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

High blood pressure in childhood: Anthropometric risk factors related to its presence

Introducción: Debido a que las enfermedades cardiovasculares cada día son más frecuentes y que constituyen la primera causa de muerte en los países desarrollados, es importante definir cuales son los factores involucrados para el desarrollo de dichos padecimientos. Objetivo: Identificar los factores de riesgo de predicción de la enfermedad cardiovascular adquirida en niños, reflejada en la presencia de hipertensión arterial. Método: Se seleccionaron para el estudio niños de 8 a 11 años de dos escuelas primarias de Santa Clara, a los cuales se les confeccionó un formulario y se les realizó un examen físico detallado. Resultados: En la muestra estudiada es de importancia señalar un estimado puntual de la prevalencia de prehipertensión e hipertensión en las edades analizadas, predominando estas en el grupo racial no blanco. Se determinó que el peso, la talla y el índice de masa corporal de forma aislada no son buenos predictores para la TA, sin embargo, entre los marcadores antropométricos estudiados, la variable circunferencia de la cintura muestra un carácter continuamente creciente de sus medias, en este grupo de variables, este resulta ser el mejor predictor. Conclusiones: Es de destacar la alta incidencia de infantes prehipertensos e hipertensos en este estudio, los cuales presentaron una sintomatología muy sutil que inclusive pueden ser atribuidas a otras patologías, la circunferencia de la cintura fue el marcador antropométrico de más relevancia asociado a los niños hipertensos.Introduction: Due to the fact that cardiovascular diseases are increasingly frequent and constitute the first cause of death in developed countries, it is important to define the factors involved in its development. Objective: To identify the presence of hypertension in a pediatric population and the anthropometric risk factors that predicts acquired cardiovascular disease in hypertensive children, and to demonstrate the possible relationship between the presence of risk factors and the onset of hypertension in children. Methods: A descriptive cross-sectional study was carried out to analyze how the predictive risk factors of cardiovascular disease influence the pediatric population. Children from 8 to 11 years of age from two primary schools in Santa Clara were selected for the study. Results: It is important to indicate a specific estimate of the prevalence of prehypertension and hypertension in the ages analyzed, the non-white color of the skin was predominant, it was determined that weight, height and body mass index, alone, are not good predictors for blood pressure. However, among the anthropometric markers studied, the waist circumference variable shows a continuously increasing character of its means (among the variables it turns out to be the best predictor). Conclusions: The high incidence of prehypertensive and hypertensive infants was determined, some of them presented very subtle symptoms that can even be attributed to other diseases, and the circumference of the waist was the most important anthropometric marker associated with hypertensive children

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

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

The electrocardiogram in hypertensive patients. P wave dispersion: a new measure to be considered

The electrocardiogram is a complementary test with high specificity but low sensitivity. In the case of patients with arterial hypertension it is of great importance in the diagnosis, prognosis and monitoring during treatment. The prevalence of left ventricular hypertrophy observed through electrocardiogram in hypertensive patients has been reported in up to 9% of them. Different indexes have been described to approach the diagnosis of left ventricular hypertrophy, including the Sokolow and Cornell indexes. Atrial and ventricular arrhythmias are both considered as comorbidity in arterial hypertension. The mechanisms involved are varied and include left ventricular hypertrophy and myocardial ischemia. In patients suffering from hypertension, premature atrial complexes are frequently found and there is an increasing risk of atrial fibrillation, mainly in patients over 65 years old. The predisposition of patients with hypertension to episodes of paroxysmal atrial fibrillation can be determined through manual measurement of P wave’s maximum, minimum and dispersion. The highest values of P wave dispersion in the reading of a 12-lead surface electrocardiogram are more related to events of paroxysmal atrial fibrillation. Irrigation increases in patients with P wave maximum values up to 134 ms and P wave dispersion values up to 46 ms

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