Implementing myocardial infarction systems of care in low/middle-income countries.

Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

Primary cardiac angiosarcoma: case report of a rare neoplasia / Angiossarcoma cardíaco primário: relato de caso de uma rara neoplasia

ABSTRACT This article reports a case of primary cardiac angiosarcoma and a brief review is provided. A 44-year-old male patient was suspected of having myxoma in the right atrium. The tumor, on pathology examination, was shown to be a cardiac angiosarcoma. In the postoperative period, the patient developed a cardiac tamponade, requiring reoperation and evolving to death. Angiosarcomas are malignant tumors characterized by a devastating clinical course. They have a predilection for the right atrium, occurring between the third and fifth decades of life, with a male preponderance. Because of its rarity, the ideal treatment has not been identified yet.

RESUMO Este artigo ilustra um caso de angiossarcoma primário cardíaco acompanhado de uma revisão dessa rara neoplasia. Relatamos o caso de um paciente do sexo masculino, 44 anos, com suspeita de mixoma em átrio direito. O tumor, ao exame anatomopatológico, mostrou tratar-se de um angiossarcoma cardíaco. No pós-operatório, o paciente cursou com tamponamento cardíaco, necessitando ser reoperado e evoluindo a óbito. Angiossarcomas são tumores malignos caracterizados por curso clínico devastador. Apresentam predileção pelo átrio direito, e ocorrem entre a terceira e a quinta década de vida, com preponderância no sexo masculino. Devido a sua raridade, o tratamento ideal ainda não está bem estabelecido.

One Million Electrocardiograms of Primary Care Patients: A Descriptive Analysis.

In 722 cities of Minas Gerais (Brazil), primary care patients can have their ECGs remotely interpreted by cardiologists of the Telehealth Network of Minas Gerais (TNMG), a public telehealth service. As of December 2014, more than 1.9 million ECGs were interpreted. This study analyzed the database of all ECGs performed by the TNMG on primary care patients from 2009 to 2013 (n=1,101,993). Structured patient data and the results of automated ECG interpretation by the Glasgow Program are described. Mean patient age is 51 years old, 59% of them are women. The average body mass index is 25.9 kg/m2, with an average increase of 0.15 kg/m2 per civil year. Those patients notably have hypertension (33.2%), family history of coronary artery disease (14.5%), smoking (6.9%), diabetes (5.8%), obesity (5.8%) or Chagas Disease (3.0%). Seventy percent of ECGs are normal. This percentage is higher in women (72.3%) and decreases in average by 7.4 every 10 years of life. There are notably 12% of possible myocardial infarction, 10% of possible left ventricular hypertrophy and 8% of possible supraventricular extra systole.