CONTENTS

EDITORIAL
Sergio V. Perrone
Insuf Card 2009;4(3):100.
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IV WEEKEND ON HEART FAILURE AND PULMONARY HYPERTENSION
Pulmonary hypertension in connective tissue diseases. New perspectives on a problem of difficult solution
Enrique Barimboim
Pulmonary arterial hypertension (PAH) can be detected in clinical practice as an isolated phenomenon, or it can also be associated with other diseases among which we highlight the connective tissue diseases (CTD). PAH is one of the potential causes of dyspnea in patients with CTD and has a direct impact on the morbidity and mortality caused by them. The author discusses some concepts regarding its diagnosis and treatment. Without question, the therapeutic advances of the next few years will achieve a change in our way of propounding this medical problem and its serious complications.
Keywords: Pulmonary hypertension- Connective tissue diseases - Interstitial disease
Insuf Card 2009;4(3):101-106.
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Heart failure and diabetes. A high risk combination
Cristian E. Botta
Diabetes mellitus (DM) and heart failure (HF) are two diseases that show some common problems. One of them is the high prevalence of the general population that increases with age and with improved life expectancy of patients, also associated with an increase in the cost of management of both conditions. The author analyzes the relationship between diabetes and cardiovascular risk of developing coronary heart disease, concluding that it is one of the most important risk factors of HF, being DM an independent risk factor of heart failure.
Keywords: Diabetes - Heart failure - Left ventricular dysfunction - Body-mass index - Insulin resistance
Insuf Card 2009;4(3):107-113.
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REVIEW ARTICLE
Contemporary management of severe mitral insufficiency
Valentina M. Bichara, Héctor I. Michelena, Yan Topilsky, Rakesh Suri, Maurice Enriquez-Sarano
High prevalence of mitral insufficiency (MI) in the population and its progression with impaired left ventricular function show the grave prognosis due to this disease in patients who are not receiving the appropriate treatment. According to authors, the early detection of ventricular dysfunction which may precede the onset of symptoms, leads to early consider surgical treatment (for organic MI) using the echocardiogram as the most useful tool for this purpose. Is necessary to evaluate each patient individually to determine appropriate treatment. According to them, when absence of symptoms in patients with severe MI without cardiac dysfunction, the presence of risk factors should encourage early surgery to repair, if the surgical risk is low and the possibility of repair is>90-95%. Proper training of surgeons in mitral valve repair is critical if we want to give back to patients with severe organic MI their normal survival. New percutaneous procedures are being studied, promising potential applications for some selected patients.
Keywords: Heart failure - Mitral valve insufficiency - Risk - Thoracic surgery - Prognosis
Insuf Card 2009;4(3):114-122.
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ORIGINAL ARTICLE
The utility of estimating cardiac index and systemic vascular resistance by Doppler echocardiography for the diagnosis of heart failure
Lucía Florio, Gustavo Vignolo, Raúl Centurión, Jorge Pouso
According to the results obtained by the authors and other teams, the estimation of cardiac index (Ci) and systemic vascular resistance (SVR) by Doppler echocardiography (DE) is feasible and reproducible. Authors propound to determine the value of hemodynamic pattern estimated by DE in the diagnostic evaluation of patients with possible congestive heart failure (CHF). Three groups were defined: “Systolic Dysfunction (SD)” patients with LVEF ≤ 40%; “CHF without significant SD” patients with LVEF>40%, and “Rejected from the unit” (R) patients without SD or CHF. The authors concluded that in patients with suspected CHF, low Ci finding confirms the diagnosis of CHF or a high risk to suffer it (asymptomatic SD), with high PPV and specificity.
Keywords: Heart failure - Echocardiography - Cardiac index - Systemic vascular resistance
Insuf Card 2009:4(3):123-129.
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UPDATE ARTICLE
Sudden death in athletes. Importance of recognition of cardiomyopathies
América Pérez, Jorge González Zuelgaray
Sudden cardiac death is a serious public health problem. Its estimated annual incidence in the general population is one per 1000 habitants, and although it occurs most frequently in the second half of life, when the individual concerned is a young and still more if athlete, becomes a shocking fact. It is essential to recognize that the causes of sudden death in young athletes are different from those identified for the general population. In this article, the authors conducted an update of the topic.
Keywords: Heart failure - Cardiomyopathy - Sudden death
Insuf Card 2009;4(3):130-135.
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OPINION ARTICLE
New paradigms about “congestive issues” in acute heart failure
Lilia Luz Lobo Márquez
The difficulty to diagnose and to treat appropriately these patients is reflected in the frequent dissociation: symptom-clinic-hemodynamic. Systemic vascular resistances begin to play a fundamental role in the initiation of vascular and congestive scenarios. The author emphasizes the idea of modifying our thoughts on “old paradigm of congestive topics” based on traditional pathophysiological concepts, in order to expand new horizons on the diagnostic and therapeutic field of acute heart failure.
Keywords: Acute heart failure - Congestion - Hemodynamic - Inflammation
Insuf Card 2009;4(3):136-141.
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PHARMACOLOGICAL UPDATE
Beta-blockers in elderly patients with heart failure
Carlos Daniel, Raúl J. Bevacqua
Although the existence of enough information on the effectiveness of beta blockers (BB) in patients with heart failure (HF), these drugs are often not properly used in elderly patients, mainly because of the possible adverse effects. However, the data indicate that these drugs are well tolerated in most cases. The results of the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with Heart Failure (SENIORS)as well as other retrospective studies support the use of these drugs in elderly patients with heart failure, although in the professional community this option treatment is not usually seen. The authors make a brief introduction of endothelial function and nitric oxide and then analyze important aspects that must be taken into account when indicating a BB and even more in elderly patients.
Keywords: Heart failure - Nebivolol - Cardioselective beta blockers - Elderly patients
Insuf Card 2009;4(3):142-148.
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IMAGES IN HEART FAILURE
Unresectable right atrial angiosarcoma
Claudio Burgos, Daniel Peroni, Martín Burgos
Report of a case of a 41-year-old male patient with pericardial effusion and intra cardiac mass, mixoma like, which produces a valve effect in the tricuspid valve. Due to the impossibilities to perform a radical surgery and the anátomo-pathological diagnosis they decided to do a total explant and to perform an orthotopic heart transplant, which was successfully taken place 23 days after the diagnostic surgery.
Keywords: Angiosarcoma - Right atrium - Cardiac transplantation
Insuf Card 2009;4(3):149-150.
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