Salud comunitaria ir mas allá de lo teórico : un caso de ruidos cardíacos audibles y latido cardíaco visible : caso clínico interactivo

摘要

In this interactive clinical case, one that has been elaborated for medical education purposes in different areas like, cardiology, paediatric cardiology and community health, we present a unique 3-year-old patient, from a rural zone in the Andean area of Ecuador, with a visible heartbeat and audible cardiac sounds without the use of a stethoscope. This case is very interesting not only on the congenital cardiac abnormality, but in the different health determinants that influence the natural history of this disease, specially the social determinants that play a substantial role in this case, for these and many other reasons it makes it really interesting for future medical generations.This case will be analysed in an organized way. The first point to be presented is a detailed clinical history that not only gathers information about the organic pathology, but gathers social and community information. In second place, a complete and detailed physical examination. A series of different complementary exams will be presented in order to get to the final diagnosis. Finally, it will be discussed how the different determinants of health, especially the social ones, influence this particular case. This clinical case will also discuss how the Ecuadorian public health system plays a role on this child and some aspects of how the system works.