RESUMEN
The ultimate goal of antihypertensive therapy is cardiovascular risk reduction. As lowering blood pressure per se reduces risk for myocardial infarction only by 20%-25%, it is obvious that a better protection is needed. An optimal strategy to reduce risk in hypertensives may include lifestyle modification, promotion of adherence to therapy, early and aggressive target levels achievement by appropriate drug choice. Clinical trial data suggest that RAAS blockers can reduce the risk at least partly independently of BP lowering. In addition, as hypertension is associated with a constellation of other risk factors, the global risk reduction is nowadays going to become the gold standard in therapy. The most common and important coexisting risk factor is hypercholesterolemia. This is not simply a co-existence but there is an independent and causal relationship between lipids and hypertension and there is a physiologic rationale and evidence for statins use especially in patients with complicated hypertension or in patients with more than two risk factors. So, whilst blood pressure lowering is undoubtedly beneficial, we have to focus on the global cardiovascular risk. We must go beyond blood pressure and the most effective way to go "beyond BP" is to add a statin.
RESUMEN
Aim of this study was to investigate the significance of cardiac rehabilitation (CR) on Health Related Quality of Life ( HRQoL) in post acute myocardial infarction (AMI) patients. Methods. A total number off 110 individuals divided in 3 groups was included in the study. Group A consisted of 60 post-AMI pts participating in a CR program. It was a multidisciplinary rehabilitative approach including supervised bike exercise, with parallel education, counselling, psychological and social support, performed 3 times per week for 2 months after AMI . Group B consisted of 40 post-AMI pts not participating in any CR program while the control group C consisted of 10 apparently healthy people. HRQoL was evaluated by the Velasco-Del Barrio questionnaire. Questions on this questionnaire are reffered to 9 categories (health, sleep and rest, emotional behavior, concerns for the future, mobility, social interaction, alertness behavior, communication, work and leisure time). A 5-point scale (1=all of the time, 5=none of the time) and a special (1 to 8) coefficient for each parameter were used for the evaluation of each parameter. The highest score of 220 indicates the poorest QL. Results. Group A pts had better score of HRQoL as compared to Group B (94±3 vs 114±3, p<0.001) and slightly worse than Group C pts (94±4 vs 69±3, p<0.01).Significant difference was found among Group A and B pts regarding the most important evaluated parameters such as symptoms (17±6.8 vs 22±6.5, p<0.001) and social behavior (21±4.2 vs 23±5.5, p<0.0001).Conclusion. It is concluded that participation in a multidisciplinary CR program significantly improves HRQoL in post AMI pts. All these pts must urged to take part in such programs.
RESUMEN
A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. Echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. Coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. Cardiopulmonary resuscitation was unsuccessful.
