Carcinoid syndrome is characterized by the presence of a carcinoid tumor that can release chemical mediators that, if not adequately controlled, can even lead to carcinoid crisis. In this condition occurs hemodynamic instability, with distributive shock, bronchospasm, and cardiac arrhythmias. Carcinoid tumors have an incidence of 1-2 cases per 100,000 patients, and 20-30% of them present episodic vasomotor symptoms such as bronchospasm, hypotension and diarrhea secondary to therelease of vasoactive amines. Because it is an infrequent situation, we present the anesthetic management of a patient withcarcinoid syndrome undergoing surgery for tricuspid and pulmonary valve replacement, where we indicate the procedure forinduction, maintenance and termination of anesthesia without any reported events. The risk of a carcinoid crisis must beconsidered, in conjunction with a multidisciplinary approach to ensure effective surgery.

Intimal sarcoma (IS) is an extremely rare but aggressive malignant tumor and is now recognized as the most frequent primary malignancy of the heart and great vessels. Its clinical presentation is often non-specific, frequently mimicking common conditions such as pulmonary embolism or cardiac myxoma, leading to significant diagnostic delays. This case series describes four women with IS in various locations: two in the left atrium with mitral valve involvement, one in the main pulmonary artery, and one presenting as a pulmonary mass. Diagnosis relied on multimodal imaging, including echocardiography, computed tomography, and magnetic resonance imaging, followed by histopathological confirmation. Microscopic analysis revealed marked cellular pleomorphism and high mitotic activity. Immunohistochemistry (IHC) was essential for the final diagnosis, as all cases demonstrated nuclear mouse double minute 2 (MDM2) expression, a defining marker associated with gene amplification. Other markers, such as h-caldesmon and diffuse cluster of differentiation 31, were negative, effectively excluding leiomyosarcoma and angiosarcoma. Given its poor prognosis and high embolic potential, early recognition and radical surgical resection remain crucial for patient survival. This series emphasizes the clinical relevance of considering IS in the differential diagnosis of intracardiac and endovascular masses, highlighting MDM2 IHC as a reliable diagnostic tool.

Floating thrombus of the thoracic aorta is an uncommon but potentially catastrophic source of systemic embolization. Although most cases are associated with structural abnormalities of the aortic wall, pre-operative imaging may occasionally suggest an isolated intraluminal thrombus, with the underlying pathology becoming evident only during surgical exploration. We report the case of a 49-year-old woman with active tobacco use who presented with progressive pain and dysesthesia of the left upper limb and was diagnosed with brachial artery thrombosis. Computed tomography angiography revealed an intraluminal thrombus within the aortic arch, while echocardiography showed a large, highly mobile pedunculated mass attached to the lesser curvature. Given the high risk of recurrent embolization, urgent surgical intervention was performed. Intraoperative inspection identified a giant floating thrombus measuring approximately 8 cm. Further exploration revealed an ulcerated lesion with a contained dissection of the ascending aorta, considered the likely nidus for thrombus formation. The thrombus was removed, and the affected ascending aortic segment was resected and reconstructed using a supracoronary Dacron graft. The post-operative course was uneventful, and the patient was discharged on oral anticoagulation. This case highlights a key diagnostic limitation of pre-operative imaging and supports surgical exploration as both a diagnostic and therapeutic strategy in selected high-risk patients.

Cardiovascular diseases (CVD) are among the top causes of morbidity and mortality among Mexican adults. Night shift work disorder (NSWD) has been reported as a possible risk factor for CVD. The objective of this review was to determine whether there is an association between CVD and NSWD in nurses. We performed a systematic review of these variables in PubMed. Of 68 original research articles addressing CVD and NSWD in nurses, four found an association between CVD and NSWD. A possible association between these variables was documented, supported by the alteration of wake/sleep circadian cycles and the work schedules that characterize nursing work. In conclusion, there is a possible mild association between CVD and NSWD, in nurses. Preventive and early diagnosis and treatment measures must be developed for nursing staff that works night shifts in hospitals to reduce CVD.

The objective was to analyze the effect of pulmonary expansion exercises on pulmonary functional capacity in patients undergoing cardiac surgery. An integrative review with a quantitative approach was conducted, structured based on methodological principles of PRISMA 2020. The research question was formulated using the PIO framework. The literature search was performed in PubMed, BVS, Journal of PeriAnesthesia Nursing, Epistemonikos, SciELO, ScienceDirect, and EBSCO, using DeCS and MeSH terms combined with Boolean operators. A total of 45 potentially relevant studies were identified, of which 12 met the inclusion criteria, incorporating both primary studies and systematic reviews. Methodological quality was assessed using the FLC instrument version 3.0 and the Oxford Centre for Evidence-Based Medicine classification. Risk of bias was evaluated according to study design, using RoB 2 for randomized controlled trials and ROBIS for systematic reviews. The synthesis considered comparisons across levels of evidence to minimize potential duplication of results. Findings suggest that inspiratory muscle training is associated with improvements in respiratory muscle strength, pulmonary function, and functional capacity. Additionally, the use of volume-oriented incentive spirometry, particularly when guided by nursing staff, is associated with favorable pulmonary outcomes in the postoperative period.

The objective was to analyze the effect of pulmonary expansion exercises on pulmonary functional capacity in patients undergoing cardiac surgery. An integrative review with a quantitative approach was conducted, structured based on methodological principles of PRISMA 2020. The research question was formulated using the PIO framework. The literature search was performed in PubMed, BVS, Journal of PeriAnesthesia Nursing, Epistemonikos, SciELO, ScienceDirect, and EBSCO, using DeCS and MeSH terms combined with Boolean operators. A total of 45 potentially relevant studies were identified, of which 12 met the inclusion criteria, incorporating both primary studies and systematic reviews. Methodological quality was assessed using the FLC instrument version 3.0 and the Oxford Centre for Evidence-Based Medicine classification. Risk of bias was evaluated according to study design, using RoB 2 for randomized controlled trials and ROBIS for systematic reviews. The synthesis considered comparisons across levels of evidence to minimize potential duplication of results. Findings suggest that inspiratory muscle training is associated with improvements in respiratory muscle strength, pulmonary function, and functional capacity. Additionally, the use of volume-oriented incentive spirometry, particularly when guided by nursing staff, is associated with favorable pulmonary outcomes in the postoperative period.

Takotsubo syndrome is a transient cardiomyopathy that is uncommon in pediatric patients, characterized by acute left ventricular dysfunction and regional wall motion abnormalities in the absence of obstructive coronary artery disease. Its recognition in children remains challenging because of its low incidence and its overlap with other causes of hemodynamic deterioration, particularly in the postoperative cardiovascular setting. We report the case of a 15-year-old adolescent with Barlow syndrome and severe mitral regurgitation who underwent mechanical mitral valve replacement. During the procedure, findings suggestive of endocarditis were identified and subsequently confirmed by isolation of Serratia marcescens. On postoperative day 4, the patient developed hemodynamic deterioration requiring vasoactive support, with moderate elevation of cardiac biomarkers and an echocardiographic pattern consistent with takotsubo syndrome, characterized by apical and midventricular akinesia, compensatory basal hypercontractility, and a left ventricular ejection fraction of 35%. Given the limited response to catecholamines, levosimendan was administered, with progressive clinical improvement. In the third postoperative week, cardiac magnetic resonance imaging ruled out myocarditis and demonstrated in-hospital functional recovery. This case highlights the importance of considering takotsubo syndrome in the differential diagnosis of postoperative hemodynamic deterioration in pediatric patients, particularly when echocardiography reveals typical segmental abnormalities that allow early diagnostic suspicion and timely management.

Cardiorenal-metabolic syndrome (CRMS) is a pathophysiological interaction of metabolic, cardiovascular, and renal dysfunctions, sharing mechanisms such as chronic inflammation, insulin resistance, neurohormonal activation and vascular dysfunction. This progressive condition can begin in subclinical stages and evolve into established cardiovascular and renal disease. The CRMS staging classification stratifies patients from a stage with no risk factors (stage 0) to clinical cardiovascular disease with or without kidney failure (stages 4a and 4b). This framework guides interventions based on absolute risk and disease progression. The recently developed PREVENT model improves prediction of total cardiovascular risk (myocardial infarction, heart failure, stroke, and mortality) by incorporating variables from the cardio-renal-metabolic axis. Using this tool, therapeutic strategies can be personalized and patients who benefit most from intensive or combination therapies can be identified. Compared to traditional comorbidity-based approaches, CRMS demands an interdisciplinary, anticipatory, and patient-centered strategy. The implementation of integrated models improves clinical outcomes and promotes health equity. CRMS should be considered a strategic priority in precision medicine, public health, and global health policy.

The objective is to compare the safety and efficacy of dual-axis rotational coronary angiography (DARCA) with standard coronary angiography (SA). We performed a systematic review and meta-analysis comparing the efficacy of coronary lesions visualization and safety endpoints for patients with suspected coronary artery disease undergoing DARCA and SA. We searched PubMed, Google Scholar, and Cochrane databases for head-to-head trials. Mean differences (MD) with 95% confidence intervals (CI) were pooled with a random-effects model with a Paule-Mendel estimator using RStudio software. Three studies corresponding to 128 patients met the inclusion criteria. 128 (100%) patients underwent both DARCA and SA. Compared with SA, DARCA had no significant diagnostic accuracy difference for coronary lesion visualization (MD = -0.19 lesions per patient; 95% CI = [-0.52; 0.15]; p = 0.28) but was associated with a substantially lower contrast dose used (MD = -16.77 cm[3]; 95% CI = [-26.00; -7.55]; p < 0.01) and radiation exposure (MD = -11.89 Gycm[2]; 95% CI = [-17.09; -6.65]; p < 0.01). In the meta-analysis, DARCA had no significant difference in coronary lesion visualization and lower contrast and radiation used compared with SA.