Brugada Syndrome in Puerto Rico: a Case Series.

Brugada syndrome (BrS) is characterized by ST-segment changes in the right precordial ECG leads and a high incidence of sudden death in patients with structurally normal hearts. Life-threatening ventricular arrhythmias are the hallmark of Brugada syndrome. The incidence and prevalence of BrS in Puerto Rico, to our knowledge, has never been studied and there is only one case report of BrS in Puerto Rico in the literature [1]. We present 3 cases of BrS in Puerto Rican patients who presented to our institution with syncope and review the literature.

Brugada syndrome in Puerto Rico: a case series.

Brugada syndrome is characterized by ST-segment changes in the right precordial ECG leads and a high incidence of sudden death in patients with strutural norm hearts. Life-threatening ventricular arrhythmias are the hallmark of Brugada syndrome whice incidence and prevalence of BrS in Puerto Rico, to our knowledge, has never been studied and there is only one case report of BrS in Puerto Rico in the literature. We review three cases of BrS in Puerto Rican patients who presented to our institution with syncope reviewing the literature.

Screening for Peripheral Arterial Disease.

Lower extremity peripheral artery disease is a manifestation of systemic atherosclerotic disease, which affects over 8 million Americans and conveys a significant health burden globally. Although PAD can be asymptomatic and subclinical, it is associated with a reduction in functional capacity and quality of life when symptomatic, and, in its most severe form, is a major cause of limb amputation. Peripheral arterial disease (PAD) commonly results from progressive narrowing of arteries in the lower extremities. Previous studies have shown that PAD is associated with a significantly elevated risk of cardiovascular disease morbidity and mortality. This is the reason screening is crucial for diagnosis and prevention of future adverse cardiovascular events. The most common etiology is atherosclerosis, although other disease process like inflammatory, immune, and hypercoagulable disorders can cause signs and symptoms of arterial insufficiency. When recognized early and appropriately managed, complications that lead to limb loss can be minimized. All patients should have a comprehensive history taken and be examined for PAD, but patients with risk factors should be specifically examined which is currently suboptimal in our daily practice.

Total right pulmonary venous return to the inferior vena cava: a rare variant of Scimitar syndrome.

Scimitar syndrome is a rare congenital disorder characterized by a partial, or rarely total, unilateral anomalous pulmonary venous return to the inferior vena cava. This anomaly has a distinctive bimodal presentation with the infantile form having a higher incidence, severity and mortality than the adult form, which is usually asymptomatic on diagnosis. We present the case of a 36-year-old-male transferred to our institution due to incidental anomalous vascular findings on contrast enhanced chest tomography while being evaluated for dyspnea on exertion. Patient underwent right and left heart catheterization with evidence of left-to-right shunt secondary to complete anomalous right pulmonary venous return. Patient was referred to a cardiovascular surgeon with expertise in congenital heart disease for definitive surgical correction.

Analysis of heart failure management at the Heart Failure and Transplantation Clinics of the Cardiovascular Center of Puerto Rico and the Caribbean.

BACKGROUND: Disease management programs (DMP) have been shown to be effective in management of patients with heart failure (HF). OBJECTIVE: To describe the experience at the Heart Failure and Transplantation Clinic of the Cardiovascular Center of Puerto Rico and the Caribbean (HFTC-CCPRC) implementing a model of DMP to a Hispanic population afflicted by HF. METHODS: A retrospective study was performed. Medical records from patients referred to the HFTC-CCPRC from 1999 to 2005 were selected for review. Information regarding drug regimen, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) determinations by echocardiography or scintigraphic ventriculography, left ventricular dimensions measurements, maximal oxygen consumption (MVO2 max) determination, hospitalizations, and death cases were obtained from the initial evaluation and at 3, 6, and 12 months post-intervention at the HFTC-CCPRC. RESULTS: A total of 633 records were screened, from which 244 had complete information for analysis. After 12 months of treatment at the HFTC-CCPRC, NYHA functional class had decreased from 2.70 + 0.59 to 2.13 +/- 0.53 (p < 0.01). LVEF had also increased from 21.0 +/- 8.2% to 39.9 +/- 14.6% (p < 0.01). Hospitalization rate was reduced from 62.7% within the year prior to initial evaluation to 7.2% at the end of the 12-month period (p < 0.01). CONCLUSIONS: In our patient population, we found significant improvement in several parameters, including NYHA functional class, LVEF, and hospitalization rate after intervention at the HFTC-CCPRC. These findings are most likely related to improved guideline adherence, and are consistent with published data regarding the value of DMP's.

Chronic heart failure: a review for the primary care physician.

Heart failure is a complex clinical syndrome. The pharmacological therapy for chronic heart failure has been changing in the past decade with acquired knowledge of the pathophysiology of this medical condition. Primary care physicians currently treat a significant number of patients. This article summarizes core topics of heart failure including epidemiological information, etiology, pathophysiology, clinical features and diagnostic tools. Also, we review some of the most relevant research studies that have led to the current recommendations for the pharmacological therapeutic strategies in the management of chronic heart failure. We make reference to the latest guidelines in the management of chronic heart failure submitted by the American College of Cardiology and the American Heart Association (ACC/AHA). New technological advances, such as the biventricular-pacing devices, are an important adjuvant to the established pharmacological therapies for chronic heart failure.