COVID-19 has disproportionately affected the Latinx community, leading to heightened economic instability and increased mortality/morbidity. Frontline community health workers (promotoras) have played an integral role in serving low-income Latinx immigrant communities, disseminating health information to this vulnerable community while also facing heightened risks to their own health and well-being. This study explores the impact of the pandemic on Latinx communities and the promotoras that serve them, examining how the stresses and inequities the pandemic wrought might be mitigated. Promotoras (N = 15, all female) were recruited from a local health agency in Santa Ana, California, and completed a semistructured interview about their experiences during COVID-19. Qualitative analyses demonstrated that the pandemic substantially affected the daily lives both of community members, via economic challenges, limited access to reliable pandemic-related information, and psychological and social stress, and of promotoras, via changes to the nature of their work and psychological and social stress. Promotoras perceived that these harms might be mitigated by providing for economic and material needs in the community and that promotoras can be fortified to continue serving the community through self-care and psychosocial healing practices. According to promotoras, the Latinx community needs economic and material resources to overcome COVID-19-related stressors. Additionally, promotoras may benefit from programming to preserve mental and physical health in the wake of new stressors. Lending greater support to promotoras within the agencies in which they are nested may enable them to be more successful in fulfilling their mission and sustaining their own health.

Introduction Peripartum cardiomyopathy (MPP) is a type of cardiomyopathy characterized by heart failure secondary to left ventricular systolic dysfunction during the last month of pregnancy or in the first 5 months of puerperium without other apparent etiology, being a diagnosis of exclusion. The left ventricle is not always dilated, but the fraction of left ventricular ejection is always less than 45%. The natural history and prognosis of the disease is diverse. Ventricular dysfunction is usually transient and normalizes at 3-6 months in up to 60% of cases. Mortality is variable, with reports ranging from 0 to 28%, affecting more certain ethnic groups, in patients with persistent ventricular dysfunction, evidence of the efficacy of a specific treatment beyond optimal medical therapy for heart failure is limited. Clinical case We present the clinical case of a 22-year-old woman, who was referred to the our institute with an acute heart failure syndrome two months after the end of her first pregnancy. On admission to the hospital, dilated cardiomyopathy and intracavitary thrombi were documented by transthoracic echocardiography (TTE) with dilatation and eccentric left ventricular hypertrophy, generalized hypokinesia and mobile thrombi inside, the largest of 34x16mm with severe left ventricular dysfunction 3D LVEF of 28% and global longitudinal strain (GLS) of -5.8%, pulmonary hypertension and right ventricular dysfunction with severe functional tricuspid regurgitation. Other specific etiologies of dilated cardiomyopathy were investigated and discarded, finally establishing the diagnosis of peripartum cardiomyopathy. The support management was carried with inotropic, diuretic, supplemental oxygen and parenteral anticoagulation was initiated, with gradual improvement. Subsequently, optimal medical treatment was started for heart failure, cabergoline and vitamin K antagonist. He was released to his home on II NYHA. Two months later she presented with progressive dyspnea, increased abdominal perimeter. On March 14, 2018, a TTE was performed, with absence of improvement in conventional and advanced ventricular function parameters. Apical thrombi of smaller size compared with previous study, severe left ventricular dysfunction, which worsened with respect to the previous echocardiogram, with 3D LVEF of 25% and GLS 3.7% Discussion We present the case of a woman with MPP, in whom persistent left ventricular dysfunction after 6 months of diagnosis, although cabergoline scheme in addition to optimal medical management for heart failure, with no improvement. In patients who dont present an adequate response to the management, it is necessary to consider enlisting for heart transplantation. Abstract P626 Figure. TTE, severe ventricular dysfunction

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Introduction Intravascular leiomyomatosis (IL) is a rare type of tumor common and was first described by Birch-Hirschfeld in 1896. There are currently few cases reported in the literature involving this type of vena cava tumor and the right atrium. This tumors are characterized by nodular, intravascular, histologically benign masses of smooth muscle with variable extensión. The most frequently affected women are pre-menopausal and multiparous. There are no specific clinical manifestations of vascular leiomyomas. Clinical case This is 51-year-old woman with a history of morbid obesity (body mass index of 47kg / m2SC) in bariatric surgery protocol, mixed dyslipidemia, is presented to the emergency service of our Institute, with uterine myomatosis diagnosed 6 months prior to admission. She was admitted for a 2-week evolution characterized by dyspnea of medium efforts that progressed at rest on the day of his admission with acute heart failure. A transthoracic and transesophageal echocardiograhy three-dimensional (TTE, TEE 3D) was made in which a solid-appearing, regular-border, heterogeneous tumor was reported from the inferior vena cava to the right atrium without being attached to the interatrial septum or other structures, with severe protrusion to the right ventricle, highly mobile, heterogeneous, without vascularity with color doppler, causing intermittent obstruction and tricuspid stenosis with a mean gradient of 8mmHg, pulmonary artery systolic pressure calculated at 46 mmHg. TAC showed invasion from the uterine leiomyoma to the inferior vena cava and right atrium. The patient was taken to emergency surgery, the vascular surgery and cardiothoracic surgery performed a long intervention. Macroscopic description reported uterine tumor of 25x19x18cm. Weight of 3.90Kg, with multiple nodular lesions, the largest being 18x15cm. Intracavitary tumor with fragment of tissue. The pathological diagnosis was uterine leiomyomatosis, intravascular leiomyomatosis in right periadnexal vessels. The patient was taken to intensive therapy, although the postoperative period was prolonged, she was discharged in functional class II NYHA. Discussion This case demonstrates the importance of recognizing this rare disease and suspecting it in patients who present with the a symptoms and the role of the echocardiography is fundamental for the characterization of the tumor and the invasion of neighboring structures. The reported cases of intravascular leiomyomas with intracardiac extension are approximately 10% and to date, less than 300 cases have been reported in the literatura. Vascular leiomyomas arise from uterine leiomyomas with vascular invasión, the etiology still remains unknown, it has been associated with high levels of estrogen. The key in its treatment is the complete resection. The prognosis is good after its resection. The recurrence rate is up to 30%. Anti-estrogenic therapy has been considered but its efficacy is controversial. Abstract P1696 Figure. Intravascular leiomyomatosis