Cardiac Amyloidosis with Dynamic Subaortic Obstruction

La amiloidosis es una enfermedad infiltrativa sistémica que  compromete el corazón y representa una causa importante de miocardiopatía restrictiva. En esta presentación se describe el caso de una paciente con insuficiencia cardíaca (IC) secundaria a miocardiopatía infiltrativa por depósito amiloide y obstrucción dinámica del tracto de salida del ventrículo izquierdo. El diagnóstico hematológico fue de mieloma múltiple por cadenas livianas y se demostró amiloidosis en dos tejidos extracardíacos.(resumen completo en pdf

Early reperfusion and late clinical outcomes in patients presenting with acute myocardial infarction randomly assigned to primary percutaneous coronary intervention or streptokinase

Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction (AMI). The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates, as evidenced by ST-segment resolution. Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes. Patients with ischemic chest pain with duration ≤12 hours and no contraindication for thrombolytic therapy were included. Between October 1993 and August 1995, 58 patients were randomly assigned to streptokinase (SK) and 54 patients to primary PCI. Baseline clinical characteristics and infarct location were well balanced in both groups. Median age (interquartile range) was 68 (58, 75) years, 29% were women, and 78% of the patients met at least one criterion for “not low risk” AMI (anterior location, age >70 years old, previous MI, systolic blood pressure 100 bpm). The median time from symptom onset to random assignment was 217 (139, 335) minutes in the PCI group and 210 (145, 334) minutes in the SK group. Median random assignment to balloon time was 82 (55, 100) minutes, and median random assignment to needle time was 15 (10, 26) minutes ( P < .0001). TIMI grade 3 flow after primary PCI was obtained in 85% of patients. The proportion of patients with ST-segment resolution ≥50% at 120 minutes was 80% in the PCI group and 50% in the SK group ( P = .001). The predischarge angiogram showed the presence of TIMI 3 flow in 96% of patients who received PCI and 65% of patients who received SK ( P < .001). A composite of in-hospital death, reinfarction, severe heart failure, stroke, and major bleeding occurred in 15% of patients who received PCI and 21% of patients who received SK ( P = .4). At 3 years, freedom from the composite end point of AMI, postdischarge revascularization, and death was 61% in the PCI group and 40% in the SK group ( P = .025). Our study shows that primary PCI, as compared with SK, is associated with more effective ST-segment resolution, higher patency rates in the infarct vessel at 7 days, and more favorable clinical outcomes at 3 years of follow-up

Life history of the gray snapper at the warm edge of its distribution range in the Caribbean

Knowledge of the life history of populations at the warm edge of their distributional range can provide a better understanding of how they will adapt to climate warming, including potential poleward redistribution. The range of Gray Snapper Lutjanus griseus has the potential to expand along its northern temperate fringe, but little is known about this species in the warmest portion of its range. We studied the age, growth, reproduction, and mortality of commercially caught Gray Snapper in the Guatemalan Caribbean, where sea surface temperature consistently exceeds 26°C. Longevity was estimated as 10 years, and von Bertalanffy growth parameters that were consolidated through Bayesian estimation incorporating earlier estimates from the Caribbean region were as follows: asymptotic length (L∞) was 35 cm, the growth coefficient (K) was 0.56 year−1, and the theoretical age at zero length (t0) was −0.7 year. Gray Snapper grew slowest in April, prior to the rainy season, and at the onset of the reproductive season, which lasted to September. Fifty percent of the Gray Snapper matured at 31 cm and at 3.5 years of age. Gray Snapper had a lower maximum size, longevity, and peak reproductive investment, a protracted spawning season and reproductive life span, and elevated natural mortality at the warm edge of their distribution relative to temperate climates. Despite the plasticity in life history of Gray Snapper observed in this study, their potential to further adapt to warming remains unknown