Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 589
Filter
1.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1358295

ABSTRACT

Objetivo: compreender as principais complicações ocasionadas pelo vírus SARS-CoV-2 no sistema cardíaco do público idoso. Métodos: trata-se de uma revisão sistemática da literatura de abordagem qualitativa e característica descritivo-exploratória realizada no ano de 2020. Resultados: as complicações cardíacas mais prevalentes na população idosa foram miocardite, arritmias, insuficiência cardíaca, infarto agudo, choque cardiogênico, lesão miocárdica aguda e parada cardiorrespiratória. O principal biomarcador cardíaco foi a troponina, apresentando elevação superior ao percentil 99°, evidenciando a necessidade de tratamento em Unidade de Terapia Intensiva. Considerações Finais: o aparecimento desse vírus causou grande prejuízo no campo da saúde, especialmente a população idosa, que apresenta risco elevado de óbito ao contrair essa doença. Destarte, é de extrema importância se ater a mensuração da troponina sérica no público alvo e realizar monitorização longitudinal, utilizando para tal a telecardiologia, uma vez que diminuem as chances de contaminação entre infectado e profissional de saúde


Objective: to understand the main complications of SARS-CoV-2 in the elderly cardiac system. Methods: systematic literature review conducted in 2020. Results: the most prevalent cardiac complications in the elderly population were myocarditis, arrhythmias, heart failure, acute infarction, cardiogenic shock, acute myocardial injury and cardiorespiratory arrest. The main cardiac biomarker was troponin, showing an elevation above the 99th percentile, evidencing the need for treatment in the Intensive Care Unit. Final Considerations: the appearance of this virus has caused great damage in the health field, especially the elderly population, who is at high risk of death when contracting this disease. Therefore, it is important to stick to the measurement of serum troponin in the target audience and perform longitudinal monitoring, using telecardiology for this purpose, since they reduce the chances of contamination between infected and health professionals


Objetivo: comprender las principales complicaciones del SARS-CoV-2 en el sistema cardíaco anciano. Métodos: revisión sistemática de la literatura realizada en 2020. Resultados: las complicaciones cardíacas más prevalentes en la población anciana fueron miocarditis, arritmias, insuficiencia cardíaca, infarto agudo, shock cardiogénico, lesión miocárdica aguda y parada cardiorrespiratoria. El principal biomarcador cardíaco fue la troponina, mostrando una elevación por encima del percentil 99, evidenciando la necesidad de tratamiento en la Unidad de Cuidados Intensivos. Consideraciones finales: la aparición de este virus ha provocado un gran daño en el campo de la salud, especialmente en la población anciana, que se encuentra en alto riesgo de muerte al contraer esta enfermedad. Por tanto, es importante ceñirse a la medición de troponina sérica en el público objetivo y realizar un seguimiento longitudinal, utilizando para ello la telecardiología, ya que reducen las posibilidades de contaminación entre los infectados y los profesionales sanitarios


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Troponin , Health of the Elderly , COVID-19/complications , Heart Diseases/etiology , Patient Care Team , Shock, Cardiogenic , Telecardiology , Heart Arrest , Heart Failure , Intensive Care Units , Myocarditis
2.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.143-148.
Monography in Portuguese | LILACS | ID: biblio-1349467
3.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.436-441, tab, ilus.
Monography in Portuguese | LILACS | ID: biblio-1352663
5.
Arq. bras. cardiol ; 116(5): 867-876, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1248899

ABSTRACT

Resumo Fundamento: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. Objetivos: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. Métodos: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. Resultados: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). Conclusões: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876)


Abstract Background: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. Objective: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. Methods: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. Results: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). Conclusions: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876)


Subject(s)
Humans , Coronary Artery Disease , Acute Coronary Syndrome , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/surgery , Myocardial Infarction , Portugal/epidemiology , Shock, Cardiogenic , Registries , Retrospective Studies , Treatment Outcome , Hospital Mortality
6.
Medicina (B.Aires) ; 81(5): 761-766, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351048

ABSTRACT

Resumen El shock cardiogénico (SC) presenta una elevada mortalidad y puede requerir de terapéuticas avanzadas como la asistencia circulatoria mecánica (ACM) y el trasplante cardíaco (TC). Se analizaron en forma retrospectiva, en un único centro, aquellos pacientes que presentaron un infarto agudo de miocardio (IAM), SC y requirieron ACM puente al TC. Entre enero 1997 y junio 2020, 524 pacientes recibieron un TC, 203 por cardiopatía isquémica, 103 en lista de emergencia. Se incluyeron once pacientes con los criterios mencionados (edad media 53 ± 11 años; hombres 73%). Se realizaron 5 angioplastias primarias y 2 cirugías de revascularización miocárdica de urgencia. Cuatro pacientes presentaban anatomía coronaria no pasible de revascularización. Todos recibieron tratamiento inotrópico y vasopresor y requirieron soporte con balón de contrapulsación intra aórtico (BCIA). Dos requirieron el implante de bomba centrífuga univentricular izquierda (BioMedicus®, Medtronic) y 2 de oxigenador de membrana extracorpóreo veno-arterial (ECMO-VA) periférico (Maquet®, Getinge Group). La mediana entre IAM y TC fue 15 días (rango 7-21) y la edad de los donantes 28 ± 11 años. Todos presentaron un IAM extenso (monto necrótico 35 ± 5%) con signos histopatológicos de necrosis transmural e injuria de reperfusión. La mediana de seguimiento fue 9 años (rango 1-15). Ninguno falleció en la internación ni durante el primer año post trasplante. La supervivencia a los 5 y 10 años fue 73% y 55%. El TC en situación de emergencia ha demostrado ser, en nuestro medio, la mejor opción en aquellos pacientes con IAM y SC refractario a la terapia convencional.


Abstract Cardiogenic shock (CS) has a high mortality rate and often requires advanced therapies such as mechanical circulatory support (MCS) and heart transplantation (HT). Those patients who presented an acute myocardial infarction (AMI) with CS and required support through MCS as bridge to HT were retrospectively analyzed in a single Center. Between January 1997 and June 2020, 524 patients received HT, 203 for ischemic-cardiomyopathy, 103 were in emergency waiting list. Eleven patients met the inclusion criteria (mean age 53 ± 11 years old; men 73%). Five primary angioplasties and 2 emergency myocardial revasculariza tion surgeries were performed. Four patients had coronary anatomy not subject to revascularization. All received inotropic and vasopressor treatment and required intra-aortic balloon pump (IABP). Subsequently, two required support with a left univentricular centrifugal pump (BioMedicus®, Medtronic) and two with peripheral veno-arterial extracorporeal membrane oxygenator (VA-ECMO) (Maquet®, Getinge Group). The median between AMI and HT was 15 days (range 7-21) and the mean age of the donors 28 ± 11 years. All had extensive AMI (necrotic amount 35 ± 5%) with histopathological signs of transmural necrosis and reperfusion injury. The median follow-up was 9 years (range 1-15). None died in hospitalization or during the first year after transplantation. Survival at 5 and 10 years was 73% and 55%. Emergency HT may be the best option for selected patients with acute myocardial infarction and cardiogenic shock refractory to conventional therapy.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Young Adult , Heart-Assist Devices , Myocardial Infarction , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Retrospective Studies , Intra-Aortic Balloon Pumping
10.
Med. infant ; 27(2): 192-199, Diciembre 2020.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1151212

ABSTRACT

Entre los años 2000 y 2016 en Argentina, se reportaron al Registro Oncopediátrico Hospitalario Argentino (ROHA) 22.450 casos de cáncer en niños menores de 15 años de edad. Las Leucemias constituyen la enfermedad oncológica más frecuente, seguida de los Tumores de Sistema Nervioso Central y los Linfomas. Esta distribución es similar a la descripta en los países desarrollados de Europa y Norteamérica. Su tasa de curación a nivel mundial, llega al 80% debido al uso de quimioterapia intensiva, situación que mejora la supervivencia pero que también aumenta la frecuencia de complicaciones. Estas complicaciones pueden ser debidas tanto al propio cáncer como al tratamiento y en ocasiones ser la primera manifestación de la enfermedad oncológica. Los eventos que amenazan la vida en pacientes inmunocomprometidos son mayores que en la población general, y cuando ocurren tienen una mortalidad elevada. El reconocimiento temprano es clave para el resultado en términos de sobrevida y disminución de la mortalidad. Las acciones deberán centrarse al reconocimiento temprano de eventos críticos en pacientes oncológicos. Los pacientes Hemato-Oncológicos constituyen un gran número de ingresos no planificados a las unidades de cuidados intensivos. Uno de cada 4 pacientes requerirá durante su evolución ingreso a Unidades de Cuidados Intensivos. El propósito de este artículo es describir tres de las urgencias oncológicas que requieren con mayor frecuencia admisión en UCI: la presentación y manejo del shock séptico, Shock Cardiogénico y las complicaciones neurológicas en los pacientes con leucemias agudas (AU)


Between 2000 and 2016, 22,450 cases of cancer in children younger than 15 years of age were reported to the Argentine Hospital Registry of Childhood Cancer (ROHA). Leukemia was the most common cancer reported, followed by central nervous system tumors and lymphoma. This distribution is similar to that described in the developed countries of Europe and North America. The worldwide cure rate is up to 80% due to the use of intensive chemotherapy, which improves survival but also increases the complication rate. These complications may be due both to the cancer itself and to the treatment and are sometimes the first manifestation of the disease. Life-threatening events are more common in immunocompromised patients than in the general population, and when they occur, the mortality rate is high. Early recognition is essential for the outcome in terms of survival and decreased mortality. Interventions should focus on early recognition of critical events in cancer patients. Patients with hematology-oncology diseases account for a large number of unplanned admissions to intensive care units (ICU), while one in four of these patients will require admission to the ICU in the course of their disease. The aim of this study was to describe three oncology emergencies that most frequently require ICU admission: septic shock and its management, cardiogenic shock, and neurological complications in patients with acute leukemia (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Shock, Septic/etiology , Shock, Septic/therapy , Intensive Care Units, Pediatric , Leukemia, Myeloid, Acute/complications , Central Nervous System Diseases/etiology , Central Nervous System Diseases/therapy , Hematologic Neoplasms/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Survival Rate , Critical Illness/therapy
11.
CorSalud ; 12(4): 372-382, tab
Article in Spanish | LILACS | ID: biblio-1278951

ABSTRACT

RESUMEN Introducción: Las mujeres afectadas por síndromes coronarios agudos (SCA) tienen peor pronóstico y son más propensas a presentar complicaciones. Objetivo: Caracterizar las pacientes con SCA ingresadas en el Hospital Dr. Carlos J. Finlay (La Habana, Cuba) entre junio de 2012 y junio de 2018. Método: Estudio descriptivo transversal con 1252 mujeres. Fueron definidos 2 grupos: SCA con (SCACEST) y sin elevación del segmento ST (SCASEST). Las variables de estudio fueron: grupos de edad, factores de riesgo, características angiográficas y complicaciones intrahospitalarias. Resultados: La media de edad fue 66,2 ± 11,9 años, predominó el SCASEST (73,4% vs. 26,6%). La hipertensión arterial (95,2%), el tabaquismo (37,9%) y la diabetes mellitus (36,3%) fueron factores de riesgo más prevalentes, con diferencias significativas a favor del SCASEST (p<0,004). Los valores de glucemia (69,1% vs. 51,5%; p<0,0001) y colesterol total (46,2% vs. 16,6%; p<0,0001) fueron significativamente mayores en el SCASEST. A un 29,3% de los casos se les realizó coronariografía, donde se encontró una alta prevalencia de lesiones significativas (73,3%) y una incidencia de enfermedad de tronco de 4,9%. Un 23% presentó complicaciones, las más prevalentes fueron la insuficiencia cardíaca (35,1%) y el shock cardiogénico (18,1%), esta última predominó como causa de muerte en el SCACEST (45,1 vs. 11,8; p<0,0001). Ambas complicaciones se relacionaron directamente con la mortalidad (3,8%). Conclusiones: En las mujeres con SCA predominó el SCASEST en edades posmenopáusicas. La hipertensión arterial, la diabetes mellitus y el tabaquismo constituyeron las principales características clínicas. La insuficiencia cardíaca y el shock cardiogénico se asociaron frecuentemente a la mortalidad.


ABSTARCT Introduction: Women suffering from acute coronary syndromes (ACS) have worse prognosis and are prone to major adverse events. Objective: To characterize female patients with ACS admitted to the Hospital Dr. Carlos J. Finlay (Havana, Cuba) between June 2012 and June 2018. Method: A cross-sectional descriptive study with 1252 women was carried out. Two groups were defined: ST-segment elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS). Study variables were: age groups, risk factors, angiographic characteristics and in-hospital major adverse events. Results: Mean age was 66.2 ± 11.9 years old, NSTE-ACS predominated (73.4% vs 26,6%). High blood pressure (95.2%), tobacco smoking (37.9%) and diabetes mellitus (36.3%) were the prevailing risk factor, with significant differences in favor of NSTE-ACS (p <0.004). Glycemia values (69.1% vs 51.5%, p <0.00001) and total cholesterol (46.2% vs 16.6%, p <0.00001) were significantly higher in the NSTE-ACS. A 29.3% of cases underwent coronary angiography where a high prevalence of serious lesions of 73.3% and an incidence of left main coronary artery disease of 4.9% were found. A 23% presented major adverse events, heart failure (35.1%) and cardiogenic shock (18.1%) being the most prevalent ones. Cardiogenic shock predominated as cause of death in STE-ACS (45.1 vs 11,8; p<0,0001). Both major adverse events were directly related to mortality (3.8%). Conclusions: There is a predominance of NSTE-ACS in women with ACS in postmenopausal ages. High blood pressure, diabetes mellitus and tobacco smoking were the main clinical characteristics. Cardiogenic shock and heart failure were the major adverse events most frequently associated to mortality.


Subject(s)
Shock, Cardiogenic , Women , Risk Factors , Acute Coronary Syndrome
13.
Arch. cardiol. Méx ; 90(2): 137-141, Apr.-Jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131022

ABSTRACT

Abstract Objective: The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock. Methods: The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms. The registry is designed to compare the efficacy and safety of primary PCI and pharmacoinvasive strategy. The simple size was calculated in 344 patients divided into two groups, with an estimated loss rate of 10%. Patients included in the PHASE-MX cohort will be followed for up to one year. Conclusion: In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience.


Resumen Objetivo: El objetivo del registro PHASE-MX es validar la eficacia y seguridad de la estrategia farmacoinvasiva en comparación con la angioplastia coronaria transluminal percutánea primaria (ACTPp) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en una región metropolitana de México. El desenlace primario es el compuesto de muerte cardiovascular, reinfarto, accidente vascular cerebral y choque cardiogénico. Métodos: El registro PHASE-MX es una cohorte prospectiva de pacientes con IAMCEST que recibieron tratamiento de reperfusión (mecánico o farmacológico) en las primeras 12 horas desde el inicio de los síntomas, atendidos en el Instituto Nacional de Cardiología Ignacio Chávez. El análisis estadístico se basa en la no inferioridad de la estrategia farmacoinvasiva en comparación con la ACTPp. Se calcula un tamaño de muestra de 344 pacientes divididos en dos grupos (angioplastia primaria y estrategia farmacoinvasiva), considerada una tasa de pérdidas de 10%. Los pacientes incluidos en la cohorte PHASE-MX se seguirán durante un año. Discusión: En México, sólo 5 de cada 10 pacientes con IAMCEST tienen acceso al tratamiento de reperfusión. La estrategia farmacoinvasiva aprovecha la accesibilidad de la fibrinólisis y la efectividad de la ACTPp, por lo que podría resultar el método de elección en el tratamiento del IAMCEST en la mayoría de los casos. El presente protocolo de investigación pretende aportar información que sirva como enlace entre la información derivada de los estudios clínicos controlados y los registros derivados de la experiencia del mundo real.


Subject(s)
Humans , Male , Female , Reperfusion/methods , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/therapy , Research Design , Shock, Cardiogenic/epidemiology , Registries , Prospective Studies , Cohort Studies , Follow-Up Studies , Stroke/epidemiology , Percutaneous Coronary Intervention/adverse effects , Mexico
14.
Rev. méd. Chile ; 148(3): 409-413, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115807

ABSTRACT

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.


Subject(s)
Humans , Female , Middle Aged , Shock, Cardiogenic/therapy , Heart-Assist Devices , Ventricular Dysfunction, Left , Extracorporeal Membrane Oxygenation , Diabetes Mellitus, Type 2
15.
Arch. cardiol. Méx ; 90(1): 48-55, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131005

ABSTRACT

Abstract One-third of the population in intensive care units is in a state of circulatory shock, whose rapid recognition and mechanism differentiation are of great importance. The clinical context and physical examination are of great value, but in complex situations as in cardiac care units, it is mandatory the use of advanced hemodynamic monitorization devices, both to determine the main mechanism of shock, as to decide management and guide response to treatment, these devices include pulmonary flotation catheter as the gold standard, as well as more recent techniques including echocardiography and pulmonary ultrasound, among others. This article emphasizes the different shock mechanisms observed in the cardiac care units, with a proposal for approach and treatment.


Resumen Un tercio de la población de pacientes en unidades de cuidados intensivos se encuentran en choque circulatorio, el identificarlo y determinar su mecanismo de manera rápida y eficaz es de gran importancia. El contexto clínico y el examen físico son de gran utilidad, sin embargo existen situaciones de alta complejidad en las que se requiere del uso de las distintas modalidades de monitorización hemodinámica avanzada, tanto para determinar la causa, como para decidir el manejo y guiar respuesta al tratamiento, incluyendo el catéter de flotación pulmonar como gold standard, así como técnicas más recientes incluyendo ecocardiografía y ultrasonido pulmonar, entre otros. Este artículo enfatiza los distintos mecanismos de choque observados en las unidades de cuidados cardiacos, con propuesta de abordaje y tratamiento.


Subject(s)
Humans , Shock/physiopathology , Coronary Care Units , Hemodynamics/physiology , Shock/therapy , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapy , Echocardiography/methods , Ultrasonography/methods
17.
Med. interna (Caracas) ; 36(3): 138-148, 2020. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1129863

ABSTRACT

Determinar la utilidad del protocolo FATE (Focused Assessment with Transthoracic Echocardiography) en la evaluación de los pacientes en shock. ingresados al Servicio de Cuidados Intermedios del Hospital Central Universitario Dr. "Antonio María Pineda", Barquisimeto, Venezuela en el período agosto-octubre 2019, Métodos: se realizó un estudio descriptivo transversal, de 30 pacientes, con promedio de edad de 56,86 ± 15,85 años, Resultados: predominó el grupo de 71-80 años (23,33%), de sexo masculino (63,33%). Según la clasificación del shock por Weil y Shubin el 50% presentó shock distributivo (todos por sepsis), 20% cardiogénico, 16,67% hipovolémico y obstructivo. 13,33% Los principales hallazgos ecocardiográficos fueron presencia de derrame pleural bilateral (33,33%), derrame pleural unilateral (30%) y derrame pericárdico (23,33%). Además, 26,67% presentaron espesor miocárdico patológico, 33,33% dimensiones de VD-VI aumentadas, 46,67% función sistólica ventricular alterada; sumado al hecho que 70% de la contractibilidad y 60% de la visualización pulmonar eran patológicas. El valor cualitativo del protocolo FATE resultó en: 43,33% soportaba la información disponible, 26,67% añadió información decisiva a la terapéutica, 23,33% agregó nueva información y 6,67% información fue pobre por mala ventana. La mortalidad a los 7 días fue de 43,33%, siendo más frecuente en pacientes con shock distributivo (61,54%), seguido de cardiogénico (23,08%) y obstructivo (15,38%), no hubo defunciones por shock hipovolémico. Los valores cualitativos del protocolo FATE en pacientes fallecidos; por shock distributivo 37,5%, soportó la información disponible y agregó nueva información, respectivamente. En cambio en 100% de los fallecidos por shock cardiogénico y obstructivo, el protocolo FATE añadió información decisiva a la terapéutica. Los resultados demuestran la importancia del Protocolo FATE en el manejo de pacientes con shock(AU)


To determine the usefulness of the FATE protocol (Focused Assessment with Transthoracic Echocardiography) in the evaluation of patients in shock admitted to the Intermediate Care Unit of the "University Hospital Antonio Maria Pineda" in Barquisimeto, Venezuela, during the period August-October 2019, Methods: A descriptive cross-sectional study was done, selecting 30 patients, with an average age of 56.86 ± 15.85 years; the most affected group was 71-80 years old (23.33%), with a predominance of the male sex (63.33%) Results: According to the classification of shock by Weil and Shubin, 50% were found to have distributive shock (all due to sepsis), 20% cardiogenic, 16.67% hypovolemic and obstructive 13.33%. The main echocardiographic findings were the presence of bilateral pleural effusion (33.33%), unilateral pleural effusion (30%) and pericardial effusion (23.33%). In addition, 26.67% presented pathological myocardial thickness, 33.33% increased RV-LV dimensions, 46.67% impaired ventricular systolic function; also, 70% of contractibility and 60% of pulmonary visualization were pathological. The qualitative value of the FATE protocol resulted in: 43.33% supported the available information, 26.67% added decisive information to the therapy, 23.33% added new information and 6.67% information was poor due to a bad US window. (Mortality at 7 days was 43.33%, being more frequent in patients with distributive shock (61.54%), followed by cardiogenic (23.08%) and obstructive (15.38%); there were no deaths due to hypovolemic shock. The qualitative values of the FATE protocol in patients with distributive shock who died, was that 37.5% In contrast, in 100% of those who died by cardiogenic and obstructive shock, the FATE protocol added decisive information to the therapy. Conclusion:The results demonstrate the importance of the FATE Protocol in the management of patients with shock(AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Shock, Cardiogenic/physiopathology , Blood Volume , Ultrasonography , Focused Assessment with Sonography for Trauma , Pulmonary Embolism , Intensive Care Units , Myocardial Infarction
18.
Korean Circulation Journal ; : 220-233, 2020.
Article in English | WPRIM | ID: wpr-811357

ABSTRACT

BACKGROUND AND OBJECTIVES: Although complete revascularization is known superior to incomplete revascularization in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVCD), there are no definite instructions on the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). We compared 1-year clinical outcomes between 2 different complete multi-vessel revascularization strategies.METHODS: From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 606 patients with STEMI and MVCD who underwent complete revascularization were enrolled from November 2011 to December 2015. The patients were assigned to multi-vessel single-staged PCI (SS PCI) group (n=254) or multi-vessel multi-staged PCI (MS PCI) group (n=352). Propensity score matched 1-year clinical outcomes were compared between the groups.RESULTS: At one year, MS PCI showed a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.42; 95% confidential interval [CI], 0.19–0.92; p=0.030) compared with SS PCI. In subgroup analysis, all-cause mortality increased in SS PCI with cardiogenic shock (HR, 4.60; 95% CI, 1.54–13.77; p=0.006), age ≥65 years (HR, 4.00; 95% CI, 1.67–9.58, p=0.002), Killip class III/IV (HR, 7.32; 95% CI, 1.68–31.87; p=0.008), and creatinine clearance ≤60 mL/min (HR, 2.81; 95% CI, 1.10–7.18; p=0.031). After propensity score-matching, MS PCI showed a significantly lower risk of major adverse cardiovascular event than SS PCI.CONCLUSIONS: SS PCI was associated with worse clinical outcomes compared with MS PCI. MS PCI for non-infarct-related artery could be a better option for patients with STEMI and MVCD, especially high-risk patients.


Subject(s)
Arteries , Coronary Artery Disease , Coronary Vessels , Creatinine , Humans , Korea , Mortality , Myocardial Infarction , Myocardial Revascularization , Percutaneous Coronary Intervention , Propensity Score , Shock, Cardiogenic
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4,Supl): 423-426, out.-dez. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1047342

ABSTRACT

O balão intra-aórtico (BIA) é um dispositivo de contrapulsação utilizado no tratamento de pacientes que sofreram choque cardiogênico secundário ao IAM, insuficiência cardíaca ou pós-cirúrgico. Os pacientes com cateteres cardíacos necessitam de uma assistência de enfermagem individualizada 24 horas por dia. O trabalho objetiva analisar as condutas da assistência de enfermagem nas terapias intervencionistas em cardiologia e assim destacar indicação, contraindicação, complicações do dispositivo intra-aórtico e o cuidado de enfermagem frente a esse dispositivo. Esta é uma pesquisa de revisão de literatura, com busca em referencias bibliográficas, artigos científicos, teses e dissertações. Os resultados mostram suas indicações, contraindicações, complicações e os cuidados da equipe de enfermagem com paciente em uso de BIA, sendo alguns deles orientação ao paciente e familiares sobre o procedimento, manter cabeceira em até 45º e comparar pulso do membro cateterizado com o membro não cateterizado. Conclui-se que a assistência de enfermagem adequada e sistematizada é essencial para assegurar o controle e manutenção do balão intra-aórtico no paciente


The intra-aortic balloon (IAB) is a counterpulsation device used in the treatment of patients who have suffered cardiogenic shock secondary to acute myocardial infarction, cardiac insufficiency or postoperative period. Patients with cardiac catheters require one-to-one nursing care 24 hours a day. The objective of this study is to analyze nursing care behaviors in interventional therapies in cardiology and thus highlight indication, contraindication, complications of the intra-aortic device and the nursing care with this device. This is a literature review research study, with search in bibliographical references, scientific articles, theses and dissertations. The results show the indications, contraindications, complications and care of the nursing team with patients using IAB, including advising patient and family about the procedure, maintaining head rest up to 45º, and comparing the catheterized limb pulse with the non-catheterized limb pulse. It is concluded that adequate and systematized nursing care is essential to ensure the control and maintenance of the intra-aortic balloon in the patient


Subject(s)
Intra-Aortic Balloon Pumping , Nursing Care , Shock, Cardiogenic , Cardiovascular Diseases , Vascular Access Devices , Cardiac Catheters , Heart Failure , Myocardial Infarction
20.
Medicina (B.Aires) ; 79(6): 506-508, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1056760

ABSTRACT

La membrana de oxigenación extracorpórea arteriovenosa se utiliza cuando ocurre falla hemodinámica y respiratoria refractaria al tratamiento convencional; brinda soporte hemodinamico transitorio, oxigenacion y remocion de CO2, y permite reposo pulmonar. Asimismo ofrece la posibilidad de realizar ventilación ultraprotectiva y evitar la generación de VILI (Ventilation-Induced Lung Injury). No ha sido demostrada su utilización como una terapia frecuente en los casos con insuficiencia hemodinámica secundaria a shock obstructivo por afectación mediastínica. Presentamos el caso de un paciente con shock obstructivo por una masa mediastínica de origen linfoproliferativo tratada con membrana de circulación arteriovenosa extracorpórea.


The arteriovenous extracorporeal membrane is used in patients with hemodynamic and respiratory failure, unresponsive to conventional treatment. It provides transitory hemodynamic support, oxygenation and removal of CO2, allowing pulmonary rest. Moreover it offers the possibility of ultraprotective ventilation and avoids generation of VILI (Ventilation-Induced Lung Injury). It is not frequently used in patients with hemodynamic failure secondary to obstructive shock due to mediastinal compromise. We present the case of a patient with obstructive shock, mediastinal mass of lymphoproliferative origin that was treated with extracorporeal arteriovenous circulation membrane.


Subject(s)
Humans , Female , Adult , Respiratory Insufficiency/therapy , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Extracorporeal Membrane Oxygenation/methods , Lymphoma, Large B-Cell, Diffuse/complications , Shock, Cardiogenic/diagnostic imaging , Tomography, X-Ray/methods , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Treatment Outcome , Computed Tomography Angiography/methods , Hemodynamics
SELECTION OF CITATIONS
SEARCH DETAIL