Investigación reciente

Congenit Heart Dis. 2008 Jan;3(1):16-25

Health behaviors among adolescents and young adults with congenital heart disease

Reid GJ, Webb GD, McCrindle BW, Irvine MJ, Siu SC.
Contact: Department of Psychology, University of Western Ontario, London, Ontario, Canada.

OBJECTIVES: Document the frequency of substance use and oral hygiene among adolescents and young adults with moderate to complex congenital heart disease (CHD).
BACKGROUND: Patients' knowledge of health behaviors, including substance use and oral hygiene, has been examined among patients with CHD, but patients' actual behavior has not been studied. Understanding patients' behavior is needed to inform interventions that enhance healthy lifestyles, and in turn encourage patients to better care for their own health.
METHODS: Young adults (19 or 20 years old) and older adolescents (16-18 years old) with moderate or complex CHD (n = 328) reported their substance use (i.e., smoking, marijuana, alcohol, other illicit drugs) and oral hygiene. Rates of these health behaviors were contrasted with comparison samples of peers of the same age.
Just over half of the young adults (54%) and over one-quarter of the adolescents (28%) reported significant substance use (i.e., smoking cigarettes on more than 2 days, using marijuana or other illicit drugs at least once, or binge drinking) during the previous 30 days. Rates of significant substance use among the patients with CHD were either comparable to, or lower than, rates in comparison samples of similar aged peers. Only about 15% of the patients with CHD had excellent oral hygiene (i.e., self-reported annual teeth cleaning by dentist, brushing and flossing daily); however, virtually all patients (>95%) brushed daily. Patients with CHD generally had comparable oral hygiene to comparison samples in previously published data.
CONCLUSIONS: Many older adolescents and young adults with CHD are engaging in behaviors that may compromise their health. The impact of substance use and poor dental hygiene warrants further investigation. Nevertheless, health behaviors should be routinely discussed in this population.

Przegl Lek. 2005;62(10):1148-50.

Education program about tobacco for medical students

Florek E, Piekoszewski W
Contact: Laboratory of Environmental Research, Department of Toxicology, University of Medical Sciences, Poznan, Poland.

Tobacco smoking is one of the principal causes of morbidity and mortality in the worldwide. By the year 2030, more than four million people per year worldwide will die of tobacco-related cause. No other consumer product is as dangerous as many people. Tobacco causes more deaths than any other dependence-producing substances, e.g. poor diet, alcohol, bacterial infections, poisoning, firearms, and illicit drugs. The morbidity and the mortality associated with tobacco use is caused by several toxic substances (e.g. nicotine, polynuclear aromatic hydrocarbons, aza-arenes, N-nitrosamines, aromatic amines, acrylonitrile, crotonaldehyde, vinyl chloride, formaldehyde, benzene, inorganic compounds). Tobacco smoking is a major independent risk factor for chronic obstructive pulmonary diseases (COPD), cancer (lung, larynx, pharynx, oesophagus, pancreas, kidney, urinary bladder, nasal cavity, uterine cervix), coronary heart disease (CHD) and reproduction. In 2004 42% of Polish man and 23% Polish women smoked. This publication presents a program that has been designed to educate medical students (fourth or fifth year) about tobacco in University of Medical Sciences. There are two parts in total six hours education. Part I is concerned with the epidemiology of smoking, the toxicology of tobacco smoke, the health effects of tobacco use, the process of smoking cessation, the treatment for smokers, and smoking prevention. Part II (workshops) deals with teaching medical students how to motivate patients to stop smoking. The second part consist of: identifying the smoker, taking a smoking history, evaluation of the level of dependence and assessing the smoker's readiness to stop smoking, motivating smokers to change, and preventing relapse. Both parts (theory and practical sessions), are scheduled to take three hours each.

Anesth Analg. 2009 Mar;108(3):777-85

Cardiac surgery in the parturient

Chandrasekhar S, Cook CR, Collard CD.
Contact: Baylor College of Medicine Division of Cardiovascular Anesthesiology at the TX Heart Institute, St. Luke's Episcopal Hospital, 6720 Bertner Ave., Room 0520, Houston, TX 77030. ccollard@bcm.tmc.ed.

Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L . min(-1) . m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

Int J Cardiol. 2008 Jun 23;127(1):93-7. Epub 2007 Aug 10

Smoking and its effects on mortality in adults with congenital heart disease

Engelfriet PM, Drenthen W, Pieper PG, Tijssen JG, Yap SC, Boersma E, Mulder BJ.
Contact: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.

AIMS: To describe smoking habits in adults with congenital heart disease (ACHD) and to assess the relationship between smoking exposure and cardiovascular mortality.
METHODS: Data on smoking history and cardiovascular mortality were extracted from the Euro Heart Survey on adult congenital heart disease - a retrospective cohort study, that included patients diagnosed with 1 of 8 subgroups of ACHD (Atrial Septal Defects, Ventricular Septal Defects, Marfan Syndrome, Aortic Coarctation, Tetralogy of Fallot (ToF), Transposition of the Great Arteries (TGA), Fontan circulation, and Cyanotic disease).
RESULTS: Complete data of 3375 ACHD patients (median age 28 years) were available for analysis. At inclusion, 9.3% (n=314) were current smokers and 4.2% (n=142) of the patients had smoked in the past. During a median follow-up of 5.1 years, 101 patients (3%) died. In the majority of cases the cause of death was cardiovascular (n=81; 80%). Kaplan-Meier and Cox survival analysis for each of the defects separately showed a significantly increased age and sex-adjusted cardiovascular mortality associated with smoking exposure in TGA patients (Hazard ratio 4.2 (95% CI 1.0-16.8); P=0.044). Also in ToF mortality was higher amongst smokers, though not significantly (HR 3.4 (95% CI 0.6-18.5); P=0.15). In the remaining defects no relationship between smoking and cardiovascular mortality was observed.
CONCLUSION: The prevalence of smoking amongst ACHD patients is relatively low. Smoking exposure is associated with increased cardiovascular mortality in patients with TGA. Prospective long-term follow-up studies are necessary.

Cardiovasc Nurs. 2007 Nov-Dec;22(6):488-92

Outpatient nursing clinic for congenital heart disease patients: Copenhagen Transition Program

Berg SK, Hertz PG.
Contact: Copenhagen University Hospital, The Heart Center, Copenhagen, Denmark.

Adolescents with congenital heart disease need support transitioning from childhood to adulthood. To become independent, adolescents need to possess knowledge about the disease and how to handle life with congenital heart disease. Outpatient nursing clinics can address issues relevant for adolescents. Creating an environment in which worries and questions can be discussed better prepares adolescents to meet the struggles of living with congenital heart disease. The Copenhagen Transition Program was established in 2004. This outpatient nursing clinic was established by (1) defining the target group, (2) conducting a literature review, (3) collaborating with interdisciplinary colleagues, (4) scheduling visits to the transition-nursing clinic, (5) arranging clinic visits, (6) charting, and (7) testing and evaluating the clinic. Adolescents with congenital heart disease are invited to a consultation with a specially trained nurse, and it is the patients themselves who decide the content of the consultation. Topics such as knowledge about the disease, endocarditis, acute situations, nutrition, contraception, alcohol/drugs, smoking, physical activity, sleep/rest, and education may be discussed. Parents are asked not to participate.

Int J Cardiol. 2007 May 31;118(2):141-4. Epub 2006 Sep 26

Marijuana as a trigger of cardiovascular events: speculation or scientific certainty?

Aryana A, Williams MA.
Contact: Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street-GRB-109, Boston, MA 02114, USA.

Marijuana is the most widely used illicit substance in the United States. Cardiovascular complications in association with marijuana use have been reported during the past three decades. In view of the elevated public interest in this drug's role in pharmacotherapy in the recent years and the aging population of long-term marijuana users from the late 1960s, encounters with marijuana-related cardiovascular adversities may be silently on the rise. The purpose of this article is to increase awareness of the potential of marijuana to lead to cardiovascular disease. Here, we will discuss the physiologic effects of marijuana and include a comprehensive review of the studies and case reports that provide supportive evidence for marijuana as a trigger of adverse cardiovascular events, including tachyarrhythmias, acute coronary syndrome, vascular complications, and even congenital heart defects.