Rotura espontánea de la válvula mitral / Spontaneous rupture of acute mitral insufficiency

Presentamos el caso de una paciente, sin antecedentes de interés, que acude a nuestro Servicio de Urgencias por su propio pie, por empeoramiento de un dolor epigástrico que viene sufriendo desde hace meses. Durante su estancia en Urgencias presenta de forma repentina e inesperada un cuadro de disnea intensa y hemoptisis, entrando en un estado de shock cardiogénico. La causa de esta situación crítica fue, como demostró el diagnóstico final, la rotura espontánea de las cuerdas tendinosas de la válvula mitral, debido a una miocardiopatía hipertrófica y prolapso de la válvula mitral, sin diagnosticar hasta ese momento. Se discute la etiopatogenia de la insuficiencia mitral aguda (AU)

[Postpartum depression in the health area of Toledo]. / Depresión posparto en el Area de Salud de Toledo.

OBJECTIVES: To find how common post-natal depression is in our area and its relationship with social and demographic variables, vital events and morbidity. DESIGN: Descriptive crossover study based on initial interview face-to-face, and follow-up telephone interview. SETTING: Community framework; our area's health districts. PARTICIPANTS: 190 women who attended our reference hospital to give birth between February and April 1998. MEASUREMENT AND RESULTS: Through face-to-face interview at the hospital, social and demographic variables, morbidity, intercurrent vital events and family support were collected for 190 women. Six to eight weeks after the birth, these women were phoned and the Edinburgh Depression Scale (EPDS) was conducted. According to the EPDS, the frequency of depression was 13.16% (95% CI, 8.86-19). Characteristics of the sample were: mean age 30.13 (SD 4.63), rural setting. 56% had basic schooling. 32% had psychiatric history, and 44% had family history of depression. 80% thought they were going to be supported after the birth: after seven weeks this figure was 75%. In comparison between women with and without post-natal depression, we found statistically significant differences on relating it to psychiatric history of the woman (p < 0.05) and of the women's family (p < 0.01). For mother's educational level, we found a nearly significant association (p < 0.1). No significant differences were found with the other variables studied. CONCLUSIONS: The frequency of post-natal depression found was similar to in the literature. Our profile of women with post-natal depression was: medium-low educational level, personal and family history of depression. Unlike other studies, we found no relationship between post-natal depression and family support during the puerperium.