[Impact of variation in altitude above sea level on clinical and hemodynamic parameters in pulmonary arterial hypertension: case report]. / Impacto de la variación en la altura sobre el nivel del mar, en los parámetros clínicos y hemodinámicos en hipertensión arterial pulmonar: a propósito de un caso.

Clinical monitoring of pulmonary arterial hypertension in our country, in which patients come from different altitudes above sea level, forces us to rule out pulmonary hypertension in relation to chronic exposure to high heights, described in third group of international classification. When reviewing the hemodynamic variations in pulmonary pressure with exercise at altitude with respect to sea level in healthy patients, this is greater in height, this would explain that the patient with pulmonary arterial hypertension is more symptomatic while living at a higher altitude above sea level.

[Invasive hemodynamic monitoring by Swan-Ganz pulmonary artery catheter: concepts and utility]. / Monitoreo hemodinámico invasivo por catéter de arteria pulmonar Swan-Ganz: conceptos y utilidad.

Since its beginnings in the last century, pulmonary artery catheterization (PAC) has evolved into an invasive hemodynamic evaluation technique that can be performed at the patient's bedside through a Swan-Ganz catheter; this procedure has maintained an intermittent course in terms of its use; however, it has currently demonstrated relevance in specific scenarios. The PAC allows access to the central venous circulation, the right heart and the pulmonary artery; it performs the calculation of hemodynamic variables directly or indirectly by means of established formulas and methods. This makes possible to perform an adequate hemodynamic evaluation and classification, perform specific tests (e.g. vasoreactivity test), which help to define the diagnosis, therapeutic , monitor the response to treatment, evaluation prior to advanced therapies (e.g. cardiac transplantation or mechanical circulatory assistance devices), and prognosis in our patients. In this article we discuss the concepts and usefulness of pulmonary artery catheterization.

[Epidemiological characteristics of heart transplant recipients in Peru 2010-2020]. / Características epidemiológicas de receptores de trasplante cardiaco en el Perú, 2010-2020.

Objective: To evaluate the epidemiological, clinical, surgical, pathological characteristics and outcomes in the follow-up of heart transplant recipients at the National Cardiovascular Institute during 2010-2020. Material and Methods: A retrospective descriptive study was performed by reviewing the medical records of patients undergoing heart transplantation at a national referral center, describing the clinical, surgical, laboratory, pathology characteristics and survival of patients up to 10 years of follow-up. Results: Eighty-six patients were transplanted in 10 years, the median age was 41 years (RIQ 28-56), being predominantly male (66.3%). The three leading causes of indication for heart transplantation were: dilated cardiomyopathy (48.9%), ischemic heart disease (17.4%), and myocarditis (6.9%). Total ischemia time was 160 minutes (RIQ 129.7-233.5). Survival at one, five, and ten years was 84.8%, 73.6%, and 65.7% respectively. The main cause of death was non-cardiac: infectious (39.1%) and of unknown origin (26%). Conclusions: The main etiology of heart failure in heart transplant recipients in Peru in recent years was nonischemic dilated cardiomyopathy. We observed that the survival rate was similar to that of international registries; however, the rate of mortality due to infectious causes and death of unknown origin is high, which poses a challenge in the management of post-transplant patients.

Reporte de caso: bloqueo del ganglio estrellado para manejo de la tormenta eléctrica / Case report: stellate ganglion blockade for electric storm management

The electric storm is an emergency whose handling is very demanding. Our case report describes a patient with multiple episodes of ventricular tachycardia, refractory to conventional therapy (antiarrhythmics, beta blockers and sedoanalgesia) where the sympathetic activity of the heart seems to play a crucial role. We decided to try as additional therapeutic strategy, the performing of a transient and bilateral blockade of the stellate ganglion under ultrasound guidance, this procedure was carried out at the patient's bed, without complications during the same. The sympathetic modulation allowed us to optimize conventional antiarrhythmic therapy, thus reducing the appearance of malignant arrhythmias.

La tormenta eléctrica es una emergencia cuyo manejo es muy exigente. Nuestro reporte de caso describe a un paciente con múltiples episodios de taquicardia ventricular refractarios a terapia convencional (antiarrítmicos, betabloqueadores y sedoanalgesia) donde la actividad simpática del corazón parece jugar un rol crucial. Decidimos plantear como estrategia terapéutica adicional la realización de un bloqueo transitorio y bilateral del ganglio estrellado bajo guía ecográfica, este procedimiento se realizó en la cama del paciente, sin complicaciones durante el mismo. La modulación simpática nos permitió optimizar la terapia antiarrítmica convencional, logrando así reducir la aparición de arritmias malignas.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI).

OBJECTIVES: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. METHODS: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. RESULTS: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age>75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age>75 years, and the absence of electrocardiographic signs of reperfusion. CONCLUSIONS: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Heart failure complicating myocardial infarction. A report of the Peruvian Registry of ST-elevation myocardial infarction (PERSTEMI) / Insuficiencia cardiaca complicando el infarto de miocardio. Un reporte de Peruvian Registry of ST-elevation Myocardial Infarction (PERSTEMI)

Abstract Objectives: The aim of this study is to determine the incidence, associated factors, and 30-day mortality of patients with heart failure (HF) after ST elevation myocardial infarction (STEMI) in Peru. Methods: Observational, cohort, multicentre study was conducted at the national level on patients enrolled in the Peruvian registry of STEMI, excluding patients with a history of HF. A comparison was made with the epidemiological characteristics, treatment, and 30 day-outcome of patients with (Group 1) and without (Group 2) heart failure after infarction. Results: Of the 388 patients studied, 48.7% had symptoms of HF, or a left ventricular ejection fraction <40% after infarction (Group 1). Age > 75 years, anterior wall infarction, and the absence of electrocardiographic signs of reperfusion were the factors related to a higher incidence of HF. The hospital mortality in Group 1 was 20.6%, and the independent factors related to higher mortality were age > 75 years, and the absence of electrocardiographic signs of reperfusion. Conclusions: Heart failure complicates almost 50% of patients with STEMI, and is associated with higher hospital and 30-day mortality. Age greater than 75 years and the absence of negative T waves in the post-reperfusion ECG are independent factors for a higher incidence of HF and 30-day mortality.

Resumen Objetivos: Se desea saber la incidencia, los factores asociados y la mortalidad a 30 días de los pacientes con insuficiencia cardiaca (IC) postinfarto de miocardio con elevación del segmento ST (IMCEST) en Perú. Métodos: Estudio observacional, de cohortes, multicéntrico a nivel nacional, de pacientes enrolados en el registro peruano de IMCEST, excluyendo los pacientes con antecedente de IC. Se compararon las características epidemiológicas, tratamiento y evolución a 30 días de los pacientes con (grupo 1) y sin (grupo 2) IC postinfarto. Resultados: De 388 pacientes se encontró un 48.7% con síntomas de IC o fracción de eyección de ventrículo izquierdo < 40% postinfarto (grupo 1). La edad > 75 años, el infarto de pared anterior y la ausencia de signos electrocardiográficos de reperfusión fueron los factores relacionados a mayor incidencia de IC. La mortalidad intrahospitalaria en el grupo 1 fue del 20.6% y los factores independientes relacionados a mayor mortalidad fueron la edad > 75 años y la ausencia de signos electrocardiográficos de reperfusión. Conclusiones: La IC complica casi al 50% de pacientes con IMCEST y está asociada a mayor mortalidad intrahospitalaria y a 30 días. La edad > 75 años y la ausencia de ondas T negativas en el electrocardiograma posreperfusión son factores independientes de mayor incidencia de IC y de mortalidad a 30 días.