S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100001 Tubo "taqueado", tubo destapado Gutiérrez Sotelo Oswaldo ,Revista Costarricense de Cardiología 12 2010 2010 12 03 04 Boden WE Surgery, angioplasty, or medical therapy for symptomatic multivessel coronary artery disease J Am Coll Cardiol 2004 43 Boden WE O’Rourke RA Teo KK Optimal Medical Therapy with or without PCI for Stable Coronary Disease N Engl J Med 2007 356 Schoenhagen P Murat Tuzcu E Ellis GE Plaque Vulnerability, Plaque Rupture, and Acute Coronary Syndromes. (Multi)-Focal Manifestation of a Systemic Disease Process Circulation 2002 106 Danesh J Wheeler J Hirschfield G C-Reactive Protein and Other Circulating Markers of Inflammation in the Prediction of Coronary Heart Disease N Engl J Med 2004 350 Nagueh SF Dobutamine echocardiography versus nuclear cardiac imaging for evaluation of myocardial viability Curr Opin Cardiol 1997 12 6
S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100002 Revascularización Percutánea de Emergencia del Tronco Común de la Arteria Coronaria Izquierda: Resultados tempranos y seguimiento Díaz Picado Geiner Chavarría Víquez Jorge ,Hospital México Servicio de Cardiología Unidad de Hemodinamia San José Costa Rica 12 2010 2010 12 05 10

Introducción. El tratamiento de elección en la enfermedad arterioesclerótica del tronco coronario izquierdo (TCI) es la cirugía de revascularización miocárdica. La intervención percutánea de este tipo de lesión es una alternativa terapéutica efectiva en centros con experiencia. Objetivo. Evaluar los resultados de la angioplastia del TCI no protegido en pacientes con síndrome coronario agudo de alto riesgo o asociado a choque cardiogénico. Material y métodos. Se realizaron 12 intervenciones percutáneas sobre TCI no protegido; 6 pacientes cursaban un infarto agudo de miocardio, 4 angina inestable de alto riesgo y 2 fueron intervenidos por disección del TCI durante intervención percutánea de otros vasos. En 4 pacientes, la intervención se realizó durante choque cardiogénico. Se comparó la mortalidad hospitalaria observada con la esperada según el índice EUROSCORE logístico y con la de otras series reportadas en la literatura. Resultados. La mediana de la edad fue 75 años, el 25% eran mujeres, el 83% hipertensos, el 33% tabaquistas activos, el 50% con antecedente de cirugía de revascularización previa, el 41% con infarto reciente y todos los procedimientos fueron de emergencia.. El éxito angiográfico fue del 100%, pero uno de los pacientes, a pesar del éxito angiográfico, evolucionó desfavorablemente y falleció. Todos fueron tratados con implante de stent y en aproximadamente 90% de los pacientes, también se trataron percutáneamente otras lesiones coronarias. El tiempo de seguimiento promedio fue 8,4 meses: se registró una muerte intrahospitalaria, una al mes de evolución y 2 después de un año del procedimiento; no se registró ningún infarto no fatal en el grupo de angina inestable asociado a la intervención percutánea. La mediana de EUROSCORE fue 11 puntos, la esperada para esta población. Conclusión. La angioplastia de rescate del TCI en el contexto de un síndrome coronario agudo es efectiva como procedimiento de rescate y conlleva baja mortalidad, aunque es necesaria mayor investigación para conocer su rol, en comparación a la cirugía de revascularización miocárdica.

Emergency Stenting of "unprotected" left main coronary artery stenoses. Primary results and follow-up. Introduction. Coronary-artery bypass grafting (CABG) has been the treatment of choice to treat complex coronary artery disease or left main coronary artery stenoses, although percutaneous coronary intervention involving stents is increasingly used to treat these forms of coronary disease in experienced centers. Objective. To evaluate results of emergency angioplasty with stenting of unprotected left main coronary artery stenoses in acute coronary syndromes associated with high risk or cardiogenic shock. Material and methods. Twelve percutaneous coronary interventions were performed on left main coronary artery obstructions; 6 patients were enrolled during acute myocardial infarction, 4 with high risk unstable angina and 2 because of left main coronary artery dissection during percutaneous interventions on other coronary arteries. In 4 patients, the intervention was performed during cardiogenic shock. Hospital mortality was recorded and compared with the expected rate, according to the EUROSCORE index. Results. The median age was 75 years and all procedures were performed as emergencies. Of the patients, 25% were women, 83% had hypertension, 33% were active smokers, 50% were patients with a history of prior CABG, and 41% had had a recent myocardial infarction. Angiographic success was 100%, but one patient died despite a successful coronary artery dilatation. All were treated with deployment of a stent. The average follow-up period was 8.4 months. There was 1 in-hospital death, 1 death occurred at the end of the first month of follow-up and 2 deaths occurred after a year from the initial procedure. There was no occurrence of a non-fatal myocardial infarction in the unstable angina group treated with percutaneous coronary intervention. The median EUROSCORE index was 11 points, as expected for this population. Conclusion. Rescue left main coronary artery angioplasty with stenting in the context of an acute coronary syndrome, is effective and carries a low mortality. Nevertheless, further investigation is necessary to evaluate the role of this approach as compared to CABG.

 Intervención coronaria Percutánea Revascularización quirúrgica Tronco Común de la Arteria Coronaria Izquierda Síndrome coronario agudo Percutaneous coronary intervention Surgical revascularization Left main corornary artery acute coronary syndrome García Robles JA García E Rico M Esteban E Emergency coronary stenting for acute occlusive dissection of the left main coronary artery Cathet Cardiovasc Diagn 1993 30 Ayman A El-Menyar, Jassim Al Suwaidi, David R. Holmes. Left Main Coronary Artery Stenosis: State-of-the-Art Curr Probl Cardiol 2007 32 Smith SC Jr Feldman TE Hirshfeld JW Jr Jacobs AK Kern MJ King SB American College of Cardiology/American Heart Association Task Force on Practice Guidelines; ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to update the 2001 Guidelines for Percutaneous Coronary Intervention) Circulation 2005 113 Chairperson SS Colombo A Hamm C Stone GW Wijns W Urban P Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Task Force Members. ESC Committee for Practice Guidelines European Heart Journal 2005 26 Smith SC Antman EM Alpert JS ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery) Developed in Collaboration With the American Association for Thoracic Surgery and the Society of Thoracic Surgeons Circulation 2004 110 Serruys PW PCI versus Coronary-artery bypass grafting for severe coronary artery disease N Engl J Med 2009 360 Caracciolo EA Davis KB Sopko G Comparison of surgical and medical group survival in patients with left main coronary artery disease: longterm CASS experience Circulation 1995 91 Nashef SA Roques F Michel P European system for cardiac operative risk evaluation (EuroSCORE) Eur Heart J 2003 M ay 24 9 Kim YH Ahn JM Park DW Lee BK Lee CW Hong MK EuroSCORE as a predictor of death and myocardial infarction after unprotected left main coronary stenting Am J Cardiol 2006 98 O’Keefe JH Hartzler GO Rutherford BD Left main coronary angioplasty: early and late results of 127 acute and elective procedures Am J Cardiol 1989 64 Laruelle CJ Brueren GB Plokker TH Stenting of "unprotected" left main coronary artery stenoses: early and late results Heart 1998 79 Ten Morro F Rincón de Arellano Castellví A Cebolla Rosell R Implantación emergente de stent intracoronario tras oclusión aguda del tronco común de la coronaria izquierda Rev Esp Cardiol 1998 51 Chieffo A Stankovic G Colombo A Early and Mid-Term Results of Drug-Eluting Stent Implantation in Unprotected Left Main Circulation 2005 111 Leguizamón J Azzari F Schipani G Angioplastia del tronco de la arteria coronaria izquierda no protegido en pacientes con alto riesgo quirúrgico Revista Argentina de Cardiología 2008 76 2 Serruys P Morice M-C Kappetein P Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease N Engl J Med 2009 M ar 360 10 Taggart DP Kaul S Boden WE Ferguson TB Jr Guyton RA Mack MJ Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery J Am Coll Cardiol 2008 51 Boden WE O’Rourke RA Teo KK Hartigan PM Maron DJ Kostuk WJ Optimal medical therapy with or without PCI for stable coronary disease N Engl J Med 2007 356
S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100003 Infección de Esternotomía Media Después de Cirugía Cardiovascular: Experiencia en el Hospital R.A. Calderón Guardia Soto Pernudi Susan Quirós Molina Pablo Chamorro Castro Rodrigo Garita Jiménez Elliott Robelo Pentzke Bayardo Salazar Vargas Carlos ,Hospital R.A. Calderón Guardia Servicio de Cirugía de Tórax y Cardiovascular San José Costa Rica 12 2010 2010 12 11 16

Introduccón y objetivo. La esternotomía media es la incisión que se emplea con más frecuencia en procedimientos quirúrgicos cardiovasculares. La infección de esta incisión puede ser superficial o profunda, conllevando alta morbilidad y mortalidad. Nuestro objetivo es determinar la incidencia, características, manejo y resultados de las infecciones en pacientes cardiovasculares operados mediante este abordaje en nuestro Hospital. Material y métodos. Se revisaron los expedientes clínicos de los individuos que desarrollaron infección superficial o profunda de su esternotomía media, desde el inicio del programa de cirugía cardiovascular en marzo de 2003 hasta abril de 2009 en el Hospital R.A. Calderón Guardia, Costa Rica. Resultados. Durante los 6 años del estudio, 525 pacientes fueron intervenidos mediante una esternotomía media; la mayoría eran hombres y padecían enfermedad arterial coronaria. Dieciocho (3.24%) pacientes desarrollaron infección: superficial en 4 y profunda en 14, solo 1 enfermo murió. Durante la reintervención se produjo un desgarro ventricular derecho, que no se pudo controlar. La infección esternal apareció en promedio en el 9no. día postoperatorio y el staphylococcus sp. fue el agente causal más común. A 9 de los 14 pacientes con infección profunda se les practicó drenaje y cierre con colgajo de pectoral mayor y los otros fueron manejados con medidas locales, cierre asistido por vacío y antibióticos sistémicos. Se identificaron factores de riesgo mayores como diabetes mellitus, obesidad, ventilacion postoperatoria prolongada e infección pulmonar. Conclusión. La infección de la esternotomía media continúa siendo un problema relativamente frecuente in pacientes sometidos a cirugía cardiovascular y conlleva alta morbilidad. Causan además mucho más trabajo y ansiedad para el equipo tratante y un elevado costo de la hospitalización. Por lo tanto, se debe tener presente esta complicación y tomar todas las medidas necesarias para evitarla.

Median Sternotomy Infections After Cardiovascular Surgery. R. A. Calderón Guardia Hospital Experience. Introduction and objective. Currently, median sternotomy is the most commonly employed approach for cardiovascular surgical procedures. Infection of this incision can be superficial or deep, carrying high morbidity and mortality. Our objective was to assess the incidence, characteristics, management and results of superficial or deep median sternotomy infections of patients operated upon using this approach in our medical center. Material and methods. The records of individuals who developed a superficial or deep median sternotomy incision infection were reviewed at the R.A. Calderon Guardia Hospital. This included the period from the opening of the cardiovascular surgery program in march 2003 until april 2009. Results. During the 6 year study period, 525 patients underwent a median sternotomy incision for cardiovascular interventions; most of the patients were male and most of them had coronary artery disease. Eighteen (3.24%), developed a sternal wound infection which was superficial in 4 and deep in 14. There was 1 death and this occurred as a consequence of a cardiac tear during reopening of the sternum for drainage and repair. The sternal wound infections appeared as an average on the 9th postoperative day and staphylococcus sp. was the most commonly isolated microorganism. Of the 14 patients with deep wound infections, 9 patients underwent drainage and pectoral muscle flap closure and the others were managed with local treatment, vacuum assisted closure and systemic antibiotics. The major risk factors identified for a sternal wound infection were diabetes mellitus, obesity, prolonged postoperative ventilation, and pulmonary infection. Comment. Median sternotomy infections continue to be a relatively frequent problem in patients undergoing cardiovascular operations. Such infections carry serious morbidity and they impose an extra workload and anxiety for the treating team, along with a significant increase in the cost of hospitalization. Therefore, this possible complication must be kept in mind and all measures should be taken to avoid it.

 Arteria mamaria interna cirugía cardiaca infección esternal mediastinitis revascularización Internal mamary artery cardiac surgery revascularization mediastinitis sternal infections Dalton ML Connally SR Sealy WC Julian`s reintroduction of Milton`s operation Ann Thorac Surg 1992 53 Careaga G Aguirre G Medina L Borrayo G Prado G Agüero R Factores de riesgo para mediastinitis y dehiscencia esternal después de cirugía cardiaca Rev Esp Cardiol 2006 59 Bitkover CY Gardlung B Mediastinitis after cardiovascular operations: a case control study of risks factors Ann Thor Surg 1998 65 Combes A Trouillet JL Baudot J Mokhtari M Chastre J Gibert C Is it possible to cure mediastinitis in patients with major post cardiac surgery complications Ann Thorac Surg 2001 72 Elizondo J Pucci JJ Soto L Cierre asistido con presión negativa (VAC), en el tratamiento de esternotomia infectada: Primer caso en Latinoamérica Rev Costarric Cien Med 2001 22 Gustafsson RI Sjogren J Ingemansson R Deep sternal wound infection: a sternal sparing technique with vacuum assited closure therpy Ann Thorac Surg 2003 76 Tang G Maganti M Weisel RD Borger M Prevention and management of deep sternal wound infections Semin Thorac Cardiovasc Surg 2004 16 Borger M Rao V Weisel RD Ivanov J Cohen G Scully HE Deep sternal wound infections: factors and outcomes Ann Thorac Surg 1998 65 Crabtree TD Codd JE Fraser VJ Bailey MS Olsen M Damiano RJ Multivariate analysis of risk factors for deep and superficial sterna nfections after coronary artery bypass grafting at a tertiary care medical center Sem Thorac Cardiovasc Surg 2004 1 Braxton JH Marrin CA Mc Grath PD Morton JR Norotsky M Charlesworth DC 10-year follow-up of patients with and without mediastinitis Sem Thorac Cardiovasc Surg 2004 1 Fynn-Thompson F Vander Salm TJ Methods for reduction of sternal wound infection Semin Thorac Cardiovasc Surg 2004 16 Pezzella T Mediastinitis following open heart surgery Sem Thorac Cardiovasc Surg 2004 1 Matsa M Paz Y Gurevitch J Shapira I Kramer A Pevney DJ Bilateral skeletonized internal thoracic artery grafts in patients with diabites mellitus Thorac Cardiovasc Surg 2001 121 Arnold M The surgical anatomy of sternal blood supply J Thorac Cardiovasc Surg 1972 64 Grossi EA Esposito R Harris LJ Crooke GA Galloway AC Colvin SB Sternal wound infections and use of internal mammary artery grafts J Thorac Cardiovasc Surg 1991 102 He GW Ryan WH Acuff TE Bowman RT Douthit MB Yang CQ Risk factors for operative mortality and sternal wound infection in bilateral internal mamamary artery grafting J Thorac Cardiovasc Surg 1994 107 Grossi EA Culliford AT Krieger KH Kloth D Press R Baumann G Spencer FC A Survey of 77 major infectious complications of median sternotomy: a review of 7949 consecutive operative procedures Ann Thorac Surg 1985 40 Francel TJ A rational approach to sternal wound complications Semin Thorac Cardiovasc Surg 2004 16 Fynn-Thompson F Vander Salm TJ Methods for reduction of sternal wound infections Semin Thorac Cardiovasc Surg 2004 16 Robicsek F Daugherty H Cook JW The prevention and treatment of stemum separation following open-heart surgery J Thorac Cardiovasc Surg 1977 73 Seyfer AE Graeber GM Akind FF Seyfer AE Graeber GM Wind GG The pectoralis major muscle and musculocutaneous flaps Atlas of chest wall reconstruction Atlas of chest wall reconstruction 1986 Rockville, Md Aspen Publishers
S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100004 Insuficiencia Cardíaca y Dislipidemias: Rol actual de las Estatinas Speranza Sánchez Mario O ,Hospital Clínica Bíblica Clínica de Insuficiencia Cardiaca San José Costa Rica 12 2010 2010 12 17 21

La insuficiencia cardíaca es parte de la progresión de las enfermedades cardiovasculares que se inician tempranamente con la aparición de factores de riesgo y evolucionan a través del continuo cardiovascular, hasta desencadenar en daño orgánico irreversible y la muerte. La intervención terapéutica con los inhibidores de la HMG-CoA reductasa (estatinas) ha demostrado reducir la mortalidad y morbilidad cardiovascular en pacientes con dislipidemia o enfermedad arterial coronaria. Sin embargo, en pacientes con insuficiencia cardíaca crónica, los beneficios sobre la morbimortalidad que arrojaron estudios iniciales observacionales, retrospectivos y análisis post-hoc de ensayos aleatorizados pequeños han sido cuestionados, a la luz de los resultados de investigaciones recientes de gran tamaño, aleatorizados, doble ciego y controlados con placebo. En esta revisión se analizan algunos de estos estudios y se intenta dar respuesta a las controversias generadas, con algunas recomendaciones finales.

Heart failure and dyslipidemia: the role of statins Heart failure is part of the progression of heart diseases in the cardiovascular continuum. The treatment with the HMGCoA inhibitors (statins) has shown benefit in reducing mortality and morbidity in patients with dyslipidemia and coronary artery disease. In addition, in patients with heart failure, benefit of statins has also been reported but only in observational, retrospective and post-hoc analysis of small randomized trials. Recently, with new data available from randomized, doubleblind, placebo-controlled trials with thousands of patients, statin therapy failed to show any beneficial effect on outcome in heart failure patients despite significant reductions in low-density lipoprotein and high sensitivity C- reactive protein. In this review, we discuss unresolved issues and recent findings regarding the use of statins in heart failure.

 Insuficiencia cardíaca Estatinas heart failure statins Baker DW Prevention of Heart Failure J Card Fail 2002 8 Randomised trial of cholesterol lowering in 4444 patients with CHD: the Scandinavian Simvastatin Survival Study (4s) Lancet 1994 344 Kjekshus J Pedersen TR Olsson AG Faergeman O Pyorala K The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease J Card Fail 1997 3 Lewis SJ Moye LA Sacks FM Johnstone DE Timmins G Mitchell J Limacher M Kell S Glasser SP Grant J Davis BR Pfeffer MA Braundwald E Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol level in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial Ann Intern Med 1998 129 Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels N Engl J Med 1998 339 Rubins HB Robins SJ Collins D Fye CL Anderson JW Elam MB Faas FH Linares E Schaefer EJ Schectman G Wilt TJ Wittes J Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high density lipoprotein cholesterol: Veterans Affairs High Density Lipoprotein Cholesterol Intervention Trial Study Group N Engl J Med 1999 341 Fischer D Rossa S Landmesser U Spiekermann S Engberding N Horing B Drexler H Endothelial dysfunction in patients with chronic heart failure is independently associated with increased of hospitalization, cardiac transplantation, or death European Heart Journal 2005 26 Packard C Improving outcomes through statin therapy a review of ongoing trials European Heart Journal Supplements 2004 6 ^sA Kjekshüs J Apetrei E Barrios V Rosuvastatin in Older Patients with Systolic Heart Failure N Engl J Med 2007 357 Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomized, double-blind, placebo-controlled trail Lancet 2008 372 Ghio S Scelsi L Eleuteri E Effect of N-3 Polyunsaturated fatty acid and rosuvastatin on left ventricular function in patients with chronic heart failure: A substudy of the GISSI-HF trail J Am Coll Cardiol marc h 9, 55 10A Krum H Tonkinm A The rosuvastatin impact on ventricular remodeling, cytokines and neurohormones (UNIVERSE) study J Am Coll Cardiol 2006 47 4 Lipinski MJ Cauthen CA Biondi-Zoccai GGL Meta-Analysis of Randomized Controlled Trials of Statins Versus Placebo in Patients With Heart Failure Am J Cardiol 2009 104 Sadek MM Haddad T Haddad H The role of statins in chronic heart failure Curr Opin Cardiol 2009 24 Vasan RS Sullivan LM Roubenoff R Inflamatory markers and risk of heart failure in eldery subjects without prior myocardial infarction: the Framingham Heart Study Circulation 2003 107 Khush KK Waters DD Effects of statin theraphy on the development and progression of heart failure: Mechanisms and clinical trials Journal of Cardiac Failure 2006 12 8 Shanes JG Minadeo KN Moret A Groner M Tabaie SA Statin therapy in heart failure: Prognostic effects and potential mechanisms Am Heart J 2007 154 Ridker PM Danielson ED Fonseca FAH Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein N Engl J Med 2008 359 Charach G George J Roth A Baseline Low-Density Lipoprotein Cholesterol Levels and Outcome in Patients with Heart Failure Am J Cardiol 2010 105 Grundy SM Cleeman JI Bairey Merz CN Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Circulation 2004 110 Tang WHW Francis GS Nat. Rev. Cardiol 16 M ar ch Cleland JG McMurray JJ Kjekshus J Plasma concentration of aminoterminal pro-brain natriuretic peptide in chronic heart failure: prediction of cardiovascular events and interaction with the effects of rosuvastatin: a report from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) J Am Coll Cardiol 2009 54
S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100005 Choque cardiogénico: Historia, fisiopatología e implicaciones terapeúticas. Parte II Zeledón S Fernando Méndez J Edgar Pucci C Juan Escalante G Carlos Estrada G Carlos ,Hospital México Servicio de Cirugía de Tórax y Cardiovascular San José Costa Rica ,Hospital México Servicio de Cirugía de Tórax y Cardiovascular San José Costa Rica ,Hospital San José San José Costa Rica 12 2010 2010 12 23 32

El choque cardiogénico es la principal causa de muerte entre los pacientes que presentan un síndrome coronario agudo. Después de la revisión histórica y de los conceptos fisiológicos y fisiopatológicos de esta condición clínica expuesta en la primera parte, se revisa su abordaje terapéutico, principalmente la revascularización de emergencia con angioplastía o cirugía.

Cardiogenic shock: History, pathophysiology and therapeutical implications. Part II. Cardiogenic shock is the first cause of death among patients with acute coronary syndromes. After a previous discussion of the history and the physiologic and pathophysiologic aspects of this clinical condition in part 1, we review the therapeutic management which predominantly involves urgent angioplasty with stenting or coronary artery bypass graft surgery.

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Saunders Co Mohrman Heller LJ Fisiología Cardiovascular Fisiología Cardiovascular 2007 México D.F McGraw-Hill Sperelakis N Heart Physiology an Pathophysiology Heart Physiology an Pathophysiology 2001 Philadelphia Academic Press van der Vusse G van Bilsen M Glatz J Cardiac fatty acid uptake an transport in health an isease Cardiovascular Research 2000 45 Williams S Wright D Tan L Management of cardiogenic shock complicating acute myocardial infarction: towards evidence base medical practice Heart 2000 83 Marín-García J Goldenthal M Fatty acid metabolism in cardiac failure: biochemical,genetic an cellular analysis Cardiovacular Research 2002 54 Stanley W Recchia F Lopaschuk G Myocardial Substrate Metabolism in the Normal an Failing Heart Physiol Rev 2005 85 Stanley W Lopaschuck G McCormack J Cardiovascular Research 1997 34 Lopaschuck G Folmes C Stanley W Cardiac Energy Metabolism in Obesity Circ Res 2007 101 Taegtmeyer H King L Jones B Energy Substrate Metabolism,Myocardial Ischemia,an Targets for Pharmacotherapy Am J Cardiol 1998 82 Schwenk R Luiken J Bonen A Regulation of sarcolemmal glucose and fatty acid trasnporters in cardiac isease Cardiovascular Research 2008 79 Ingwall J Weiss R Is the Failing Heart Energy Starve: On Using Chemical Energy to Support Cardiac Function Circ Res 2004 95 Patterson B Fields A Shannon R New insights into myocardial glucose metabolism: surviving under stress Curr Opin Clin Nutr Metab Care 2009 12 Sadoshima J Izumo S The Cellular And Molecular Response of Cardiac Myocytes to Mechanical Stress Annu Rev Physiol 1997 59 Ulate G Fisiología renal Fisiología renal 2006 San José Editorial Universidad de Costa Rica Debrunner M Schuiki E Minder E Proinflammatory cytokines in acute myocardial infarction with and without cardiogenic shock Clin Res Cardiol 2008 97 Sherwood E Mechanisms of the inflammatory response Best Practice & Research Clinical Anaesthesiology 2004 18 Kohl B Deutschman C The inflammatory response to surgery and trauma Curr Opin Crit Care 2006 12 Pfisterer M Right ventricular involment in myocardial infarction and cardiogenic shock Lancet 2003 362 Vlahakes G Right ventricular failure following cardiac surgery Coronary Artery Disease 2005 16 Gogo P The Evaluation and Management of Cardiogenic Shock Crit Pathways in Cardiol 2006 5 Gurm H Bates E Cardiogenic Shock Complicating Myocardial Infarction Crit Care Clin 2007 23 Antonelli M Levy M Andrews P Hemodynamic monitoring in shock and implications for management Intensive Care Med 2007 33 International Consensus Conference 27-28 April 2006 Paris Pinsky M Hemodynamic Evaluation and Monitoring in the ICU Chest 2007 132 Pinsky M Rationale for cardiovascular monitoring Curr Opin Crit Care 2003 9 Pinsky MR Payen D Functional Hemodynamic Monitoring Functional Hemodynamic Monitoring 2005 ^eNew York Springer Tibby S Murdoch I Monitoring cardiac function in intensive care Arch Dis Child 2003 88 Hoffman G Ghanayem N Tweddell J Noninvasive Assessment of Cardiac Output Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2005 8 Liepert D Rosenthal M Thomas S Shock: A Comparative Physiologic Approach to Mechanisms and Therapy Seminars in Anesthesia, Perioperative Medicine and Pain 1999 18 Hett D Jonas M Non-invasive cardiac output monitoring CurrentAnaesthesia & Critical Care 2003 14 Kuper M Continous cardiac output monitoring Current Anaesthesia & Critical Care 2004 15 Maus T Lee D Arterial Pressure-Based Cardiac Output Assessment Journal of Cardiothoracic and Vascular Anesthesia 2008 22 Gelman S Venous Function and Central Venous Pressure Anesthesiology 2008 108 Madger S Central venous pressure: A useful but not so simple measurement Crit Care Med 2006 34 Hadian M Pinsky M Functional hemodynamic monitoring Curr Opin Crit Care 2007 13 Fincke R Hochman J Lowe A Cardiac Power Is the Strongest Hemodynamic Correlate of Mortality in Cardiogenic Shock: A Report from the SHOCK Trial Registry J Am Coll Cardiol 2004 44 Hasdai D Topol E Califf R Cardiogenic 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S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100006 Araya Gómez Vivien ,Centro Radiológico Integral San José Costa Rica 12 2010 2010 12 33 33
S1409-414220100001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422010000100007 El Nacimiento de la clínica: Una arqueología de la mirada médica , 12 2010 2010 12 34 34