Disección Aórtica Tipo A como diagnóstico diferencial potencialmente letal de dolor torácico: revisión de casos / Type A Aortic Dissection as a potentially lethal differential diagnosis of chest pain: case Review

Chest pain (CP) is a frequent reason for consultation in emergency departments (ED). It responds to a broad spectrum of pathologies, ranging from banal causes to severe conditions with high mortality. The clinician must be able to distinguish prompt when CP is due to severe pathology and thus make a timely intervention for the patient's benefit. Acute Aortic Syndrome (AAS) is one of the potentially fatal causes of CP. Within this syndrome, we find aortic dissection (AD), intramural hematoma and atherosclerotic penetrating ulcer. AD is the most frequent presentation of AAS. Although it is not a common condition, its high lethality and low suspicion make it of particular interest as a differential diagnosis of CP. The following are two clinical cases of AD of the ascending aortic treated at the Hospital Regional de Talca (HRT) to analyse the clinical characteristics that help to differentiate this condition, the main electrocardiographic and imaging findings, as well as some of its complications and management.

Hipertensión arterial en paciente de raza negra: a propósito de un caso / Hypertension in a black patient: a purpose of a case

Hypertension in black patients is usually more frequent and associated with higher morbidity and mortality. Due to demographic changes in the Chilean population, dealing with this group of patients has become more frequent. The case of a young Haitian patient with severe hypertension and target organ damage is presented.

Rotura del septum interventricular post infarto agudo al miocardio: una complicación potencialmente letal Revisión de la literatura a propósito de un caso clínico / Ventricular septal rupture after acute myocardial infarction: a potentially lethal complication Case report and literature review

Rupture of the ventricular septum with the appearance of an interventricular communication is an infrequent and life-threatening mechanical complication after acute myocardial infarction. The advent of coronary reperfusion therapies has reduced the incidence of this complication, but mortality remains high. The clinical presentation varies from mild compromise with exertional dyspnea to severe compromise with cardiogenic shock. In this pathology, early diagnosis is fundamental and surgical repair is the treatment of choice. In this article we report an interesting clinical case about a 77-year-old woman who was belatedly referred to our hospital and diagnosed with postinfarction rupture of the ventricular septum with an unfortunately fatal evolution. Relevance of this case lies in its atypical clinical presentation which led to a delay in diagnosis and a missed opportunity for early reperfusion therapy. An updated literature review about rupture of the ventricular septum complicating acute myocardial infarction was carried out.

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.