¿Son inadecuadas las remisiones urgentes a cardiología desde atención primaria? / Are urgent cardiology referrals from primary care inappropriate?

Introducción. El objetivo del presente estudio es describir las características de la derivación desde AP a la consulta extrahospitalaria de cardiología, con carácter urgente, si esta es excesiva, inadecuada, y el grado de concordancia entre el diagnóstico principal del médico de AP y el del especialista. Material y método. El diseño del estudio es descriptivo y transversal, se incluyen todas las derivaciones urgentes para diagnóstico y/o tratamiento cardiológico realizados desde AP durante 9 meses, caracterizándolas por fecha de remisión, sexo, edad, historia clínica, pruebas complementarias, solicitadas tanto por el médico de AP como por el especialista, y diagnóstico, informatizando los datos para su procesamiento estadístico. Resultados. Sobre una muestra de 543 pacientes, sin diferencias significativas en la distribución de edades según sexo, la demanda fue homogénea en su distribución mensual. El 88% de las remisiones se realizan con historia clínica, exploración física e impresión diagnóstica del proceso. El 77% de los pacientes son seguidos en la consulta de atención especializada. El grado de concordancia global entre el diagnóstico del médico de AP y el cardiólogo ha sido aceptable (κ=0,62; p<0,001). Conclusión. Como conclusión podemos refutar la opinión del abuso de las remisiones urgentes inadecuadas a la consulta extrahospitalaria de cardiología por parte de los profesionales de AP (AU)

Introduction. The aim of this study is to describe the characteristics of urgent referrals from Primary Care (PC) to the cardiology outpatient clinic, and if this is excessive and inappropriate, as well as the level of agreement between the primary diagnosis of the PC physician and the specialist. Material and method. The study design is descriptive and transverse, and includes all urgent referrals for diagnosis and/or cardiological treatment made from PC over 9 months, characterising them by date of referral, sex, age, history, complementary tests, ordered by the PC physician and the specialist, and diagnosis, computerized data for statistical processing. Results. On a sample of 543 patients, without significant differences in the distribution of ages according to sex, the demand showed homogeneity in its monthly distribution. A total of 88% of the patient referrals were made with clinical history, physical examination and diagnostic impression of the process, with 77% being followed up in the specialist clinic. The overall level of agreement between the PC diagnosis and that of the cardiologist was acceptable (κ=0.62, P<0.001). Conclusion. In conclusion, we can refute the opinion of the abuse of inappropriate urgent referrals to the cardiology outpatient clinic by the primary care professionals (AU)

[Female gender is an independent predictor of in-hospital mortality in patients with ST segment elevation acute myocardial infarction treated with primary angioplasty]. / El género femenino es un predictor independiente de la mortalidad intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST revascularizado mediante una angioplastia primaria.

OBJECTIVE: The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA). DESIGN AND SCOPE: Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA. PATIENTS: Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women. MAIN VARIABLES OF INTEREST: In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model. RESULTS: The women were older (70+/-8 versus 65+/-11; p=0.02) and had greater prevalence of diabetes (37% versus 18%; p=0.002) and hypertension (58% versus 37%; p<0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p=0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p=0.01) and in-hospital mortality (17% versus 8%; p=0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality. CONCLUSIONS: In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA.

El género femenino es un predictor independiente de la mortalidad intrahospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST revascularizado mediante una angioplastia primaria / Female gender is an independent predictor of in-hospital mortality in patients with ST segment elevation acute myocardial infarction treated with primary angioplasty

Objetivo. Analizar la influencia del sexo en el pronóstico intrahospitalario del infarto agudo de miocardio con elevación del segmento ST (IAMEST) revascularizado mediante una angioplastia primaria (AP). Diseño y ámbito. Estudio prospectivo de una cohorte de pacientes consecutivamente ingresados en la Unidad Coronaria de un hospital terciario durante el periodo de enero a octubre de 2004, con diagnóstico de IAMEST y tratados con AP. Pacientes. Muestra consecutiva de 86 pacientes con dicho diagnóstico dividida en dos grupos en función del sexo: 52 hombres y 34 mujeres. Variables de interés principales. En ambos grupos analizamos las características clínico-demográficas basales, la extensión de la enfermedad coronaria (EEC), el éxito de la AP, la aparición de insuficiencia cardiaca (IC) y la mortalidad intrahospitalaria en los primeros 28 días tras el ingreso. Se analizaron predictores de mortalidad en un modelo multivariado. Resultados. Las mujeres presentaron mayor edad (70 ± 8 frente a 65 ± 11; p = 0,02) y prevalencia de diabetes (37% frente a 18%; p = 0,002) y de hipertensión arterial (58% frente a 37%; p < 0,001) que los hombres, mientras que estos presentaron mayor frecuencia de tabaquismo (34% frente a 22%; p = 0,001). No hubo diferencias en la presencia de hiperlipidemia, la EEC o el éxito de la AP. Las mujeres presentaron mayor incidencia de IC al ingreso (22% frente a 12%; p = 0,01) y de mortalidad intrahospitalaria (17% frente a 8%; p = 0,002). En el análisis multivariado, el sexo femenino y la IC al ingreso permanecieron como predictores de mortalidad intrahospitalaria. Conclusiones. En nuestro estudio, el sexo femenino fue un predictor independiente de mortalidad intrahospitalaria en pacientes con IAMEST tratados con AP

Objective. The aim of this study was to determine the influence of gender on in hospital outcome in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary angioplasty (PA). Design and scope. Prospective study of a cohort of patients consecutively admitted to the Coronary Unit of a tertiary hospital in the period of January to October 2004 with the diagnoses of IAMEST and treated with PA. Patients. Consecutive sample of 86 patients with this diagnosis divided into two groups based on sex: 52 men and 34 women. Main variables of interest. In both groups, we analyzed the baseline clinical-demographic characteristics, extension of the coronary disease (ECD), success of the PA, appearance of heart failure (HF) and in-hospital mortality in the first 28 days after admission. We analyzed predictors of mortality in a multivariate model. Results. The women were older (70 ± 8 versus 65 ± 11; p = 0.02) and had greater prevalence of diabetes (37% versus 18%; p = 0.002) and hypertension (58% versus 37%; p < 0.001) than the men while the men had greater frequency of smoking (34% versus 22%; p = 0.001). There were no differences in the presence of hyperlipidemia, ECD or the success of PA. Women had a higher incidence of HF on admission (22% versus 12%; p = 0.01) and in-hospital mortality (17% versus 8%; p = 0.002). In the multivariate analyses, female sex and HF on admission continued to be predictors of in-hospital mortality. Conclusions. In our study, female gender was an independent predictor of in-hospital mortality in patients with IAMEST treated with PA

Upgrade of a pacemaker defibrillator to a biventricular device: the internal jugular vein approach in a case of bilateral subclavian veins occlusion.

Cardiac resynchronization improves survival and functional class of patients with advanced chronic heart failure. Placement of a stimulation electrode in the coronary sinus via the left subclavian vein is not always possible and other alternatives are required, above all when it concerns upgrading a previous device. This paper presents the case of a patient with a pacemaker/defibrillator and occlusion of both subclavian veins who had a stimulation electrode successfully placed in the coronary sinus via the right internal jugular.

[Infectious endocarditis of prosthetic valves due to Staphylococcus capitis: a new case]. / Endocarditis infecciosa sobre válvulas protésicas causada por Staphylococcus capitis: un nuevo caso.

We present the case of a male patient with aortic and mitral valve bioprostheses who developed infectious endocarditis due to Staphylococcus capitis, which has recently been described as an agent producing infectious endocarditis in native and prosthetic cardiac valves. The patient's course evolved unfavorably, despite specific antibiotic treatment, leading to the surgical replacement of the valve, which completely resolved the problem. This case points out that, although rare, in infectious endocarditis due to Staphylococcus capitis its pathogenicity is significant.

[The adult respiratory distress syndrome as a complication of the APSAC treatment of acute myocardial infarct. Apropos a case]. / Síndrome de distrés respiratorio del adulto como complicación del tratamiento del infarto agudo de miocardio con APSAC. A propósito de un caso.

Thrombolytic therapy has shown to be effective in acute myocardial infarction, and its benefits on left ventricular function and later survival are well known. However it is not a therapy free of complications and side effects. Allergic reactions, anafilaxia, hypotension, and several kinds of hemorrhages have been reported. Adult respiratory distress syndrome after streptokinase administration has been also described, and one case, recently communicated, after APSAC therapy. We present the case of a male with acute myocardial infarction who developed adult respiratory distress syndrome after APSAC therapy, with different outcome than the first case published in the literature. Finally, we discussed the mechanisms by means these drugs can produce such a complication.

[Acute myocardial infarct in a cocaine-addicted young man]. / Infarto de miocardio agudo en un joven cocainómano.

We present a case of acute myocardial infarction in a 22 year old cocaine user. The absence of coronary artery stenotic lesions, as was seen in the coronary arteriography, and the absence of personal past cardiovascular or family history, suggest a cocaine-induced coronary spasm as responsible for the acute myocardial event.

[A-V conduction block at His bundle level; as the cause of syncopal crisis in patients with normal ECG (author's transl)]. / Bloqueos A-V completos intermitentes de localización intrahisiana, como causa de crisis sincopales con ECG de base normal.

The history, clinical evolution and complementary studies used to identify the diagnostic etiology of syncopal crisis in a series of 5 patients are presented. The crisis consisted of advanced disturbances of the A-V conduction at the level of the His bundle. It is pointed out that although the evolution of the disturbance was intermittent, the surface ECG was normal and neither A-V block nor broadening of the QRS complex were seen. The importance of continued monitorization, whether as out-patients (Holter system) or, in some cases in an Intensive Care Unit, as well as the need to practice electrophysiologic studies in all these cases as the only way of establishing a firm diagnosis, are underlined. The fact that these disturbances do not always lead to an advanced blockage of A-V conduction is discussed as being reminiscent of the prospective and retrospective studies in the similar case of bi-fascicle block.

[Latent chronic constrictive pericarditis. Rapid filling overload for an accurate hemodynamic diagnosis (author's transl)]. / Pericarditis crónica constrictiva latente. Confirmación diagnóstica hemodinámica con sobrecarga volumétrica rápida.

Chest roentgenogram showed a pericardial calcification in a patient with inconspicuous signs of cardiac disease and normal basal pressures in the right cavities. A typical hemodynamic tracing of chronic constrictive pericarditis was obtained with rapid filling overload. The uncommeness of silent chronic constrictive pericarditis is mentioned and the usefulness of rapid filling overload for an accurate hemodynamic diagnosis of this condition is emphasized. Denomination of "latent" chronic constrictive pericarditis for similar cases to this reported is proposed.