ABSTRACT
RESUMEN: El tratamiento del Infarto Agudo del Miocardio con supradesnivel del segmento ST debe iniciarse en el escenario prehospitalario, en el sitio del primer contacto médico. El diagnóstico electrocardiográfico precoz debe ser realizado, idealmente, dentro de los primeros 10 min después de la consulta y confirmado por un especialista. A este respecto, la teletransmisión del electrocardiograma a un centro de llamados atendido por especialistas en horario 24/7 es un modelo muy eficiente, idealmente como parte de una red de tratamiento. El control del dolor y la administración de agentes antiplaquetarios son imperativos y si la intervención coronaria percutánea (angioplastia primaria) no es factible dentro de las ventanas de tiempo universalmente recomendadas, se debiera realizar un tratamiento fibrinolítico, seguido por angioplastia diferida.
ABSTRACT: Treatment of acute myocardial infarction should be initiated in the prehospital scenario at the site of first medical contact. Prompt electrocardiographic diagnosis should be performed ideally within 10min after consultation and diagnosis confirmed by a specialist. Teletransmission of the electrocardiogram to a call center staffed with specialists on a 24/7 basis is a very efficient model, ideally as part of a network of treatment. Pain control and administration of antiplatelets agents are mandatory and if primary percutaneous intervention is not feasible within time limits universally recommended, prehospital fibrinolyisis should be performed followed by deferred angioplasty.
Subject(s)
Humans , Myocardial Infarction/drug therapy , Myocardial Infarction/therapy , Remote Consultation/methods , Electrocardiography , Prehospital Services , FibrinolysisABSTRACT
Resumen: Este artículo resume algunos de los trabajos realizados por el autor en las áreas de las Ciencias Básicas y Clínicas, seguidos por lo que es su trabajo actual en Telemedicina. Se describe lo que es la Telemedicina como herramienta fundamental en la atención médica actual, tanto para el informe de exámenes, como en atención médica a distancia, con énfasis en al campo de la Cardiología. Se da una visión de lo que será la práctica médica en el futuro con la aplicación de herramientas, como el Internet de las cosas, la inteligencia artificial, Big Data y la robótica, que se traducirán en una práctica médica cada vez más tecnológica y con menor contacto directo entre pacientes y médicos. Se insiste en que pese al progreso que significa la aplicación de tales herramientas, lo más importante sigue siendo la Prevención de la Enfermedades cardiovasculares, con énfasis en nuestra población infantil (prevención primordial).
Subject(s)
Humans , Cardiology/trends , Telemedicine , Biomedical ResearchABSTRACT
Abstracts: 24 hour blood pressure monitoring. Recommendations from the Chilean Society of Cardiology and Cardiovascular Surgery. The recommendations for blood pressure monitoring from the Chilean Society of Cardiology and Cardiovascular Surgery are analyzed. Emphasis is placed on indications for the procedure, according to different classes and causes of hypertension. Implications of different types of hypertension for prognosis and indications for adequate therapy are discussed.
Subject(s)
Humans , Blood Pressure Monitoring, Ambulatory/standards , Hypertension/diagnosisABSTRACT
This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.
Subject(s)
Humans , Atherosclerosis/prevention & control , Cardiovascular Agents/administration & dosage , Cardiovascular Diseases/prevention & control , Medication Adherence/statistics & numerical data , Atherosclerosis/epidemiology , Cardiovascular Diseases/epidemiology , Chile/epidemiology , Cost-Benefit Analysis , Risk Factors , Secondary PreventionABSTRACT
Background: The association of stress and acute coronary events has been extensively explored. An increased output of catecholamines leading to high blood pressure and alteration of hemostasis may be responsible for this effect. A severe earthquake and tsunami is a major stress. Methods and Results. 280,592 electrocardiograms (ECG) obtained via a telemedicine system in the years 2009 and 2010 were analyzed. The frequency of subepicardial lesions recorded during the weekend in which the earthquake took place (27/2/2010 - 28/2/2010) was compared to that observed in all other weekends throughout the period. 7 subjects had a blood pressure Holter monitoring on that weekend. A subepicardial lesion was diagnosed in 0.64% of ECGs recorded throughout the period, increasing significantly in the earthquake's weekend (p<0.05). The age distribution of subepicardial lesions was similar in all weekends. However, the higher proportion of males with sub epicardial lesions throughout the study period changed to a higher proportion of females in the earthquake's weekend. Significant increases in blood pressure and heart rate were observed in coincidence with the earthquake in patients undergoing blood pressure monitoring. Conclusion: a statistically significant increase in subepicardial lesions demonstrated by telemedicine ECG recordings was associated to the stressful situation of the 2010 earthquake in Chile.
La asociación de estrés y eventos coronarios agudos ha sido extensamente estudiada. En relación a un evento estresante existiría un aumento en la liberación de ca-tecolaminas que incide en un incremento en la presión arterial y alteraciones de hemostasia, como sería el caso de un terremoto. En el presente trabajo se describe la relación contemporánea observada entre el terremoto del 27 de febrero del 2010 y el diagnóstico de lesión subepicárdica, en electrocardiogramas recibidos en ITMS, Telemedicina de Chile. Se analizaron 280.592 electrocardiogramas (ECGs) provenientes de todo el territorio nacional, que corresponden a un periodo de 12 meses de los años 2009 y 2010. Se realizó una comparación estadística entre el porcentaje de lesiones subepicárdicas registradas en el fin de semana del terremoto (27/02/2010 y 28/02/2010) versus los fines de semana de los meses estudiados. Se obtuvieron los datos correspondientes a siete pacientes que se encontraban con monitoreo ambulatorio de presión arterial (MAPA) el día 27/02. El diagnóstico de lesión subepicárdica se hizo en 1.795 trazados, correspondientes a un 0.64% del total de ECGs recibidos. Hubo un aumento estadísticamente significativo de las lesiones subepicárdicas (p<0,05) en el fin de semana del terremoto, la distribución por edad se mantuvo similar al resto de los períodos analizados. Sin embargo se invirtió la distribución por género durante dicho fin de semana siendo mayor en mujeres que en hombres, como es en el resto de los períodos analizados. En los registros MAPA se documentó un aumento de la presión arterial y frecuencia cardíaca en relación al evento estresante. Se confirmó entonces un aumento estadísticamente significativo del diagnóstico electrocardiográfico de lesiones subepicárdicas en relación al estrés producido por el terremoto del 27 de febrero de 2010.
Subject(s)
Humans , Male , Female , Middle Aged , Earthquakes , Electrocardiography/instrumentation , Cardiovascular Diseases/epidemiology , Tsunamis , Telemedicine/methods , Chile , Stress Disorders, Post-TraumaticABSTRACT
Traditional tools to evaluate cardiovascular disease risk may underestimate the risk of cardiovascular events. Although reduction of low-density lipoprotein cholesterol (LDL-C) is the mainstay of therapy to mitigate cardiovascular risk from atherosclerosis, noninvasive imaging techniques and biomarkers are now allowing us to identify subclinical atherosclerosis, or high-risk patients, and are providing clinical researchers with new target end points for randomized controlled clinical trials. Current surrogates include carotid intima-media thickness, coronary artery calcification, and high-sensitivity C-reactive protein levels. There is evidence that these biomarkers are useful in clinical practice to improve risk quantification in subjects considered at intermediate risk of coronary events according to clinical risk stratification. Some studies, but not all, have demonstrated achievement of surrogate end points with lipid-lowering therapy in addition to LDL-C reductions. A group of clinical lipidologists from Latin American countries convened to give a perspective on recent clinical trials in clinical lipidology, their designs, and data regarding currently used biomarkers. It was noted that the success of some surrogate end points as possible markers of clinical efficacy has relied heavily on patient selection and trial design. On the basis of current evidence, we believe that correcting elevated LDL-C levels should remain the primary target of therapy for patients with dyslipidemia. The group also agreed that the evidence from recent clinical trials supports the potential role of new biomarkers for the screening and identification of patients at high cardiovascular risk in the absence of overt hyperlipidemia.
Subject(s)
C-Reactive Protein/analysis , Clinical Trials as Topic , Dyslipidemias/therapy , Anticholesteremic Agents/therapeutic use , Atherosclerosis/diagnosis , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Dyslipidemias/diagnosis , Dyslipidemias/physiopathology , Humans , Hyperlipoproteinemia Type II/diagnosis , Hyperlipoproteinemia Type II/therapy , Hypolipidemic Agents/therapeutic use , Latin America , Lipoproteins, LDL/blood , Risk FactorsABSTRACT
BACKGROUND: The relationship between hyperhomocysteinemia and cardiovascular disease has not been totally elucidated. HYPOTHESIS: The study aimed to verify the association between hyperhomocysteinemia and endothelial dysfunction before and after modification of total homocysteine (tHcy) serum levels with vitamin supplementation in young male subjects devoid of any other cardiovascular risk factor. METHODS: Twenty hyperhomocysteinemic (tHcy > 15 [micromol/l) male volunteers (< or = 40 years) and 20 age-matched subjects with normal tHcy levels (tHcy < 13 micromol/l) were included. Exclusion criteria were smoking, hypertension, diabetes, vitamin ingestion, obesity, hypercholesterolemia, renal failure, and positive antiphospholipid antibodies. Serum tHcy, folate, vitamin B12 levels, activated protein C and S, protein C resistance, fibrinogen, prothrombin, thrombin, antithrombin III, and in vitro oxidation of low-density lipoprotein (LDL) particles were measured. Noninvasive ultrasound measurements of endothelium-dependent (EDD) and -independent dilatation (EID) of the brachial artery were performed. Each pair was then randomly assigned to receive a vitamin capsule (0.6 mg folic acid, 0.8 mg B12. and 2.0 mg B6) oran identical placebo during 8 weeks, in a double-blind study design. After the treatment phase, blood samples and vascular reactivity were repeated. RESULTS: Nine pairs of volunteers received vitamins and 11 received placebo. Hyperhomocysteinemic subjects had lower baseline serum levels of vitamin B12. Serum folate levels, antithrombotic function, in vitro LDL oxidation, and EDD were similar in all groups. After the vitamin supplementation, serum folic acid levels increased significantly both in normo- and hyperhomocysteinemic subjects, unlike vitamin B12, which increased only in the hyperhomocysteinemic individuals. Plasma tHcy decreased significantly in the supplemented groups. Treatment with vitamins was not associated with improvement in EDD or antithrombotic function. CONCLUSIONS: Mild hyperhomocysteinemia is not associated with endothelial dysfunction in young male subjects with no additional cardiovascular risk factors, and reduction of tHcy by vitamin supplementation does not modify EDD in this age group. In this sample, tHcy was more related to vitamin B12 than to folic acid status.
Subject(s)
Dietary Supplements , Endothelium, Vascular/drug effects , Folic Acid/therapeutic use , Hyperhomocysteinemia/drug therapy , Vitamin B 12/therapeutic use , Vitamin B 6/therapeutic use , Adolescent , Adult , Double-Blind Method , Folic Acid/blood , Homocysteine/blood , Humans , Male , Vitamin B 12/blood , Vitamin B 6/bloodABSTRACT
La prevención de enfermedades cardiovasculares se basa en el manejo de factores de riesgo cardiovascular utilizando medios farmacológicos o cambiando hábitos de vida. En los estudios de prevención primaria o secundaria, la reducción en las concentraciones de colesterol se asocia a una menor incidencia de eventos y mortalidad cardiovascular. La reducción de la presión arterial también disminuye la incidencia de infarto agudo de miocardio y accidentes cerebrovasculares. El ejercicio regular conlleva una mayor supervivencia y los beneficios de dejar de fumar son bien conocidos. Los valores aumentados de homocisteína en el plasma se asocian a enfermedades cardiovasculares. Sin embargo, no hay estudios prospectivos que demuestren un efecto beneficioso de la reducción de los valores de homocisteína sobre la mortalidad cardiovascular. Cambios en el tipo de grasa dietética también deberían ser beneficiosos para la salud cardiovascular; sin embargo, tampoco contamos con estudios prospectivos que demuestren este efecto. En Chile, las enfermedades cardiovasculares son la principal causa de muerte en adultos y la prevalencia de factores de riesgo cardiovascular, incluyendo la hiperhomocisteinemia, es similar a la de América del Norte o Europa. Se han desarrollado clínicas de prevención cardiovascular primaria y secundaria en Chile, con buenos resultados. Por tanto, los criterios de prevención cardiovascular propuestos para América del Norte y Europa deberían aplicarse en Chile y otros países latinoamericanos con muy leves modificaciones (AU)
