Aplicación práctica de la lectura computarizada del electrocardiograma / Practical application of electrocardiogram computerization

El electrocardiograma (ECG) continúa siendo en el momento actual la exploración complementaria inicial e imprescindible en el paciente hipertenso. Es especialmente trascendente para el diagnóstico de la cardiopatía hipertensiva en todas sus vertientes, como son la hipertrofia ventricular izquierda, la cardiopatía isquémica y los trastornos del ritmo. Sin embargo, la correcta lectura del ECG del paciente hipertenso, a pesar de ser una actividad diaria, sigue siendo un reto para la mayoría de los médicos. Por ello desde finales del siglo pasado se han desarrollado programas informáticos que incorporados a los equipos de electrocardiografía puedan ayudar al médico en la interpretación del ECG. El rendimiento y la precisión de los diferentes programas han demostrado ser muy aceptables y en muchas ocasiones con una exactitud equivalente a la lectura realizada por expertos. La digitalización del ECG es especialmente interesante cuando, como en la mayoría de los casos, no se dispone de la opinión del experto en electrocardiografía, porque disminuye la carga de trabajo, reduce la variabilidad interintraobservador y, lo que es más importante, contribuye a mejorar la precisión diagnóstica. Además se ha mostrado extraordinariamente útil para poder aplicar en la práctica clínica los nuevos criterios electrocardiográficos descritos en los últimos años, y en especial los referidos a hipertrofia ventricular izquierda. Por ello, la lectura computarizada del ECG se presenta como una herramienta con un gran potencial presente y futuro porque, además de las ventajas que aporta su aplicación a la práctica diaria, puede desde el campo de la investigación aportar nueva información de gran importancia para el pronóstico y tratamiento del paciente hipertenso

The electrocardiogram (ECG) continues to be the initial and essential complementary examinations in the patient with high blood pressure. It is especially relevant in the diagnosis of hypertensive heart disease in all its varieties, such as left ventricle hypertrophy, ischemic heart disease and rhythm disorders. Although the ECG is a daily routine in the study of the patient with high blood pressure, it is still a matter of concern for most doctors. This is the reason why different computer programs have been developed to be adapted to the electrocardiographic monitors in order to help the doctor interpret the results. The results and accuracy of the different programs has been shown to be quite acceptable, often with an accuracy equals to that of the lecture made by experts. The computerization of the ECG is very interesting when, as occurs in many cases, there is no expert on ECG available, because it decreases the work load, reduces variability between different observers, and what is more important, helps to make the diagnostic accuracy higher. It has become very useful in the application of the new ECG criteria in the last years especially when it comes to left ventricle hypertrophy. This is the reason why ECG computerization becomes a major tool with great present and future potential, because it not only has the advantages from its application to the daily practice, but can supply new information of great importance in the prognosis and treatment of the patient with a high blood pressure in the research field (AU)

Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study.

The CONTROLRISK study was designed to determine the cardiovascular risk profile of the hypertensive population attended at primary care and specialist setting in Spain and to investigate whether physicians stratify the risk correctly, according to the 2003 European guidelines. A total of 8920 patients were recruited from primary care (n=4485) and specialist outpatient clinic (n=4435). The age criteria was 62.6+/-11.1 years; 51.6% were women. No differences were observed in the severity of hypertension. More than 85% presented other cardiovascular risk factors, similarly in both groups. Target organ damage (TOD) and associated clinical conditions (ACC) were more frequent in specialist setting (57.6 vs 34.3% and 39 vs 28.7%, both P<0.0001). The most common risk factor was age. The most frequently reported TOD was left ventricular hypertrophy (42.3 and 22.1%; P<0.0001). Ischemic heart disease was the most common ACC (21.5 vs 13.1%; P<0.0001). The risk profile was significantly higher in specialist population (75.1 vs 60.3% of patients belonged to high- or very high-risk groups). Specialists and primary care physicians stratified only 54.6 and 48% of their patients correctly, respectively (P<0.05). Both, specialists and general practitioners (GPs) strongly underestimated the risk. Very high-risk patients were adequately assessed only in 44.9% of cases by specialists and in 25.3% by GPs (P<0.001). More than half of the hypertensive patients attended by GPs in Spain belong to the high- or very high-risk groups. GPs and specialists tend to underestimate the cardiovascular risk in daily clinical practice, mainly in very high-risk patients.

Empleo de reboxetina en el trastorno por déficit de atención e hiperactividad infantil asociado a retraso mental y epilepsia. A propósito de dos casos / The use of reboxetine in attention deficit and hiperactivity disorder in children, associated to mental retardation and epilepsy. Presenting two cases

El Trastorno por déficit de atención e hiperactividad (TADH) constituye uno de los problemas clínicos y de salud mental más importantes en niños y adolescentes por la incapacidad que asocia. Su etiología es aún desconocida, y aunque tradicionalmente se han implicado sistemas dopaminérgicos, en los últimos años están apareciendo nuevos datos que sugieren un papel relevante de los sistemas noradrenérgicos. Los psicoestimulantes son actualmente el tratamiento de elección del TADH, si bien un importante porcentaje de niños y adolescentes no responden, presentan alguna contraindicación para su uso, o no pueden tolerar los efectos adversos asociados. Es por ello la necesidad de encontrar agentes terapéuticos alternativos. Algunos autores han propuesto la Reboxetina, cuyo mecanismo de acción es predominantemente noradrenérgico, como fármaco efectivo en el tratamiento del TADH. Presentamos dos casos de niñas con Trastorno por déficit de atención e hiperactividad, Retraso Mental y Epilepsia en los que se ha utilizado Reboxetina, con buena tolerancia, y una respuesta positiva tanto a nivel conductual como cognitivo. Sugerimos la utilidad de este fármaco en niños con similar perfil clínico y planteamos la necesidad de realizar futuras líneas de investigación que vayan en esta dirección

The attention deficit/hyperactivity disorder (ADHD) represents one of the most predominant clinical and mental health problems in children and adolescents due to the great incapacity it produces. The etiology is still unknown, and although traditionally it was associated to the dopaminergic system in these last years new information reveals the growing importance of the noradrenergic system. At this moment we use stimulants as the main treatment in attention deficit and hyperactivity disorder, although a big percentage of children and adolescents don't respond or have major side effects. This is why we need to find new treatments in this field .Some authors have suggested the use of Reboxetine, which mainly works trough a noradrenergic mechanism, as an effective treatment. We present the cases of two girls with attention deficit and hyperactivity disorder plus mental retardation and epilepsy in which we used Reboxetine with good tolerance and a positive response in conduct and cognitive areas. We suggest this treatment as a useful option in children with a similar clinical pattern and we express the need to create future lines of investigation in this direction