Morbilidad y mortalidad por cardiopatías congénitas en lactantes. Villa Clara, años 2006-2010

The advances occurred in recent years in the field of Pediatric Cardiology have changed the natural course of congenital heart disease. Objective: To determine the morbidity and mortality due to congenital heart disease in infants from 2006 to 2010 in Villa Clara. Methods: A prospective descriptive study was conducted in the Department of Pediatric Cardiology of the José Luis Miranda Provincial Pediatric University Hospital in Santa Clara. It included 401 infants who were diagnosed with congenital heart disease during the aforementioned years. Data were collected through a survey given to parents at the time of diagnosis. The variables sex, birth weight, municipality of origin, type of heart disease, associated anomalies and deaths were considered. Results: An incidence rate of 10.8 per thousand live births was found. Female sex predominated. The most common congenital heart disease was the ventricular septum disease; the right weight at birth was the most frequent one. The municipality with the highest incidence was that of Santa Clara and the most frequent associated abnormality was the Down syndrome. Eighteen patients died and aortic coarctation was the fundamental cause of death. Conclusions: These abnormalities are still a health problem in our province with a significant mortality.Los avances ocurridos durante los últimos años en el campo de la Cardiología Infantil han cambiado el curso natural de las cardiopatías congénitas. Objetivo: determinar la morbilidad y mortalidad por cardiopatías congénitas en lactantes durante los años 2006-2010 en Villa Clara. Métodos: se realizó un estudio prospectivo descriptivo en el Servicio de Cardiología del Hospital Pediátrico Universitario “José Luis Miranda” de Santa Clara en el que se incluyeron 401 lactantes a los que se les diagnosticaron cardiopatías congénitas durante los  referidos años; los datos se obtuvieron a través de una encuesta aplicada a los padres en el momento del diagnóstico y se consideraron las variables sexo,  peso al nacer,  municipio de procedencia, tipo de cardiopatía, anomalías asociadas y fallecidos. Resultados: se encontró una tasa de incidencia de 10,8 por mil nacidos vivos, predominó el sexo femenino, la cardiopatía congénita más frecuente fue la comunicación interventricular, el peso adecuado al nacer fue el más frecuente, el municipio con mayor incidencia fue el de Santa Clara y la anomalía asociada más frecuente el síndrome de Down; fallecieron 18 pacientes y la coartación aórtica fue la causa fundamental de fallecimiento. Conclusiones: estas anomalías, con una mortalidad importante, son un problema de salud en esta provincia

Síntesis temática de predictores de riesgo cardiovascular en la infancia

En las últimas décadas se ha incrementado el interés por la identificación de la enfermedad cardiovascular y los factores que predisponen su desarrollo en niños y adolescentes. Al respecto se han citado predictores de riesgo importantes, como la presencia de antecedentes patológicos familiares y personales, predisposición genética, así como la alteración de marcadores antropométricos y bioquímicos. El conocimiento de estos factores es de vital importancia para evitar la aparición precoz de la enfermedad cardiovascular

Electrocardiographic Voltages: Normal Criteria for a Pediatric Population in Cuba

Background: the electrocardiogram is a simple cardiac evaluation method. Even more, it is the simplest complementary tool in cardiology and its interpretation is always of clinical interest. Objective: to describe the normal criteria for electrocardiographic voltages in a Cuban pediatric population. Methods: a descriptive study was conducted. The sample included 376 students in third, fourth and fifth grade from two elementary schools in the Municipality of Santa Clara, Villa Clara. All patients underwent 12-derivation surface, two-dimensional and M-mode echocardiographies. Left ventricular mass index was calculated according to the 95th percentile. Electrocardiogram voltages were measured and the 98th percentile was selected for each of these values, so that voltage criteria in a pediatric population would emerge. Results: size, size 2,7and age did not differ significantly according to sex; the 95th percentile of left ventricular mass index was 48.0 g / m 2, 7. Significant differences for average voltages were only found in SV1 and SV2. Conclusions: it is necessary to establish cutoff points for left ventricular mass index and voltage criteria for left ventricular hypertrophy in different populations, so that biases are eliminated in future samples selection

ESTUDIO DE LA CARDIOPATÍA ISQUÉMICA EN PACIENTES MENORES DE 45 AÑOS

Introduction and objectives: Coronary artery disease is the main cause of death in the developed world, also affecting young people. This investigation aims at determining the characteristics of such an illness in people under 45 years of age. Method: A retrospective study was carried out during a two year period in the provincial hospitals of Villa Clara province. Results: 84,0 percent of the patients were male, and 68,0 percent were between the ages of 40 and 45. The infarction of the inferior wall represented 56.0 percent, 31 patients (62,0 %) presented a positive ergometry, 44 patients (88,0 %) had a normal ejection fraction, 34 patients (68,0 %) suffered from alterations of the regional motility, 92,0 percent had normal ventricular diameters and 76,0 percent showed a normal pattern of relaxation of the left ventricle (p = 0,000). Only 7 patients (14,0 %) had normal arteries. In the 43 remaining patients, 46,5 % presented type C lesions, 60,5 percent had the right coronary as the one responsible for the infarction, 60,5 percent had only one vessel affected, and 88.4 percent had stenosis obstructing more than half the diameter of the artery. Conclusions: In the investigation there was a prevalence of male individuals, the group between 40 and 45 years of age, an inferior localization, alterations of the ergonometric test, a normal LVEF, alterations of the regional contractibility, normal ventricular diameter and relaxation pattern, and a positive coronariography with a predominantdamage of one vessel, left coronary and type C lesions.Introducción y objetivos: La cardiopatía isquémica es la principal causa de muerte en el mundo desarrollado y afecta también a personas jóvenes. Esta investigación pretende conocer las características de dicha enfermedad en pacientes menores de 45 años. Método: Se realizó un estudio retrospectivo en un período de dos años, en los hospitales provinciales de Villa Clara. Resultados: El 84,0 % de los pacientes eran hombres, y el 68,0 % tenía edades entre 40 y 45 años. El infarto de cara inferior representó el 56,0 %, 31 pacientes (62,0 %) presentaron ergometría positiva, 44 (88,0 %) tenían fracción de eyección normal, 34 (68,0 %) padecían alteraciones de la motilidad regional, 92,0 % poseían diámetros ventriculares normales y el 76,0 % mostraba un patrón de relajación del ventrículo izquierdo normal (p = 0,000). Solo 7 pacientes (14,0 %) presentaban las arterias normales y de los 43 restantes, el 46,5 % sufrían lesiones tipo C, en el 60,5 % la coronaria derecha fue la arteria responsable del infarto, 60,5 % tuvo un solo vaso afectado, y 88,4 % poseían estenosis que obstruían más de la mitad del diámetro de la arteria. Conclusiones: En la investigación predominaron los hombres, el grupo de edad entre 40 y 45 años, la localización inferior, las alteraciones de la prueba ergométrica, la FEVI normal, la contractilidad regional alterada, el diámetro ventricular y el patrón de relajación normales, y la coronariografía positiva con afectación predominante de 1 vaso, coronaria derecha y lesión tipo C

ESTUDIO DE LA CARDIOPATÍA ISQUÉMICA EN PACIENTES MENORES DE 45 AÑOS / Study of coronary artery disease in patients under 45 years of age

Introduction and objectives: Coronary artery disease is the main cause of death in the developed world, also affecting young people. This investigation aims at determining the characteristics of suchan illness in people under 45 years of age. Method: A retrospective study was carried out during a two year period in the provincial hospitals of Villa Clara province. Results: 84,0 percent of the patients were male, and 68,0 percent were between the ages of 40 and 45. The infarction of the inferior wall represented 56.0 percent, 31 patients (62,0 %) presented a positive ergometry, 44 patients (88,0 %)had a normal ejection fraction, 34 patients (68,0 %) suffered from alterations of the regional motility, 92,0 percent had normal ventricular diameters and 76,0 percent showed a normal pattern of relaxation of the left ventricle (p = 0,000). Only 7 patients (14,0 %) had normal arteries. In the 43 remaining patients, 46,5 % presented type C lesions, 60,5 percent had the right coronary as the one responsible for the infarction, 60,5 percent had only one vessel affected, and 88.4 percent had stenosis obstructing more than half the diameter of the artery. Conclusions: In the investigation there was a prevalence of male individuals, the group between 40 and 45 years of age, an inferior localization, alterations of the ergonometric test, a normal LVEF, alterations of the regional contractibility, normal ventricular diameter and relaxation pattern, and a positive coronariography with a predominant damage of one vessel, left coronary and type C lesions

Dispersao da onda P, critérios de normalidade para uma populaçao pediátrica cubana

INTRODUÇAO: Vários estudos demonstraram que a hipertensao arterial se relaciona com maior dispersao da onda P e desenvolvimento de fibrilaçao atrial. Determinar os valores normais para a dispersao da onda P e para sua maior duraçao em uma populaçao pediátrica cubana é o nosso principal objetivo. MATERIAL E MÉTODOS: Foram estudados 137 meninos e 130 meninas. Foram incluídas no estudo crianças com exame físico negativo e que nao possuíam sintomatologia cardiovascular; excluindo aquelas cujos pais nao quiseram que participassem do estudo e aquelas com patologias congênitas conhecidas, além das que foram diagnosticadas como pré-hipertensas e hipertensas. Foram medidos os valores de P máxima e P mínima em cada uma das 12 derivaçoes e foi calculada a dispersao da onda P. RESULTADOS: Os valores de média para a Pmax sao similares para ambos os sexos (82,9 ± 8,4 y 84,0 ± 8,9; masculino e feminino, respectivamente p=0.275) e para Pd (33,1 ± 9,1 y 31,9 ± 9,7 masculino e feminino, respectivamente p=0.320). DISCUSSAO: A média mais duas vezes o desvio padrao, a utilizaçao dos percentuais e o estimador de Tukey sao métodos razoáveis para encontrar um intervalo de confiança de uma variável numérica. CONCLUSOES: O uso do método do estimador de Tukey é uma alternativa estatística razoável para estimar uma faixa de normalidade na nossa amostra

Dispersao da onda P, critérios de normalidade para uma populaçao pediátrica cubana

INTRODUÇAO: Vários estudos demonstraram que a hipertensao arterial se relaciona com maior dispersao da onda P e desenvolvimento de fibrilaçao atrial. Determinar os valores normais para a dispersao da onda P e para sua maior duraçao em uma populaçao pediátrica cubana é o nosso principal objetivo. MATERIAL E MÉTODOS: Foram estudados 137 meninos e 130 meninas. Foram incluídas no estudo crianças com exame físico negativo e que nao possuíam sintomatologia cardiovascular; excluindo aquelas cujos pais nao quiseram que participassem do estudo e aquelas com patologias congênitas conhecidas, além das que foram diagnosticadas como pré-hipertensas e hipertensas. Foram medidos os valores de P máxima e P mínima em cada uma das 12 derivaçoes e foi calculada a dispersao da onda P. RESULTADOS: Os valores de média para a Pmax sao similares para ambos os sexos (82,9 ± 8,4 y 84,0 ± 8,9; masculino e feminino, respectivamente p=0.275) e para Pd (33,1 ± 9,1 y 31,9 ± 9,7 masculino e feminino, respectivamente p=0.320). DISCUSSAO: A média mais duas vezes o desvio padrao, a utilizaçao dos percentuais e o estimador de Tukey sao métodos razoáveis para encontrar um intervalo de confiança de uma variável numérica. CONCLUSOES: O uso do método do estimador de Tukey é uma alternativa estatística razoável para estimar uma faixa de normalidade na nossa amostra

Aumento da dispersao da onda P dependente da tensao arterial média em préhipertensos e hipertensos

Introduçao: A dispersao de onda P do eletrocardiograma constitui uma ferramenta para predizer fibrilaçao atrial. Os maiores valores de dispersao de onda P têm sido relacionados em adultos com paroxismo de Fibrilaçao Atrial. Material e métodos: Em três escolas primárias, do total de 450 alunos entre 8 e 11 anos de idade, foram estudadas 400 crianças, excluindo aquelas cujos pais nao desejaram que participassem do estudo e aquelas com patologias congênitas conhecidas. Foi realizado eletrocardiograma nelas e também foi tirada sua pressao arterial quatro vezes. Foram medidos os valores de P máxima, P mínima em cada uma das 12 derivaçoes e foi calculada a dispersao da onda P. Resultados: A média de dispersao da onda P é maior em hipertensos que em normotensos (38.5 a 32.5; respectivamente, p=0.04). Existe correlaçao significativa entre dispersao da onda P e a tensao arterial média para pré-hipertensos e hipertensos: r=0.334, p=0.000 e r=0.37, p=0.000; respectivamente. Discussao: O aumento nos valores de dispersao de onda P está relacionado com aumentos na vulnerabilidade atrial para o desenvolvimento de arritmias. Conclusoes: Existem diferenças significativas entre os valores de dispersao de onda P do eletrocardiograma em populaçoes normotensas, pré-hipertensas e hipertensas desde a infância

Dispersión de la onda P en niños hipertensos, su relación con el peso corporal

Introduction and objective: Atrial fibrillation is the paradigm of atrial electrical heterogeneity. The prolongation of intra and interatrial conduction and inhomogeneous propagation of electrical impulses are electrophysiological characteristics in paroxysmal atrial fibrillation. Obesity is a potential risk factor for atrial fibrillation. There are some reports about higher values of P wave dispersion in obese women. The aim was to determine the relationship between P wave dispersion and body weight in normotensive and hypertensive children between 8 and 11 years old. Methods: 358 children from a total of 543 were studied. Those whose parents did not want them to participate in the study and those who had known congenital diseases were excluded. A 12-lead surface ECG and 4 blood pressure measurements were conducted. Maximum and minimum P values were measured and P wave dispersion in the electrocardiogram was calculated. Other variables such as body weight were also obtained. Results: The difference between mean values for P-wave dispersion between normotensive and hypertensive patients was 31.85 ms vs 39.74 ms, respectively, p<0.001. There was an increased dispersion of P wave with weight gain, r=0.18 p=0.05. Conclusions: In hypertensive patients, P-wave dispersion and weight showed a significant correlation since childhood. There are significant differences between P wave dispersion values of the electrocardiogram between normotensive and hypertensive populations since childhood.Introducción y objetivo: La fibrilación auricular es el paradigma de heterogeneidad eléctrica auricular. La prolongación de la conducción intra e interauricular y la propagación no homogénea del impulso eléctrico, son características electrofisiológicas en la fibrilación auricular paroxística. La obesidad constituye un factor de riesgo potencial de fibrilación auricular. Se han informado valores más elevados de dispersión de la onda P en mujeres obesas. El objetivo de la investigación fue determinar la relación entre los valores de dispersión de la onda P y el peso corporal en niños normotensos e hipertensos, entre 8 y 11 años. Método: Se estudiaron 358 niños, de 543. Se excluyeron aquellos cuyos padres no desearon que participaran en el estudio y los que tenían enfermedades congénitas conocidas. Se realizó electrocardiograma de superficie de doce derivaciones y se practicaron cuatro tomas de presión arterial. Se midieron los valores máximos y mínimos de la onda P, se calculó su dispersión, y se obtuvieron otras variables como el peso corporal. Resultados: Las diferencias entre los valores medios para la dispersión de la onda P entre normotensos e hipertensos, fue de 31,85 vs. 39,74 ms, respectivamente (p<0.001). Existió un aumento de la dispersión de la onda P con el aumento del peso (r=0,18 y p=0.05). Conclusiones: La dispersión de la onda P y el peso corporal muestran una correlación significativa desde la infancia en la hipertensión arterial. Existen diferencias significativas entre los valores de la dispersión de la onda P del electrocardiograma entre normotensos e hipertensos desde la infancia

DISPERSIÓN DE LA ONDA P EN NIÑOS HIPERTENSOS, SU RELACIÓN CON EL PESO CORPORAL / P−wave dispersion in hypertensive children; its relationship with body weight

ResumenIntroducción y objetivo: La fibrilación auricular es el paradigma de heterogeneidad eléctrica auricular. La prolongación de la conducción intra e interauricular y la propagación no homogénea del impulso eléctrico, son características electrofisiológicas en la fibrilación auricular paroxística. La obesidad constituye un factor de riesgo potencial de fibrilación auricular. Se han informado valores más elevados de dispersión de la onda P en mujeres obesas. El objetivo de la investigación fue determinar la relación entre los valores de dispersión de la onda P y el peso corporal en niños normotensos e hipertensos, entre 8 y 11 años. Método: Se estudiaron 358 niños, de 543. Se excluyeron aquellos cuyos padres no desearon que participaran en el estudio y los que tenían enfermedades congénitas conocidas. Se realizó electrocardiograma de superficie de doce derivaciones y se practicaron cuatro tomas de presión arterial. Se midieron los valores máximos y mínimos de la onda P, se calculó su dispersión, y se obtuvieron otras variables como el peso corporal. Resultados: Las diferencias entre los valores medios para la dispersión de la onda P entre normotensos e hipertensos, fue de 31,85 vs. 39,74 ms, respectivamente (p<0.001). Existió un aumento de la dispersión de la onda P con el aumento del peso (r=0,18 y p=0.05). Conclusiones: La dispersión de la onda P y el peso corporal muestran una correlación significativa desde la infancia en la hipertensión arterial. Existen diferencias significativas entre los valores de la dispersión de la onda P del electrocardiograma entre normotensos e hipertensos desde la infancia. / AbstractIntroduction and Objective: Atrial fibrillation is the paradigm of atrial electrical heterogeneity. The prolongation of intra and interatrial conduction and inhomogeneous propagation of electrical impulses are electrophysiological characteristics in paroxysmal atrial fibrillation. Obesity is a potential risk factor for atrial fibrillation. There are some reports about higher values of P wave dispersion in obese women. The aim was to determine the relationship between P wave dispersion and body weight in normotensive and hypertensive children between 8 and 11 years old. Method: 358 children from a total of 543 were studied. Those whose parents did not want them to participate in the study and those who had known congenital diseases were excluded. A 12-lead surface ECG and 4 blood pressure measurements were conducted. Maximum and minimum P values were measured and P wave dispersion in the electrocardiogram was calculated. Other variables such as body weight were also obtained. Results: The difference between mean values for P-wave dispersion between normotensive and hypertensive patients was 31.85 ms vs 39.74 ms, respectively, p <0.001. There was an increased dispersion of P wave with weight gain, r = 0.18 p = 0.05. Conclusions: In hypertensive patients, P-wave dispersion and weight show a significant correlation since childhood. There are significant differences between P wave dispersion values of the electrocardiogram between normotensive and hypertensive populations since childhood