Focused cardiac ultrasound in pregnancy.

Cardiac disease in pregnancy is an important cause of maternal morbidity and mortality. In many high-income countries, acquired cardiac disease is now the largest cause of maternal mortality. Given its prevalence in low- and middle-income countries (LMICs), rheumatic heart disease is the most common cause of cardiac disease in pregnancy worldwide and is associated with poor maternal outcome. The diagnosis of cardiac disease in pregnancy is often delayed resulting in excess maternal morbidity and mortality. Maternal mortality review committees have suggested that prompt recognition and treatment of heart disease in pregnancy may improve maternal outcome. Given the similarities between symptoms of normal pregnancy and those of cardiac disease, the clinical diagnosis of heart disease in pregnancy is challenging with echocardiography being the primary diagnostic modality. Focused cardiac ultrasound (FOCUS) at the point of care provides supplemental data to the history and physical examination and has been demonstrated to permit early diagnosis and improvement in the management of cardiac disease in emergency medicine, intensive care, and anesthesia. It has also been demonstrated to be useful in surveillance for rheumatic heart disease in LMICs. The use of FOCUS may allow earlier and more accurate diagnosis of cardiac disease in pregnancy with the potential to decrease morbidity and mortality in both developed and developing countries.

Sub-Saharan Africa Tackles COVID-19: Challenges and Opportunities.

As of May 2020, the global COVID-19 pandemic had reached 187 countries with more than 3.7 million confirmed cases and 263,000 deaths. While sub-Saharan Africa (SSA) has not been spared, the extent of disease is currently far less than in Europe or North America leading some to posit that climatic, genetic or other conditions will self-limit disease in this location. Nonetheless, infections in tropical Africa continue to rise at an alarming pace with the potential to soon exceed health resource availability and to exhaust a health care workforce that is already grossly under supported and ill-equipped. This perspective outlines the context of COVID-19 disease in Africa with a focus on the distinctive challenges faced by African nations and a potential best path forward.

COVID-19 and the heart: An update for clinicians.

SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.

Impacto de la hipertensión arterial sobre la masa ventricular izquierda, la función sistólica y la función diastólica miocárdica / Impact of systemic hypertension on the left ventricular mass, systolic and diastolic miocardial function

La hipertrofia ventricular izquierda (HVI), permite la adaptación cardiaca a la presión y la post carga aumentada por la hipertensión arterial, sin embargo, la HVI constituye un factor de riesgo independiente, de morbimortalidad cardiovascular. En el presente estudio realizamos una evaluación ecocardiográfica-Doppler a cuarenta pacientes, veinte de los cuales fueron normotensos (Grupo I) y los restantes (Grupo II) tuvieron evidencia electrocardiográfica de HVI secundaria a hipertensión sistémica. Se analizaron en forma prospectiva y comparativa, variables estructurales (grosor septal, grosor de la pared posterior, dimensiones ventriculares, índice de masa del ventrículo izquierdo), variables de función sistólica (fracción de acortamiento, fracción de eyección) y función diastólica miocárdica (flujo de llenado del ventrículo izquierdo temprano (E) y tardío (A), relación E/A, período de relajación isovolumétrica). Los resultados demostraron el impacto significativo de la hipertensión arterial que progresa a estadio de cardiopatía hipertensiva, sobre las variables estudiadas, en relación con el grupo de pacientes normotensos