[The effect of the duration of the cardiac cycles on determining mitral valve area by means of pressure half-time]. / Influencia de la duración de los ciclos cardíacos en la determinación del área valvular mitral mediante el tiempo de hemipresión.

INTRODUCTION AND AIMS: To analyze the influence of variations in the length of cardiac cycle length of calculating mitral valve area by means of the pressure half time in patients with mitral valve stenosis and atrial fibrillation. METHODS: Fifty-nine patients with pure mitral valve stenosis and atrial fibrillation were subjected to transmitral flow measurements by continuous Doppler monitoring from the apical window. In each patient the pressure half time was quantified, corresponding to a minimum of 30 consecutive cycles. RESULTS: Considering all the measurements made in each patient, the correlation between pressure half time and cardiac cycle was significant in 20 cases (34%). The pressure half time variation coefficients were significantly greater when including the values corresponding to the shortest cycles. Thus, for cycle duration of > or = 800, 700, 600, 500 and 400 ms, the mean values were 0.096 +/- 0.041, 0.106 +/- 0.042 (NS), 0.128 +/- 0.032 (p < 0.05), 0.167 +/- 0.048 (p < 0.001) and 0.231 +/- 0.057 (p < 0.0001), respectively. Upon analyzing the relation between pressure half time and cardiac cycle with progressive exclusion of the longer cycles > or = 800, 700 and 600 ms the number of patients with significant correlation coefficients increased to 19/37 (51%), 12/23 (52%) and 4/6 (67%) on respectively excluding. CONCLUSIONS: Patients with mitral valve stenosis and atrial fibrillation show a variation in pressure half time that may complicate calculation of the mitral valve area. Variability is inherent to the measurement method, and is furthermore dependent upon cardiac cycle duration. This may be resolved by limiting determinations to cycles longer than 800 ms.

[Concealed conduction and fatigue phenomenon in an accessory pathway]. / Conducción oculta y fenómeno de fatiga en una vía accesoria.

We report the appearance of concealed conduction and fatigue phenomenon in the accessory pathway of a patient with WPW syndrome. Both phenomena were demonstrated by the loss of delta wave during and after rapid atrial pacing. The mechanisms involved in these unusual properties of accessory pathways are discussed.

[Cardiac cysts. A case of isolated cardiac hydatidosis]. / Quistes cardíacos. Un caso de hidatidosis cardíaca aislada.

In the presence of cardiac cysts we must discard a hydatid disease, even if there is no involvement of other organs. Imaging techniques are useful for guiding the initial diagnosis. The presence of daughter vesicles or multiple cysts is very characteristic. We present a patient affected by cardiac hydatid disease, in the form of multiple cardiac cysts, without extracardiac affectation, who presented pericardial chest pain. The patient was dealt with surgery to avoid the risks of a cyst rupture.

[Evolution of the filling pattern of the left ventricle during the first year after an acute myocardial infarct. The influence of the infarct size]. / Evolución del patrón de llenado del ventrículo izquierdo durante el primer año tras un infarto agudo de miocardio. Influencia del tamaño del infarto.

OBJECTIVES: Acute myocardial infarction induces diastolic dysfunction as a result of the alteration of left ventricular relaxation and stiffness caused by ischemia and fibrosis. This study analyzes the association of infarct size with the diastolic filling pattern and the evolution of the latter during the first postinfarction year. PATIENTS AND METHODS: The study group consisted of 68 patients with a first acute myocardial infarction treated with thrombolytic agents. A Doppler echocardiography was performed at 8 +/- 2, 32 +/- 7 and 370 +/- 23 days after infarction. Five measurements of the ratio between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms) were averaged in each echocardiographic study. The patients were divided according to infarct size into a large infarct group (creatine kinase > 1,000 U/ml; 1,913 +/- 883; n = 26) and a small infarct group (creatine kinase < 1,000 U/ml; 556 +/- 227; n = 42). RESULTS: The large infarct group exhibited a greater E/A ratio and shorter EDT than the small infarct group in the first week (E/A ratio: 1.4 +/- 0.7 vs 0.8 +/- 0.3; p = 0.0001; EDT: 159 +/- 49 vs 192 +/- 56; p = 0.02) and at one month (E/A ratio: 1.2 +/- 0.7 vs 0.9 +/- 0.3; p = 0.01; EDT: 170 +/- 55 vs 207 +/- 40; p = 0.004); however no differences were observed between either group at one year in either E/A ratio (0.8 +/- 0.2 vs 0.9 +/- 0.4; NS) or EDT (207 +/- 44 vs 219 +/- 54; NS). In the large infarct group, E/A ratio decreased and EDT increased at one year compared to the first week (E/A ratio: p = 0.0004; EDT: p = 0.0001) and the first month (E/A: p = 0.02; EDT: p = 0.003); in contrast, in the small infarct group there were no significant differences in E/A ratio nor EDT during the first year postinfarction. CONCLUSIONS: In the first month postinfarction, large infarcts exhibit a greater E/A ratio and shorter EDT than small infarcts. The evolution of large infarcts is characterized by an attenuation of this pattern, with a progressive reduction of E/A ratio and prolongation of EDT during the first year post-infarction.

[Late potentials in patients during the hospitalization period following acute myocardial infarction]. / Potenciales tardíos en la fase hospitalaria del infarto agudo de miocardio.

Serial signal-averaged electrocardiograms were recorded every 72 hours in 60 patients admitted to the coronary care unit with acute myocardial infarction. The prevalence of late potentials was 61.6% (37 patients) during hospitalization. Of these 37 patients, late potentials appeared transiently in 20 (54%), while in 9 patients (24%), once late potentials had appeared, they tended to persist. No specific clinical characteristics were related to the development of late potentials (site of infarction, peak creatine kinasa activity, Killip class, thrombolytic therapy). The presence of late potentials did not identify patients who developed clinically significant ventricular tachyarrhythmias (primary ventricular fibrillation, ventricular tachycardia). The abnormal late potentials were modified by the administration of lidocaine. This lack of correlations suggests that the abnormal signal averaged electrocardiogram and complex ventricular arrhythmias during acute myocardial infarction have different electrophysiological bases. Late potentials could be only a bystander electrophysiological phenomenon without clinical correlation in this clinical phase.

[Atypical bidirectional tachycardias]. / Taquicardias bidireccionales atípicas.

Two cases of bidirectional tachycardia are presented. The ventricular origin of these arrhythmias was assessed by His bundle recordings. Because of the V1 morphology of the ventricular complexes during tachycardia in one case and the unknown etiology in the other, these arrhythmias were considered to be atypical. The involved mechanisms and the causes inducing these tachycardias are discussed. Whatever the involved mechanism, our cases reaffirm the opinion that the terminology bidirectional tachycardia should be used only to describe an electrocardiographic pattern that may be caused by different electrophysiological mechanisms.

[E wave deceleration time predicts left ventricular telediastolic pressure in acute myocardial infarction in patients with systolic dysfunction]. / El tiempo de deceleración de la onda E predice la presión telediastólica del ventrículo izquierdo tras un infarto agudo de miocardio en pacientes con disfunción sistólica.

OBJECTIVES: Left ventricular end-diastolic pressure (LVEDP) is a useful parameter for the management of postinfarction patients. As the current methods of estimating LVEDP are invasive, the existence of non-invasive methods would be of great practical value. This study investigates the relation between LVEDP and Doppler parameters such as E wave deceleration time (EDT) and E/A ratio, at one month following an acute myocardial infarction. METHODS: Eighty-nine patients with a first acute myocardial infarction treated with thrombolytic agents were studied. Doppler-echocardiography at 29 +/- 3 days and cardiac catheterization at 30 +/- 4 days postinfarction were performed. According to the ejection fraction (EF), the patients were divided into group 1 (n = 17) with EF < 45%, and group 2 (n = 72) with EF > 45%. RESULTS: Overall, the E/A ratio showed a weak correlation with LVEDP (r = 0.32; p = 0.007), and EDT did not correlate with LVEDP. When patients from group 2 were analyzed, no correlation was found between LVEDP and either E/A or EDT. However, in patients from group 1, LVEDP strongly correlated with both EDT (r = -0.83; p = 0.00001) and E/A (r = 0.70; p = 0.003). Moreover, the sensitivity and specificity of an EDT of less than 150 ms in predicting a LVEDP > 20 mmHg was 100%. CONCLUSIONS: We conclude that at the first month after a myocardial infarction EDT provides a non-invasive and useful parameter for estimating LVEDP in patients with systolic dysfunction.

[Extrinsic compression of the pulmonary artery by non-microcytic lung carcinoma]. / Compresión extrínseca de la arteria pulmonar por un carcinoma no microcítico de pulmón.

A patient with a remitting non-microcytic pulmonary carcinoma was subjected to Doppler-echocardiography. The detection of a pericardial effusion with compression of the pulmonary artery due to an extrinsic mass indicated that the disease was progressing. The Doppler technique was used to evaluate the degree of arterial stenosis by determining the pressure gradient caused by it (49 mmHg) and to calculate the right ventricle pressure (75 mmHg). Tumor infiltration of mediastinal structures was posteriorly confirmed by computed tomography.

[Inflammatory response in acute myocardial infarction. Predictive values]. / Respuesta inflamatoria en el infarto agudo de miocardio. Valores predictivos.

INTRODUCTION AND OBJECTIVES: Our purpose was to investigate the significance of inflammatory acute phase response early after myocardial infarction. We also observed how these indices were influenced by trombolytic therapy. METHOD: We examined the blood samples of 200 non consecutive patients at the first day of acute myocardial infarction (155 [77%] males; mean age 65 +/- 13 years) to characterize the proteins and proinflamatory reactants profile. Results were correlated with hospital mortality. Thrombolytic therapy was administrated to 117 patients on admission and in these patients the samples were taken after the procedure. RESULTS: Overall mortality was 8%. Serum C-reactive protein (69 vs 41 mg/l), haptoglobine (237 vs 190 mg/dl), gammaglobuline (0.93 vs 0.84 g/dl), alpha-1-globuline (0.28 vs 0.23 g/dl) and alpha-2-globuline (0.7 vs 0.6 g/dl) were significantly higher in patients without trombolytic therapy. Conversely, patients who had received lytic therapy, had higher plasma concentrations of interleukin-1 beta (104 vs 40 pg/dl). The only clinical variable which was associated with mortality was a Killip class > or = 2 on admission (mortality = 21%; odds ratio = 5.2; p = 0.02). Other biochemical variables associated with a higher mortality were a white blood cell count > 10/nl (mortality = 12%; odds ratio = 5.4; p = 0.01), increased activated neutrophils > 80% (mortality = 18%; odds ratio = 5.4; p = 0.004) and C-reactive protein > 20 mg/l (mortality = 11%; odds ratio = 6; p = 0.05). Only patients with activated neutrophils > 80% on admission had a higher probability of dying during hospital stay (Exp[B] = 3.6; B = 1.2; r = 0.29; p = 0.001). CONCLUSION: The acute phase reaction in early myocardial infarction is determined by thrombolytic treatment. A high increase of activated neutrophils on patient admission is the only biochemical predictive value for hospital mortality.

[The single coronary artery arising from the sinus of Valsalva. A rare cause of myocardial ischemia]. / Arteria coronaria única desde seno de Valsalva derecho. Una causa poco frecuente de isquemia miocárdica.

The presence of a congenital anomaly in coronary arteries can be the cause of a defective coronary flow and ischaemic symptoms. Although they are rare, we must suspect them in the presence of major cardiac events in young people. A single coronary artery is present if the entire coronary system arises from a solitary ostium. Its presence is regarded as having little clinical significance and it is usually a fortuitous finding on coronary angiography. We report the case of a patient with effort anginal symptoms, with a single coronary artery arising from the right sinus of Valsalva without obstructive atherosclerotic lesions.

[Legionellosis at intensive care units: study of 30 cases]. / Legionelosis en cuidados intensivos: estudio de 30 casos.

A prospective study during 44 months has been carried out in order to establish the incidence of pneumonia due to Legionella sp. in our hospital's intensive care unit (ICU). Thirty cases of legionellosis were diagnosed (22.2% of the studied pneumonias) two of them were acquired in the ICU and 76.6% were caused by L. pneumophila serotype. The most evident symptomatology was intense dyspnea, neurological disorders, acute respiratory and renal failure. The biochemical alterations, most commonly encountered were increased liver enzymes, hypoxemia, hypoalbuminemia, increased urea, creatinine and hematuria. As a consequence of this severe disease, the mortality rate was high (13 out of 30 cases).