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Biomedical subjects

E Badui

Publications and source records attributed to E Badui.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

[Cardiovascular manifestations in mixed connective tissue disease in adults].

Twenty two patients with mixed connective tissue disease (MCTD) were studied with noninvasive cardiovascular techniques. Fifty percent of the cases presented cardiovascular abnormalities which in order of importance were: pericarditis with effusion (28%), myocarditis (14%) and one case; myocardial infarction. Complications of less importance were: supraventricular and ventricular premature beats, enlargement of left and right cardiac chambers, septal hypertrophy and type A paradoxical septal movement. We consider that patients with MCTD should have a routine cardiological evaluation.

Adolescent↗
PubMedDate not supplied

[The first myocardial infarct in the elderly patient].

UNLABELLED: Acute myocardial infarction (AMI) in patients over 65 years of age represent more than half of the patients with AMI. Among them, between 60 and 80% represent the first AMI. The objective of this study is to evaluate the behavior of AMI in this group of patients. The clinical charts of patients over 65 years of age with ischemic heart disease admitted into the hospital during the past two years, were reviewed. We used the international criteria (clinical, ECG, enzymatic, echocardiographic and scintigraphic studies) for the diagnosis of AMI. Patients with previous AMI were excluded. We included 274 patients (68% males and 32% females). The age varied from 65 to 91 years with an average of 71.7 +/- 5.3 years. Typical symptoms were present in 90.5% and atypical in 9.5% of the cases, being the latest most frequent in those over 75 years of age. RISK FACTORS: cigarette smoking was present in 60% of the patients, hypertension in 52% and diabetes mellitus in 37%. Both of them were associated in 21%. In 144 cases (52.5%) the MI localization was anterior and in 130 (47.5%) inferior; among them 47 patients (36%) had extension to the right ventricle and 7 (2.5%) had a non Q AMI. COMPLICATIONS: Type I-II VPCs of Bernard Lown were present in 18% and type V 10.2%. Compete AV block in 14.2% (all of them with inferior wall MI); bifascicular block in 55 and mitral insufficiency due to papillary muscle dysfunction in 6.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Distribution↗
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[Morphofunctional correlation in congenital anomalies of the coronary arteries. II. The ectopic origin of the coronary arteries].

The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.

Adult↗
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[The echo-dobutamine pharmacological stress test in ischemic cardiopathy].

We report our experience with Echo-Dobutamine stress test. In order to evaluate the sensitivity, specificity and the safety, of the pharmacologic echo-dobutamine stress test, we studied 30 patients with ischemic heart disease based on clinical history, 2D echocardiogram, standard exercise stress test and cardiac catheterization. The test was started under continuous videotape of the segmental left ventricular motility on the conventional views. Dobutamine was administer intravenously 2.5 to 40 micrograms/kg/min every 3 minutes, the mean higher dobutamine dose was 19 +/- 14.3 micrograms/kg/min, having a continuous electrocardiographic monitoring of the heart rate as well as blood pressure. The myocardial motility was recorded with each increment in the dobutamine dose. Among the cases, 22 were males and 8 females with an average age of 55 +/- 9 years. Twenty two patients had history of remote myocardial infarction and were asymptomatic at the moment of the test; 8, who had angina pectoris were on a functional class I-II of the CCS. The mean basal ejection fraction was 62.6 +/- 11.7% by echo vs 64.4 +/- 16.8% obtained by cardiac catheterization (p no significant). There were no arrhythmias in any case. The heart rate increased from 68.7 +/- 10.1 to 85.5 +/- 15.7 beats per minute (p < 0.001). The systolic B/P was increased from a mean of 124 +/- 14.5 to 138.3 +/- 14.4 mmHg (p < 0.0005) while the diastolic pressure varied from 82.3 +/- 8.2 to 90.8 +/- 9.6 mmHg (p < 0.001). There were no severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Calculation of the mitral valve area with the proximal convergent flow method with Doppler-color in patients with mitral stenosis].

In this study we evaluate prospectively a new color Doppler method for calculating the mitral valve area based on identifying a blue-red aliasing interfase proximal to the orifice, corresponding to the flow convergence region (FCR). This method can be used to calculate areas using the continuity equation. We studied 61 patients with stenosis. The mitral valve area was calculated using pressure half-time (PHT) Doppler method which were compared with values that obtained by the FCR method, according to the following formula. AVM (cm2) = 2 pi r2 x VN/Vmax; where "r" is the FCR radius measured from the orifice to the first color aliasing (blue-red interface); VN is Nyquist velocity and Vmax is the peak flow velocity by continuous wave Doppler. Twenty three patients had pure mitral stenosis and 38 double mitral lesion. Twenty patients were on sinus rhythm while 41 in atrial fibrillation. Calculated mitral valve area using the FCR method correlated well with mitral valve area determined by PHT method at a correlation coefficient of r = 0.96 (y = 0.097 x + 54.9, SEE = 0.10 cm2, p < 0.001). MVA by FCR ranged from 0.4 to 2.5 cm2 (mean = 1.19 cm2). MVA by PHT ranged from 0.42 to 2.48 cm2 (mean = 1.15 cm2). Color Doppler FCR method provides an accurate estimate of effective mitral valve area and may be useful as an alternative to the pressure half-time method. The calculated mitral valve area by the FCR method is not influenced by the presence of mitral regurgitation nor atrial fibrillation.

Adult↗
PubMedDate not supplied

[Morphofunctional correlation in congenital anomalies of the coronary arteries. I. Coronary artery fistulas].

In order to explain the congenital coronary arteries malformations, the authors review the recent concepts on the coronary artery morphogenesis, based in the findings that in the human embryo, these arteries evolve from three sources: 1) endothelial aortic buds, 2) cavitary cellular groups from pericardial origin and with angiogenic character, which migrate to the cardiac zones where the coronary arteries will be distributed, and 3) the intramyocardial sinusoids. The anatomic and histologic cardiac alterations will be reflected in modifications of the coronary artery pattern. The coronary artery fistulae are formed by the persistence of the sponge structure of the myocardial wall, present in the early ontogenic steps of the cardiac development; such fistulae alter the normal functions of the coronary vascular tree and are capable to cause angina pectoris to the patient through diverse mechanisms: absence of capillarization, steal phenomenon aggravated by the altered coronary arteries properties when aneurysm or vascular channels are developed. The authors suggest a classification of the congenital coronary arteries anomalies: I. Anomalous origin in the sinus of Valsalva (anomalous and ectopic origin), II. Malformations of the coronary branches (in number, distribution and wall anomalies) and III. Anomalous connection of the coronary arteries: fistulae and persistence of the intramyocardial sinusoids isolated or communicated to left and right ventricles. The latter are frequently associated with aortic or pulmonary valve atresia. They do not cause myocardial ischemia and are formed secondary to the intracavitary elevated pressure which maintained the persistence, dilatation and communication of the ventricular chambers with such sinusoids and coronary arteries in the case of pulmonary valve atresia and with coronary veins in the case of aortic valve atresia.

Adolescent↗
PubMedDate not supplied

[Percutaneous transluminal coronary angioplasty. The experience of the Hospital de Especialidades of the La Raza Medical Center, IMSS].

UNLABELLED: We analyzed the initial results of the PTCA program at the Hospital de Especialidades CMR, IMSS. During the last year we studied 33 patients in whom we performed 35 PTCA procedures with total of 45 lesions. The age of the patients varied from 27 to 75 years of age (average 57 year +/- 10.9). Among them, 84.8% were males and 15.2% females. In 54.5% of the patients, stable angina was present, whereas in 45.5% unstable angina was observed. Multivessel disease was detected in 39.4% of the cases. In 17.8% the coronary lesions were type "A", in 77.8% type "B" and in 4.4% type C. The most frequent lesions were present at the left anterior descending artery in 46.6%, right coronary artery in 40% and circumflex in 13.4%. The global procedural success was 88.5% (32/35 procedure) whereas the procedural success by isolated lesion was 88.8% (40/45 lesions). The average artery stenosis was decreased from 85 +/- 10.4% to 23 +/- 16%. A procedural failure occurred in 4 instances (11.4%), among them, 2 (5.71%) without complications and 2 more, associated to acute myocardial infarction. In the present study there were no emergency operation neither deaths. CONCLUSIONS: Although the number of PTCA performed in our hospital is limited, we consider that the initial results are good, with a success rate of 88.5% with a minimal complications.

Adult↗
PubMedDate not supplied

[Acute myocardial infarct in young adults. A report of 142 cases].

We present 142 cases of myocardial infarction in the young (MIY) which correspond to 5.6% of a total of 2525 patients with MI hospitalized in the past 5 years at the Hospital de Especialidades del Centro Médico La Raza, IMSS. Among them, 124 (87%) were males and 18 (13%) females. The age varied from 25-40 years, average 35 years for both sexes. Occupational labor: 56 (39.5%) were workers, 27 (19%) officemen, 22 (15.5%) professionals, 20 (14%) taxi drivers, 15 (10.5%) merchants and 2 (1.5%) students. Personal cardiac history: 42 (30%) had history of angor pectoris and 5 (3.5%) of MI. Coronary risk factors: 106 patients (75%) had emotional stress due to type "A" personality, 101 (71%) cigarette smoking, 59 (42%) systemic arterial hypertension, 35 (25%) diabetes mellitus, 35 (25%) hyperlipidemias and 28 (20%) obesity. Among them, 34 (24%) had no risk factors. MI localization: 48 (34%) anteroseptal, 37 (26%) anterolateral, 36 (25%) posteroinferior and 21 (15%) inferior. Only in 83 cases coronary angiogram was performed, among them: 34 (41%) had disease of the left coronary artery and 18 (22%) of the right; 33 (40%) had one vessel, 15 (18%) 2 vessel and 4 (5%) 3 vessel disease. In 31 (37%) the coronary angiogram was normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Isolated agenesis of the pulmonary valve in the adult. When is the proper time for surgery?].

The congenital absence of the pulmonary valves is a rare malformation that mainly affects children, frequently is associated with other cardiac malformations and very rarely is present in adults. Elective or urgent surgery is indicated in the symptomatic child; on the other hand, surgical treatment in the asymptomatic adult with this anomaly is controversial. Based on the reported experience in the literature, in the present article, the authors discuss the therapeutic approach of an asymptomatic 22-year-old male with pulmonary valvular absence with practically no hemodynamic repercussion. Although there had been few reported cases of isolated pulmonary valvular absence, the authors concluded that surgery is not a satisfactory solution and that it might be postponed to the time that patients develop congestive heart failure and or respiratory insufficiency. In order to detect that on time, we recommend a follow up based on periodic echocardiographic studies.

Adult↗
PubMedDate not supplied

[Thrombolysis in mechanical prosthetic valve thrombosis. Its management with streptokinase].

We present the first experience in Mexico in 10 patients, 9 female and 1 male with an average age of 42.5 years. All patients had clinical, echocardiographic and fluoroscopic criteria of dysfunctioning mechanical valvular prosthesis due to thrombosis (9 Sorin type and 1 Starr-Edwards). None of the patients had contraindications for thrombolytic therapy. All cases were treated with intravenous streptokinase: 250,000 U in 30 minutes followed by an infusion of 100,000 U per hour, always under clinical, echocardiographic and fluoroscopic control every 2 and 24 hours respectively until the normalization of the clinical and hemodynamic parameters with a top limit of 72 hour. The average duration of the thrombolysis was 54 +/- 6.1 hours with an average total doses of 5' 200,000 U of streptokinase. In 90% of the cases there was an increase in the valvular area: mitral (n = 7), from 1.02 +/- 0.21 to 1.75 +/- 0.36 cm2 (p < 0.001), while the mean transvalvular gradient decreased from 10.42 +/- 3.77 to 3.42 +/- 0.975 mmHg (p < 0.001); the systolic pulmonary artery pressure also decreased from 53.7 +/- 15.29 to 35 +/- 2 mmHg (p < 0.001). In the tricuspid prosthesis (n = 2) the average valvular area was increased from 0.8 +/- 0.44 to 1.55 +/- 0.77 cm2, decreasing proportionally the mean transvalvular gradient from 12.5 +/- 2 to 4.5 +/- 3.5 mmHg with no changes in the systolic pressure of the pulmonary artery. In the Starr-Edwards prosthesis in aortic position (n = 1), no hemodynamic changes were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Conduction disorders at multiple levels during the acute phase of a myocardial infarct: an electrophysiological study].

Forty patients with a diagnosis of acute myocardial infarction (anterior 24, and inferior 16) were studied. Of these patients, 37.5% manifested second and third degree atrioventricular (AV) block as a complication; another 30% showed complete right bundle branch and left anterior hemiblock. Right bundle branch and left posterior hemiblock were evidenced in 12.5% of the subjects. There was 20% with complete left bundle branch block. Electrophysiologic studies were performed in all patients to assess the site of block. A direct relation was found between the surface ECG and the His bundle electrogram studies in patients with an inferior myocardial infarction and AV block, both procedures located the conduction disturbances at the AV node (suprahisian block), in contrast to patients with anteroseptal myocardial infarction whose surface ECG only showed bundle branch block or fascicular block. The His bundle electrogram registered multiple levels of AV block, 70% with troncular and infrahisian block that gave way to sudden AV block. The mechanism responsible for this block was considered to be a functional longitudinal dissociation of conduction system due to an acute ischemic injury of the His bundle, more than a sudden and simultaneous failure of all the bundle branch of His. We conclude that electrophysiologic studies are a useful procedure for identification of a group of patients with multiple AV conduction disturbances that have a less favorable prognosis than those with only suprahisian level of block.

Adult↗
PubMedDate not supplied

[Percutaneous mitral commissurotomy using Inoue's balloon during pregnancy].

The authors present three cases of pregnant women with symptomatic severe mitral stenosis with a mean age of 28.6 +/- 2.3 years, and during 27.6 +/- 1.52 weeks of pregnancy. Two patients were in class III and one in class IV of the New York Heart Association (NYHA). All patients had a mitral valvular area equal or less than 1 cm2, with a Wilkins score of 7 to 9 and mitral insufficiency grade I in two cases; two, had severe pulmonary arterial hypertension (mean > 50 mm Hg). After Percutaneous Mitral Valvuloplasty (PMV) the mitral valve measured by 2D echocardiography increased form 0.83 +/- 0.2 cm2 to 1.8 +/- 0.15 cm2; the mean transmitral gradient diminished from 13 +/- 3.4 mm Hg to 3.6 +/- 1.15 mm Hg; the degree of mitral insufficiency was no modified in neither case. Hemodynamic results revealed increasing of the mitral valve from 0.83 +/- 0.18 cm2 to 2.23 +/- 0.3 cm2; the mean mitral gradient decreased from 21.6 +/- 9 to 4.3 +/- 0.5 mm Hg; the mean left atrial pressure from 30 +/- 12 to 12.3 +/- 4 mm Hg; the mean pressure of the pulmonary artery diminished suddenly from 44.3 +/- 16 to 25.6 +/- 11 mm Hg. The average fluoroscopic time was 15.3 +/- 3 minutes. There were no complications. The patients were discharged 48 hours after the procedure and continued their pregnancies in class I NYHA, which resolved in a non complicated vaginal delivery with normal products. We conclude that PMV is a safe and useful therapy in pregnant patient with severe mitral stenosis refractory to medical treatment.

Adult↗
PubMedDate not supplied

[Limitation of myocardial expansion in late thrombolysis evaluated by two-dimensional echocardiography].

Myocardial expansion in acute myocardial infarction (AMI) is present in about 45% of the patients within the first 72 hours. This is associated with ventricular aneurysm formation, myocardial rupture, heart failure and early death. Experimental studies in animals with AMI have used late reperfusion to decrease the incidence of expansion with success. The present is a prospective, longitudinal, open and randomized study in 21 patients with anterior AMI, to evaluate if the late reperfusion (6 to 12 hours) can decrease the incidence of myocardial expansion graded quantitatively with bidimensional echocardiography. Two groups were made: group A (n = 12) who received thrombolysis with streptokinase 1.5 mill. IU plus oral aspirin 150 mg OD (n = 9). Both groups had the same characteristics of AMI and functional class of Killip and Kimball (I-II class). Intrahospital treatment was given freely in both groups. The expansion was evaluated with bidimensional echocardiography used Jugdutt's method. In group A, expansion was present in 25% of the cases, while in group B was 66.6% (p < 0.0005). The distortion area, distortion peak, septal thickness and large asynergic segment were more sensitive parameters to identify myocardial expansion. Our results are similar to some experimental studies. We conclude that late thrombolysis can be useful in decreasing the incidence of myocardial expansion. Bidimensional echocardiography is a useful, fast and safe method to identify myocardial expansion.

Administration, Oral↗
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[Cardiac rupture in acute myocardial infarct. Presentation of 20 postmortem cases].

With the advancement of the Coronary Care Units in the past three decades, there had been an important reduction in mortality secondary to arrhythmias in acute myocardial infarction (AMI): been now days, cardiogenic shock and cardiac rupture the first and second causes of in-hospital death in these patients. The purpose of this report is to know the anatomoclinical characteristics in our hospital of cardiac rupture and to look for risk factors that may be considered to diagnose at the precise time this complication that might cause sudden death secondary to hemodynamic and electromechanical changes. From 300 postmortem cases with AMI proved clinical, and by anatomopathological studies, 20 cases with cardiac rupture were obtained, among which: 11 (55%) were males with an average age of 61.7 years and 9 (45%) females, with an average age of 60 years. The following coronary risk factors were detected: systemic hypertension in 15 (75%) cases; cigarette smoking in 13 (65%) cases and diabetes mellitus in 11 (55%) cases. Long lasting or recurrent history of chest pain previous to death was present in 14 (70%) cases. Conduction disturbances were detected in 13 (65%) cases; among them, 7 (35%) had third degree heart block in whom permanent pacemaker was inserted; 4 (20%) had CRBBB and 2 (10%) ASB. The average heart weight was 478 gr. in males and 434 gr. in females. Evidence of an old MI was present in 7 (35%) cases. All patients had transmural MI. Free cardiac wall rupture was seen in 14 (70%) cases and from the ventricular septum, 6 (30%) cases. Hemopericardium was present in all cases (100%) with an average amount of 425 ml of blood. Pericarditis in 3 (15%). The average time of evolution since the beginning of the AMI until death were 4 days and the main causes of death were cardiogenic shock in 17 (85%) and congestive heart failure in 3 (15%).

Acute Disease↗
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A case of a coronary artery arising from the pulmonary artery.

We present a case of an anomalous origin of the left coronary artery arising from the pulmonary artery in a 60 year old woman with ventricular arrhythmias and ischemic electrocardiographic changes but who had tolerated eleven normal pregnancies and deliveries without complications. No cardiac surgical repair has been performed and she is asymptomatic and has been well controlled with diisopyramide during a ten year follow up.

Collateral Circulation↗
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[Identification and treatment of coronary atherosclerosis, before resection of abdominal aortic aneurysm].

Atherosclerotic aortic aneurysm, is frequently associated to coronary atherosclerosis. When myocardial ischemia is asymptomatic, aortic surgery commonly is deferred because unexpected ischemic cardiopathy. To diminish the risk of aortic surgery, aortocoronary bypass must be installed before the aortic graft. Percutaneous transluminal coronary angioplasty is an alternative treatment of coronary atherosclerosis, principally in elderly patients. We present the case of a male patient with an abdominal aortic aneurysm and myocardial silent ischemia secondary to right coronary artery stenosis treated by mean the percutaneous transluminal coronary angioplasty (PTCA) before aortic surgery, with the objective of decreasing surgical risk and its possible complications (myocardial infarction, cardiogenic shock, death, etc.). Nine months after the PTCA, the patient is asymptomatic and stress test on treadmill is negative.

Aged↗