Boletín de la Asociación Médica de Puerto Rico
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In the last few decades cardiac rehabilitation has evolved dramatically. It consists of a multidisciplinary approach for secondary prevention and rehabilitation treatment after an individual has sustained a cardiac event. A key principle for successful cardiac rehabilitation management is the modification of risk factors which have been demonstrated to have a significant impact on overall mortality and morbidity outcomes. This article summarizes some of the evidence that supports modification of risk factors through the use of cardiac rehabilitation.
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The population of pregnant women with valvular heart disease represents a unique patient group with increased risk for adverse outcomes. The significant hemodynamic changes that occur during pregnancy can mimic symptoms of congestive heart failure. Furthermore, many patients with valvular heart disease are first recognized during pregnancy. ⋯ Low molecular weight heparin is not recommended to be administered to pregnant patients with mechanical prosthetic valves unless anti-Xa levels are monitored 4 to 6 h after administration. Aspirin at low doses, 81-325 mg has been proposed to reduce the risk of thrombosis. At this moment, optimal antithrombotic therapy in pregnant women with mechanical valves cannot be definitively recommended due to lack of properly designed studies.