Consideraciones prácticas sobre la cirugía oftalmológica en el paciente cardiópata / Practical considerations on eye surgery in the cardiac patient

La responsabilidad de la evaluación preoperatoria integral en las intervenciones oftalmológicas, con frecuencia recae en el cirujano, quien debe identificar a los afectados con riesgo cardiovascular incrementado y tomar a tiempo las medidas para evitar complicaciones de esta índole. El presente artículo se enfoca en tales aspectos, definiendo las acciones que corresponden directamente al oftalmólogo, aquellas en que funge como gestor, y las que rigurosamente no le competen. También se exponen las estrategias farmacológicas más modernas, con énfasis en el consumo de antiagregantes plaquetarios o anticoagulantes y en la necesidad de la profilaxis antimicrobiana; se refieren las entidades cardíacas inestables que, salvo escasas excepciones, exigen postergar la intervención, y los principios del tratamiento en las enfermedades cardiovasculares más comunes.

Responsibility for comprehensive preoperative evaluation in ophthalmologic interventions often falls on the surgeon, who should identify those patients with increased cardiovascular risk and take timely measures to prevent these complications. This article focuses on such aspects, defining the actions that correspond directly to the ophthalmologist, those in which he serves as manager, and those which do not concern him rigorously. The most modern pharmacological strategies are also described, with emphasis on the use of antiplatelet drugs or anticoagulants and on the need of antimicrobial prophylaxis; unstable heart entities, which, with few exceptions, require postponing the intervention and treatment principles in the most common cardiovascular diseases are referred.

Intervención tanatológica en la Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata del Instituto Nacional de Cardiología Ignacio Chávez / Thanatological intervention in the Advanced Comprenhensive Care Unit for cardiopathy patient of the National", "_i": "

Los cuidados paliativos (CsPs) surgen por la necesidad de ayudar al enfermo que está cercano a la muerte, por esta razón la Organización Mundial de la Salud los propuso como un componente de toda política sanitaria nacional y los define como: “El enfoque que mejora la calidad de vida de pacientes y familias que se enfrentan a los problemas asociados con enfermedades amenazantes para la vida, a través de la prevención y alivio del sufrimiento por medio de la identificación temprana e impecable evaluación y tratamiento del dolor y otros problemas, físicos, psicológicos y espirituales”. En el año 2011, el Instituto Nacional de Cardiología Ignacio Chávez presenta ante la Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, un plan de trabajo en el cual se otorgarán CsPs, cuyo nombre queda establecido como Unidad de Cuidados Integrales Avanzados para el Paciente Cardiópata y su Familia. En el presente escrito se aborda cómo está constituida esta unidad y el tipo de intervenciones tanatológicas que se realizan.

Palliative care, arise from the need to help the patient who is close to death, that is why the World Health Organization, he proposed that they should constitute a component of any national health policy and defined as The approach that improves the quality of life of patients and families facing the problems associated with disease threatening to life, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual. In 2011, the National Institute of Cardiology Ignacio Chavez presented to the Coordinating Commission of National Institutes of Health and Hospitals of High Specialty, the work plan of the service in which the palliative care whose name is established as Advanced Cardiopathy Patient and your Family Comprehensive Care Unit will be awarded. In the present study deals with how it is organized and the interventions of thanatology implemented.

Anestesia para gestante cardiopata / Anaesthesia for pregnant cardiac disease

Gestantes com doença cardíaca habitualmente possuem prognóstico favorável tanto materno quanto fetal. Com exceção das pacientes com a síndrome de Eisenmenger, hipertensão pulmonar primária e síndrome de Marfan com aortopatia, morte materna durante a gravidez em pacientes cardiopatas é rara. A gravidez por si só impõe modificações hemodinâmicas significativas, colocando à prova o sistema cardiovascular. Doença cardíaca reumática é a mais frequente nas gestantes, e o edema agudo pulmonar, a complicação mais comum. Defeito do septo atrial é a cardiopatia congênita acianótica mais prevalente na população adulta, enquanto que a Tetralogia de Fallot é a mais frequente das cardiopatias congênitas cianóticas. Gravidez e cardiopatia são uma associação de grandes desafios para o anestesiologista. Para evitar complicações decorrentes da morbidade ou mortalidade materno-fetal, o anestesiologista deve conhecer a evolução da doença durante a gravidez. Aqui são discutidas a fisiopatologia, apresentação clínica e a condução anestésica das doenças cardíacas valvulares adquiridas, das doenças cardíacas congênitas, da doença isquêmica do miocárdio e das miocardiopatias na gravidez.

Pregnancy in most women with heart disease has a favorable maternal and fetal outcome. With the exception of patients with Eisenmenger syndrome, pulmonary hypertension primary, and Marfan syndrome with aortopathy, maternal death during pregnancy in women with heart disease is rare. Pregnancy per se imposes significant hemodynamic changes placing a major burden on the cardiovascular system. Rheumatic heart disease remains the most frequent heart disease in the pregnant population and the pulmonary edema is the most frequent complication. Atrial septal defect is the most frequent congenital acianotic heart disease in the adult population, whereas tetralogy of Fallot is the most common cyanotic congenital heart disease. Pregnancy and heart disease present a unique challenge to the anesthesiologist. To avoid untoward complications resulting in significant maternal and/or fetal morbidity or mortality, the anesthesiologist must be familiar about the progression of heart disease during pregnancy. In this article, we review the pathophysiology, clinical presentation, and anesthetic management of valvular, congenital, vascular and ischemic heart disease, and cardiomyopathy in pregnancy.

La anestesia de la embarazada cardiópata: presentación de un caso / Anesthesia in cardiopathic pregnant: case report

Paciente de 22 años, con embarazo de 40 semanas + desproporción céfalo pélvica + Estenosis aórtica. Es ingresada en el área de Emergencia del departamento de Gineco – Obstetricia del Hospital Teodoro Maldonado Carbo del IESS de la ciudad de Guayaquil, es sometida a cesárea de emergencia bajo anestesia general con resultados satisfactorios para la madre y el producto.

22 years old patient with 40 weeks pregnancy, cephalo-pelvic disproportion and aortic stenosis. She is admitted to the Emergency service of the Gyn-Obstetric department at the Teodoro Maldonado Carbo Hospital in Guayaquil; she was submitted to emergency c-section under general anesthesia with satisfactory results from mother and product.

Realização de atividades da vida diária por idosos cardiopatas: possibilidades e dificuldades / Carrying out activities of daily living by elderly people with heart disease: possibilities and difficulties

Este estudo teve como objetivos descrever a capacidade atual de um grupo de idosos cardiopatas quanto à realização das atividades da vida diária, básicas e instrumentais, sozinhos ou com necessidade de ajuda, assim como a presença ou não de dificuldades no desempenho destas tarefas; e, verificar a existência de associação entre as dificuldades para realizar estas atividades e os sinais e sintomas apresentados. Para tal, foi feita uma investigação do tipo descritiva-exploratória, quantitativa, por intermédio de entrevistas com 100 idosos cardiopatas em tratamento ambulatorial. As respostas das questões abertas foram agrupadas e descritas por similaridade; e, foi verificada a associação entre as variáveis: dificuldades para realizar atividades da vida diária e sinais e sintomas, em suas freqüências e intensidade, pelos testes qui-quadrado de Pearson ou pela razão de verossimilhança, considerando os valores de p<0,05 significativos. Houve associação entre a freqüência da dor precordial típica e a dificuldade para caminhar fora de casa; a intensidade da dor precordial atípica e a dificuldade para usar transporte coletivo; a freqüência da dispnéia e a dificuldade para tomar banho, vestir-se, caminhar dentro e fora de casa, usar transporte coletivo, alimentar-se, limpar a casa e subir escadas; e, a intensidade da fadiga e a dificuldade de tomar banho. A avaliação da capacidade funcional de idosos para realização das atividades da vida diária poderá contribuir parao planejamento e implementação de uma assistência integral à saúde desta parcela da população.

The aim of this study is to describe the actual ability to perform activities of daily living (ADL), basics and instrumental, by elderly people with heart disease, and if they required or not some assistance as well to verify the association between difficulties to perform these activities and the signs and symptoms frequency and intensity. It was designed an observational cohort study of 100 elderly with heart disease, who were interviewed and asked to answer questions from a questionnaire. The answers were classified by similarity. It was examined the relationship between difficulties to perform activities of daily living and the frequency and intensity of signs and symptons by Pearson chi-square and lekelihooh Ratio Tests, and meaning values for p<0.05. The difficulty in performing ADL was associated with the following signs and symptons: the typical angina and the difficulty of taking public transportation; and, the typical angina intensity and the difficulty walking out of home; the atypical angina and difficulty taking public transportation; frequency of dyspnea and difficulty taking a shower, dressing, walking into and out of home, taking public transportation, preparing the own meal, cleaning the house, climbing upstairs; and, dyspnea intensity and the difficulty dressing, walking out of home and taking public transportation; the tiredness frequency and difficulty taking a shower, dressing, walking into and out of home, taking publictransportation, feeding, cleaning the house, climbing upstais; and, tiredness intensity and difficulty taking a shower, walking into and out of home, taking public transportation, dizziness frequency and difficulty taking a shower, dressing, walking into and out of home and taking public transportation; the frequency of legs pain and difficulty walking out of home, taking public transportation and climbing upstais; and, the legs pain intensity was associated to difficulty to perform own shower. The assessment of functional elederly status by performing the activities of daily living, will contribute to design and to accomplish the holistic health care of this part of population.