Myocardial Inflammatory Changes Before and After Antiretroviral Therapy Initiation in People With Advanced Human Immunodeficiency Virus Disease.

Because of the high frequency of late presentation of human immunodeficiency virus (HIV) disease in our population, we decided to explore the presence of myocarditis among people with HIV infection and advanced immunosuppression (less than 200 CD4+ cells/µL) and to describe the inflammatory changes observed after combined antiretroviral therapy initiation in an observational, longitudinal, prospective cohort. We performed both cardiovascular magnetic resonance imaging and doppler transthoracic echocardiogram.

Infarto de miocardio tipo 2 con elevación del segmento ST / Type 2 myocardial infarction with ST segment elevation

Resumen: El infarto de miocardio es causa importante de muerte y discapacidad en todo el mundo. Es secundario al desequilibrio entre la relación aporte/consumo de oxígeno miocárdico y tiene características clínicas propias. En este artículo se comunica el caso clínico de un paciente con múltiples factores que generaron un desequilibrio en la relación aporte/consumo de oxígeno del miocardio, además de elevación significativa del segmento ST en el electrocardiograma y marcada elevación de la troponina I. Todos estos cambios revirtieron con el inicio del manejo médico de los factores que contribuyeron a este desequilibrio.

Abstract: Myocardial infarction (MI) is a major cause of death and disability worldwide. Type 2 MI is secondary to an imbalance in myocardial oxygen delivery/consumption relationship and has its own clinical characteristics. We report the case of a patient with multiple factors that created an imbalance in the myocardial oxygen delivery/consumption relationship and also had significantly ST segment elevation on the electrocardiogram and marked elevation of troponin I. All these changes reversed with the onset of medical management of the factors that contributed to this imbalance.

[Atrial fibrillation. New views on an old disease]. / Fibrilación auricular. Nuevos aspectos sobre una vieja enfermedad.

Atrial fibrillation (Afib) is clinically the most common arrhythmia. Its main complications are recurrent embolic events and a variable deterioration of functional class. Atrial fibrillation induces changes in cellular ionic channels that self-perpetuate the arrhythmia. The pharmacologic treatment of Afib is directed toward correction of those changes and return to sinus rhythm. It is also intended to maintain adequate heart rates and prevent embolic events through anticoagulation or platelet antiagregation. There are presently several class IC or class III antiarrhythmics available for attempting a return to sinus rhythm. The success rates are irregular, the best achieved with flecainide or propafenone among patients without structural heart disease. Amiodarone is the best choice when there is such a problem. The combination possibilities are huge, so that each case must be individualized. The new class III antiarrhythmics are very effective, but have a relatively high rate of side effects including torsade de pointes. Anticoagulation should be the preferred treatment among the majority of patients, but each case should be individually evaluated. New therapies such as focal or linear catheter ablation techniques, atrial or biatrial programmed stimulation, and atrial cardioverter-defibrillator need longer follow-up and experience to be objectively evaluated, although there are reasons to be optimistic in the future, even if patients need antiarrhythmic support at present. Surgery has high morbi-mortality rates, so it is not the preferred approach.

Cardiac conduction disturbances in mixed connective tissue disease.

BACKGROUND: Myocardial involvement occurs in about 20% of patients with mixed connective tissue disease. The purpose of this study was to determine the prevalence of conduction disturbances, their association with other manifestations of the disease. OBJECTIVE: Determine the prevalence of cardiac conduction disturbances in patients with mixed connective tissue disease attended in an institute in Mexico City and their relation with other manifestations of the disease. METHODS: One hundred thirteen patients admitted to the Institute with a diagnosis of mixed connective tissue disease were divided into those with conduction disturbances (n = 23) and those without (n = 90). Over a mean follow-up of 10.2 +/- 7.8 years, clinical course, treatment, duration of the disease, types of conduction disturbances and systemic alterations were examined. RESULTS: There was an overwhelming predominance of women in both groups. Conduction disturbances occurred in about 20% of the patients with mixed connective tissue disease and that was not possible to find significant differences in the outcome of them. As could be expected a significant difference between the two groups was QRS axis, related to anterior hemiblock, the most common conduction alteration observed. During the follow-up one patient death in-group A, but none in group B. CONCLUSION: Conduction disturbances were present in 20%; in agree with other authors in the literature. However, did not participate in the outcome of the disease.

[The usefulness of transesophageal echocardiography during percutaneous balloon mitral valvulotomy]. / Utilidad del ecocardiograma transesofágico durante la valvulotomía mitral percutánea con balón.

The purpose of this study is to report the experience at Instituto de Cardiología de México with transesophageal echocardiography during percutaneous mitral valvulotomy and to compare its utility with transthoracic echocardiography. Sixteen patients with isolated or predominant mitral stenosis were examined and underwent percutaneous mitral valvulotomy with a single balloon catheter (Inoue [correction of Ionue] technique). Transthoracic echocardiography was done in all cases previous to the procedure. The procedure orientation was done with transesophageal in thirteen patients and with. Transthoracic echocardiography in the other three. The results were successful in all cases. Transesophageal echocardiography was more useful in the initial evaluation in patients with poor transthoracic windows, in those with clinical and/or transthoracic evidence of atrial thrombosis, as well as in procedure orientation, spontaneous contrast detection, mitral regurgitation and atrial septal defect evaluation after the procedure. Transesophageal echocardiography is superior to transthoracic technique in procedure orientation, early evaluation of results and potential complications. However, its practical utility is limited and its routine use is not recommended.