Conceptos actuales sobre la clasificación clínica y alteraciones electrofisiológicas en la disfunción del nódulo sinusal

La disfunción del nódulo sinusal (DNS) es generalmente secundaria a la senescencia del nodo sinusal y del miocardio auricular circundante. Los pacientes con este trastorno son a menudo añosos y en general presentan otras comorbilidades. Los pacientes a menudo buscan atención médica con síntomas de aturdimiento, pre-síncope, síncope y, en pacientes con periodos alternantes de bradicardia y taquicardia, palpitaciones u otros síntomas asociados con una frecuencia cardíaca rápida. Debido a que los síntomas pueden ser de naturaleza variable, inespecíficos y frecuentemente transitorios, a veces puede ser difícil establecer esta relación síntoma-alteración electrocardiográfica. Los hallazgos electrocardiográficos típicos son uno o más episodios de bradicardia sinusal extrema (Rubenstein Tipo I), o pausas sinusales, paro y bloqueo de salida sinoatrial (Rubenstein Tipo II), o episodios de bradicardia y/o pausas alternantes con taquiarritmias auriculares (Rubenstein Tipo III). Las investigaciones basadas en el registro de electrogramas locales auriculares anormalmente prolongados y fraccionados durante el ritmo sinusal y su distribución característica en la aurícula derecha de pacientes con DNS han aportado un conocimiento importante sobre las propiedades electrofisiológicas de la aurícula patológica. El electrograma auricular anormal traduce una conducción auricular irregular, caracterizada por una actividad eléctrica local no homogénea, relacionada con una conducción anisotrópica, no uniforme y retardada a través de un miocardio auricular patológico, en el que se pueden originar arritmias por reentrada. La detección de electrogramas auriculares anormales en la DNS identifica a un grupo de pacientes con vulnerabilidad auricular aumentada y con una incidencia significativamente mayor de episodios espontáneos o inducidos de fibrilación auricular

Manejo terapéutico y diagnóstico en equipo multidisciplinario y resultados obtenidos en gestantes con cardiopatía orgánica

Las enfermedades cardiovasculares afectan aproximadamente al 2% de las mujeres embarazadas, por lo que suponen un aumento del riesgo tanto para la madre como para el feto. El embarazo y el parto producen cambios fisiológicos sustanciales que requieren de una adecuada adaptación del sistema cardiovascular. Estos cambios fisiológicos que son muy bien tolerados en las gestantes sin cardiopatía, exponen a la mujer con enfermedad cardiovascular a eventos clínicos significativos. Este es un trabajo descriptivo, retrospectivo, de casos consecutivos de pacientes que acudieron a la División de Medicina Cardiovascular, del Hospital de Clínicas en un período comprendido entre Agosto de 2013 a Junio de 2014. Incluye a 5 pacientes embarazas y portadoras de cardiopatías conocidas o desconocidas. La edad promedio fue de 27 años, rango etario de 17 a 36 años. La edad gestacional al momento de la consulta fue de 34 semanas por fecha de última menstruación, menor edad gestacional 30 semanas y mayor edad gestacional 38 semanas. El síntoma principal de consulta fue la disnea (100%), edema de miembros inferiores en 3 pacientes (60%), y palpitaciones en 2 pacientes (40%). El manejo diagnóstico y terapéutico conjunto con un seguimiento detallado y adecuado por un equipo multidisciplinario de cardiólogos, clínicos, ginecólogos, anestesiólogos y cirujanos cardiovasculares facilitan una buena evolución clínica y un desenlace exitoso del embarazo y parto de la gestante con la cardiopatía orgánica. Como resultado de este manejo multidisciplinario todos los recién nacidos tuvieron buena evolución durante su permanencia en la unidad de cuidados intensivos sin inconvenientes

Successful double valve replacement in a pregnant woman with refractory heart failure due to early dysfunction of the biological prosthesis in the aortic valve position

Rheumatic fever continues to be a frequent cause of cardiac valve disease in developing countries. The combination of rheumatic heart disease and pregnancy represents a challenge in the management of these patients. Prevention strategies are often insufficient; this is why we continue to observe complicated cases that demand more complex treatments. We are reporting the case of a 20-year-old woman, with a history of aortic valve replacement and mitral valve repair due to rheumatic heart disease. Two years later after her valve replacement, she attended consultation with signs and symptoms of heart failure in functional class III during a pregnancy of 20 weeks. The echocardiography showed: dysfunctional biological aortic prosthesis with severe stenosis and moderate regurgitation (central and para-valve leak), as well as severe mitral valve insufficiency, eccentric, directed towards the atrial free wall. She was admitted, and received optimal medical treatment for 4 weeks with little response and subsequent worsening. A multidisciplinary committee was formed including cardiologists, cardiac surgeons, obstetricians, neonatologists, and specialists in bioethics. It was decided to proceed with valve replacement surgery during the 21st week of her gestation. Successful double valve replacement (mitral and aortic) was performed, without complications for the patient or the fetus. She was discharged in good health. In her 38th week of gestation, a successful cesarean delivery was performed without any complications.</p

Determination of internal transcribed spacer regions (ITS) in Trichomonas vaginalis isolates and differentiation among Trichomonas species

The nucleotide sequence of the 5.8S rRNA gene and the flanked internal transcribed spacer (ITS) regions of six Trichomonas vaginalis isolates with different metronidazole sensitivity and geographic origin were genotyped. A multiple sequence alignment was performed with different sequences of other isolates available at the GenBank/EMBL/DDBJ databases, which revealed 5 different sequence patterns. Although a stable mutation in position 66 of the ITS1 (C66T) was observed in 26% (9/34) of the T. vaginalis sequences analyzed, there was 99.7% ITS nucleotide sequence identity among isolates for this sequence. The nucleotide sequence variation among other species of the genus Trichomonas ranged from 3.4% to 9.1%. Surprisingly, the % identity between T. vaginalis and Pentatrichomonas hominis was ~. 83%. There was >. 40% divergence in the ITS sequence between T. vaginalis and Tritrichomonas spp., including Tritrichomonas augusta, Tritrichomonas muris, and Tritrichomonas nonconforma and with Tetratrichomonas prowazeki. Dendrograms grouped the trichomonadid sequences in robust clades according to their genera. The absence of nucleotide divergence in the hypervariable ITS regions between T. vaginalis isolates suggests the early divergence of the parasite. Importantly, these data show this ITS1-5.8S rRNA-ITS2 region suitable for inter-species differentiation. © 2014 Elsevier B.V.Peer Reviewe

The relation between QRS complex fragmentation and segmental abnormalities of the myocardial contractility in patients with coronary artery disease

Background: Fragmented QRS (fQRS) is defined as any QRS complex with duration of less than 120 ms (ms) and at least one notch in the R or S wave in two or more leads belonging to the same coronary territory. The fQRS represents a delay in ventricular conduction caused by a myocardial scar associated to arrhythmic events. Methods: This is a descriptive, retrospective, cross-sectional study of a total of 123 patientsadmitted with ischemic heart disease. The aim was to correlate the presence of fQRS in a conventional 12-leads electrocardiogram (ECG) with myocardial regional motility disorders. Results: A total of 62% of the patients were male, the mean age was 63 ± 12 SD. fQRS was observed in 44% (64% men and 36% women), the most frequent location being the inferior wall (61%), followed by the anteroseptal and lateral walls (14% for both). Of the 36 patients with fQRS, 30 had segmental disorders, while 6 did not. Of the 45 patients without fQRS, 28 had segmental disorders, but 17 did not, which gives us a sensitivity of 52% (moderate SnNout) and specificity of 74% (high SpPin), with a positive predictive value of 83%, a negative predictive value of 38% and a prevalence of 72%. Conclusion: The presence of fQRS in the ECG has high specificity and a high positive predictive value of the existence of segmental myocardial motility disorders in patients with documented coronary artery disease