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LA INSUFICIENCIA CARDIACA CRONICA DESCOMPENSADA Y LA PROBLEMATICA DE LA CONGESTION (especial para SIIC © Derechos reservados) |
| Se analizan los datos disponibles a la fecha sobre una población de pacientes con cardiopatías dilatadas que recuperaron la fracción de eyección. Se evalúa la posibilidad de considerar esta población como una nueva entidad clínica dentro del continuum de la insuficiencia cardíaca con un fenotipo distinto a aquellos con insuficiencia cardíaca y fracción de eyección preservada. |
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Autor: Lilia Luz Lobo Marquez Columnista Experta de SIIC Institución: Instituto de Cardiología Artículos publicados por Lilia Luz Lobo Marquez |
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Recepción del artículo 15 de Septiembre, 2011 |
Aprobación 31 de Enero, 2012 |
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Primera edición 24 de Mayo, 2012 |
Segunda edición, ampliada y corregida 2 de Agosto, 2012 |
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ResumenLa congestión en pacientes con insuficiencia cardíaca (IC) crónica descompensada no sólo refleja fracaso del músculo cardíaco. Las presiones de llenado elevadas favorecen la progresión de la IC y la muerte celular. Tratar la "congestión clínica" no sólo es "calmar síntomas"; tenemos evidencia de que las intervenciones terapéuticas destinadas a descender la presión capilar pulmonar elevada cambian el pronóstico de esta población, con un impacto mayor que la mejoría del IC. Sin embargo, existen grandes dificultades en el diagnóstico de patrones congestivos. Parte de este fracaso se explica no sólo por lo tardío de la presentación clínica, sino por la frecuente disociación entre examen clínico y perfiles hemodinámicos. Conocer e intervenir precozmente patrones de congestión hemodinámica (etapa preclínica) tiene efecto favorable en la calidad de vida; nos queda definir el impacto en la supervivencia. Los avances tecnológicos actuales permitirán detectar variaciones hemodinámicas tempranas. Vamos en camino de sistemas de monitorización cada vez más inteligentes. La combinación de múltiples elementos diagnósticos podrá incrementar la utilidad clínica de la monitorización con dispositivos. Nuestro mayor desafío actual y futuro es implementar nuevas estrategias de manejo basadas en estas novedosas tecnologías.
Palabras claveinsuficiencia cardíaca crónica, congestión clínica, congestión hemodinámica, monitorización con dispositivos Clasificación en siicsalud Artículos originales > Expertos del Mundo > página www.siicsalud.com/des/expertocompleto.php/ Especialidades 
Principal: Cardiología
Relacionadas: Cuidados Intensivos,
Cirugía,
Geriatría,
Medicina Interna
Enviar correspondencia a:Lilia Luz Lobo Márquez, Instituto de Cardiología, 4000, Av Mitre 760, San Miguel de Tucumán, Argentina
Key wordschronic heart failure, clinical congestion, hemodynamic congestion, devices monitoring
Bibliografía del artículo
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J Am Coll Cardiol 2009;54:1683–94 |
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