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1.
Rev. méd. Chile ; 148(1): 93-102, Jan. 2020. graf
Artículo en Español | LILACS | ID: biblio-1094211

RESUMEN

Cardiovascular diseases and cancer account for 27 and 25% of mortality in Chile, respectively. In the last decades, survival of people with cancer has improved due to preventive programs, early detection strategies, advances in technology and development of new antineoplastic therapies. Consequently, a progressive number of cancer-surviving patients have been generated, who may develop cardiovascular diseases, secondary to the same cancer therapy. Cardio-Oncology has emerged as the necessary link between both specialties to promote the prevention and early detection of cardiac complications, in patients undergoing oncological therapies. The aim is to curb cardiovascular complications. Also, to acquire knowledge about the mechanisms and effects of drugs that lead to heart damage aiming to develop efficient cardioprotective therapies. In this article we review and propose a didactic organization and classification of the main cardiovascular effects of cancer control therapy. We recognize that there is still a knowledge gap in basic sciences about the mechanisms that underlie these alterations.


Asunto(s)
Humanos , Enfermedades Cardiovasculares , Neoplasias , Chile , Cardiotoxicidad , Antineoplásicos
2.
Rev. chil. cardiol ; 35(1): 52-55, 2016. ilus
Artículo en Español | LILACS | ID: lil-782645

RESUMEN

A 39 year old man presented with signs of an ischemic in-farct in the territory of the medial cerebral artery. A large mobile mass was present in the left atrium and a biopsy showed tissue heavily infiltrated with fat and resection was not possible. A small lesion located at the dorsum allowed a histologic confirmation of a melanoma. The patient died 4 months after surgery. The second patient, a 34 year old woman being treated with chemotherapy for an ovarian melanoma was found to have a right atrial mass. After successful resection of the mass a metastasis of the original melanoma was confirmed and the patient remains in good condition at mid term follow up.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Neoplasias Cutáneas/patología , Neoplasias Cardíacas/secundario , Melanoma/secundario
3.
Rev. méd. Chile ; 141(12): 1499-1505, dic. 2013. ilus, graf
Artículo en Español | LILACS | ID: lil-705567

RESUMEN

Introduction: Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Patients and Methods: Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Results: Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). Operative technique: orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Conclusion: Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Supervivencia de Injerto , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/estadística & datos numéricos , Cardiomiopatía Dilatada/epidemiología , Cardiomiopatía Dilatada/cirugía , Chile/epidemiología , Estudios de Seguimiento , Rechazo de Injerto , Insuficiencia Cardíaca/epidemiología , Trasplante de Corazón/mortalidad , Corazón Auxiliar/estadística & datos numéricos , Terapia de Inmunosupresión/efectos adversos , Sistema de Registros , Estudios Retrospectivos , Donantes de Tejidos
4.
Rev. méd. Chile ; 140(12): 1517-1528, dic. 2012. ilus, tab
Artículo en Español | LILACS | ID: lil-674022

RESUMEN

Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.


Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Endocarditis Bacteriana/mortalidad , Mortalidad Hospitalaria/tendencias , Cardiopatía Reumática/mortalidad , Recolección de Muestras de Sangre/normas , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Chile/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Métodos Epidemiológicos , Pronóstico , Cardiopatía Reumática/diagnóstico , Cardiopatía Reumática/cirugía , Factores de Riesgo , Tasa de Supervivencia/tendencias
5.
Rev. méd. Chile ; 139(1): 19-26, ene. 2011. ilus
Artículo en Español | LILACS | ID: lil-595261

RESUMEN

Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however cu-rrent practices are unknown in Chile. Aitn: To evalúate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: Oneyear prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5 percent at the end ofthe follow-up. Mean age was 61.6 years, and 30.6 percent were female. Most of the patients had at least one risk factor (98 percent): hypertension (84 percent), previous myocardial infarction (33 percent), dyslipidemia (54 percent), diabetes (33 percent), current smoking (30 percent). Main procedures duringthe hospitalization were coronary angiogram (67 percent), angioplasty (33 percent; 88 percent with stent) and coronary bypass surgery (7 percent). Duringprocedures, 31 percent of patients received clopidogrel, and 4.2 percent glycoprotein Ilb/IIIa antagonists. Medical management was selected for 60 percent of patients. In comparison to men, women received less interventional procedures despite havingmore risk factors. Treatments prescribed at discharge were aspirin (97 percent), clopidogrel (49 percent), beta blockers (78 percent), diuretics (21 percent), lipid lowering agents (78 percent), oral hypoglycemic agents (13 percent) and insulin (9 percent). At the end ofthe 1-year follow-up, treatments were aspirin (84 percent), beta blockers (72 percent), diuretics (19 percent), and dual antiplatelet therapy with clopidogrel (16 percent). Conclusions: A high prevalence of múltiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50 percent at discharge and decreases during the one year-follow-up.


Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Angina Inestable/terapia , Adhesión a Directriz/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Infarto del Miocardio/terapia , Alta del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Angina Inestable/mortalidad , Chile/epidemiología , Prescripciones de Medicamentos/normas , Prescripciones de Medicamentos/estadística & datos numéricos , Estudios de Seguimiento , Infarto del Miocardio/mortalidad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo
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