Hipertensión arterial sistémica en el embarazo / Hypertension and pregnancy

Increasing evidence indicates that hypertension in pregnancy is an under recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Hipertensión arterial sistémica en la mujer / Hypertension in women

The cardiovascular disease is a crucial cause of morbidity and mortality in the woman mainly when they arrive at menopause. The pathophysiology and neurohormonal mechanisms widely vary with respect to the man. This finding has given the support to think that the estrogens may be playing a protector role in cardiovascular disease. However, the associated risk factors like obesity, diabetes, dislipidemia, smoking and sedentary life are increasing in an exponential form. In Mexico the population age distribution establishes that 60% of the women with hypertension are aged < 54 years old. This is reason why as factor of independent cardiovascular risk is commonest. Nevertheless, after the menopause cardiovascular mortality is greater in the woman than in the man. In this review, the importance of the new pathophysiological mechanisms and the clinical-therapeutic approach are analyzed, making emphasis in the importance of the change in the life style and also in the nutritional aspects. In Mexico the woman still have a unique role in the nutritional culture.

Abordaje clínico terapéutico del paciente adulto mayor con hipertensión arterial sistémica: recomendaciones para la práctica clínica / Therapeutic clinical approach for the elderly patient with hypertension: recommendations for clinical practice

The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.

Hipertensión arterial sistémica en el niño y adolescente / Hypertension in children and adolescence

The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus.

Elevación extrema de la presión arterial (crisis hipertensiva): recomendaciones para su abordaje clínico-terapéutico / Extreme elevation of the blood pressure (hypertensive crisis): recommendations for its clinical-therapeutic approach

From beginnings of last century the hypertensive emergency was defined as the association of acutely elevation from the arterial pressure and the appearance of damage to end organ. At present is recognized the effects of the hypertensive emergency, the aspects of its patophysiology in which are included phenomenon of vasomotricity and the participation of different substances with vasoactives properties. The clinical presentation includes not only the manifestations of the increase of the arterial pressure, the end organ damage too; for this reason the hypertensive emergency needs the immediate reduction of the arterial tension to prevent the damage to specific organs. The treatment in every case will have to be individualized, with a wide knowledge of the characteristics of every medicament to obtain the best results. The diagnosis and treatment of the hypertensive emergencies needs often of the attention of its complications if they have appeared and later, of a treatment of support for the arterial hypertension.

Prevención y tratamiento de la hipertensión arterial sistémica en el paciente con enfermedad arterial coronaria / Prevention and treatment of hypertension and coronary heart disease

The association between arterial systemic hypertension arterial coronary disease has been demonstrated by cumulated evidence of several epidemiological studies. Hypertension is an important independent risk factor for the development of coronary artery disease, vascular cerebral disease and nephropathy. Important advances exist in the knowledge of neurohumoral and hemodynamic factors that come together in the pathophysiology of the hypertension and in the development of coronary disease that allow to establish better strategies not only of treatment, but also of prevention, with the purpose of diminishing the cardiovascular mortality. The spectrum of the coronary artery disease secondary to atherosclerosis is wide and the strategies of treatment of hypertension must be adapted to each particular case. The treatment of both conditions needs of specific limits of agreement to the conditions of the patient and the form of presentation of each one of these disease.

Guías clínicas para la detección, prevención, diagnóstico y tratamiento de hipertensión arterial sistémica en México (2008) / Clinical guidelines for detection, prevention, diagnosis and treatment of systemic arterial hypertension in Mexico (2008)

The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology [quot ]Ignacio Chávez[quot ] presents its update (2008) of [quot ]Guidelines and Recommendations[quot ] for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). [quot ]We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases[quot ]. In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes that hypertension is not an isolated disease; therefore its approach must be in the context of the prevalence and interaction with other cardiovascular risk factors such as obesity, diabetes, dislipidemia and smoking among others. The urgent necessity is emphasized to approach in a concatenated form the diverse cardiovascular risk factors, since independently of which they share common pathophysiological mechanisms, its suitable identification and cont

Bloqueo auriculoventricular completo durante el esfuerzo / Exercise induced atrioventricular block

El bloqueo aurículo-ventricular (AV) completo desencadenado al ejercicio, con electrocardiograma normal en reposo, es un hallazgo infrecuente. Reportamos dos casos con este trastorno. El primero corresponde a una mujer de 54 años con presíncope al ejercicio, que desarrolló bloqueo AV completo durante la prueba de esfuerzo, sin evidencia de isquemia miocárdica. El estudio electrofisiológico demostró bloqueo AV de tercer grado infrahisiano; se le sugirió implante de marcapasos definitivo. El segundo enfermo, un hombre de 31 años que consultó por angina y síncope al ejercicio, desarrolló angina, bloqueo AV completo y cambios electrocardiográficos sugestivos de isquemia miocárdica durante la prueba de esfuerzo control no desarrolló bloqueo AV y el estudio electrofisiológico fue normal. En el primer caso el ejercicio indujo bloqueo AV por inestabilidad del sistema de conducción His-Purkinje a la modulación autonómica, probablemente por alteración degenerativa intrínseca. En el segundo caso, el bloqueo era secundario a isquemia miocárdica, por lo que desapareció con el tratamiento médico. El bloqueo AV completo al esfuerzo, puede ocurrir en pacientes sin alteraciones electrocardiográficas en reposo. Estos casos deben ser tratados con marcapaso definitivo, una vez descartado el sustrato isquémico

Fijación anterior con tornillos trans-odontoideos en las fracturas recientes y pseudoartrosis de la apófisis odontoides / Anterior fixation by trans-odontoid screws for recent fractures and pseudoarthrosis of the odontoid process of the axis

En nuestro país el tratamiento de las fracturas recientes tipo II y pseudoartrosis de la apófisis odontoides, usualmente ha sido efectuado mediante fijación externa o artrodesis primaria posterior de C1-C2. Existe una alternativa para estabilizar directamente estas lesiones, mediante un abordaje anterior y tornillos de compresión a través de los fragmentos de la fractura y pseudoartrosis. Este artículo reporta tres pacientes tratados con fijación interna estable con tornillo en el Hospital de traumatología "Magdalena de las Salinas" Instituto Mexicano del Seguro Social (IMSS) México, D.F. Actualmente los pacientes tienen más de 12 semanas de postoperatorio, con datos de unión ósea

Evaluación de plommo y cromo como contaminantes de aguas / Lead and chromium evaluation as water pollutants

El presente trabajo incluye el comienzo de un amplio estudio sobre el Pb y Cr, como contaminantes y una evaluación por Espectrofotometría de Absorción Atómica de estos metales en aguas de la Bahía de Montevideo, arroyos Miguelete, Pantanoso y Manga