[The induction of a septal infarct as a therapeutic alternative in hypertrophic obstructive cardiomyopathy: new observations apropos a case]. / Inducción de infarto septal como alternativa terapéutica en la miocardiopatía hipertrófica obstructiva: nuevas observaciones a propósito de un caso.

The hypertrophic cardiomyopathy may be associated with a variable degree of left ventricular outflow tract obstruction. There are several available therapeutic strategies for treatment: pharmacological, dual-chamber pacing, surgery and induced septal infarction. This last one is a novel technique with less experience in practice. We present the clinical case of a patient which showed persistent and severe obstruction in spite of the medications and dual-chamber pacing, and who underwent this novel technique. The results were optimal but new observations arise from this particular case.

[Mitral insufficiency caused by isolated rupture of the papillary muscle secondary to blunt thoracic trauma]. / Insuficiencia mitral por rotura aislada de músculo papilar secundaria a traumatismo torácico cerrado.

We report a patient suffering from mitral insufficiency after isolated rupture a papillary muscle as a result of a car accident with blunt chest trauma. The diagnosis is often difficult due to related multiple lesions which vary the clinical picture. Physical exploration, electrocardiogram, enzymatic and nuclear scan lack adequate sensitivity and specificity. Echocardiography appears to be the most reliable noninvasive diagnostic method now available.

[Depression and elevation of the ST segment in the V4R lead during the stress test of a patient with a proximal lesion of the right coronary artery]. / Descenso y elevación del segmento ST en la derivación V4R durante la prueba de esfuerzo de un paciente con lesión proximal de la arteria coronaria derecha.

We report a patient with a proximal right coronary artery lesion in whom opposite shifts of ST segment in V4R lead were observed during and after exercise. ST-segment depression was provoked by exercise, while ST-segment elevation appeared in the recovery phase. We speculate that different degrees of myocardial ischemia (non-transmural vs transmural) may explain this apparently paradoxical response.