Background The COVID-19 pandemic is associated with more than 127 million of infected people and 2.7 million deaths in the world. However, cardiovascular diseases are still a worldwide main health problem. Patients are afraid to go to the hospital because of the risk of being infected with SARS-COV2. In particular, exercise testing (ET) has been underused, due to the fear of the airborne aerosol generation. There are cardiology centers performing ET that ask patient to wear a mask, although its consequences are not yet well known and there is only preliminary information of its use in patients with heart disease. Purpose Our objective was to evaluate the ergometric behavior of patients that performed an ET wearing a mask during the COVID-19 pandemic (COVID-G) and compare them with patients in the pre-pandemic period. Methods A cohort of patients who underwent an ET from march to december 2020 was compared with patients that performed an ET between march and december 2019. Because of COVID-19 preventive restrictions, we used a larger and highly ventilated room to perform ET. The antisepsis protocol was performed (room and equipment) and healthcare crew always wore high efficiency masks and ocular protection. All patients studied in 2020, must had succeeded a biological triage, and wore a mask throughout the ET. Variables are presented as frequency (percentage), mean (standard deviation) or median (interquartile interval) according to variable-type and distribution. Chi-square test, Student's t test or the Wilcoxon rank test were used as appropriate. All p values less than 0.05 were considered stochastically significant. Results A total of 361 stress tests were studied, where 209 (58%) belonged to pre-pandemic group and 152 (42%) to COVID-G. Eighty-one percent were male, the mean age was 46±20 years and the most prevalent diagnosis was coronary heart disease (61%). There were no statistically diferences between groups according to demographic variables. No mayor adverse outcome occurred during ET. The most common reason of exercise suspension in COVID-G was dyspnea compared to pre-pandemic studies: 117 (77%) vs 8 (4%), OR= 6.3 (95% CI, 4.6 to 8.6, p<0.001). Heart rate behavior along ET did not show significant differences between groups. Nevertheless, blood pressure levels were significantly higher in COVID-G patients than those in pre-pandemic group. Exertional blood pressure index was higher in the COVID-G (1.31±0.24 vs 1.26±0.2, p<0.05) than the pre-pandemic group. On the other side, maximal exercise tolerance (METs) did not show significant differences between groups (p=ns). Conclusions Exercise testing can be safely performed in patients with cardiovascular disease while wearing masks. In the COVID period, a significantly lower number of ET was performed. In addition, ET performance with mask was associated with higher values of systolic blood pressure and an increased number of tests suspended due to dyspnea. FUNDunding Acknowledgement Type of funding sources: None. Blood pressure behavior Ergometric performance

El estudio científico del corazón nos ha permitido conocer su estructura y función profundamente, mediante la fragmentación y el análisis de sus partes, atendiendo a las pautas del método que tantos logros nos ha dado. Sin embargo, al momento de volver a ensamblar esos fragmentos analizados nos percatamos de que algo falta; simplemente la suma de las partes no hace al todo. Es así que, desde hace décadas, numerosos científicos han estudiado estrategias novedosas que permitan entender los fenómenos naturales desde modelos más incluyentes, abiertos e integradores, que atiendan con cercanía a las interacciones más que a los componentes. De esta manera, observamos que muchas variables suelen transgredir el plano convencional y parten hacia la no linealidad y la fractalidad, formando un tejido complejo que mantendrá su estructura mientras termodinámicamente sea viable. Así, en este documento se muestra la manera en que el estudio no lineal de la dinámica compleja cardiovascular comienza a darnos luz en muchas de las preguntas que a diario se plantea el cardiólogo clínico.

Patients suffering from cardiovascular disease require comprehensive medical attention that involves therapies and procedures necessary to reintegrate them optimally to their personal, family, work, and social life. Interventions aimed at achieving these goals are included in cardiac rehabilitation programs. These programs are designed to limit the harmful physiological and psychological effects of heart disease, reduce the risk of sudden death or reinfarction, control cardiovascular symptoms, stabilize or reverse the atherosclerosis process, and improve the psychosocial and vocational status of patients. These programs have existed in Mexico since the 1940s and have evolved over the years, adapting to the disease conditions present in our country, starting with therapies to treat patients with rheumatic heart disease until the application of physical exercise in patients with heart failure complexes congenital heart disease or pulmonary arterial hypertension. These activities are of a transdisciplinary nature and involve the integration of cardiologists, physiotherapists, psychologists, and nutritionists among others. At present, these programs have spread throughout the Mexican Republic thank rehabilitation cardiologists graduating from the main health institutions in the country such as health institutes, Mexican Social Security Institute, and Institute of Security and Social Services of State Workers. In this document, the origins of rehabilitation from the pre-Hispanic era to the present will be discussed, highlighting the contributions in teaching and research of the physicians who have practiced in this area in the aforementioned institutions.

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Artículo de reviSión resumenLos pacientes que sufren una enfermedad cardiovascular requieren de atención médica integral que involucre las terapias y procedimientos necesarios para reintegrarlos de forma óptima a su vida personal, familiar, laboral y social. Las intervenciones dirigidas a alcanzar dichas metas se incluyen en los programas de rehabilitación cardiaca. Estos programas son diseñados para limitar los efectos dañinos tanto fisiológicos como psicológicos de las cardiopatías, reducir el riesgo de muerte súbita o reinfarto, controlar la sintomatología cardiovascular, estabilizar o revertir el proceso de aterosclerosis y mejorar el estado psicosocial y vocacional de los pacientes. Dichos programas existen en México desde la década de 1940 y han evolucionado a lo largo de los años, adaptándose a las condiciones de enfermedad presentes en nuestro país, desde su inicio con terapias para tratar a pacientes cardiopatía reumática hasta la aplicación del ejercicio físico en pacientes con insuficiencia cardiaca, cardiopatías congénitas complejas o hipertensión arterial pulmonar. Estas actividades son de índole transdisciplinaria e implica la integración de cardiólogos, fisioterapeutas, psicólogos y nutriólogos, entre otros. Actualmente, estos programas se han extendido a lo largo de la República Mexicana gracias a cardiólogos rehabilitadores egresados de las principales instituciones de salud del país, como son los Institutos de Salud, el IMSS (Instituto Mexicano del Seguro Social) y el ISSSTE (Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado). En este documento se expondrán los orígenes de la rehabilitación, desde la época prehispánica hasta la actual, destacando las contribuciones en docencia e investigación de los médicos que han ejercido en esta área en las instituciones previamente mencionadas.