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

Thermal evolution of Monte Blanco dome: Low-angle normal faulting during Gulf of California rifting and late Eocene denudation of the eastern Peninsular Ranges

Footwall rocks of the Cañada David detachment fault, northeastern Baja California, record late Eocene-earliest Oligocene and late Neogene cooling events previously unrecognized in the region. Biotite ^(40)Ar/^(39)Ar ages of ∼65 Ma reflect slow cooling through ∼350°C, 5 to 10 m.y. later than is typical in the region. Multiple diffusion domain modeling of K feldspar ^(40)Ar/^(39)Ar release spectra shows very slow cooling (∼1°C/m.y.) from ∼65 to ∼45 Ma. Accelerated cooling from ∼315°C to ∼215°C between ∼45 and ∼33 Ma records at least 3–4 km of denudation that we relate to east-side-up reactivation of late Cretaceous structures that generally follow the oceanic-continental suture. Previously established rivers flowing west from mainland Mexico apparently became further entrenched during this uplift and continued to supply distinctive rhyolitic detritus to the coast. Ultimately, surface uplift disrupted and rerouted the extraregional rivers some 2 to 6 m.y. before the cooling event ended. Footwall rocks remained nearly isothermal from ∼30 to ∼15–10 Ma, when renewed rapid cooling (33° ± 17°C/m.y.) began in response to footwall exhumation by top-to-the-west low-angle normal faulting that accommodated rift-related extension in what finally became the Gulf of California. Apatite fission track and (U-Th)/He ages of ∼5 Ma and ∼4 Ma, respectively, record final detachment-related cooling through ∼110°C to ∼70°C. Thermal-kinematic modeling suggests that 5–7 km of late Neogene tectonic denudation and 10–12 km of horizontal extension were necessary in order to unroof the samples by 2 Ma. Additional extension, of unknown magnitude, has probably occurred subsequently. Geodetically measured horizontal extension rates are considerably higher than the long-term extension rate that can be attributed to detachment faulting

Asociación de la dilatación auricular izquierda con los trastornos del sistema de conducción en pacientes con hipertensión arterial sistémica

La dilatación de la aurícula izquierda (AI) se considera un predictor ecocardiográfico para la remodelación auricular y la fibrilación auricular. Por ende, hemos investigado la correlación existente entre la dilatación de la AI con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). En este estudio observacional y prospectivo hemos investigado las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos y no hipertensos ambulatoria y hospitalizados que acuden a un hospital terciario entre marzo a septiembre del 2018. Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El diámetro promedio de la AI fue significativamente mayor (p=0,03) en pacientes hipertensos que los no hipertensos (37±8 mm vs. 34±5 mm). Se encontró una asociación significativa entre hipertensión y la aurícula izquierda dilatada (>40 mm) (p= 0,026 OR: 3,25 IC95%: 1,01–11,02). La dilatación de la AI tuvo una especificidad de 73% y un valor predictivo negativo de 98% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Se encontró asociación entre la hipertensión arterial y la dilatación de la aurícula izquierda. La dilatación de la aurícula izquierda tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dispersión de la onda P, y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

(U-Th)/He zircon and archaeological ages for a late prehistoric eruption in the Salton Trough (California, USA)

U-Th and (U-Th)/He zircon geochronology redefines the timing of volcanic activity in the Salton Trough (Southern California, USA), the subaerial extension of the incipiently oceanic Gulf of California. U-series disequilibrium corrected (U-Th)/He zircon analyses for a granophyre ejecta clast from the Red Island rhyolite dome indicate an eruption age of 2480 ± 470 a (calendric dates between 0 and 940 Before Common Era, BCE; error at 95% confidence). This eruption age is supported by U-Th zircon crystallization ages for two obsidian-bearing lavas: Red Island (the host for the granophyre) and Obsidian Butte, a prehistoric quarry for obsidian that is widely distributed in southern California and northern Mexico archaeological sites. Lavas and granophyre display overlapping zircon crystallization age distributions that support field and compositional evidence that they are cogenetic and contemporaneous. The (U-Th)/He eruption age is younger and significantly more precise than previous ages for these volcanoes, and is the first indication that the eruption of obsidian flows coincided with human presence in the region. A late prehistoric eruption age agrees with the absence of the Obsidian Butte lithic source among early prehistoric cultural artifacts, previously attributed to submergence of the quarry location during hypothesized persistent flooding by ancient Lake Cahuilla

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

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

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology