Method of pacing does not affect the recurrence of syncope in carotid sinus syndrome.

INTRODUCTION: Pacemaker therapy is effective in reducing recurrent syncope in patients with symptomatic carotid sinus hypersensitivity (CSH), yet the optimal pacing modality for this syndrome is not known. The objective of this study is to prospectively investigate the impact of three pacing methods (DDDR vs DDDR with sudden bradycardia response [SBR] vs VVI) on recurrent syncope and quality of life. METHODS: Twenty-one patients with symptomatic CSH (syncope or near syncope) were randomized to VVI, DDDR, or DDDR with SBR on a double-blinded basis in a sequential crossover fashion with 6 months in each mode. The primary endpoints were recurrent events and quality of life (assessed by SF-36). The mean number of events and SF-36 scores were compared. RESULTS: At baseline, over the preceding 6 months, there were a total of 29 syncopal events and 258 presyncopal events among 21 patients. Following pacing in any mode, the total number of these syncopal events reduced to two in two patients (P < 0.001) and 17 presyncopal events (P < 0.001) in 12 patients. The mean number of events was not significantly different between the three pacing methods. SF-36 scores revealed some minor benefits of DDDR pacing versus baseline in the categories, but no pacing method was found to be superior. CONCLUSIONS: The study was unable to confirm the initial study hypothesis of a superiority of one pacing modality over another. Quality of life measures allude to potential benefit from DDDR pacing alone.

La prescripción de ejercicio físico en pacientes cardíacos: características y estructura del programa / The physical exercise prescription in cardiac patients: characteristics and structure of the program

La rehabilitación cardíaca ha demostrado ser uno de los elementos, en términos prospectivos, más eficaces para mejorar la capacidad física del paciente cardíaco, disminuir los factores de riesgo, mejorar la calidad de vida, reducir la dosis o número de medicamentos después de un evento isquémico y facilitar la incorporación más temprana a la actividad laboral en mejores condiciones. Entre los componentes que integran la rehabilitación cardíaca: educación, asesoramiento nutricional, asistencia psicológica, orientación vocacional y/o laboral y ejercicio, este último, adquiere la mayor importancia por ser el componente que de forma más temprana y efectiva aumenta la capacidad física del paciente, proporcionándole seguridad e independencia en sus actividades personales y profesionales, y un mayor grado de responsabilidad y participación en su entorno social y familiar. En esta revisión se presentan las pautas recomendadas por las organizaciones profesionales relacionadas con la rehabilitación cardíaca más prestigiosas y confiables del mundo médico, que proponemos sean consideradas en la planificación, organización y ejecución de los programas de rehabilitación en nuestro país, adaptándolas a las condiciones existentes de cada centro donde se realice.

Cardiac rehabilitation has proven to be prospectively an effective element in heart disease patients to endurance functional capacity, diminish risk factors, improve quality of life, reduce dosing and number of medications after an acute event and facilitate an early incorporation to daily labor activities in the best of conditions. Of the elements that compose cardiac rehabilitation one can mention; education, nutritional counseling, psychological assistance, vocational orientation and exercise, the latter being of great significance as responsible of an early and effective improvement of physical capacity that leads to self insurance and independence for personal and professional duties with a greater degree of responsibility and participation in social and family environments. In the following review, guidelines from the most important and trusted professional organizations in the field of cardiac rehabilitation are presented along with a proposal for their use in the planning, organizing and execution of cardiac rehabilitation programs in our country, adjusting them to the existing conditions where to be implemented.

[Changes in serum lipids, plasma fibrinogen and other haemostatic parameters induced by ciprofibrate action in hyperlipidemic patients with and without coronary artery disease]. / Modificaciones de los lipidos séricos, el fibrinógeno y otros parámetros hemostáticos por acción del ciprofibrato, en pacientes hiperlipidémicos con y sin enfermedad arterial coronaria.

The effects of drugs with hypolipidemic properties in the prevention of the atherothrombotic vascular disease, go further than reducing serum lipids, suggesting that there are other nonlipid-related mechanisms involved; the maintenance of appropriate haemostatic balance being one of them. The objective of this investigation was a drug intervention with ciprofibrat in hyperlipidemic people with high level of plasmatic fibrinogen with the purpose of knowing the effects of the drug over these risk factors and other haemostatic parameters. Forty people, both sexes, 20 of them apparently healthy and the other 20 with clinical and angiographic evidence of coronary artery disease, were randomized to receive 100 mg of ciprofibrat or placebo during an average of 56 weeks. All of them had a clinical exam, EKG and stress test. Laboratory exams included lipid profile, plasma fibrinogen (Fg), VII factor, vonWillebrand factor, protein C (PC) and the tissue plasminogen activator with samples taken every 8 weeks. The Ciprofibrat group showed significant changes of lipids: cholesterol -23%, triglycerides -31%, high-density lipoprotein (HDLc) +24% and very low-density lipoprotein -23%, except low-density lipoprotein -24%. The haemostatic parameters in 40 weeks showed that Fg decreased 21% (p = 0.001), decreasing to 9% at the end of the follow-up. In the placebo group the HDLc showed a 10% increase (p = 0.02), PC reduced to 20% (p = 0.01) and Fg kept blood levels close to basal line, descending 10% at the end of the follow-up. In this study, the use of ciprofibrat in patients with high risk of developing atherothrombotic events, showed efficiency and security in handling hyperlipidemia, such as keeping and appropriate haemostatic balance.

[Fibrinogen: cardiovascular risk factor]. / El fibrinógeno: factor de riesgo cardiovascular.

This paper demonstrate that plasmatic fibrinogen is a risk factor for ischaemic cardiovascular disease. Apart from its hemostatic functions, it has an important role in the atherothrombotic process. Prospective studies in a normal population and on patients with pre-existent cardiovascular disease demonstrate that fibrinogen is a predictor of cardiovascular events, either as first episode or recurrence. It is also reviewed a epidemiological study which is been carried out in Venezuela as a pilot study for Latinamerica because our population is different from those where the studies have been performed up to now. It is also mentioned the factors that influence the fibrinogen levels, some of them can be modified which could be useful for the prevention of the disease. It is considered the necessity of further studies to evaluate the benefit of the control of the fibrinogen level.

Disfunción del nodo sinusal en el postoperatorio de un transplante cardíaco. Enfoque clínico a partir de un caso / Sinus node dysfunction in the postoperative of cardiac transplantation

La técnica quirurgica del transplante cardiaco ortotopico permite que el receptor tenga dos nodos sinusal, el nativo y el del corazón donante, siendo el ultimo el que comandara ta actividad electrica del injerto. Presentamos el caso de un paciente masculino de 43 anos, que en el post-operatorio immediato, presenta en los trazos electrocardiograficos una discuncion del nodo sinusal donante. Se le implantó un marcapasso definitivo, modo AAIR, con el qual se logra que el paciente lieve una actividad normal. En el analisis del caso se determina que la causa de la disfuncion del nodo sinusal fue por un trauma quirurgico durante el acto operatorio.

Cálculo del área valvular mitral con el método del flujo convergente proximal por eco Doppler-color en pacientes con estenosis mitral / Echo-doppler evaluation of mitral valve area

En este estudio se evalúa en forma prospectiva un nuevo método por eco Doppler-color pra calcular el área valuvlar mitral, basado en identificar la interfase rojo-azul proximal al orificio estenótico, que corresponde a la reagión de flujo convergente proximal (RFC). Este método puede ser usado para calcular el área aplicando la ley de la continuidad. Se estudiaron 61 pacientes con estenosis mitral. Se calculó el área valvular mitral por eco Doppler, mediante el método del tiempo de hemipresión (THP), y se comparó con el AVM determinada por eco Doppler-color por el método de RFC, aplicando la fórmula: AVM(cm²)=2pi r² x VN/vmáx; donde "r" es el radio del RFC medido del orificio valvular a la kprimera interfase de color, VN es la velocidad Myquist a nivel de RFC y Vmáx es la velocidad máxima del flujo transmitral determinado por Doppler continua Venintitrés pacientes tuvieron estenosis mitral pura y 38 doble lesión mitral. Veinte pacientes se enocntraron en ritmo sinusal y 41 en fibrilación auricular. El valor del área valvular mitral obtenido por RFC se correlacionó bien con el determinado por THP, co un coeficiente de correlación: r=0.96 (y=0.097 x + 54.9; SEE=0.10 cm², p<0.001). El AVM obtenido por RFC estuvo comprendida entre 0.4 y 2.5 cm² (media=1.15 cm²). El método de RFC por eco Doppler-color da una cuantificación precisa del AVM y puede ser de utilidad como un método alternativo al del timepo de hemipresión por eco Doppler. El cálculo del AVM no se ve influenciado por la presencia de insuficiencia mitral o de fibrilación auricular.