Heart failure with preserved ejection fraction (HFpEF) is a frequent and overlooked medical condition that represents a great challenge for diagnosis and treatment. Current data shows a temporal trend towards a higher prevalence of HFpEF, even above heart failure with reduced ejection frac- tion (HFrEF). The pathophysiology of HFpEF is heterogeneous and involves several factors such as genetics, lifestyle, and cardiac and non-cardiac comorbidities. These factors result in remodeling, maladaptation and cardiac stiffness, that later on cause dyspnea, exercise intolerance, and fatigue. Although the mortality outcome of HFpEF is as high as HFrEF, no speci c therapy has demonstrat- ed overall bene t in these patients; which is why future therapies will bet on an individualized approach according to the patients phenotype.

Heart failure with preserved ejection fraction (HFpEF) is a frequent and overlooked medical condition that represents a great challenge for diagnosis and treatment. Current data shows a temporal trend towards a higher prevalence of HFpEF, even above heart failure with reduced ejection frac- tion (HFrEF). The pathophysiology of HFpEF is heterogeneous and involves several factors such as genetics, lifestyle, and cardiac and non-cardiac comorbidities. These factors result in remodeling, maladaptation and cardiac stiffness, that later on cause dyspnea, exercise intolerance, and fatigue. Although the mortality outcome of HFpEF is as high as HFrEF, no speci c therapy has demonstrat- ed overall bene t in these patients; which is why future therapies will bet on an individualized approach according to the patients phenotype.

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

Accelerated atherosclerosis has become a complication of multiple autoimmune diseases, among which Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis stands out. The case of a patient with hypertension, diabetes, and chronic kidney disease of unknown etiology is described, who presented two acute coronary syndromes with a difference of only six months, with rapid progression of coronary involvement, in search of the etiology with an increase in inflammatory response markers, tomography with usual interstitial pneumonia and positive antibodies directed against myeloperoxidase (anti-MPO) that led to the diagnosis of microscopic polyangiitis (PAM). The situation in which a timely diagnostic suspicion is crucial since early treatment has a notable impact on the course and prognosis of the disease.

La Cardiomiopatía hipertrófica presenta diferentes espectros de presentación, entre ellos la obstrucción al tracto de salida del Ventrículo izquierdo. El fenotipo más común es la variante septal asimétrica, siendo infrecuente encontrar la variante medio apical. Por otra parte, existen mutaciones puntuales asociadas a la Cardiomiopatía hipertrófica siendo la variante de la Filamina C una condición poco usual en estos pacientes. A continuación, se presenta el caso de un paciente sexo masculino de 23 años con diagnóstico de Cardiomiopatía hipertrófica variante medio apical, en quien se documenta variante de la Filamina C, ante la inadecuada respuesta y persistencia de sintomatología frente al manejo médico, se realizó el procedimiento de miectomía con abordaje transapical, con posterior mejoría de sintomatología clínica y obstrucción al tracto...

Endomyocardial fibrosis or Davies disease is a rare cause of restrictive cardiomyopathy. It is characterized by the deposit of fibrous material in the endocardium that leads to quickly progressive heart failure. It most frequently affects both ventricles, with isolated involvement of the right ventricle being the least common form. The clinical presentation of this entity is based on symptoms of right heart failure, although arrhythmias and conduction disorders may also be present. The treatment is determined by the management of congestion and surgical intervention in symptomatic patients. We present the first case of endomyocardial fibrosis isolated from the right ventricle in Colombia, we describe the clinical, etiological, imaging and management characteristics in order to deliver to the medical community an approximate understanding of this disease focusing on an unusual way...

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

Tuberculosis is a disease that is increasing and affects about 1/3 of the world’s population. In line with the increase in tuberculosis, cardiovascular disease has had a similar behavior to this group, ischemic coronary heart disease has become the main cause of death worldwide. It could be extracted, based on literature, a relationship between tuberculosis and ischemic coronary heart disease through risk factors in common and from a possible pathophysiological substrate that links them. The presentation of these two entities reported so far is varied: it has been found as a debut of an acute coronary syndrome in patients with active tuberculosis, and the progressive development of coronary atherosclerosis in patients with latent tuberculosis, among others. Given this possible link and the progressive increase in its incidence rates, we can affirm that we are facing an inadvertent synd...

La aterosclerosis acelerada se ha identificado como una complicación de múltiples enfermedadesautoinmunes, entre las que destacan las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilo (VAA). Se describe el caso de una paciente de 60 años, con antecedentes de hipertensión arterial , diabetes mellitus y enfermedad renal crónica de etiología no filiada, que presentó dos síndromes coronarios agudos con una diferencia de solo seis meses. Se evidenció rápida progresión del compromiso coronario, presencia de aumento de marcadores de respuesta inflamatoria, tomografía con neumonía intersticial usual y anticuerpos antimieloperoxidasa (anti-MPO) positivos que llevaron al diagnóstico de poliangitis microscópica (PAM). En estos casos, la sospecha diagnóstica oportuna es crucial, ya que el tratamiento temprano impacta de forma notable en el curso y pronóstico de la enf...

Objective.  Evaluate the change of lactate levels and its prognostic role in the postoperative period of patients undergoing pulmonary thromboendarterectomy. Methods. Retrospective study between 2001 and 2019. Patients older than 18 years and who underwent pulmonary thromboendarterectomy were included. The U Mann Whitney test was performed to evaluate the change between lactate levels, and Cox regression analysis to evaluate the relationship with mortality. Areas under the curve were constructed for lactate levels. Results. Seventy-three patients were operated on during the study period. Median age was 51 years, 55% female. The median lactate on days 1 was 4.65 mml/L and on day 2 it was 1.62 mml/L with a change of 2.87 mml/L. No differences were found between the levels measured on day 1 and 2 between the people who died and those who did not on day 30. In the multivariate regressio...

Objective.  Evaluate the change of lactate levels and its prognostic role in the postoperative period of patients undergoing pulmonary thromboendarterectomy. Methods. Retrospective study between 2001 and 2019. Patients older than 18 years and who underwent pulmonary thromboendarterectomy were included. The U Mann Whitney test was performed to evaluate the change between lactate levels, and Cox regression analysis to evaluate the relationship with mortality. Areas under the curve were constructed for lactate levels. Results. Seventy-three patients were operated on during the study period. Median age was 51 years, 55% female. The median lactate on days 1 was 4.65 mml/L and on day 2 it was 1.62 mml/L with a change of 2.87 mml/L. No differences were found between the levels measured on day 1 and 2 between the people who died and those who did not on day 30. In the multivariate regressio...