%, low-HDL = 21.7%, high LDL = 44.0%, high-TG = 11.8%. Between females with DLP, 83.5% was in puberty. We find correlation between the presence of DLP, a poor GC and BMC.Conclusion We found a high prevalence of DLP in young patients with T1D, particularly in puberty females. Programs targeting the prevention of dyslipidemia should be adopted, especially for this group, in order to prevent/delay chronic complications and cardiovascular disease. Arch Endocrinol Metab. 2015;59(3):215-9.

A reduced grade of liver fibros-steatosis after raltegravir, maraviroc and fosamprenavir in an HIV/HCV co-infected patient with chronic hepatitis, cardiomyopathy, intolerance to nelfinavir and a marked increase of serum creatine phosphokinase levels probably related to integrase inhibitor use / Grado reducido de fibroesteatosis tras la administración de raltegravir, maraviroc y fosamprenavir en un paciente co-infectado de VIH/VHC con hepatitis crónica, cardiomiopatía, intolerancia al nelfinavir y un aumento pronunciado de los niveles de creatina fosfoquinasa sérica probablemente debido al uso del inhibidor de la integrasa

The use of new antiretroviral drugs in HIV infection is particularly important in patients with intolerance or resistance to other antiretroviral agents. Raltegravir and maraviroc represent new, important resources in salvage regimens. A reduced grade of liver fibro-steatosis after a combination of raltegravir and maraviroc (second-line) has not been studied and the mechanism by which these new drug classes induced a marked reduction of grade of liver diseases is currently unknown. In the present case report, nested in an ongoing multicentre observational study on the use of new antiretroviral inhibitors in heavy treatment-experienced HIV patients, we evaluated the correlation between a "short therapeutic regimen" raltegravir, maraviroc and fosamprenavir and liver diseases. The aim of this report is to describe the use of a three-drug regimen based on two novel-class antiretroviral agents (raltegravir and maraviroc) plus the protease inhibitor fosamprenavir, in an experienced HIV-infected patient with chronic progressive hepatitis C complicated by liver fibrosis; an overwhelming increased serum creatine kinase level occurred during treatment, and is probably related to integrase inhibitor administration. At present no information is available regarding this correlation.

El uso de nuevos medicamentos antiretrovirales para la infección por VIH es particularmente importante en los pacientes con intolerancia o resistencia a otros agentes antiretrovirales. Raltegravir (RTV) y maraviroc (MRV) representan nuevos e importantes recursos en las terapias de salvamento. Un grado reducido de fibroesteatosis hepática después de una combinación de raltegravir y maraviroc (terapia de segunda línea) no ha sido estudiado, y el mecanismo por el cual estas nuevas clases de droga indujeron una marcada reducción de grado de las enfermedades hepáticas se desconoce hasta el momento. Como parte de la realización en curso de un estudio observacional multicentro acerca del uso de nuevos inhibidores antiretrovirales en pacientes de VIH altamente experimentados en el tratamiento, en el presente reporte de caso se evalúa la correlación entre un "régimen terapéutico corto" (raltegravir, maraviroc y fosamprenavir) y las enfermedades del hígado. El objetivo de este reporte es describir el uso de un régimen de tres medicamentos - basado en dos agentes antiretrovirales de nuevo tipo (raltegravir y maraviroc) además del fosamprenavir inhibidor de la proteasa - en un paciente de VIH experimentado. El paciente también sufre de hepatitis C evolutiva, progresiva, crónica, complicada por fibrosis hepática. Durante el tratamiento, se produjo un aumento extraordinario del nivel de creatina quinasa sérica, el cual probablemente esta relacionado con la administración del inhibidor de la integrasa. Actualmente no hay información disponible con respecto a esta correlación.

Miocardiopatía tirotóxica grave: consideraciones a propósito de un caso clínico / Severe thyrotoxic myocardiopathy: report of one case

We report a previously healthy 43 years old male, that one year ago presented with a hyperthyroidism, treated with metimazole and radioiodine. Two months after receiving the latter, he was admitted to the hospital for dyspnea, tachycardia and chest pain. An atrial fibrillation with a frequency of 190 beats per minute was found. During hospital stay, the patient suffered a cardiogenic shock that recovered. The patient was discharged five days after admission. During follow up, there was a progressive reduction of cardiac symptoms.

Survival and echocardiographic evaluation of dogs with idiopathic dilated cardiomyopathy treated with carvedilol / Avaliação ecocardiográfica e de sobrevida de cães com cardiomiopatia dilatada idiopática tratados com carvedilol

Sixty dogs with idiopathic dilated cardiomyopathy were randomly treated with traditional therapy - digitalis, diuretics, angiotensin-converting inhibitors - (group A) or treated with these drugs plus carvedilol (group B). Echocardiographic variables were measured before and after 3, 13, 26, and 52 weeks of treatment or until death. Comparisons between groups and time were performed. No significant differences between groups were found in the most of the echocardiographic variables. The left ventricular end-systolic diameter indexed to body surface area (LVESDi) increased significantly in the group A dogs compared to the group B animals. The survival of groups A and B dogs were not different (P-value=0.1137). In conclusion, the stability of the LVESDi observed in the group treated with carvedilol may represent the beneficial effect over the ventricular remodeling.

Sessenta cães com cardiomiopatia dilatada idiopática receberam, aleatoriamente, tratamento convencional - digitálicos, diuréticos, inibidores da enzima conversora de angiotensina - (grupo A) ou esses fármacos mais carvedilol (grupo B). As variáveis ecocardiográficas foram avaliadas antes e depois de três, 13, 26 e 52 semanas de tratamento ou até o óbito. Não foram encontradas diferenças significativas entre os grupos de animais quanto à maioria das variáveis ecocardiográficas. O diâmetro sistólico final do ventrículo esquerdo indexado à superfície corpórea (DSVEi) aumentou de forma significativa no grupo A quando comparado ao grupo B. Não se observou diferença na sobrevida dos grupos A e B (P=0,1137). Concluiu-se que a estabilização do DSVEi no grupo tratado com carvedilol pode representar o efeito benéfico deste fármaco sobre o remodelamento ventricular.

Chronic eosinophilic leukemia with a unique translocation.

We report a case of chronic eosinophilic leukemia in a 9 year old girl who presented with anemia, thrombocytopenia, leucocytosis (mostly dysplastic eosinophils), lymphadenopathy and hepatosplenomegaly. There was no increase in blasts but myelofibrosis was seen in the bone marrow. A previously unreported translocation 46,XX,t(1;4)(q24;q35), was found on cytogenetic analysis and involvement of the myocardium was also present. Shortly after commencing steroids, the family abandoned therapy.

Protective effect of total aralosides of Aralia elata (Miq) Seem (TASAES) against diabetic cardiomyopathy in rats during the early stage, and possible mechanisms

Total aralosides of Aralia elata (Miq) Seem (TASAES) from Chinese traditional herb Longya Aralia chinensis L was found to improve cardiac function. The present study was to determine the protective effects of TASAES on diabetic cardiomyopathy, and the possible mechanisms. Therefore, a single dose of streptozotocin was used to induce diabetes in Wister rats. Diabetic rats were immediately treated with low, medium and high doses of TASAES at 4.9, 9.8 mg/kg and 19.6 mg/kg body weight by gavage, respectively, for eight weeks. Cardiac function was evaluated by in situ hemodynamic measurements, and patch clamp for the L-type Ca2+ channel current (ICa2+-L) and transient outward K+ channel current (Ito). Histopathological changes were observed under light and electron microscope. The expression of pro-fibrotic factor, connective tissue growth factor (CTGF) was monitored using immunohistochemistry staining. Compared with diabetic group, medium and high doses, but not low dose, of TASAES showed a significant protection against diabetes-induced cardiac dysfunction, shown by increased absolute value of left ventricular systolic pressure (LVSP) and maximum rates of pressure development (+/-dp/dt(max)), and enhanced amplitude of ICa2+-L (P < 0.05). Histological staining indicated a significant inhibition of diabetes-caused pathological changes and up-regulation of CTGF expression (P < 0.05). The results suggest that TASAES prevents diabetes-induced cardiac dysfunction and pathological damage through up-regulating ICa2+-L in cardiac cells and decreasing CTGF expression.

Cardiopatias e gravidez - parte II / Heart diseases and pregnancy - part II

Apesar do desenvolvimento da assistência às pacientes cardiopatas, a doença cardíaca continua sendo uma das complicações médicas mais importantes da gestação. O atendimento à gestante portadora de cardiopatia deve levar em conta as modificações hemodinâmicas que ocorrem na gravidez e a interpretação das mesmas nas diferentes fases da gestação. Há pouco mais de 100 anos, a mulher portadora de cardiopatia era desencorajada a engravidar, porém, devido ao avanço terapêutico e à cirurgia cardíaca, houve melhora significativa no prognóstico das gestantes cardiopatas. Objetivou-se com a presente revisão, informar ao toco-ginecologista a abordagem das cardiomiopatias, arritmias, assistência ao feto, manejo clínico e a relação com o período gestacional

Revisión clínica: depresión miocárdica en sepsis y shock séptico / Clinical revision: myocardial depression in sepsis and septic shock

La sepsis y el shock séptico son patologías de gran mortalidad, cuyo evento final es la hipotensión refractaria, colapso cardiocirculatorio y falla multiorgánica. En los últimos años se han realizado importantes esfuerzos para entender la disfunción cardiaca asociada a este cuadro, que puede objetivarse hasta en el 50 por ciento de los pacientes con sepsis severa y shock séptico. A pesar de que hoy se acepta que la disfunción miocárdica juega un importante rol en la sepsis, aún no existe consenso respecto a la manera de evaluar la función cardiaca en este contexto, surgiendo nuevas propuestas como el uso de marcadores séricos. Por otra parte, el tratamiento más utilizado hasta hoy han sido los inótropos como la dobutamina, sin embargo con los nuevos estudios sobre la etiología de la disfunción miocárdica, se ha logrado el desarrollo de nuevas líneas experimentales de tratamiento.

The sepsis and the septic shock are pathologies of the great mortality, whose final event is the refractory hypotension, circulatory collapse and multiorganic failure. In the last years important efforts have been made to understand the associate cardiac dysfunction to this picture, which can appear until in 50 percent of the patients with severe sepsis and septic shock. Although today it is accepted that the myocardial dysfunction plays an important role in the sepsis. It does not yet exist consensus with respect to the way to evaluate the function cardiac. New proposals arising as the use from seric markers. On the other hand, the more used treatment until today has been the inotropic agent like the dobutamine. But with the new studies on the etiology of the myocardial dysfunction, has been obtained the development of experimental new line of treatment.

Correlação da capacidade funcional individual e função ventricular esquerda em pacientes sobreviventes de câncer pediátrico pós-tratamento com antraciclinas / Cardiorespiratory exercise capacity and its relation to left ventricular function in pediatric cancer survivors after late anthracycline therapy

As antraciclinas têm sido largamente utilizadas no tratamento do câncer infantil e o seu uso está limitado a sua cardiotoxicidade. Este estudo tem por objetivo avaliar a correlação entre capacidade funcional individual e função ventricular esquerda em sobreviventes de câncer infantil pós-antraciclinas. Avaliamos 29 pacientes e 30 controles por meio do teste cardiopulmonar, do ecocardiograma e da dosagem sérica da fração N-terminal do peptídeo natriurético cerebral, que foram pareados segundo sexo, idade e índice de massa corpórea (IMC). As variáveis estudadas foram: capacidade funcional, limiar anaeróbico (LA), VO2/kgmáx, consumo de oxigênio por kg por minuto, no limiar aneróbico (VO2/kgLA), NT-proBNP, FE, fração de encurtamento (%ΔD), espessura da parede posterior (PPd/m) e do septo (SEPTOd/m) em diástole, índice de massa do ventrículo esquerdo (IMVE), espessura relativada parede posterior (ERPP), tempo de desaceleração da onda E mitral corrigido pela freqüência cardíaca (TD-c), Índice de Performance Miocárdica (IPM) e a relação entre velocidade máxima da onda E do fluxo valvar mitral e pico de velocidade precoce diastólica máxima E’ (relação E/E’). A dose média cumulativa de antraciclinas utilizada durante o tratamento foi 303,6mg/m2 (166 a 455mg/ m2); a idade média ao diagnóstico foi de 6 anos (1 a14 anos); os pacientes em média estavam fora de terapia há 14,69 anos (10 a 23 anos); quatro pacientes (13,8%) queixaram de dispnéia aos grandes esforços e seis pacientes (20,7%) fizeram radioterapia de mediastino associada ao uso de antraciclinas. ... Os pacientes apresentaram redução da capacidade funcional, redução discreta dos valores de fração de ejeção e fração encurtamento e níveis elevados da dosagem sérica do NT-proBNP quando comparados ao grupo controle.

Anthracycline has been used for cancer treatment and its usefulness is limited by cardiotoxicity. The aim of this study is to evaluate cardio respiratory status, its relation to left ventricular function evaluated by echocardiogram and measurement of NT-terminal pro-brain natriuretic peptide level and correlate with clinic variables in pediatric cancer survivors after late anthracycline treatment. Twenty nine patients treated and thirty controls were matched for age, gender and body-surface. The study variables were:functional capacity exercise; anaerobic threshold; peak oxygen consumption (VO2max); oxygen consumption at anaerobic threshold (VO2at); NT-proBNP; ejection fraction(EF); shortening fraction (SF); left ventricle posterior wall and septal thickness; left ventricle mass index (LVM); relative wall thickness; deceleration time heart rate corrected (DT); Tei index (PMI) and ratio of transmitral flow velocity to early annular velocity (E/E'). Mean total dose of anthracycline, mean age at diagnosis and mean evaluation time from diagnosis were 304 (166-455) mg/m2 , 6(1-14) years and 14,69(10-23) years, respectively. Four patients(13,8%) referred cardiac vascular symptoms and six(20,7%) have received mediastinal irradiation. The mean of: functional capacity exercise (p<0,001), anaerobic threshold (p<0,001), posterior wall (p=0,009), septal thickness (p=0,005), LVM (p=0,020), relative wall thickness (p=0,004), EF (p<0,001) and SF (p<0,001) were decreased in patients. DT (p=0,023) and NT-proBNP mean level was increased in patients group (p=0,001). The mean levels of NT-proBNP were higher in symptomatic patients and mediastinal radiotherapy submitted patients (p=0,047; p=0,005, respectively). VO2max and LVM were reduced in female (p=0,001; p=0,010). Linear multivariate regression- VO2max was correlated with female sex (ß= - 7,603; p=0,001), LVM(ß= 0,177; p=0,004) and NTproBNP(ß= -0,028; p=0,004); NT-proBNP was correlated with PMI (ß= 270,964; p=0,024); E/E' rate (ß= 31,207; p=0,002), functional capacity exercise (ß= -1,866; p=0,030) e BSI (ß= -13,048; p<0,001); EF was inversely correlated with anthracycline total doses (r=-0,374; p=0,045), NT-proBNP (r= -0,378; p =0,043), VO2at (r= - 0,164; p =0,028) and with relative wall thickness (r= 0,507; p=0,005). In conclusion, patients had functional capacity exercise, fraction ejection and shortening fraction decreased and NT-terminal pro-brain natriuretic peptide increased level (AU)

High-dose deferoxamine treatment [intravenous] for thalassaemia patients with cardiac complications

As a means to manage cardiac conditions, we determined the effects of high-dose intravenous [IV] deferoxamine in 15 thalassaemia patients with cardiomyopathy and high ferritin and haemoglobin levels. The patients received IV deferoxamine, 130 mg/kg per day over 10-14 hours [maximum 5 g] for 5 consecutive days. All patients underwent a full evaluation before receiving deferoxamine, and 2 days and 1 month after completing the treatment. Visual and auditory examinations were done to detect any side-effects. After treatment, cardiovascular symptoms decreased considerably and systolic function showed significant improvement, but there was no significant effect on diastolic function, electro-cardiography and physical findings. There were no significant side-effects reported

Peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a condition that affects women during the reproductive years in the late pregnancy period and/or early postpartum period. Although it is associated with several risk factors and various hypotheses exist of its etiology the cause of this disorder is still unknown. Standard therapy for PPCM is the same as for heart failure. Studies examining new therapeutic approaches are adding to the armamentarium available to physicians treating patients with PPCM. Despite all the current knowledge the mortality rates associated with PPCM remain relatively high. This article is a review of the current knowledge of etiology, diagnosis, treatment and prognosis of PPCM and attempts to present areas of need of further research.

Efectos beneficiosos y perfil de seguridad del citrato de sildenafil en pacientes con miocardiopatía chagásica y otras miocardiopatías / Beneficial effects profile of security of the sildenafil citrate in patient with myocardiopathies chagasic and other myocardiopathies

El citrato de sildenafil es un potente donante de oxido nítrico que ha probado ser eficaz para el tratamiento de la disfunción eréctil masculina, pero ha sido contraindicado en paciente con enfermedades cardiovasculares debido a efectos colaterales graves. El objetivo de este estudio es valorar los efectos cardiovasculares y la seguridad de fármaco en pacientes con miocardiopatías. Material y método: Se reclutaron 26 pacientes con miocardiopatías de cualquier origen, excluyendo aquellos con enfermedad arterial coronaria severa y miocardiopatía hipertrófica obstructiva, todos vistos por el autor consecutivamente de marzo a noviembre de 1998. Se valoraron los siguientes parámetros inmediatamente antes y 60 minutos después de una dosis única de 50 mg de citrato de sildenafil. 1. Parámetros electrocardiográficos: ritmo, frecuencia cardiaca, y despolarización / repolarización ventriculares. 2. Presión arterial sistólica y diastólica. 3. Función sistólica ventricular izquierda. 4. Función diastólica ventricular derecha con eco-doppler-color. Resultados: Se estudiaron 26 pacientes con cardioneuromiopatía chagásica crónica, cardioneuromiopatía diabética, cardiomiopatia hipertensiva y/o hipertrófica con o sin insuficiencia cardiaca congestiva concominante encontrándose: 1) mejoría significativa de la bradicardia basal en pacientes con miocarditis chagásica y enfermedad del nodo sinusal concominante; 2) reducción significativa de la presión arterial sistólica y diastólica; 3) mejoría significativa de la función sistólica ventricular izquierda en pacientes que la tenían basalmente deprimida y 4) normalización de la función diastólica ventricular izquierda, tanto en los que presentaban inversión E/A como en los de patrón restrictivo. Conclusión: El citrato de sildenafil tiene efectos cardiovasculares potencialmente beneficiosos en pacientes con miocariopatías, con un perfil de seguridad aceptable.

El calcio en los miocitos cardíacos y su papel en las miocardiopatías / The calcium in the cardiomyocytes and their papaer in the cardiomypathies

El papel que desempeña el calcio en los miocitos cardíacos abarca un gran número de funciones, desde su rol en el acoplamiento excitación-contracción hasta su papel de segundo mensajero en las diversas vías de señalización algunas de las cuales se activan en procesos que afectan la integridad del tejido miocárdico y que tienen que ver con el crecimiento y la apoptosis de los miocitos y que al final, son los que determinan la evolución de la mayoría de las cardiomiopatías. En esta revisión se abordan los mecanismos fisiológicos en las células de músculo cardíaco en los que este ión juega un papel determinante y los cambios que se presentan en ciertas cardiopatías como la miocardiopatía arritmogéncia del ventriculo derecho, las miocardiopatías asociadas a alteraciones en el receptor de rianodina y la miocardiopatía dilatada. Se revisa también la farmacodinamia de los agentes inotrópicos positivos que actúan sensibilizando los miofilamentos del sarcómero al calcio. Palabras clave: Calcio, miocitos cardíacos, miocardiopatías, levosimendán, enfermedad cardíaca.