El tabaco como factor de riesgo cardiovascular. Importancia de la actuación desde la especialidad de cardiología / Tobacco as a cardiovascular risk factor. The importance of an actuation from the speciality of cardiology

Se revisa la "situación actual" del tabaquismo contemplado desde la especialidad de cardiología. El artículo discute la importancia epidemiológica y la relación del tabaquismo con las enfermedades cardiovasculares y de forma resumida, pasa revista a los mecanismos de efecto del tabaco y sus aditivos sobre el aparato cardiovascular, sin olvidar algo tan importante para todos como es el tabaquismo pasivo y la específica acción del tabaco sobre mujeres.En el último apartado se aborda el tratamiento del tabaquismo resaltando la importancia del consejo médico regular, para conseguir abstinencias en un alto porcentaje de pacientes y la forma de intervenir farmacológicamente en los momentos indicados.Se concluye con el mensaje de que estamos ante un reto interesante, en el que a medio plazo se pueden obtener buenos resultados, respecto a la salud pública, pero que requiere implicación sin reservas por parte de los profesionales de la salud y de las instituciones públicas (AU)

[Influence of coronary risk factors in secondary prevention: tobacco]. / Influencia de los factores de riesgo coronario en prevención secundaria: tabaco.

Tobacco smoking is a strong independent factor for atherosclerotic disease, equivalent to hypertension or high cholesterol levels. Middle age people are especially involved, with a mortality rate of about 20% as a consequence of smoking, and a mean loss of life expectancy of 20 years. There is a positive correlation between smoking and severity of atherosclerotic disease in the coronary and cerebral arteries, and the aorta. It has been shown that smoking cessation clearly enhances the prognosis of patients with myocardial infarction. Twice a increase in mortality rate has been found among nonstopping smokers compared with those who stopped smoking eight years after myocardial infarction. In addition, progression of atherosclerosis as shown by angiography is slowed by stopping to smoke. As the coronary risk factors act in a synergistic way, a comprehensive approach to the patient is recommended, especially in smokers with myocardial infarction. It is justified an intensive intervention because of the advantages in this population. The physician should clearly communicate to the patient the need of stopping to smoke, which carries sometimes as beneficial effects as other interventions. A wise use of replacement therapy with transdermal nicotine, together with other useful measures, allows us to manage patients with a broad margin of safety, especially in coronary patients, who win most benefit from ceasing to smoke.

[Severe digoxin intoxication in a 15-year-old girl treated with Fab antidigoxin]. / Intoxicación severa por digoxina en una joven de 15 años tratada con Fab antidigoxina.

A 15-year-old-female admitted after ingesting 5 milligrams of digoxin, presented atrial tachycardia with 2.0 degree atrioventricular block and frequent ventricular premature complexes. Serum digoxin determination at admission was 16 ng/ml. Two hours following the administration of 2 amp of Fab antidigoxin (160 milligrams) the arrhythmias disappeared and remained asymptomatic until discharge.