Contribución del tabaquismo como factor de riesgo cardiovascular en la aparición de un segundo evento isquémico / Contribution of smoking as cardiovascular risk factor in the appearance of a second ischemic event

Introducción y objetivos: Valorar la repercusión del consumo de tabaco y su cese, en pacientes que han presentado un infarto agudo demiocardio y su seguimiento a 5 años. Material y métodos: Se incluyeron sólo fumadores activos (64 casos), excluyéndose exfumadores, no fumadores y fallecidos en el mismo evento y se realizó seguimiento a 5 años, analizándose: sexo, edad, factores de riesgo asociados, eventos cardiovasculares posteriores, y características del IAM de los que abandonaron el tabaco y de los que persistíaél. Las variables cuantitativas con distribución normal se expusieron con la media, con la mediana si la distribución no era normal. La comparación de variables cualitativas continuas se utilizaron test paramétricos y no paramétricos (χ2 y U de Mann-Whitney). Resultados: A los 5 años el 37,5% (24/64) continúan fumando (edad media 59,43 años) y el 62,5% (40/64) abandonaron el tabáquico (edad media 53, 58 años). Los pacientes que continuaban fumando presentabanun mayor riesgo de presentar episodio cardiovascular que los que abandonaban el hábito tabáquico (70,8% vs 17,5%), existía una mayor mortalidad y un peor grado funcional. Conclusiones: La persistencia del tabaquismo después de un IAM se asocia a mayor riesgo de padecer un segundo episodio cardiovascular respecto a los pacientes que dejan de fumar. Se debería incidir en desarrollo de protocolos de deshabituación tabáquica con el fin de aumentar el porcentaje de éxito en los pacientes cardiovasculares (AU)

Material and methods: 310 myocardial infarctions that occurred in 1998 were analysed, in the follow-up were included the active smokers(64 patients), excluding the ex-smokers, non-smokers and the deceased in the same cardiovascular event, a study has been conducted of these five years later, analysing sex, age, existence of risk factors associated with the consumption of tobacco and characteristics of those that abandoned the use of tobacco and those that persisted in its use, following cardiovascular events, characteristics of the myocardial infarction. The quantitative variables with normal distribution were exposed with the average and with the median if the distribution was not normal. In the comparison of continuous cualitative variables, parametric and non parametrictests were used (χ2 and U of Mann-Whitney). Results: After 5 years, 37.5% (40/64) abandoned smoking, and 24 (37.5%) persisted in its consumption. The average age of the groups was 53.58 and 59.43 years old respectively. After 5 years, the patients that continued smoking presented a higher risk of presenting a cardiovascular episode than those that abandoned their smoking habit (70.8% vs 17.5%) as well as a higher mortality rate end worse functioning level. Conclusions: The persistence of tobacco use after a myocardial infarction is associated with a higher risk of having a second cardiovascular event in respect to the patients that stopped smoking. We should incite in the development of protocols of stop smoking with the end of increasing the percentage of success in cardiovascular patients (AU)

[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing]. / Guías de práctica clínica de la Sociedad Española de Cardiología en pruebas de esfuerzo.

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

Catheter ablation of repetitive monomorphic ventricular tachycardia from left ventricular outflow tract guided by unipolar mapping.

Repetitive monomorphic ventricular tachycardia from the left ventricular outflow tract is an uncommon arrhythmia. Successful catheter ablation has been previously reported in a few cases, but a large number of applications were usually needed when an approach based on either activation mapping or pace mapping was used. In our patient, the selection of the target point for application was based exclusively on unipolar mapping criteria of the ectopic beats, resulting in a short procedure with successful outcome.

Cardiomyopathies and oxidative stress.

Cardiomyopathies are the group of diseases affecting the cardiac muscle. Although they have never been related to oxidative stress diseases, an analysis of the causes of these pathologies reveals the presence of a pro-oxidative agent or that the intracardiocytic balance between oxidation and antioxidation has been broken. In support of this hypothesis, we analyse the pro-oxidative factors which co-operate with other factors or by themselves to promote the development of this group of pathologies. We show also data demonstrating that the tissue and cellular damages are characteristic of an oxidative stress situation. Finally, we present evidence that in some cases of particular cardiomyopathies, the use of antioxidative strategies greatly improves the health of the patients. Therefore, we suggest that the use of antioxidants can be an alternative or complementary therapy in this group of diseases.

[Non-invasive diagnosis of a right coronary artery-right ventricle fistula by Doppler echocardiography]. / Diagnóstico no invasivo de fístula de arteria coronaria derecha a ventrículo derecho por ECO-Doppler.

A six-year-old girl with an atypical continuous precordial murmur, was suspected of having a coronary arteriovenous fistula. A markedly dilated right coronary artery was revealed by two-dimensional echocardiography. The pulsed Doppler examination showed a diastolic retrograde flow in the ascending aorta, with a normal flow in the left ventricular outflow tract. With the sample volume in the right ventricle a continuous turbulent flow was observed. Color flow mapping showed a turbulent, systolic-diastolic flow in the right ventricle. The fistula was confirmed by cardiac catheterization.