Guía práctica interinstitucional para el tratamiento del infarto agudo de miocardio / Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction

Resumen Introducción: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. Objetivo: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. Método: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología, con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. Resultados: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. Conclusión: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Abstract Introduction: Mexico has the highest 30-day acute myocardial infarction (AMI) mortality rate: 28% versus 7.5% on average for the OECD countries, and it constitutes one of the main causes of mortality in the country. Objective: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. Method: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. Results: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. Conclusion: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status.

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction.

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Resultados quirúrgicos y seguimiento postoperatorio de mixomas auriculares / Surgical results and monitoring of postoperative atrial myxomas

Resumen: Objetivo: Analizar la casuística del mixoma auricular izquierdo, haciendo énfasis en los resultados y seguimiento. Método: Se revisaron los expedientes clínicos de los pacientes operados de mixomas cardiacos en el Hospital Central Sur de Alta Especialidad (HCSAE) de PEMEX en los últimos 7 años, haciendo hincapié en los resultados y seguimiento. Resultados: El análisis mostró 10 pacientes, de los cuales el 60% fueron mujeres y el 40% varones; las edades fueron de los 12 a los 76 años, con una edad media de 50 años. En las características clínicas de los pacientes predominó la disnea en un 90%, seguido de la fatiga (80%) y dolor torácico (60%). La incidencia fue del 90% para la aurícula izquierda y del 10% en aurícula derecha, hubo tumores de menos de 3 cm hasta mayores de 10 cm (media de 6-7 cm). El informe de patología fue de mixoma en el 100% de los casos, La morbimortalidad temprana fue del 0%, con una estancia hospitalaria promedio de 6 días; una paciente de 12 años tuvo una recidiva y se sometió otra vez a cirugía 5 meses más tarde. La supervivencia a 5 años es del 100%. Conclusiones: Se sabe que la presentación de Mixomas es muy poco frecuente, la experiencia en este Centro de Concentración Nacional, es de un paciente por cada 350 cirugías, en promedio un caso por año con una nula mortalidad y una excelente supervivencia.

Abstract: Objective: To analyze the casuistics of left atrial myxoma with emphasis on results and follow-up. Method: We reviewed the clinical records of patients operated in the Hospital Cardiac Myxomas South Central High Specialty (HCSAE) of PEMEX in the last 7 years, with an emphasis on results and follow-up. Results: The analysis showed 10 patients, of whom 60% were female and 40% male, with ages from 12 to 76 years, with a mean age of 50 years. In the clinical characteristics of patients predominated dyspnea in 90%, followed by fatigue (80%) and chest pain (60%). The incidence was 90% for the left atrium and 10% for the right atrium, had tumors less than 3 cm to up to over 10 cm (average of 6 to 7 cm). The pathology report was myxoma in the 100% of cases, the morbidity and early mortality was 0%, with a mean hospital stay of 6 days, and a patient of 12 years of age recurred and underwent surgery five months later. The 5-year survival was 100%. Conclusions: The incidence of myxomas is well known for rare presentation, the experience in this national medical center is one patient for every 350 operations, one case per year with no mortality and excellent survival.

[Surgical results and monitoring of postoperative atrial myxomas]. / Resultados quirúrgicos y seguimiento postoperatorio de mixomas auriculares.

OBJECTIVE: To analyze the casuistics of left atrial myxoma with emphasis on results and follow-up. METHOD: We reviewed the clinical records of patients operated in the Hospital Cardiac Myxomas South Central High Specialty (HCSAE) of PEMEX in the last 7 years, with an emphasis on results and follow-up. RESULTS: The analysis showed 10 patients, of whom 60% were female and 40% male, with ages from 12 to 76 years, with a mean age of 50 years. In the clinical characteristics of patients predominated dyspnea in 90%, followed by fatigue (80%) and chest pain (60%). The incidence was 90% for the left atrium and 10% for the right atrium, had tumors less than 3cm to up to over 10cm (average of 6 to 7cm). The pathology report was myxoma in the 100% of cases, the morbidity and early mortality was 0%, with a mean hospital stay of 6 days, and a patient of 12 years of age recurred and underwent surgery five months later. The 5-year survival was 100%. CONCLUSIONS: The incidence of myxomas is well known for rare presentation, the experience in this national medical center is one patient for every 350 operations, one case per year with no mortality and excellent survival.

[National Registry of Cardiac Rehabilitation Programs in México]. / Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC).

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Registro Nacional sobre Programas de Rehabilitación Cardíaca en México (RENAPREC) / National Registry of Cardiac Rehabilitation Programs in México

Cardiac Rehabilitation and secondary prevention programs are a group of therapeutic maneuvers that can reduce the adverse impact of cardiovascular disease, by using the cardiovascular risk factors reduction, through secondary prevention and exercise training therapy programs. This program started in Mexico in 1944, since then, several health institutions are working on a public or private basis, mainly in an isolated way. This article presents data about fourteen cardiac rehabilitation institutions that answered the first national registry of cardiac rehabilitation programs (RENAPREC) in 2007. On this study, we observed that these centers were mainly private; nevertheless, almost all of the referred population was attended in public health institutions. The core-components for an adequate cardiac rehabilitation attention were satisfied by almost all these centers. The patients used to pay, by their own, this kind of medical practice. In our country, only the 0.58% of the population, that needed to be included on a cardiac rehabilitation program, was covered. This phenomena is due, in one hand, to the reduced number of cardiac rehabilitation centers in Mexico, but on the other hand, it happens because the primary physician do not refer all the eligible patients to this kid of programs. RENAPREC can be one first attempt to consolidate all the activities around the inter-institutional cardiac rehabilitation and secondary prevention programs in our country.

Inflammation in patients on peritoneal dialysis is associated with increased extracellular fluid volume.

BACKGROUND: Cardiovascular disorders (CD) are the most frequent cause of death in patients on dialysis. CD have been related to increased extracellular fluid volume, peritoneal transport type (PTT), hypertension, and inflammation. Inflammation is in itself a risk factor for mortality. The aim of this study was to assess the relationship of increased extracellular fluid volume, inflammation, and PTT in patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). METHODS: A cross-sectional study was carried out with 20 healthy controls (C), 21 patients on CAPD, and nine patients on APD. Clinical and demographic variables were measured and registered. Peritoneal equilibrium test (PET) was done. Blood volume (BV), total body water (TBW), inferior vena cava diameter during inspiration (IVCDi) and expiration (IVCDe), serum albumin, and serum C-reactive protein (CRP) were measured. RESULTS: All patients on peritoneal dialysis (PD) had at least one sign or symptom of increased extracellular fluid volume, hypertension being the most common. Patients also had higher TBW (C, 60.7 +/- 7.2; APD, 62.6 +/- 8.7; CAPD, 66.1 +/- 8.3, as percentage of body weight, p <0.02), higher BV (C, 7.9 +/- 1.6; APD, 9.8 +/- 2.3; CAPD, 9.6 +/- 2.3, as percentage of body weight, p <0.02), higher DIVCi (C, 2.9 +/- 1.2; APD, 4.6 +/- 2.5; CAPD, 4.5 +/- 2.4 mm/m2 BSA, p <0.02), and higher DIVCe (C, 6.2 +/- 1.7; APD, 8.3 +/- 3.4; CAPD, 8.0 +/- 2.8 mm/m2 BSA, p <0.05). PD patients also had hypoalbuminemia and higher CRP levels. There was significant positive correlation between CRP and DIVCi (r=0.43, p <0.05) and IVCe (r=0.45, p <0.05) and between serum albumin and creatinine dialysate-to-plasma ratio (D/P Cr, r=0.57, p <0.01). Serum albumin and CRP were negatively correlated (r= -0.54, p <0.02). CONCLUSIONS: Patients on PD have increased extracellular fluid volume as compared with healthy controls. Hyperhydration is related to inflammation and to higher peritoneal transport types.