Síndrome de Pickering: insuficiencia cardiaca aguda con un actor inesperado / Pickering syndrome: acute heart failure with an unexpected actor

El síndrome de Pickering es una entidad clínica descrita en 1988 que consiste en la presentación de edemas agudos de pulmón «flash» recurrentes y de predominio nocturno e hipertensión arterial secundarios a estenosis bilateral de las arterias renales o unilateral en pacientes monorrenos. Describimos el caso de un varón de 74 años que tras el tratamiento percutáneo de exclusión de un aneurisma aórtico infrarrenal presentó síndrome de Pickering debido a obstrucción hemodinámica de la arteria renal izquierda por la endoprótesis aórtica; con evolución clínica satisfactoria después de la revascularización. (AU)

Pickering's syndrome is a clinical entity described in 1988 that consists of the presentation of recurrent and predominantly nocturnal acute flash pulmonary oedema and arterial hypertension secondary to bilateral renal artery stenosis or unilateral in single-kidney patients. We describe the case of a 74-year-old man who, after percutaneous exclusion treatment of an aortic infrarenal aneurysm, developed Pickering syndrome due to haemodynamic obstruction of the left renal artery because of the aortic endoprosthesis; with satisfactory clinical evolution after revascularization. (AU)

[Pickering syndrome: acute heart failure with an unexpected actor]. / Síndrome de Pickering: insuficiencia cardiaca aguda con un actor inesperado.

Pickering's syndrome is a clinical entity described in 1988 that consists of the presentation of recurrent and predominantly nocturnal acute flash pulmonary oedema and arterial hypertension secondary to bilateral renal artery stenosis or unilateral in single-kidney patients. We describe the case of a 74-year-old man who, after percutaneous exclusion treatment of an aortic infrarenal aneurysm, developed Pickering syndrome due to haemodynamic obstruction of the left renal artery because of the aortic endoprosthesis; with satisfactory clinical evolution after revascularization.

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A ‘real life’ single center experience / Impacto del balón de contrapulsación intraaórtico en el pronóstico clínico a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico: experiencia de «vida real»

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our 'real life' experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization

OBJETIVO: Analizar el uso e impacto del balón de contrapulsación intraaórtico (BCIA) en la mortalidad a 30 días y en los desenlaces clínicos a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico. DISEÑO: Estudio de casos y controles unicéntrico y retrospectivo. Ámbito: Unidad Coronaria. PACIENTES: Los datos fueron obtenidos de 825 pacientes consecutivos admitidos en una unidad coronaria con diagnóstico de infarto agudo de miocardio con elevación del segmento ST desde enero de 2009 hasta agosto de 2015. Un total de 73 pacientes en situación de shock cardiogénico al ingreso derivados a una revascularización coronaria percutánea urgente fueron incluidos para el análisis y estratificados en función de la utilización del BCIA (44 pacientes recibieron BCIA). VARIABLES: Antecedentes cardiológicos, situación hemodinámica al ingreso, características angiográficas y periprocedimiento, y variables derivadas de la estancia en la Unidad Coronaria. RESULTADOS: La mortalidad a 30 días fue similar entre los tratados con BCIA y aquellos con tratamiento convencional (29,5 y 27,6%, respectivamente; HR con BCIA 1,10, IC 95% 0,38-3,11; p = 0,85). Así mismo, no encontramos diferencias significativas con respecto a los desenlaces clínicos a corto plazo: días en ventilación mecánica, tiempo hasta la estabilidad hemodinámica, requerimiento de fármacos vasoactivos y días de estancia en la Unidad Coronaria. En el análisis multivariante, las únicas variables asociadas de forma independiente con una mayor mortalidad a 30 días fueron peor función renal al ingreso (HR 3,9, IC 95% 1,4-10,6; p = 0,008), antecedentes de enfermedad arterial periférica (HR 3,3, IC 95% 1,2-9,1; p = 0,019) y diabetes mellitus (HR 3,2, IC 95% 1,2-8,1; p = 0,018). CONCLUSIÓN: En nuestra experiencia de la «vida real», la utilización del BCIA no modifica la mortalidad a 30 días ni los desenlaces clínicos a corto plazo en pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico que son derivados a una estrategia de revascularización coronaria percutánea urgente

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience.

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

[The prognostic factors after an acute myocardial infarct treated with fibrinolytics]. / Factores pronósticos tras el infarto agudo de miocardio tratado con fibrinolíticos.

BACKGROUND: The usefulness of the exercise test in evaluating patients with an acute myocardial infarction treated with fibrinolytics is controversial. On the other hand, the prognostic value of a patent infarct-related artery has not been clearly established. The objectives of this study were to assess the validity of the exercise test and to study the prognostic value of the artery patency after a myocardial infarction. MATERIAL AND METHODS: We studied 99 patients with a myocardial infarction treated with fibrinolytics, non-complicated. An exercise test and a cardiac catheterization were performed in the first month. The patients were followed-up for 2 years, recording the major cardiac events (death and reinfarction) and the minor events (angina class (II, left cardiac failure class (II or maintained ventricular tachycardia). RESULTS: On multivariate analysis with Cox regression, a workload < 4 METS at the exercise test was the only independent prognostic factor of major events (RR 5.6; CI 95% 1.68-19). The independent prognostic factors of minor events were: multivessel disease (RR 3.36; CI 95% 1.56-7.24), anterior infarction (RR 3.15; CI 95% 1.3-7.6), abnormal exercise test (RR 2.98; CI 95% 1.46-6.09) and ejection fraction < or = 40% (RR 2.48; CI 95% 1.07-5.74). The patency of the infarct-related artery was not a predictor of events. CONCLUSIONS: The exercise test is useful in predicting the prognosis in patients treated with fibrinolytics. An occluded infarct-related artery was not an independent predictor of cardiac events in 2 years of follow-up.

[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.

[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.