[Pulmonary arterial hypertension from the risk assessment to combined treatment]. / Hipertensión arterial pulmonar desde la evaluación del riesgo al tratamiento combinado.

This paper shows the importance of the guideline clinical practice as well as the centers for comprehensive care of pulmonary arterial hypertension. The current treatment of pulmonary arterial hypertension is analyzed according to its severity, stratified through the evaluation of the multiple parameters of risk and its mortality to 1 year. The prognosis of the disease is considered and the place of the combined treatment indicated in sequential manner or from the beginning.

En este trabajo se señala la importancia de las guías de actuación clínica, así como de los centros de atención integral de la hipertensión arterial pulmonar. Se analiza el tratamiento actual de la hipertensión arterial pulmonar de acuerdo a su severidad, estratificado a través de la evaluación de parámetros múltiples de riesgo y su mortalidad a 1 año. Además, se considera el pronóstico de la enfermedad y el lugar que tiene el tratamiento combinado indicado en forma secuencial o desde un inicio.

[Left main coronary artery aneurysm thrombosis in a young patient with acute myocardial infarction]. / Trombosis de aneurisma del tronco coronario izquierdo en paciente joven con infarto agudo de miocardio.

INTRODUCTION: The left main coronary artery aneurysm is rare, with an incidence of 0.1%, being the atherosclerosis its main etiology. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgical or pharmacologically. CLINICAL CASE: We present a case of a 44 year-old male with a history of obesity, smoking and dyslipidemia, complaining of oppressive chest pain, dyspnea and diaphoresis. An electrocardiogram showed an ST-segment elevation on the anterior and lateral wall and positive enzymatic curve for infarction. He was initially treated with streptokinase with no reperfusion evidence after 3 hours of the onset of symptoms, so he underwent to rescue angioplasty. Angiography reported left main coronary artery aneurysm thrombosis. Afterwards, he presented cardiogenic shock and was revascularized with a coronary artery bypass graft of the mammary artery to the left anterior descending artery and the saphenous vein to the obtuse marginal, however he did not survive. Determination for 4G/5G PAI-1 polymorphism, glycoprotein IIIa PLA1/A2 gene and Glu298Asp polymorphism of the endothelial nitric oxide synthase gene was performed. CONCLUSIONS: Left main coronary artery aneurysms are rare, finding ONE in an acute myocardial infarction is a serious situation because of the challenging reperfusion techniques that are implied, such as in this case. The search for genetic factors related with hypofibrinolysis could guide stratification and therapy towards medical surgical or interventional management.

Non-ST-elevation acute myocardial infarction secondary to antiphospholipid antibody syndrome in an adolescent female.

BACKGROUND: antiphospholipid antibody syndrome (APS) is characterized by the association among arterial or venous thrombosis, recurrent pregnancy loss, thrombocytopenia and the presence of circulating antiphospholipid antibodies. Antiphospholipid antibody-related thrombosis seems to constitute a significant proportion of childhood thrombosis. We present the case of an adolescent female with non-ST-elevation acute myocardial infarction secondary to APS. CLINICAL CASE: we present the case of a 14-year old female with a history of idiopathic thrombocytopenic purpura whose symptomatology initiated with oppressive chest pain, dyspnea, diaphoresis and nausea. During the physical exam she had tachycardia, accentuation of the second heart sound, a mesosystolic murmur in the pulmonary focus and pulmonary rales. Electrocardiogram showed ST-segment depression in anterior and lateral wall and positive enzymatic curve for infarction. Clinical study reported anterolateral and apical infarction, ostium secundum atrial septal defect and APS. CONCLUSIONS: many studies have demonstrated the diversity of clinical features associated with APS in children and teenagers including deep venous thrombosis, stroke, digital ischemia, pulmonary vasoocclusive disease and, more rarely, acute myocardial infarction. In pediatric patients with acute myocardial infarction we must consider the possibility of APS even though coronary thrombotic occlusion is one of the rarest manifestations.