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2.
Blood Coagul Fibrinolysis ; 34(3): 179-183, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36966807

RESUMO

Plaque rupture triggers a prothrombotic response that is counterbalanced by a fibrinolytic response. d -dimer serves as a marker of both processes. Inflammatory mediators are also released, evidenced with the rise of high-sensitive C reactive protein (hsCRP). Current evidence with these biomarkers has shown conflicting results. Determine an association between d -dimer and hsCRP within hospital and 1-year mortality in patients with acute coronary syndromes. In total, 127 patients were included. In-hospital mortality was 5.7%, and 1-year all-cause and cardiovascular mortality were 14.6 and 9.7%, respectively. The median of admission d -dimer for patients who died during hospital stay was higher than those who survived [4.59 (interquartile ranges (IQR) 1.94-6.05 µg/ml fibrinogen equivalent units (FEU)) vs. 0.56 (IQR 0.31-1.12 µg/ml FEU), P  = 0.001]. At 1-year follow-up, the median of admission d -dimer for patients who died was significantly higher than those who survived: 1.55 (IQR 0.91-5.08 µg/ml FEU) vs. 0.53 (IQR 0.29-0.90 µg/ml FEU), P  < 0.001. Positive d -dimer vs. negative d -dimer at admission analysis evidenced that almost 25% of the positive patients were dead at 1-year follow-up (22.4 vs. 2.4% negative d -dimer, P  = 0.011). Multivariate logistic regression analysis showed that d -dimer has an independent association with 1-year mortality [odds ratio 1.06 (95% confidence interval 1.02-1.10), P  = 0.006]. Positive significative correlations between d -dimer and hsCRP levels ( R  = 0.56, P  < 0.001) were found. High levels of admission d -dimer were strongly associated with in-hospital and 1-year mortality. Significant correlations with hsCRP could explain the inflammatory nature that led to poorer outcomes. d -dimer could be useful in risk stratification in acute coronary syndromes; however, a specific threshold should be defined for this type of patient.


Assuntos
Síndrome Coronariana Aguda , Proteína C-Reativa , Humanos , Proteína C-Reativa/análise , Síndrome Coronariana Aguda/diagnóstico , Biomarcadores , Inflamação , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemostasia
3.
JACC Case Rep ; 28: 102094, 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38204535

RESUMO

We describe a clinical case series of 3 patients whose electrocardiogram evolved from type A Wellens syndrome to a type B. We emphasize that the diagnosis and treatment for both patterns is the same and that these findings suggest the evolution of the same disease.

4.
J Diabetes Complications ; 36(12): 108339, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36345108

RESUMO

Background: Hyperglycemia is associated with an increased risk for death in acute coronary syndromes. This could be related to underlying glucose metabolism abnormalities or be caused by a counter-regulatory stress response. However, there is a paucity of data on the relationship between stress hormones, hyperglycemia, and clinical outcomes in myocardial infarction. Methods: Single-center, prospective, observational study. Patients admitted to the coronary care unit with a diagnosis of myocardial infarction were included. On admission, blood samples were obtained to measure serum glucose, cortisol, and catecholamines. A second sample was obtained at 8 AM after 48 h from admission. Results: There was a mild and positive correlation between serum cortisol and glucose (Spearman's rho = 0.24, p = 0.005), and no significant correlation was found between glucose and catecholamines. A similar correlation between cortisol and glucose among diabetics and non-diabetics was observed. Significantly higher serum cortisol and glucose levels were present in patients who developed heart failure or died during hospitalization. The association between glycemia and mortality lost significance in multivariate analysis, with a significant interaction term with cortisol (p = 0.003). Conclusion: Cortisol is a key responsible for stress hyperglycemia, and its deleterious effects on the cardiovascular system could be the cause for worst outcomes associated with hyperglycemia in ACS. Further research is warranted to ascertain this relationship and to investigate potential therapeutic targets.


Assuntos
Hiperglicemia , Infarto do Miocárdio , Humanos , Hiperglicemia/complicações , Hiperglicemia/prevenção & controle , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Glicemia
5.
Rev. argent. cardiol ; 90(2): 141-145, abr. 2022. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1407130

RESUMO

RESUMEN Introducción: Algunos autores han señalado que el armado de un examen con preguntas aleatorias puede perjudicar el rendimiento de los estudiantes. A partir de la pandemia por COVID -19 y del aislamiento social obligatorio, las actividades de educación médica de posgrado pasaron a la modalidad virtual y los exámenes se implementaron online. Objetivo: Estudiar si el ordenamiento al azar de las preguntas tiene algún efecto en los resultados de los exámenes. Material y métodos: Se redactaron 2 exámenes: uno sobre Prevención de la enfermedad cardiovascular y otro sobre Valvulopatías. Para cada uno de los temas se confeccionaron dos cuestionarios: una versión con las preguntas en el orden lógico y según dificultad estimada, y otra con las mismas preguntas distribuidas al azar. Cada examen tenía 50 preguntas de selección múltiple con 3 opciones. Puntaje máximo posible: 50 Los exámenes fueron administrados en plataforma Moodle, modalidad sincrónica, tiempo disponible 75 minutos. Los resultados se expresaron en puntajes obtenidos (rango y valores de tendencia central) y según el índice de dificultad de las preguntas. Resultados: Respondieron 284 residentes, alumnos del Curso Bianual de Cardiología. Dos grupos de 1° año (tema Prevención) y dos grupos de 2° año (Valvulopatías). No hubo diferencia entre los resultados de las dos versiones del mismo examen. Conclusiones: Este estudio careció de la potencia suficiente para fundamentar una u otra forma de ordenar las preguntas de los exámenes de ciencias clínicas. Surgieron nuevas preguntas que deberán ser respondidas en futuros estudios.


ABSTRACT Background: Some authors have pointed out that setting up an exam with random questions can impair student performance. Since the COVID-19 pandemic and compulsory social isolation, postgraduate medical education activities became virtual and exams were implemented online. Objective: The aim of the study was to analyse whether the random order of questions has any effect on test results. Method: Two exams were written: one on the Prevention of Cardiovascular Disease and another on Heart Valve Diseases. For each topic, two questionnaires were designed: a version with the questions in logical order and according to the estimated difficulty and another with the same questions randomly distributed. Each exam had 50 multiple-choice questions with 3 options, and the maximum possible score was 50 The exams were taken on the Moodle platform, with synchronous modality, and the time available was 75 minutes. The results were expressed as scores obtained (range and central tendency) and according to the index of difficulty of the questions. Results: The number of respondents was 284 residents, students of the Biannual Cardiology Course: two 1st year groups (Prevention topic) and two 2nd year groups (Valve diseases). There was no difference between the results of the two versions of the same exam. Conclusions: This study lacks sufficient power to support either way of question order in clinical sciences exams, giving rise to new queries.

6.
Rev. argent. cardiol ; 88(1): 48-54, feb. 2020. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1250933

RESUMO

RESUMEN Introducción: El maltrato se define como el comportamiento que hace que otra persona se sienta herida, desvalorizada o incompetente. Un cierto nivel de intimidación y humillación durante la formación se consideraba necesario para preparar al médico para una profesión difícil. Las condiciones en las que hoy se desarrollan las residencias médicas y la práctica profesional generan una alta prevalencia de burnout (agotamiento). Objetivo: Indagar la percepción que tienen los residentes de Cardiología sobre maltrato recibido y si reconocen haber incurrido en alguna conducta agraviante. Material y Métodos: Encuesta aplicada a residentes que asisten al Curso Bianual de Cardiología de la Sociedad Argentina de Cardiología Resultados: Respondieron 183 residentes. El 100% dijo haber recibido algún tipo de maltrato. Ser humillado por un error cometido y los gritos, son las formas de maltrato mencionadas con mayor frecuencia; un residente superior, un paciente y/o sus familiares fueron señalados como los responsables de las agresiones recibidas. Casi la mitad de residentes (46%) dijeron haber sido maltratados por el personal de enfermería. El 33,5% reconoció haber incurrido en situaciones de maltrato y que éste estuvo dirigido a otro residente, a un médico de planta y/o un médico de otra especialidad. Discusión: Los resultados son similares a otros estudios ya publicados. Por la seguridad de los pacientes y por la salud de los médicos se recomienda incluir en la formación profesional las estrategias para el afrontamiento del estrés y se considera indispensable promover un cambio cultural dentro de las instituciones académicas y asistenciales orientado a crear espacios de trabajo más democráticos y más saludables.


ABSTRACT Background: Mistreatment is defined as the behavior that makes another person feel hurt, undervalued or incompetent. A certain level of intimidation and humiliation during training was considered necessary to prepare the doctor for a difficult profession. The conditions in which medical residences and professional practice are developed today generate a high prevalence of burnout. Objective: The aim of this study was to investigate the perception that Cardiology residents have on the mistreatment received and if they acknowledge having incurred in any aggravating behavior. Methods: A survey was conducted in residents attending the Biannual Cardiology Course of the Argentine Society of Cardiology. Results: A total of 183 residents responded the survey and all of them (100%) reported some type of mistreatment. Being humiliated for making a mistake and shouted at were the most frequently mentioned forms of mistreatment from a senior resident, a patient or their relatives. Almost half of the residents (46%) said they had been mistreated by the nursing staff. while 33.5% acknowledged having incurred in aggravating situations directed against another resident, a staff doctor and/ or another specialty physician. Discussion: The results are similar to other studies already published. For the safety of patients and the health of physicians, it is recommended to include strategies for coping with stress and it is considered essential to promote cultural changes within academic and care institutions aimed at creating more democratic and healthier working environments.

7.
Medicina (B Aires) ; 79(3): 201-204, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284255

RESUMO

Myocardial infarction is the leading cause of death in the world, being the coronary atherosclerotic obstruction the main finding. Although 6% of all the patients had no significant coronary arteries disease on coronary angiography, defined by lumen vascular obstruction greater than 50%. This type of cases was defined by the term MINOCA (myocardial infarction with non-obstructive coronary arteries). They are usually young women, with cardiovascular risk factors, high cardiac biomarkers with non-ST elevation in the electrocardiogram. The main etiologies are myocarditis, Takotsubo syndrome and subendocardial myocardial infarction. We present the case of a 65 years-old woman with history of hypertension and complete left bundle branch block, who was admitted to the emergency department with typical chest pain, complete left bundle branch block in the electrocardiogram, with negative Sgarbossa criteria and positive cardiac biomarkers. The echocardiography evidenced inferolateral regional wall motion abnormalities, and the coronary angiography a single non-significative lesion (40%) in the proximal segment of the circumflex artery. Cardiac magnetic resonance evidenced subendocardial late adolinium enhancement in inferolateral medial with latero-apical extension segments consistent with circumflex artery-related infarction. This case illustrates an example of MINOCA secondary to myocardial infarction with posterior spontaneous thrombolysis, in which the clinical presentation was typical, however the coronary angiography showed non obstructive lesions. Therefore, another complementary imaging methods were needed such as the cardiac magnetic resonance.


El infarto agudo de miocardio es la principal causa de muerte en el mundo, siendo la obstrucción coronaria aterosclerótica el hallazgo más frecuente. Sin embargo, el 6% de los pacientes no presenta lesiones angiográficamente significativas, definidas por obstrucción de la luz vascular mayor al 50%. Estos casos se han definido bajo el término MINOCA (myocardial infarction with non-obstructive coronary arteries). Suelen ocurrir en mujeres jóvenes, con factores de riesgo cardiovascular, elevación de biomarcadores cardíacos e infradesnivel del segmento ST en el electrocardiograma. Las principales etiologías son la miocarditis, el síndrome de Takotsubo y el infarto subendocárdico. Presentamos el caso de una mujer de 65 años con antecedentes de hipertensión arterial y bloqueo completo de rama izquierda previo, que ingresó con ángor, imagen de bloqueo completo de rama izquierda en el electrocardiograma con criterios de Sgarbossa negativos y biomarcadores cardíacos positivos. En el ecocardiograma evidenció trastorno en la motilidad de la pared inferolateral y en la coronariografía solo una lesión no significativa (40%) en segmento proximal de la arteria circunfleja. La cardiorresonancia, en la secuencia de realce tardío de gadolinio, mostró retención de contraste subendocárdico a nivel de los segmentos inferolateral medial con extensión lateroapical compatible con infarto correspondiente a territorio de arteria circunfleja. Este caso ilustra un ejemplo de MINOCA secundario a infarto subendocárdico con trombólisis espontánea, en el que la presentación clínica fue típica, sin embargo en la coronariografía no se observaron lesiones significativas, por lo que fue necesario complementar con otro método de imágenes: la cardiorresonancia.


Assuntos
Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Idoso , Angiografia Coronária , Vasos Coronários/fisiologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/fisiopatologia , Fatores de Risco
8.
Rev. argent. cardiol ; 87(4): 296-300, jul. 2019. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1125762

RESUMO

RESUMEN Introducción: El Ministerio de Salud y Desarrollo Social de la Nación implementa un Sistema Nacional de Acreditación de Residencias del Equipo de Salud. La Sociedad Argentina de Cardiología (SAC) participa como entidad evaluadora de los programas de residencias médicas en cardiología. Objetivo: El propósito del presente trabajo es presentar los resultados del proceso de evaluación y acreditación de residencias de Cardiología. Material y métodos: Revisión documental de los informes elevados por los pares evaluadores designados por la SAC y de los dictámenes del Ministerio publicados en el Boletín Oficial entre 2010 y 2017. Resultados: Se revisaron 37 informes elaborados por los pares evaluadores, se identificaron fortalezas y debilidades. Fortaleza destacada: supervisión continua recibida por los residentes. Debilidad: escaso tiempo dedicado a la atención de pacientes ambulatorios. Se revisaron 28 dictámenes del Ministerio, se analizaron las recomendaciones más frecuentes: incorporación de contenidos transversales, regulación de la cantidad de guardias, de su duración y de la organización del descanso posguardia. Conclusiones: Si bien a primera vista parece que ambas instituciones tienen distintos criterios a la hora de acreditar un programa de formación en servicio, en realidad, se trata de miradas complementarias que coinciden en los siguientes aspectos: importancia de la supervisión, necesidad de sistematizar la evaluación del desempeño de los residentes y necesidad de incrementar la producción de trabajos científicos y la participación de los residentes en aquellos. También se encontró un alto grado de coincidencia entre la sugerencia de la SAC y el dictamen del Ministerio en relación con la categoría y los años de acreditación que merecía cada programa evaluado.


ABSTRACT Background: The National Ministry of Health and Social Development implements a National System of Accreditation of Health Team Residencies. The Argentine Society of Cardiology (SAC) participates as an evaluation entity of the medical residency programs in cardiology. Objective: The purpose of this study is to present the results of the evaluation process and accreditation of cardiology residencies. Methods: This was a documentary review of the reports submitted by the peer reviewers appointed by SAC and the opinions of the Ministry of Health in the Official Gazette between 2010 and 2017. Results: Thirty-seven reports prepared by peer reviewers were analyzed and strengths and weaknesses were identified. Outstanding strength: continuous supervision received by residents. Weakness: time spent on outpatient care. Twenty-eight Ministry of Health opinions were reviewed and the most frequent recommendations were analyzed: incorporation of transversal contents; regulation of number of on-call duties, their duration and the organization of the rest period after on-call shifts. Conclusions: Although both institutions seem initially to have different criteria when accrediting a health service training program, in reality, they have complementary views which coincide in the following aspects: importance of supervision; need to systematize the evaluation of residents' performance; and need to increase the number of scientific works with resident participation. A high degree of coincidence was also obtained between SAC's suggestion and the opinion of the Ministry of Health, in relation to the category and years of accreditation that each evaluated program deserved.

9.
Medicina (B.Aires) ; 79(3): 201-204, June 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1020060

RESUMO

El infarto agudo de miocardio es la principal causa de muerte en el mundo, siendo la obstrucción coronaria aterosclerótica el hallazgo más frecuente. Sin embargo, el 6% de los pacientes no presenta lesiones angiográficamente significativas, definidas por obstrucción de la luz vascular mayor al 50%. Estos casos se han definido bajo el término MINOCA (myocardial infarction with non-obstructive coronary arteries). Suelen ocurrir en mujeres jóvenes, con factores de riesgo cardiovascular, elevación de biomarcadores cardíacos e infradesnivel del segmento ST en el electrocardiograma. Las principales etiologías son la miocarditis, el síndrome de Takotsubo y el infarto subendocárdico. Presentamos el caso de una mujer de 65 años con antecedentes de hipertensión arterial y bloqueo completo de rama izquierda previo, que ingresó con ángor, imagen de bloqueo completo de rama izquierda en el electrocardiograma con criterios de Sgarbossa negativos y biomarcadores cardíacos positivos. En el ecocardiograma evidenció trastorno en la motilidad de la pared inferolateral y en la coronariografía solo una lesión no significativa (40%) en segmento proximal de la arteria circunfleja. La cardiorresonancia, en la secuencia de realce tardío de gadolinio, mostró retención de contraste subendocárdico a nivel de los segmentos inferolateral medial con extensión lateroapical compatible con infarto correspondiente a territorio de arteria circunfleja. Este caso ilustra un ejemplo de MINOCA secundario a infarto subendocárdico con trombólisis espontánea, en el que la presentación clínica fue típica, sin embargo en la coronariografía no se observaron lesiones significativas, por lo que fue necesario complementar con otro método de imágenes: la cardiorresonancia.


Myocardial infarction is the leading cause of death in the world, being the coronary atherosclerotic obstruction the main finding. Although 6% of all the patients had no significant coronary arteries disease on coronary angiography, defined by lumen vascular obstruction greater than 50%. This type of cases was defined by the term MINOCA (myocardial infarction with non-obstructive coronary arteries). They are usually young women, with cardiovascular risk factors, high cardiac biomarkers with non-ST elevation in the electrocardiogram. The main etiologies are myocarditis, Takotsubo syndrome and subendocardial myocardial infarction. We present the case of a 65 years-old woman with history of hypertension and complete left bundle branch block, who was admitted to the emergency department with typical chest pain, complete left bundle branch block in the electrocardiogram, with negative Sgarbossa criteria and positive cardiac biomarkers. The echocardiography evidenced inferolateral regional wall motion abnormalities, and the coronary angiography a single non-significative lesion (40%) in the proximal segment of the circumflex artery. Cardiac magnetic resonance evidenced subendocardial late gadolinium enhancement in inferolateral medial with latero-apical extension segments consistent with circumflex artery-related infarction. This case illustrates an example of MINOCA secondary to myocardial infarction with posterior spontaneous thrombolysis, in which the clinical presentation was typical, however the coronary angiography showed non obstructive lesions. Therefore, another complementary imaging methods were needed such as the cardiac magnetic resonance.


Assuntos
Humanos , Feminino , Idoso , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Ecocardiografia , Fatores de Risco , Angiografia Coronária , Imagem Cinética por Ressonância Magnética , Vasos Coronários/fisiologia , Eletrocardiografia , Infarto do Miocárdio/fisiopatologia
10.
Eur Cardiol ; 13(1): 29-34, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30310467

RESUMO

Neurohormonal systems are activated in the early phase of acute coronary syndromes to preserve circulatory homeostasis, but prolonged action of these stress hormones might be deleterious. Cortisol reaches its peak at 8 hours after the onset of symptoms, and individuals who have continued elevated levels present a worse prognosis. Catecholamines reach 100-1,000-fold their normal plasma concentration within 30 minutes of ischaemia, therefore inducing the propagation of myocardial damage. Stress hyperglycaemia induces inflammation and endothelial dysfunction, and also has procoagulant and prothrombotic effects. Patients with hyperglycaemia and no diabetes elevated in-hospital and 12-month mortality rates. Hyperglycaemia in patients without diabetes has been shown to be an appropriate independent mortality prognostic factor in this type of patient.

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