Giant cardiac myxoma in an asymptomatic 57-year-old woman: a case report.

Primary cardiac neoplasms are rare and left atrial myxomas represent the most common form of primary cardiac masses. We present the case of a 57-year-old woman with Diabetes Mellitus and arterial hypertension who was incidentally found to have a giant myxoma in the left atrium. She was asymptomatic but given the high risk of embolization and sudden cardiac death, surgical removal of the tumor was performed. A 6.0 x 5.0 x 4.5 cm mass was recovered, confirmed to be a benign cardiac myxoma on microscopic examination. Symptoms associated with cardiac masses will depend upon tumor location and size, usually related to flow obstruction and embolization. An inflammatory response due to secretion of cytokines may also be observed. In this case, the patient had no symptoms despite the size of the tumor that occupied virtually 90% of the left atrial volume.

Unstable angina and non ST elevation acute coronary syndromes.

Acute coronary syndromes (ACSs) are the most common cause of hospital admission in patients with coronary artery disease (CAD). The term ACS refers to a spectrum of acute life-threatening disorders that includes: unstable angina (UA), non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). The pathophysiology is similar: coronary atherosclerosis plaque rupture and subsequent thrombus formation. Such plaques usually are lesions with <50% stenosis severity prior to ACS, but are lipid-rich soft plaques (vulnerable plaques). The clinical presentation depends on the degree of partial (UA/NSTEMI) or complete lumen obstruction of the culprit coronary artery (STEMI). This article reviews the UA/NSTEMI ACS, since these two entities are closely related and usually, it is not possible to distinguish them upon presentation at the emergency department (ED). It presents the latest advancement on the pathophysiology, clinical presentations, diagnosis, risk stratification and management. It emphasizes on the selection of the optimal management approach which includes early invasive versus initial conservative strategies. Besides, it discusses the different approaches being used in the light of the information provided by the latest clinical trials. Although, at the present time, the optimal management approach remains unsettled, ACSs are usually managed using an early invasive strategy in tertiary care hospitals in the USA. The application of clinical practice guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) has confirmed definite improvement of patient care. Part of the information presented in this article, particularly in its management, is based on these guidelines (3). Evidence base scientific data insists upon using aggressive medical therapy (statins, anti-platelets, beta blockers [BBs], angiotensin converting enzyme inhibitors [ACE-Is], and control of coronary risk factors) as well as mechanical reperfusion, whether by percutaneous coronary intervention (PCI) or by coronary artery bypass graft (CABG). These approaches are considered complementary rather than as opposing strategies.

Aortic valvular heart disease in adults

Valvular Heart Disease (VHD) is an important cardiovascular problem in the adult population. The knowledge of the physiology involved, prompt recognition and diagnosis are of paramount importance for the primary care physician who is in the front line of patient care. This article is the second of a series of two that deals with valvular problems in the adults in concise and practical form (11). Each topic will be presented using the following format: description, etiology, pathophysiology, natural history, essential of diagnosis and management. In this second and final article we will discuss aortic valve disorders.

The need to comply with guidelines applied in practice (GAP) in order to improve cardiovascular patient care in Puerto Rico.

The aim of this article is to provide important information to the medical community about Clinical Practice Guidelines (CPG) in general, and particularly those developed by the American College of Cardiology and the American Heart Association (ACC/AHA). The optimal CPG is defined and the selection, writing and preparation of the guides are succinctly described. Despite counting with 19 high-quality evidence based ACC/AHA guidelines in various important cardiovascular topics and evidence that adherence to them have demonstrated improvement in the outcome of cardiovascular patient care, there is a large gap in the integration of the guidelines to everyday practice. In response to this realty the ACC/AHA developed the program, Guidelines Applied in Practice (GAP) to foster the implementation of the guidelines into clinical practice. As a plea to the application of the principles of evidence-based CPG, The Puerto Rico Chapter of the ACC has developed two programs oriented to disseminate and help physicians put the guidelines into practice. These are: (1) ACC/ AHA guidelines dissemination through traditional continuing medical education programs and (2) Developing in accord to medical advances a GAP (Guidelines Applied in Practice) in Puerto Rico on acute coronary syndromes (ACS-GAP in Puerto Rico), adapting standardized protocols to local conditions.

Aortic valvular heart disease in adults.

Valvular Heart Disease (VHD) is an important cardiovascular problem in the adult population. The knowledge of the physiology involved, prompt recognition and diagnosis are of paramount importance for the primary care physician who is in the front line of patient care. This article is the second of a series of two that deals with valvular problems in the adults in concise and practical form (11). Each topic will be presented using the following format: description, etiology, pathophysiology, natural history, essential of diagnosis and management. In this second and final article we will discuss aortic valve disorders.

Mitral valvular heart disease in the adults

Valvular Heart Disease (VHD) is an important cardiovascular problem in the adult population. The knowledge of the physiology involved, prompt recognition and diagnosis are of paramount importance for the primary care physician who is in the front line of patient care. This article is the first of a series of two that will discuss valvular problems in the adults in concise and practical form. Each topic will be presented using the following format: description, etiology, pathophysiology, natural history, essential of diagnosis and management. In this first article we will discuss mitral valve disorders including mitral valve prolapse (MVP)

Mitral valvular heart disease in the adults.

Valvular Heart Disease (VHD) is an important cardiovascular problem in the adult population. The knowledge of the physiology involved, prompt recognition and diagnosis are of paramount importance for the primary care physician who is in the front line of patient care. This article is the first of a series of two that will discuss valvular problems in the adults in concise and practical form. Each topic will be presented using the following format: description, etiology, pathophysiology, natural history, essential of diagnosis and management. In this first article we will discuss mitral valve disorders including mitral valve prolapse (MVP).