[The effect of gallopamil and propranolol in patients with ischemic cardiopathy and moderate depression of ventricular function]. / Efecto del gallopamil y del propranolol en pacientes con cardiopatía isquémica y depresión moderada de la función ventricular.

BACKGROUND: Calcium channel blockers have been wide and successfully used in the treatment of coronary heart disease. Gallopamil, a metoxylic derivative of verapamil, has many of its properties and so, caution is recommended when given to patients with depressed left ventricular function. Clinical studies about this effect are scarce, and we have assessed it in patients with coronary heart disease and diminished left ventricular function. METHODS: We studied 20 patients in a cross-over, randomized, double-blind study during three weeks active periods with two intercalating washout placebo periods of one week. Patients had history of previous myocardial infarction, positive exercise stress test and ejection fraction ranging from 30% to 50% by echocardiography. RESULTS: There were no significant differences between each drug and corresponding placebo on either systolic or diastolic function. When we compared both drugs, patients showed a milder increase in area under E after propranolol than after gallopamil (p < 0.008). Clinical episodes of cardiac failure were not reported, and ejection fraction did not change. CONCLUSIONS: Both gallopamil and propranolol can be used in patients with coronary heart disease and moderately depressed left ventricular ejection fraction.

[Cardiac rehabilitation. Other protocols]. / Rehabilitación cardíaca. Otros protocolos.

Cardiac rehabilitation programmes and secondary prevention programmes vary according to the type of cardiopathy, to the functional state and to the physical characteristics of the subject. On many occasions, they depend on the material resources and on the staff of the centre offering this type of therapeutic action. A summary of different ways of performing cardiac rehabilitation in our country is given.

[A change in the prescription of thrombolytic treatment in elderly patients. The experience of the Hospital de León]. / Cambio en la prescipción de tratamiento trombolítico en pacientes ancianos. Experiencia del Hospital de León.

INTRODUCTION AND OBJECTIVES: Most deaths caused from AMI occur in elderly patients, and it is know that these patients way also benefit from the type treatment normally offered to younger patients. We proposed to analyse how our therapeutic strategy has evolved for patients of advanced age related to the admission in the CCU and the prescription of thrombolytic treatment. METHODS: In order to carry our investigation, we compared the clinical profile, the treatment and the results of patients over the age of 70 who were hospitalized in our Service with suspected AMI during last 3 years. A total number of 366 which were divided into two consecutive periods of 18 months; 176 patients from January'91 to June'92 (Period I--former--) and 190 patients from July'92 to December'93 (Period II--latter--). RESULTS: In both periods, nearly all patients with suspected AMI and < 48 hours of since symptoms began were hospitalized in the CCU irrespective of their age. In both periods, over 40% of the total number of patients admitted to CCU were > 70 years (I: 45.2% vs II: 42.6%). We observed that in the latter group a major part of patients had complicated AMI at the moment of admittance (I: 15.3% vs II: 24.2%; p < 0.05). This is probably related to a less favorable clinical profile. Despite this, a parallel increase in hospital death rate was not observed (I: 21% vs II: 17%; p: NS). Over time, the ratio of patients prescribed with thrombolysis > 70 was nearly doubled (I: 13.7% vs II: 24.7%; p < 0.01), without a detected increase in complications of hemorrhages. CONCLUSIONS: For a variety of factors, the number of elderly patients admitted with complicated AMI has increased. In our experience the simple modification in the way thrombolysis is prescribed is capable of restraining the hospital death rate ratio.

[Myocardial infarct during pregnancy. Treatment of the acute phase and of labor. Apropos a case and a review of the literature]. / Infarto de miocardio durante el embarazo. Tratamiento de la fase aguda y del parto. A propósito de un caso y revisión de la literatura.

An acute myocardial infarction, is an infrequent complication in pregnant women. We present the case of a 29-years-old patient who suffered 2 acute myocardial infarction in relation with her two pregnancies. The first acute myocardial infarction occurred the third day after delivery, and the second, during the seventh month of the second pregnancy. In the latter, delivery was vaginal, with epidural anaesthesia. A coronary angiogram showed coronary arteries without significant narrowings, as well as an aneurysm of the left ventricle. A review of the literature published so far is made in the discussion.

[Color-coded cardiac Doppler]. / Doppler cardíaco codificado en color.

Color flow mapping with Doppler technique was reviewed. We describe the advantages and technical was reviewed. We describe the advantages and technical limitations of the technique. The usefulness of color flow mapping in acquired and congenital disease was studied. We conclude that new information was added, concerning complex intracardiac flow, in order to the traditional study with classic continuous and pulsed Doppler examination.

[Anomalous bands of the left ventricle. Study with echocardiography and Doppler ultrasound]. / Bandas anómalas del ventrículo izquierdo. Estudio con ecocardiografía y Doppler.

Of a total of 3654 echocardiographic and Doppler studies, found 95 left ventricular bands. We described the different Echo-patterns. Color-flow Doppler mapping demonstrated normal left ventricular inflow and outflow, and also lack of turbulence around the band. We conclude left ventricular bands are an abnormal but not Pathological finding.