Trombolisis coronaria sistémica en el infarto agudo del miocardio en pacientes del Hospital General Docente "Octavio de la Concepción y la Pedraja" / Thrombolysis in myocardial acute Infarction in patients of the General Teaching Hospital "Octavio de la Concepción y la Pedraja"

RESUMEN Introducción: En el Hospital General Docente "Octavio de la Concepción y la Pedraja" de Baracoa, provincia Guantánamo, Cuba, hasta la fecha no se ha caracterizado la prescripción de la trombolisis coronaria sistémica en el infarto agudo del miocardio. Objetivo: Caracterizar la prescripción de la trombolisis coronaria sistémica en el infarto agudo del miocardio en el citado hospital durante el trienio 2017-2019. Método: Se realizó un estudio descriptivo, retrospectivo, de corte transversal, del total de pacientes infartados en el periodo antes dicho (n=75). Se estudiaron las variables: edad, sexo, localización topográfica del infarto, tratamiento, evolución clínica, estado al egreso y causas de muerte. Resultados: El 72,0 % de los pacientes fueron hombres, el 37,3 % tenía 50 y 59 años de edad. La letalidad fue del 14,7 %. Fue más común el infarto anterior del ventrículo izquierdo (53,4 %). Se trombolizó el 28,0 %, pues en el 68,5 % la ventana isquémica fue superior a doce horas. La encefalopatía isquémica-hipóxica posparada cardiorrespiratoria secundaria a fibrilación ventricular (54,5 %) fue la causa directa de muerte más frecuente. Conclusiones: Fue insuficiente el porcentaje de pacientes tratados con trombolisis coronaria sistémica, sobre todo, por solicitar atención médica después de 12 horas del inicio de los síntomas.

ABSTRACT Introduction: In the General Teaching Hospital "Octavio de la Concepción y la Pedraja" of Baracoa, Guantánamo province, Cuba, the prescription of Thrombolysis in Myocardial Infarction (TIMI) has not been characterized so far. Objective: To charactirize the prescription of thrombolysis in myocardial infarction during the three-year period 2017-2019. Method: Of the total number of patients with heart attacks in the above-mentioned period (n=75) a descriptive, retrospective, cross-sectional study was carried out. Variables studied: age, sex, topographic location of the infarction, treatment, clinical evolution, state at discharge and causes of death. Results: 72.0 % of the patients were men, 37.3 % were 50 and 59 years old. The case fatality rate was 14.7%. Left ventricular infarction was the most common (53.4%) dysfunction. 28.0% of the patients received thrombolytic therapy, because in 68.5% of them, the ischemic was longer than twelve hours. Post-cardiorespiratory moderate ischemic-hypoxic encephalopathy with ventricular fibrillation (54.5%) was the most frequent direct cause of death. Conclusions: The patients´ rate treated with systemic coronary thrombolysis was insufficient, mainly due to the fact that they attend medical attention 12 hours after the onset of symptoms.

Efecto de las resinas secuestradoras de ácidos biliares en los desenlaces cardiovasculares y en los niveles séricos de lípidos: A systematic review / Effect of bile acid sequestrants on cardiovascular outcomes and seric lipids

Antecedentes: Las guías internacionales recientes proponen el uso de estatinas como piedra angular del manejo de la dislipidemia en adultos. Sin embargo, no se ha definido con claridad el tratamiento de los pacientes con intolerancia o efectos adversos asociados con estas. Las resinas secuestradoras de ácidos biliares son una alternativa interesante, pese a que la evidencia que avala su uso no ha sido evaluada cuidadosamente. Métodos: Se realizó una búsqueda de la literatura en MEDLINE, Embase y en la Biblioteca Cochrane hasta junio de 2013, acerca de artículos publicados en inglés y español, identificando experimentos clínicos aleatorizados y estudios de cohortes que evaluaran el impacto de las resinas secuestradoras de ácidos biliares en mortalidad, eventos cardiovasculares, niveles de lípidos séricos y efectos adversos. Se presenta la información de forma descriptiva. Resultados: Se identificaron cuatro experimentos clínicos aleatorizados y un estudio de cohortes, que incluían 6.833 pacientes. Solo uno de los estudios evaluó el impacto en la mortalidad cardiovascular, evidenciando que no hay diferencia estadísticamente significativa en comparación con placebo (RR de 0,76; IC 95% 0,5:1,15), aunque se observó una reducción del 16% en la incidencia de infarto agudo de miocardio (RR 0,84; IC 95% 0,67:1,00). Tres estudios evaluaron cambios en las fracciones lipídicas, los cuales mostraron disminución moderada en los niveles de colesterol LDL, sin percibir diferencias clínicamente significativas en los niveles de colesterol HDL y triglicéridos. Conclusión: La evidencia que respalda el uso de resinas secuestradoras de ácidos biliares es limitada y no avala su empleo como terapia de primera línea en pacientes con dislipidemia; no obstante, son una alternativa en pacientes con efectos adversos o intolerancia al manejo con estatinas.

Background: Recent international guidelines have proposed statins as the corner stone of dyslipidemia management in adults. However it is not clear if they are best option for patients with statin related intolerance or what their adverse effects are. The bile acid sequestrants are an interesting alternative, however its evidence has not been carefully evaluated. Methods: A search was conducted on MEDLINE, Embase and Cochrane library databases for articles published up to June 2013, limited to Spanish and English language. Randomized clinical trials (RCT) and cohort studies evaluating the impact of bile acid sequestrants on mortality, cardiovascular outcomes, seric lipids and adverse effects were selected. Information was presented in a descriptive way. Results: Four RCT and one cohort study with aggregate data on 6833 people were included. Just one study evaluated cardiovascular mortality showing no statistically significant difference when compared with placebo, (RR 0.76; 95% CI 0.5:1.15), however there was a 16% reduction on acute myocardial infarction incidence. (RR 0.84; 95% IC 0.67: 1.00). Three studies evaluated seric lipids changes showing a moderate reduction in LDL levels without clinical significant differences on HDL and triglyceride levels. Conclusions: The evidence supporting bile acid sequestrants use is lacking and not conclusive to recommend its use as first-line therapy in dyslipidemic patients; however, these are an alternative option for patients with statin-related intolerance or adverse effects.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

Criterios de Sgarbossa: ¿es momento de actualizarlos? / Sgarbossa criteria: is it time for an update?

El diagnóstico de infarto agudo de miocardio en presencia de bloqueo de rama izquierda constituye un reto y hasta ahora los criterios de Sgarbossa eran la única herramienta disponible a pesar de las limitaciones conocidas. Una nueva regla diagnóstica puede disminuir la incertidumbre y con ello mejorar la selección de pacientes candidatos a reperfusión temprana, aunque se requiere más investigación para validarla.

The diagnosis of acute myocardial infarction in presence of left bundle branch block is a challenging one, and so far Sgarbossa criteria are the only tool available despite the known limitations. A new diagnostic rule can reduce our diagnostic uncertainty and thereby improve patient selection candidates for an early reperfusion, but so far research is needed to validate.

Clinical Significance and Related Factors of Fluid-Attenuated Inversion Recovery Vascular Hyperintensi- ties in Transient Ischemic Attack / 中国神经精神疾病杂志

Objective To investigate clinical significance and related factors of fluid-attenuated inversion recov?ery vascular hyperintensities (FVH) in transient ischemic attack (TIA) of carotid system. Method Data including general information and TIA risk factors was continuously collected from 142 patients with carotid system TIA from the depart?ment of neurology of Sheng jing Hospital affiliated China Medical University from January 2012 to February 2014.All pa?tients completed brain MRI including FLAIR and diffusion-weighted imaging (DWI)and MRA examinations within 72 hours after TIA. All patients were followed up for one month. Risk factors and FVH situations were analyzed based on clinical manifestations and DWI results. Result There were 87 male cases (61.27%)and FVH positive 57 cases (40.14%) among 142 cases with carotid system TIA (mean age 63.2±11.5). Logistic regression analysis revealed that the large intra?cranial carotid artery stenosis≥50%(OR=2.44,95%CI:1.09~5.49, P=0.03) and prior history of ischemic stroke (OR=3.88,95%CI:1.04~14.5, P=0.04) were independently associated with positive FVH. At one month followed-up, 40 cas?es (28.17%) of 142 patients progressed to acute cerebral infarction. Vulnerable plaque number in the contralateral carot?id artery (P=0.018), contralateral intracranial large vessel stenosis in MRA≥50%(P=0.007) and contralateral FVH oc?currence rate (P=0.001) were significantly higher in cerebral infarction group than in non-cerebral infarction group. Con?clusion FVH is common in carotid TIA patients, which is associated with intracranial carotid artery stenosis ischemic and previous history of ischemic stroke. Vulnerable plaque number of contralateral carotid artery, contralateral intracranial large vessel stenosis≥50%and the rate of occurrence of contralateral FVH may be associated with short-term progress leading TIA to acute infarction.

Indicadores de calidad en la atención de pacientes con infarto agudo de miocardio / Quality indicators in the care of patients with acute myocardial infarction

Objetivo: Describir el cumplimiento de los indicadores de calidad en la atención del infarto agudo de miocardio en un hospital de cuarto nivel en Bogotá, Colombia. Métodos: Estudio observacional, retrospectivo, descriptivo, en el que se incluyeron todos los pacientes con diagnóstico de infarto agudo de miocardio, de acuerdo con la Tercera Definición Universal del Infarto, que ingresaron a la Fundación Santa Fe de Bogotá desde enero de 2011 hasta abril de 2013. Resultados: El 99% de los pacientes recibió aspirina al ingreso y al 98% se le formuló durante el egreso. El 97% de los pacientes tuvo valoración intrahospitalaria de la fracción de eyección. El 93% fue dado de alta con betabloqueador y el 88% con inhibidores de la enzima convertidora de angiotensina o antagonistas del receptor de angiotensina II. El 98% recibió orden de rehabilitación cardiaca. La mortalidad por cualquier causa fue del 6%. Conclusiones: Existe adherencia adecuada a los indicadores de calidad en la atención del infarto agudo de miocardio, comparable con estándares internacionales, hecho del que hasta el momento no se tiene documentación alguna en Colombia.

Objective: Describe the quality of care in patients presenting with acute myocardial infarction in a fourth level hospital in Bogotá, Colombia. Methods; Observational, retrospective, descriptive study. From January 2011 to April 2013, all patients arriving to Hospital Fundación Santa Fe de Bogotá with acute myocardial infarction according to the Third Universal Definition of Myocardial Infarction were included. Results: Aspirin at arrival was given to 99% of patients. Aspirin at discharge was given to 98%. Evaluation of left ventricular ejection fraction was performed in 97% of patients. Ninety three percent received beta-blocker at discharge, 88% received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Ninety eight percent were enrolled in a cardiac rehabilitation program. All-cause mortality was 6%. Conclusions: Quality performance indicators are fulfilled and our results are comparable to those of international standards. Actually there is no record of this information in Colombia.

Redes neuronales en el diagnóstico del infarto agudo de miocardio / Neural networks for the diagnosis of acute myocardial infarction

Introducción; El infarto agudo de miocardio representa la primera causa de muerte no trasmisible en el mundo. Una de las herramientas que sirven como soporte a las decisiones en su diagnóstico son las redes neuronales, de las cuales se ha demostrado un buen nivel de precisión. Métodos; Se realizó el entrenamiento y la prueba de varias redes neuronales, con diferentes arquitecturas para el diagnóstico del infarto, a partir de los datos de la escala de clasificación de la probabilidad de angina de Braunwald en un grupo de pacientes que ingresaron por dolor torácico al servicio de urgencias del Hospital San José de Bogotá. Resultados; Se generaron 40 redes que fueron probadas en 5 experimentos de los cuales se obtuvo mayor precisión diagnóstica con el modelo de 5 entradas electrocardiográficas más troponina, aunque el mejor valor predictivo negativo se alcanzó en el modelo con 10 variables clínicas, electrocardiográficas y troponina. Varias de las redes diseñadas tuvieron una sensibilidad y una especificidad del 100%. Se requiere un estudio de validación para comprobar estos hallazgos. Conclusiones; Con los resultados encontrados para las redes neuronales en la literatura y en este estudio se puede considerar el uso de esta estrategia de inteligencia computacional en la práctica.

Introduction; Myocardial infarction represents the leading cause of death by a noncommunicable disease worldwide; one of the tools that serve as decision support for establishing a diagnosis are neural networks. They have been shown to have a good level of accuracy. Methods; Training and testing of several neural networks was performed with different architectures for the diagnosis of the myocardial infarction in a group of patients admitted with chest pain emergency room in the Hospital de San José, Bogotá. This was carried out according to data from the incidence scale of Braunwald's classification of unstable angina. Results; Forty networks were generated and tested in five experiments obtaining an accurate diagnostic with the electrocardiographic pattern of five entries and troponin. The negative predictive value was 100% in the model with ten clinical variables, electrocardiogram and troponin. Some of the designed networks had a sensitivity and specificity of 100%. A validation study to verify these findings is required. Conclusions; With the results found for neural networks in the literature and in the present study, we should consider the practical use of this computational intelligence strategy in daily practice.

Influence of cover statement and clarity of messages upon risk decision making about thrombolysis therapy in patients with cerebral infarction / 中华行为医学与脑科学杂志

Objective Influence of cover statement and clarity of the messages upon risk decision making about thrombolysis therapy in patients with cerebral infarction was discussed in the Scenarios of thrombolytic therapy for acute cerebral infarction.Methods Inpatients and outpatients with cerebral infarction were randomly divided into two groups:detailed / simple cover statement group.Every participant underwent obscure messages and clear messages with only one frame:positive or negative frame.Results In the simple cover statement group,both obscure messages subgroup and clear messages subgroup were not influenced by the framing effect with preference to the risk seeking.In the detailed cover statement group,participants in the clear messages group were not influenced by the framing effect(x 2 =0.19,P＞0.05),while the subjects in the obscure messages group were actually affected by the framing effect,with the preference to risk seeking in the positive framework (x 2=7.90,P＜0.01).Conclusion The risk decision making about thrombolysis therapy in patients with cerebral infarction is influenced by cover statements and clarity of the messages.To improve the rate of thrombolysis therapy,the patients should be exposed to the obscure messages in the positive framing information under the detailed cover statement.

Comunicación interventricular post infarto agudo del miocardio / Post acute myocardial infarction interventricular communication

La comunicación interventricular es una de las complicaciones mecánicas posteriores al infarto agudo del miocardio que genera alta morbilidad y mortalidad. Luego del uso de trombolíticos esta complicación ha disminuido y ha hecho que esta entidad sea cada vez menos frecuente. En este artículo se expone el caso de un paciente con síndrome coronario agudo sin terapia de reperfusión inicial, con posterior ruptura del septum interventricular, en quien se evidenció la utilidad de la ecocardiografía en el diagnóstico de dicha entidad.

Interventricular communication is a one of the mechanical complications after acute myocardial infarction that generates high morbidity and mortality. After the use of thrombolytics this complication has decreased and has made it increasingly less frequent. This article presents the case of a patient with acute coronary syndrome without initial reperfusion therapy, with subsequent rupture of the interventricular septum, in whom the use of echocardiography in the diagnosis of this entity evidenced its usefulness.

Infarto agudo do miocárdio em jovem com síndrome de Turner / Acute myocardial infarction in a young with Turner?s syndrome

A Síndrome de Turner (ST) é uma doença genéticacaracterizada pela monossomia completa ou parcial docromossomo X e possui uma grande variabilidade fenotípica,podendo se manifestar na forma clássica oucom poucos sinais dismórficos que possam chamaratenção ao diagnóstico. Mulheres com Síndrome deTurner têm um risco cardiovascular duas vezes maiorque a população geral e apresentam maior prevalênciade hipertensão arterial sistêmica, dislipidemia, aumentoda resistência insulínica e deficiência estrogênica,além de doenças cardíacas congênitas, principalmenteacometendo grandes vasos, podendo estar presenteem até 50% das mulheres com ST. Devido a essas complicaçõescardiovasculares, o reconhecimento de possíveismanifestações cardíacas agudas em pacientescom anomalias genéticas torna-se imprescindível parao sucesso terapêutico. O objetivo do presente artigo édescrever um caso de infarto agudo do miocárdio emuma paciente jovem com Síndrome de Turner.

Turner?s syndrome is a genetic disease related eitherto a homogeneous complete or a partial XO monosomyand has a fenotipic variability, presenting suchin a classic syndrome or with few dysmorfic signs thatcan draw attention to diagnosis. Womem with Turner?ssyndrome have a cardiovascular risk twice higher thangeneral population and presents more prevalence inhypertension, dyslipidemia, insulin resistence and estrogendeficiency, besides cardiac congenital cardiacdiseases, mainly affecting big vassels, in approximately50% of these patients. Due to these cardiovascularcomplications, recognition of possible acute cardiacmanifestations in patients with genetic abnormalities isnecessary to therapeutic success. The goal of this articleis to present a case report of a young woman with AMIand Turner syndrome.

Incidencia del infarto agudo de miocardio / Incidence of myocardial acute infarction

INTRODUCCIÓN: El infarto agudo del miocardio constituye una de las primeras causas de muerte en el mundo y en Cuba, su distribución se desconoce en el país en los últimos años. OBJETIVO: Describir la morbilidad del infarto agudo del miocardio en Cuba, 1999 -2008. MÉTODOS: Se realizó un estudio transversal descriptivo. Universo el total de personas e» 25 años durante el período 1999-2008, en cuya población se identificaron los individuos que padecieron infarto agudo del miocardio. Los datos se obtuvieron de registros de la Dirección Nacional de Estadísticas y se calcularon las tasas de incidencia. Las variables utilizadas fueron: Lugar de ocurrencia: provincias: Pinar del Río, Provincia Habana, Ciudad de La Habana, Matanzas, Cienfuegos, Villa Clara, Sancti Spíritus, Ciego de Ávila, Camagüey, Las Tunas, Holguín, Granma, Santiago de Cuba, Guantánamo, municipio especial Isla de la Juventud. RESULTADOS: Las tasas de incidencia en el país se mantuvieron alrededor de 1,9 por 1 000 habitantes como promedio durante el periodo analizado. Ciudad de La Habana fue la provincia de mayor incidencia en el primer y segundo quinquenio con tasas de 3,0 y 2,6 por 1 000 habitantes respectivamente. CONCLUSIONES: La incidencia por infarto agudo del miocardio en Cuba en el período 1999-2008, se mantuvo sin variaciones significativas. El riesgo de padecer dicha enfermedad para la población mayor de 25 años, estuvo elevada y constante durante el decenio. Las provincias de mayor incidencia fueron Ciudad de La Habana, Camagüey, Sancti Spíritus, y provincia Habana

INTRODUCTION: The myocardial acute infarction is one the first death causes in the world and in Cuba; in past years its distribution is unknown in our country. OBJECTIVE: To describe the morbidity of myocardial acute infarction in Cuba: 1999-2008. METHODS: A descriptive and cross-sectional study was conducted. Universe included persons aged e» 25 during 1999-2008 in whose population were identified the subjects suffered myocardial acute infarction. Data were collected from registry of National Management of Statistics and the incidence rates were estimated. Variables used were: occurrence place; provinces: Pinar del Río, Provincia Habana, Ciudad de La Habana, Matanzas, Cienfuegos, Villa Clara, Sancti Spíritus, Ciego de Avila, Camagüey, Las Tunas, Holguín, Granma, Santiago de Cuba, Guantánamo, especial municipality of Isla de la Juventud. RESULTS: Incidence rates in our country remained around the 1,9 by 1 000 inhabitants as average during the study period. Ciudad de La Habana was the province of greater incidence in the first and second five-year period with rates of 3.0 and 2.6 by 1 000 inhabitants, respectively. CONCLUSIONS: The incidence due to myocardial acute infarction in Cuba during 1999-2008, remained without significant variations. Thr risk of suffering such disease for the population aged over 25, was high and constant during decade. The provinces with higher incidence were Ciudad de La Habana, Camagüey, Sancti Spíritus and province of Habana

Evaluación de las acciones de enfermería en el Tiempo Puerta Aguja en pacientes con tratamiento trombolítico / Assessment of the nursing actions in the Needle-Door-Time in patients under thrombolytic treatment

La atención del paciente con Infarto Agudo del Miocardio desde los primeros momentos, es la piedra angular de su supervivencia, así como la rapidez en la administración del tratamiento trombolítico. Nos propusimos realizar un estudio descriptivo evaluativo de corte transversal, con el objetivo de determinar el tiempo utilizado para las acciones de enfermería en el intervalo Puerta Aguja a los pacientes con Infarto Agudo del Miocardio sometidos a tratamiento trombolítico en el servicio de urgencias en el periodo de Junio- Diciembre 2009. El universo estuvo constituido por 50 pacientes trombolizados. Se utilizó la técnica de la observación para evaluar las acciones de enfermería realizadas a los pacientes, para lo cual se construyó una guía de observación para las habilidades prácticas. El tiempo utilizado para la clasificación del paciente con IAM, identificación de contraindicaciones absolutas, a través del interrogatorio y examen físico fue de 10 minutos, en la mayoría (96 por ciento) de los pacientes. Un porciento similar se les preparó y administró el tratamiento trombolítico en igual periodo de tiempo. El electrocardiograma fue realizado en la totalidad de los pacientes en un tiempo óptimo de 10 minutos. El cumplimiento de los intervalos de tiempo de las acciones de enfermería relacionadas con el Tiempo Puerta - Aguja permitió que la mayoría de los pacientes recibieran el tratamiento trombolítico en un tiempo de 30 minutos(AU)

From the first times, the care to patient presenting with an acute myocardial infarction (AMI) is the cornerstone of its survival, as well as the speed to administer the thrombolytic treatment. The objective of present paper was to conduct a cross-sectional, evaluative and descriptive study to determine the time used for nursing actions in the Needle Door to patients presenting with myocardial infarction under thrombolytic treatment in the emergences service from June to December, 2009. Universe included 50 thrombolytic patients. The observational technique was used to assess the nursing actions carried out to patients designing an observational guide for practical abilities. The time used to classify the AMI patient, identification of absolute contraindications by questioning and physical examination was of 10 minutes in most (96 percent) of patients. A similar percentage was prepared for them administering the thrombolytic treatment in a similar period. Electrocardiogram was registered in all patients in an optimal time of 10 minutes. The fulfilment of time intervals of nursing actions related to Time- Door Needle allowed that most patients received thrombolytic treatment in 30 minutes(AU)

Infarto agudo del miocardio en los centros diagnósticos integrales de Vargas, Venezuela / Myocardial acute infarction in integral diagnosis centers of Vargas, Venezuela

INTRODUCCION: el infarto agudo del miocardio constituyó más del 12 por ciento de los fallecimientos por cardiopatía isquémica en Venezuela en 2006, sin evidenciarse disminución en la mortalidad a pesar del mejoramiento tecnológico de los servicios de urgencias. OBJETIVO: caracterizar su comportamiento en los centros de diagnóstico integrales del Estado de Vargas, en el período comprendido de junio de 2006 a junio de 2009. MÉTODOS: se realizó un estudio descriptivo, retrospectivo para caracterizar el comportamiento del infarto agudo del miocardio en los servicios de urgencia y emergencia de los centros de diagnóstico integrales utilizando las estadísticas de la Misión Barrio Adentro. RESULTADOS: fueron atendidos 186 pacientes por infarto agudo del miocardio, predominaron los ingresos en la terapia intensiva (2,4 por ciento) sobre los servicios de hospitalización. Los fallecidos por esta causa fueron 35 personas, 17,1 por ciento del total de fallecidos. Fueron trombolizados el 39,2 por ciento, con el mayor número alcanzado en el 2008 con 51,2 por ciento. La letalidad por infarto agudo del miocardio osciló entre tasas de 17,3 y 20 por cada 100 pacientes vistos. La tasa de mortalidad bruta fue de 9,58 x 100 000 habitantes. CONCLUSIONES: el número de casos atendidos por infarto tuvo un comportamiento ascendente de manera estable, representaron el 0,7 por ciento del total de ingresos en estos centros, con predominio de los ingresos en la terapia intensiva sobre los servicios de hospitalización. Se le aplicó el tratamiento trombolítico con estreptoquinasa recombinante a un por ciento importante de enfermos. En los servicios de hospitalización fue superior la letalidad por esta causa. No disminuyó el riesgo de morir para los pacientes con esta enfermedad y la mortalidad general en el período estudiado fue de 35 pacientes para una tasa de 9,58 Î 100 000 habitantes

INTRODUCTION: the acute myocardial infarction was over the 12 percent of deceased from ischemic heart disease in Venezuela in 2006 without evidence of decrease in mortality despite the technological improvement of emergences services. OBJECTIVE: to characterize its behavior in the integral diagnostic centers of the Vargas State from June, 2006 to June, 2009. METHODS: a retrospective and descriptive study was conducted to characterize the behavior of myocardial acute infarction in urgency and emergency services of integral diagnostic centers using the Barrio Adentro's Statistics. RESULTS: a total of 186 patients were seen due to myocardial acute infarction with predominance of intensive therapy admissions (2,4 percent) on the hospitalization services. Those deceased from this cause included 35 persons the 17,1 percent of total of deceased. The 39,2 percent was thrombolized where the higher figure was achieved in 2008 with a 51,2 percent. The mortality from myocardial acute infarction fluctuated between rates of 17,3 and 20 by each 100 patients treated. The crude mortality rate was of 9,58 by 100 000 inhabitants. CONCLUSIONS: the figure of cases seen due to infarction had a stable increasing behavior, accounting for the 0,7 percent of total of admissions in these centers with predominance of intensive therapy admissions over the hospitalization services. Thrombolytic treatment was applied using recombinant streptokinase in a significant percentage of patients. In the hospitalization services mortality from this cause was higher. The death risk not decreased for patients presenting with this disease and the general mortality during the study period was of 35 patients for a rate of 9,58 x 100 000 inhabitants

Caracterización del infarto agudo del miocardio en la clínica popular "Simón Bolívar" / Characterization of myocardial acute infarction in "Simón Bolívar" popular clinic

Introducción: en Venezuela las enfermedades del corazón son la primera causa de defunción, y es frecuente la hospitalización por infarto en la clínica popular «Simón Bolívar¼. Hasta la fecha no existen estudios sobre el comportamiento de esta enfermedad en la misión Barrio Adentro. Objetivo: caracterizar a los pacientes con diagnóstico de infarto agudo del miocardio tratados en la clínica popular «Simón Bolívar¼. Métodos: se realizó un estudio descriptivo, retrospectivo y transversal, desde enero hasta septiembre de 2006, en la clínica popular «Simón Bolívar¼, del municipio Diego Ibarra, Carabobo, Venezuela, con los 52 pacientes con infarto agudo del miocardio, atendidos en ella. Resultados: el 63,5 % de los pacientes que sufrieron infarto pertenecían al sexo masculino, los intervalos de 60-69 años representaron el 40,4 %, el 71,2 % de los pacientes tenían hipertensión arterial, el infarto Killip I se presentó en 80,8 % de los casos, y el 13,5 % de los pacientes se complicaron con insuficiencia del ventrículo izquierdo. Conclusiones: predominó el sexo masculino con edades entre 60 y 69 años, los principales factores de riesgo fueron: hipertensión arterial, obesidad, diabetes mellitus y tabaquismo. La mayoría presentó infarto del miocardio Killip I, y las complicaciones intrahospitalarias fueron la insuficiencia del ventrículo izquierdo, las arritmias y el infarto recurrente.

Introduction: In Venezuela, the heart diseases are the leading cause of decease and it is frequent admission from infarction in the "Simón Bolivar" popular clinic. To date there are not studies on the course of this entity in the "Barrio Adentro" mission. Objective: To characterize the patients diagnosed with myocardial acute infarction treated in the above mentioned clinic. Methods: A descriptive, retrospective and cross-sectional study was conducted from January to September, 2006 in "Simón Bolivar" popular clinic from Diego Ibarra municipality, Carabobo, Venezuela in 52 patients presenting with myocardial acute infarction seen there. Results: The 63,5% of patients with infarction were men, intervals of 60-69 years old represented the 40,4%, the 71,1% of patients suffered arterial hypertension, Killip infarction was present in the 80,8% of cases, and the 13,5% becomes complicated with a left ventricle failure. Conclusions: There was predominance of male sex aged between 60 and 69, major risk factors were: arterial hypertension, obesity, diabetes mellitus and smoking. Most had a Killip I myocardial infarction and the intrahospital complications included a left ventricle failure, arrhythmias and the recurrent infarction.

Moléculas de adhesión. Importancia en el síndrome coronario agudo / Significance of adhesion molecules in acute coronary syndrome

Se presenta una revisión de los conceptos actuales de la ateroesclerosis como fenómeno inflamatorio crónico del endotelio vascular y de la importancia de la participación de las moléculas de adhesión endoteliales en las formas clínicas principales del síndrome coronario agudo: la angina inestable y el infarto agudo del miocardio. Se describen los resultados obtenidos por diferentes autores en el estudio de las moléculas de adhesión en este síndrome, su importancia en el diagnóstico asociado con los parámetros séricos convencionales y su potencial terapéutico.

Present paper is a review of current concepts of atherosclerosis as a chronic inflammatory phenomenon of vascular endothelium and of significance involvement of endothelial adhesion cells in the main clinical ways of acute coronary syndrome: unstable angina and myocardial acute infarction. Different authors describe the results achieved in adhesion molecules study in this syndrome, its significance in diagnosis associated with conventional serum parameters and its therapeutical potential.

Acute cerebral infarction due to thrombus formation during GDC embolization for the treatment of intracranial aneurysm: A case report / 대한마취과학회지

Although Guglielmi Detachable Coil (GDC) endovascular treatment of intracranial aneurysms has become an alternative to surgery, the main complication continues to be thromboembolic events. In our patient, we found thrombus at the third branch of the right middle cerebral artery after coil embolization. We added intravenous heparin and gave abciximab, an antiplatelet agent through the catheter. We then elevated the blood pressure and administered intravenous colloid solution to maintain adequate collateral circulation. One day later, the patient presented with acute focal infartion in the right frontal lobe and we treated her with low molecular weight heparin. After seven days, the patient's symptoms disappeared, and there was no residual neurological deficit. Therefore, we believe potential clinical complications can be avoided through early recognition of thrombus and appropriate medical therapy. Furthermore, it is necessary to prevent hypotension and to maintain proper hematocrit levels during operations in patients having risk factors for thrombosis.

Three simple criteria in the diagnosis of myocardial infarction in the presence of left bundle-branch block: A two-year retrospective study at OMMC

The three criteria tested above either alone or in combination are highly specific markers of infarction that may help physicians rapidly diagnose and treat acute infarction in patients with left bundle-branch block. However, with these findings, conformation with enzyme studies is still required. There was no attempt to distinguish between previous and newly developed LBBB. Nonetheless, these criteria probably apply to both old and new LBBB. (Conclusions)