PDF | El Tratado de cardiología clínica pretende realizar una puesta al día del complejo mundo de la cardiología, con un enfoque eminentemente práctico y con. Download Citation on ResearchGate | Tratado de cardiología / compilado por Eugene Braunwald | Traducción de: Heart disease: a textbook of cardiovascular . Obra de referencia en Cardiología que pretende seguir siendo un recurso fundamental en todos los aspectos de la Cardiología contemporánea proporcionando.
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Tratado de Cardiologia Clinica: Volumen 1 & 2. ISBN: # | Date: Description: PDFbb | [Text is in Spanish] El contenido textual y . Read the latest articles of EMC - Tratado de Medicina at mtn-i.info, Elsevier's leading platform Pages Download PDF Cardiologia- angiologia. En: Braunwald E, editor: Tratado de Cardiología. 7ª ed. Madrid: Elsevier; p. British Thoracic Society, Standards of Care Committee. Suspected.
Surveillance cardiac tomography CT showed the aneurysm continuing to expand, extending towards the chest wall and causing erosion of the ribs Figure 1. Figure 1. ECG-gated cardiac computed tomography of our patient showing the natural history of a left untreated type 1 endoleak arrowhead at the proximal edge of a stent-graft in the aortic arch Ao. Upper panel A1—C1 presents three-dimensional reconstructions volume-rendering technique ; lower panel A2—C2 presents the corresponding images in the axial plane maximum intensity projection.
After two years, the patient caught influenza with intense cough and suddenly noticed a pulsatile lump in his left chest wall. A new CT revealed the aneurysm expanding through the first left intercostal space, reaching the chest wall surface Figure 2. Figure 2.
The procedure was successful with complete endoleak exclusion and no major post-procedure complications. The patient was discharged home but died two months later. The exact cause of death remains to be elucidated there was no autopsy. Ten years later, James T. Dove insists that we are still unprepared to care for the elderly because of the lack of training of medical specialists 3.
The increase in population longevity requires doctors to be trained to provide medical assistance to this emerging patient category. Considering the epidemiology of cardiovascular diseases, cardiologists are the obvious responsible physicians for the health care of the elderly. The increased prevalence of elderly patients with cardiovascular disease in emergency rooms, clinics, and hospital wards is significant to the point that many healthcare service providers have created specific clinics for cardiogeriatric care.
Moreover, these patients frequently present with heart disease with associated complications. Geriatric care should be differentiated and effective. However, clinical cardiologists are usually unprepared to care for the elderly, thus reinforcing the need for adequate training of medical students, for this purpose, from as early as undergraduate level.
In this instance, Dr. Mauricio Wajgarten was elected as the first president of the group.
In , we held a conference entitled "Why cardiogeriatrics? We indicated that the focus should not be specialization but rather differentiation via which doctors gain knowledge and practice different aspects of cardiovascular disease in the elderly. Moreover, this study group was encouraged to create a department, which occurred in during the administration of Dr. Since then, other research groups interested in this topic have been established in Brazil and have promoted local courses and regional and national meetings, many of them in partnership with the Geriatrics Societies, which has greatly enriched the debates.
In and , the first 4 and second 5 Guidelines in Cardiogeriatrics were published. The second guideline included the participation of ACC members. Moreover, CD-BCS members participated in the publication of books 6 and treaties on geriatrics and gerontology 7. In , the CD-BCS had the opportunity to give a course during the ACC Congress, in conjunction with the Society of Geriatric Cardiology, and the high-standard lectures resulted in the publication of two scientific papers 8 , 9.
The goals of the CD-BCS include: To train doctors and other health care professionals to adequately care for the elderly patients with cardiac diseases; To promote continuing education; To conduct research and multicenter studies 8 ; To disseminate cardiogeriatrics-related topics among health care professionals and the general population, as occurred in the CD-BCS Congress held in Gramado, state of Rio Grande do Sul, Brazil.
The technological and therapeutic advances of the past 20 years have led to the successful treatment of cardiac diseases in adults, with a consequent increase in patient survival rate.
Natural evolution creates new diseases and pre-existing diseases can reappear at an older age. The treatment approach for the elderly is still generally based on medical evidence regarding the elderly population.
In addition, studies that specifically involve the elderly population are of limited value because they select particular study groups and exclude those with severe comorbidities or frailties, thus limiting our understanding of the elderly heart patients The elderly should be evaluated on the basis of the concept of a comprehensive clinical approach.
The medical specialties indicate the limits of our competence. Because of the ever-expanding medical knowledge, we are unable to fully comprehend all areas of expertise; therefore, each medical field is divided into specialties and subspecialties.
However, this system is of limited applicability when caring for the elderly. These individuals should be viewed as patients who have various conditions, who are often frail, and who also suffer from heart disease. The elderly population exhibit three characteristics that must be addressed: frailty, disability, and comorbidity Furthermore, the quality of communication with older people is limited, because of deficits of hearing, vision, attention, memory, understanding, and even the lack of sufficient literacy proficiency Geriatric health generally receives little attention.
However, we believe that the benefits of the medical advancements should also be applied to this age group. Despite the increased risk of the medical procedures performed on this age group, the benefits are also greater.
Furthermore, we should avoid what we call omission iatrogeny 13 , 14 , which is the failure to perform a certain treatment whose benefits have been demonstrated. Geriatric care should be differentiated and free of any generalization, stereotype, and prejudice Physicians should be trained to view the patient as a whole, with limitations and clinical complications potentially associated with heart disease The document comprises guidelines for the training of cardiologists and for the obtaining of the degree of specialist.
One of the issues discussed in the document is related to cardiovascular diseases among the elderly. In this context, the departments and study groups should provide the pedagogical resources for each item described in the guideline. A training program for the comprehensive geriatric care should include: A comprehensive geriatric assessment, including physical, functional, and psychosocial evaluation, as well as understanding the family dynamics of the elderly patients; The ageing and physiological processes of the elderly patients; Job training and coordination of the participants with a multidisciplinary team; Discussion of the ethical and legal aspects related to geriatric care; Discussion of death with dignity and respect for the choices of the patient with regards to longevity and quality of life; Economic aspects and institutionalization; Pharmacokinetics and pharmacodynamics of the drugs administered to these patients, polypharmacy, and drug interactions; Nutrition for the elderly; General and specific prevention of cardiovascular diseases; Application of evidence-based medicine in geriatric care; Communication training; Perform the activities of clinicians along the lines of classical medicine.
The training components should include: Specific geriatric care clinics; Availability of hospital beds in clinical and surgical wards; Liaison with other geriatric care segments; Geriatric care in the emergency room and ICU; Seminars by experts forensic specialists, economists, lawyers, etc.
To accomplish these steps, cardiologists should be trained and well prepared