PubMed Health⌕ Search

Biomedical subjects

R Zayas

Publications and source records attributed to R Zayas.

11 recordsLinked to original sources
PubMed1995

Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis.

To assess the incidence of a specific etiology and the role of methods for specific etiologic diagnosis in patients with primary acute pericarditis, we studied 100 patients with primary acute pericarditis consecutively admitted to our hospital between 1991 and 1993. A general diagnostic protocol was performed in all patients, whereas only pericardiocentesis was performed in patients with clinical cardiac tamponade or an unfavorable course with anti-inflammatory drugs. Surgical drainage and pericardial biopsy was performed in patients with tamponade relapse. A specific etiology was discovered in 22 patients (22%) (neoplasms in 7, tuberculosis in 4, other infections in 3, collagen diseases in 3, thyroid disorders in 4, and dissecting aortic aneurysm in 1). The general diagnostic protocol led to a specific diagnosis in 15 patients (68% of all patients with specific acute pericarditis) and pericardiocentesis in the other 7 patients (32%). The role of a diagnostic protocol, therapeutic pericardiocentesis, and diagnostic pericardiocentesis was similar and complementary. Pericardial biopsy results were negative in the 5 patients in whom it was performed. Cardiac tamponade and an unfavorable clinical outcome were significantly (p < 0.001) associated with the finding of a specific etiology; when both features were combined, sensitivity was 86% and specificity 85%, positive predictive value 63% and negative predictive value 96%. We conclude that the specific etiology in patients with primary acute pericarditis is about 20% to 25%, and that about 90% of these specific cases can be discovered by using the described systematic diagnostic protocol only in patients with an unfavorable outcome (cardiac tamponade or poor clinical course).

Acute Disease↗
PubMed1995

[Acute myocarditis with severe cardiac dysfunction in the pediatric population. The evolution and differential characteristics with respect to adult myocarditis].

AIMS: The aim of our study was to assess the spontaneous outcome of acute myocarditis associated with severe cardiac dysfunction in children, as well as to compare these features with those occurring in adult patients. METHODS: Fifty patients consecutively diagnosed of acute myocarditis during the last 7 years in our hospital were studied; 15 patients were children younger than 14 years, and 35 were adults. Immunosuppressive therapy was not used in any patient. RESULTS: Mean age was 2 +/- 3 years in children, ranging from 2 months to 12 years. One patient required temporary pacing for a third-degree atrioventricular block, while the remaining 14 children had severe congestive heart failure, with a left ventricular ejection fraction of 30 +/- 12% (16 to 44%). After a mean follow-up of 21 +/- 26 months, only 3 children died, at 1, 4 and 10 months after the initial diagnosis. Death was sudden in all 3 patients. Left ventricular ejection fraction rose to 45 +/- 14% at 1 month after diagnosis, and to 58 +/- 15% at the end of follow-up. Unfavorable evolution (death or evolution to chronic dilated cardiomyopathy, with a left ventricular ejection fraction < 45%) occurred in 6 children (40%) at 1 month after diagnosis and in only 4 (25%) at the end of follow-up. The 9 children with 1-month favorable outcome were alive and had an ejection fraction > 45% at long-term, while only 2 of the 6 children with 1-month unfavorable outcome were alive and had an ejection fraction > 45% at long-term. Only the 3 children who died had an ejection fraction < 30% at 1-month. Favorable outcome was more frequent in children that in adult patients with acute myocarditis (75% versus 46%). CONCLUSIONS: The outcome of acute myocarditis with severe cardiac dysfunction was favorable in a majority of pediatric patients; this favorable evolution was less frequent in adults. Patients in whom left ventricular ejection fraction did not increase at short-term had a higher risk of death, and they should probably be considered for heart transplantation.

Acute Disease↗
PubMed1994

[Infectious endocarditis in non-addict patients without predisposing heart disease. Differential features].

INTRODUCTION AND AIMS: Although uncommonly, infective endocarditis in non-addict patients may involve people without predisponente heart disease. The aim of our study was to assess the clinical and prognostic features of this type of endocarditis and to compare them with those of the more common type of endocarditis with underlying lesion. METHODS: With this aim, we have reviewed 71 consecutive cases of non-addict infective endocarditis diagnosed in our hospital in the last 7 years; there was no preexisting cardiac lesion in 9 patients (13% of all endocarditis and 21% of native valve endocarditis), while underlying heart disease, including mitral valve prolapse, was present in the remaining 62 patients. RESULTS: Mean age was significantly lower in 9 patients without preexistent lesion (28 +/- 18 versus 46 +/- 17 years, p < 0.01), while there was no differences for gender. Infection involved the aortic valve in 56%, the tricuspid or pulmonary valve in 33% and the mitral valve in only 11% of the patients without underlying cardiopathy (for 44%, 4% and 49%, respectively, in patients with cardiopathy). Staphylococcus aureus caused 67% of cases in patients without cardiopathy and only 9% in those with cardiopathy. Surgery was required in a similar proportion by both groups of patients (55% and 56%), although mortality was more than twice higher in patients with prior cardiac lesions (25% versus 11%). CONCLUSIONS: A significant proportion of non-addict infective endocarditis involves patients without predisponente heart disease. These cases have some differential features (younger age, aortic and right heart valves involvement, S. aureus as the main causative agent and lower mortality) in comparison to those of endocarditis in patients with underlying cardiopathy.

Adolescent↗
PubMed1994

[The incidence, mechanisms and clinical factors predictive of sudden death in patients with severe heart failure evaluated in anticipation of heart transplantation].

INTRODUCTION AND OBJECTIVES: Sudden death is not uncommon in patients with severe congestive heart failure. The aim of our study was to assess the incidence, mechanisms and clinical predictors of sudden death in a large series of patients with severe congestive heart failure evaluated for heart transplantation. METHODS: With this aim we have reviewed our experience on 240 consecutive patients with severe heart failure studied in our hospital from May 1986 to June 1992. Heart failure was due to ischemic heart disease in 35% of patients and idiopathic dilated cardiomyopathy in 65%. Age was 47 +/- 12 years, left ventricular ejection fraction was 20 +/- 6%, and symptom class was IV in 88% of patients and III in 12%. RESULTS: Sixty-eight of the 240 patients (28%) died without transplantation. Death was sudden in 21 patients (31% of deaths, and 9% of all patients), due to heart failure in 41 (68%), and due to malignancy (ampuloma) in 1 (1%). Mechanism of sudden death could be identified in 12 cases: ventricular tachycardia/fibrillation in 8 and bradycardia/electromechanical dissociation in 4. On multivariate analysis (stepwise logistic regression), a lower tolerated captopril dosage (p = 0.004), a lower systolic blood pressure (p = 0.079) and a history of a ventricular tachycardia/fibrillation (p = 0.073) were independent predictors of sudden death. CONCLUSIONS: It seems possible to identify, between patients with severe heart failure, a subgroup of patients at higher risk for sudden death by means of such simple clinical parameters.

Acute Disease↗
PubMed1994

[Infectious endocarditis due to Q fever: a recurrent disease. Apropos a new case].

We report a case of a patient with an aortic prosthetic valve who had Q fever endocarditis, glomerulonephritis and rapidly progressive renal failure. He was seen in 1987 and successfully treated by heart valve surgery and a one-year course of doxycycline. Five years later, the patient had another episode of Q fever endocarditis, involving the native mitral valve, complicated with acute renal failure and severe mitral regurgitation that required hemodialysis and mitral valve replacement. The outcome was again successful. This case report raises the question of whether Q fever endocarditis can be eradicated, and also the required duration of antibiotic therapy for this disease.

Acute Kidney Injury↗
PubMed1988

[Sinocarotid hypersensitivity].

Hypersensitivity of the carotid sinus corresponds to a ventricular pause equal to or exceeding 3 seconds and/or a blood pressure drop equal to or exceeding 50 mmHg, induced by massage of the carotid sinus (MCS). MCS remains the diagnostic method of these two syndromes: cardio-inhibitor/vasodepressor. It must be performed systematically during the work-up of transient consciousness disorders since it is not unusual that hypersensitivity of the carotid sinus may cause cardiac syncopes. In addition, hypersensitivity of the carotid sinus is often associated with sinus dysfunction and atrioventricular conduction disorders. In the case of hypersensitivity of the carotid sinus with syncope secondary to a pure or dominant cardio-inhibiting response, heart stimulation with a dual-chamber pacemaker is probably the best treatment. In cases of hypersensitivity of the carotid sinus without syncope, therapeutic abstention is commonly accepted.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[The use of endocavitary fulguration in the treatment of common auricular flutter].

Between April 1990 and July 1991, 10 patients, were fulgurated after right atrial endocardial mapping with the purpose of destroying or modifying the site of origin of atrial flutter. Mean age, 47 years old (23-61), 9 males. All patients suffered "common" atrial flutter episodes with very rapid ventricular response (greater than or equal to 150 beats per minute) refractory to pharmacological therapy. All patients had pathologic potentials with prolonged duration between 90 and 160 ms (m = 109) which preceded other reference electrodes in the high right atrium and His position. Electrical stimulation from that zone provoked the capture entrainment and termination of the flutter; the same configuration of the arrhythmia was obtained with electrical stimulation from the suspected zone. With the catheter in that situation one or two direct current cathodic, unipolar shocks were given with energy of 60-150 Joules (m = 117). In the follow up (16-73 weeks), 8 patients are free of symptoms without drugs, one suffered a new episode after 7 weeks, His fulguration was performed and a permanent pacemaker implanted. The other patient has failed two session and is still on treatment.

Atrial Flutter↗
PubMedDate not supplied

[The treatment of intranodal tachycardias with intracavitary fulguration].

The electrical ablation of the His bundle with proximal intracardiac shocks of low energy was performed through an electrical catheter, to 14 patients with AV nodal reentry tachycardias refractory to pharmacological therapy, to whom at least 3 antiarrhythmic drugs were previously administered. The electrical energy applied oscillated between 10 to 150 Joules (114 average). 11 patients (72%) recovered the normal atrioventricular conduction and in the electrophysiological evaluation was found: 1--Increase in the duration of the AH interval. 2--No existence of two AV nodal pathways. 3--Absence of retrograde conduction. 4--Impossibility to induce tachycardia. The PR interval was prolonged (60 ms average) after the electrical shocks. These criteria defined the total effectiveness of the procedure. In the 3 remaining patients (28%) a permanent atrioventricular complete block was induced and the implantation of the permanent pacemaker was required. It was concluded that the electrical fulguration of the atrioventricular junction with low energy is an effective technique as curative treatment for intranodal reentry tachycardias, which can be applied without induction of permanent cardiac block.

Adolescent↗
PubMedDate not supplied

[Experience with the use of an implantable automatic cardioverter defibrillator].

An automatic implantable cardioverter-defibrillator with pacemaker was implanted in Cuba, in ten patients with malignant ventricular arrhythmias, sudden cardiac collapse, and ventricular tachycardia with syncope, after a previous electrophysiological study for analysis of the arrhythmia and pharmacological evaluation. The patients were 9 males, ranging in age from 23 a 70 years, with a mean of 48 years, and an ejection fraction of 32% (18-62%). The etiologies were: an old myocardial infarction (7 cases) and dilated cardiomyopathy (3 cases). During the follow-up, mean from 2 to 25 months, four patients received effective shocks for rapid palpitations and presyncope. Two patients died, one due to incessant ventricular tachycardia and one of a cause unrelated to device. We concluded that the GUARDIAN 4201 and 4202 device are useful to prevent sudden cardiac death in high risk patients who experienced a life threatening arrhythmia.

Adult↗
PubMedDate not supplied

[Surgery for Wolff-Parkinson-White syndrome. Cuban experience].

Surgery is a recent approach in the treatment of arrhythmias. The first successful surgery of this type was the interruption of the accessory pathway in a patient suffering from the Wolff Parkinson White syndrome. In 25 consecutive patients who underwent surgery, 28 accessory AV pathways were identified with classical endocardial and epicardial mapping. Only three patients experienced recurrence of preexcitation without symptoms; one patient had AV block; and another patient died. In all cases we successfully used either an endocardial or an epicardial approach. The purpose of this paper is to report the Cuban experience with this procedure.

Adolescent↗