Biventricular non-compaction with predominant right ventricular involvement, reduced left ventricular systolic and diastolic function, and pulmonary hypertension in a Hispanic male.

PATIENT: Male, 22 FINAL DIAGNOSIS: Cardiomyopathy Symptoms: Shortness of breath • dispnoea • chest discomfort MEDICATION: - Clinical Procedure: Echocardiogram • cardiac MRI Specialty: Cardiology. OBJECTIVE: Challenging differential diagnosis. BACKGROUND: Non-compaction cardiomyopathy (NCM) is a rare congenital cardiomyopathy characterized by increased trabeculation in one or more segments of the ventricle. The left ventricle is most commonly affected. However, biventricular involvement or right ventricle predominance has also been described. Clinical features of NCM are non-specific and can range from being asymptomatic to symptoms of congestive heart failure, arrhythmia, and systemic thromboembolism. CASE REPORT: 22-year-old Hispanic male presented with two month history of chest discomfort. Laboratory workup revealed an elevated brain-natriuretic-peptide of 1768 pg/ml. ECG and chest x-ray was nonspecific. Transthoracic echocardiogram revealed prominent trabeculae and spongiform appearance of the left ventricle (LV) with an ejection-fraction of 15-20%; 5 of 9 segments of the LV were trabeculated with deep intertrabecular recesses also involving the right ventricle (RV) with demonstrated blood flow in these recesses on color-doppler. The biventricular spongiform appearance was morphologically suggestive for NCM with involvement of the RV. Confirmatory cardiac MRI was performed, demonstrating excessive trabeculation of the left-ventricular apex and mid-ventricular segments. Hypertrabecularion was exhibited at the apical and lateral wall of the RV. Cardiac catheterization showed an intact cardiac vessel system. The patient was discharged on heart failure treatment and was placed on the heart transplantation list. CONCLUSIONS: NCM is a unique disorder resulting in serious and severe complications. The majority of the reported cases describe the involvement of the left ventricle. However, the right ventricle should be taken into careful consideration. The early diagnosis may help to increase the event-free survival.

Antithrombotic options for atrial fibrillation in 2012.

Atrial fibrillation (AF) is a common arrhythmia in clinical practice. An important component of the management of patients with AF involves prevention of thromboembolism and stroke. Coumarins, such as warfarin had been the only available oral antithrombotic agent for prevention of thromboembolism for many decades. Following intestinal absorption, coumarins inhibit multiple steps of the clotting cascade that leads to inhibition of coagulation factors II, VII, IX and X. In addition to delayed and variable inhibition of coagulation, coumarin therapy has a narrow therapeutic window for optimal balance of risk and benefit, which requires regular assessment of the international normalized ratio (INR) to monitor coagulation. A quest for safer, more effective therapies that do not need monitoring has led to the development of dabigatran, rivaroxaban, and apixaban. In this article, we review these newer antithrombotic agents and discuss role of these drugs in clinical practice.

Desempeño ocupacional escolar de jóvenes con Síndrome de Asperger que asisten al sistema de educación regular / Performance occupational school youth with asperger syndrome attending the regular education system

El Síndrome de Asperger es un trastorno con una prevalencia aproximada de 2,6 - 4,8 por cada 1.000 habitantes, en nuestro país las cifras de este trastorno son desconocidas así como las investigaciones que describen la situación de estas personas. El acceso a la educación en igualdad de oportunidades es un derecho de todos los estudiantes , los jóvenes con este diagnóstico presentan problemas importantes en su desempeño escolar derivados de su condición o de las barreras y actitudes del contexto en donde destacan conductas de bullying y carencia de diseños educativos inclusivos que les permitan permanecer y egresar del sistema con éxito y en donde esta etapa se constituya en un aporte nutritivo para la vida de las personas que sea recordado con cariño y que promuevan la autoestima necesaria para la futura inclusión y participación social. En este escenario se desarrolla el presente estudio orientado a explorar el Desempeño Ocupacional Escolar de jóvenes con Síndrome de Asperger que asisten al Sistema Escolar Regular. El diseño corresponde a un estudio exploratorio con análisis de casos, se utilizaron técnicas de recolección de datos a través de una entrevista semiestructurada aplicada a dos jóvenes, sus madres, profesores e integrantes del equipo de salud. El método de análisis de los resultados se realizó utilizando el ATLASti. En ambos casos se registra escasa motivación para participar en ocupaciones propias del sistema escolar, desempeño escolar irregular con adaptaciones curriculares permanentes, excesiva dependencia familiar para la organización de la rutina, dependencia escasa y conflictiva relación con pares que provoca serias alteraciones de salud mental. El estudio además de recoger los obstaculizadores del proceso, describe facilitadotes personales y contextuales que serán un gran aporte al proceso de integración escolar de estos jóvenes en nuestro país.

Asperger syndrome is a disorder with a prevalence of approximately 2.6 to 4.8 per 1,000 inhabitants in our country the figures of this disorder are unknown and the investigations that describe the situation of these people. Access to education, equal opportunity is a right of all students, young people with this diagnosis have problems in school performance or arising out of its barriers and attitudes of the context in which behaviors include bullying and lack of inclusive designs that allow them access, remain in and graduate from an educational system successfully and where this stage constitute a nutritional contribution to the lives of people who will be remembered with affection and to promote self-esteem necessary for future inclusion and participation social. In this scenario, the present study is aimed at exploring the Occupational Performance School young Asperger Syndrome attending the regular school system. The design is an exploratory study with case studies; techniques were used for collecting data through a semistructured interview applied to two youths, their mothers, teachers and members of the health team. The method of analysis of the results was conducted using ATLASti. In both cases there is little motivation to engage in occupations of the school system, erratic performance in school with curricular adaptations permanent, over-reliance on the family organization of the routine, conflictual relationship with peers causing serious mental health disorders. The study also to collect hinder the process, describe personal and contextual facilitators to will be a great contribution to the process of school integration of these young people in our country.

Optimal medical therapy for coronary artery disease in 2011 - perspectives from the STICH Trial.

Medical, percutaneous interventional, and surgical treatments for the management of coronary heart disease have progressed markedly during the past decade. There is evidence to suggest that for patients with stable coronary heart disease optimal medical therapy is equal in effectiveness for lowering the risk of major cardiovascular events, such as cardiovascular death, myocardial infarction, and stroke, as are revascularization procedures, such as coronary artery bypass grafting or percutaneous coronary intervention. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial found no significant difference between medical therapy alone and medical therapy plus coronary artery bypass grafting with respect to the primary end point of death from any cause (all-cause mortality). However, secondary outcomes showed fewer deaths from cardiovascular causes in the surgical group versus the medical group. Medical therapy has improved over time, as have surgical techniques including myocardial preservation, and both approaches have their place, especially since chest pain relief and quality of life may benefit more in some cases by revascularization. Certainly, coronary artery bypass grafting has general acceptance for three-vessel coronary heart disease, and percutaneous coronary artery intervention is the standard of care for the involved artery in acute ST-segment elevation myocardial infarction when the intervention can be accomplished rapidly. Medical management includes lifestyle changes that benefit coronary heart disease, drug therapy to improve prognosis, and drug therapy to improve symptoms. The key to clinical management is the selection of the procedure and/or medical management strategy that is in the best interest of the individual cardiovascular patient. In addition, discussing with patients their options and considering what best fits their wishes is especially critical when there is no clear-cut best strategy. Continued collaboration between cardiologists concentrating on medical approaches with interventionists and cardiac surgeons (heart team approach) is essential for optimal management for each individual patient.