[Guidelines of the Spanish society of cardiology on requirements and equipment of the coronary care unit]. / Guías de práctica clínica de la Sociedad Española de Cardiología sobre requerimientos y equipamiento de la unidad coronaria.

The conceptual change and the dynamic care of patients observed in coronary care units, in recent years are reported. The coronary care unit is increasingly conceived as an intensive care unit for patients with acute or chronic cardiopathies with severe complications. Criteria for rational planification, functional and hierarchic organization and basic medical care arguments are established. The coronary care unit can not be considered as an isolated facility, but should rather be integrated in the cardiology department, under the direction of a cardiologist. The authors point out the basic, physical structure and characteristics of the equipment in the coronary care unit and the intermediate cardiac care unit, as well as the newly created chest pain units. Finally, we comment on the human resources (medical, nursing and administrative) and the criteria for admission and discharge in the coronary care unit.

[Nuclear cardiology: technical bases and clinical applications]. / Cardiología nuclear: bases técnicas y aplicaciones clínicas*

Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques makes it necessary to continuously update the requirements, equipment and clinical applications of these isotopic tests. The characteristics of the radioisotopic drugs and examinations presently used are explained in the first part of this text. In the second, the indications of them in diagnostic and prognostic evaluation of the different coronary diseases are presented.

Cardiología nuclear: bases técnicas y aplicaciones clínicas / Nuclear cardiology: technical bases and clinical applications

Aunque el papel de la cardiología nuclear está consolidado en la actualidad, la incorporación de nuevos radiotrazadores y de modernas técnicas obliga a una permanente puesta al día de los requerimientos, equipamiento y aplicaciones clínicas de estas exploraciones isotópicas. En la primera parte de este documento se exponen las características de los radiofármacos, de la instrumentación y las exploraciones que se emplean en el momento actual.En la segunda parte se detallan las indicaciones de las mismas en la evaluación diagnóstica y pronóstica de las diferentes cardiopatías. (AU)

Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques makes it necessary to continuously update the requirements, equipment and clinical applications of these isotopic tests. The characteristics of the radioisotopic drugs and examinations presently used are explained in the first part of this text. In the second, the indications of them in diagnostic and prognostic evaluation of the different coronary diseases are presented (AU)

[Unstable angina in the elderly: clinical, profile, management and mortality at three months. The PEPA Registry Data]. / Angina inestable en el anciano: perfil clínico, manejo y mortalidad a los tres meses. Datos del registro PEPA.

INTRODUCTION AND OBJECTIVES: Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients > or = 70 years of age. PATIENTS AND METHODS: A total of 1,551 patients > or = 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years. RESULTS: In comparison, the elderly (76 +/- 5 years) versus the younger group (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), diabetics (30 vs 23%)and hypertensive patients (60 vs 49%) with a lower proportion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs31%) and comorbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 out of 34 vs 15%). The elderly were treated with fewer invasive procedures (25 vs 44%) or catheterization (26 vs 36%) and they were more frequently controlled with medical treatment (86 vs 83%) although with a lower use of beta blockers (45 vs 53%). The mortality at 3 months was greater in the elderly (7.4 vs 3.0%;p < 0.005) with age being an independent predictor of bad prognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis in the elderly. CONCLUSIONS: A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortality is greater. Diabetes, heart failure and ST segment depression on admission are independent predictors of bad prognosis in elderly patients.

[The clinical management guidelines of the Sociedad Española de Cardiología. Nuclear cardiology: the technical bases and clinical applications]. / Guías de actuación clínica de la Sociedad Española de Cardiología. Cardiología nuclear: bases técnicas y aplicaciones clínicas.

Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques prompt us to permanently update the requirements, equipment and clinical applications of these isotopic tests. Radioisotopic drugs, instrumentation and characteristics of radionuclide tests that are presently used are explained in the first part of this text. In the second part, diagnostic and prognostic indications of these tests are presented in detail.

[Current prognosis of unstable angina. The results of clinical studies]. / Pronóstico actual de la angina inestable. Consideraciones sobre los resultados de los estudios clínicos.

In the last decade there has been a change in the clinical evolution of patients with unstable angina. A better knowledge of his pathophysiology has improved the progress in their treatment and prognosis. Aspirin and heparin have played an important role in this change. Nowadays, the rates of death and acute myocardial infarction at 6 weeks are about 2% and 5% respectively. Nevertheless, the debate about the stratification risk and the best therapeutic options persist. Part of this debate corresponds to the classification differences and to the heterogeneity of variables considered to be end points. On the other hand, the clinical importance conferred to variables identified as predictor of worse prognosis is not valued enough, forgetting that the low prevalence of events results in a low positive predictive value.

[Role of noninvasive examinations in the management of ischemic heart disease. III. Assessment of myocardial viability]. / Papel de las exloraciones no invasivas en el manejo de la cardiopatía isquémica. III. Estimación de la viabilidad miocárdica.

Assessment of myocardial viability is a field of growing interest. This article summarizes the pathophysiology of myocardial stunning and hibernation; both phenomena are associated with the presence of dysfunctional, viable myocardium. The techniques that are currently available for the assessment of viability, and the clinical situations in which these assessments may be more useful are discussed.

[Heart pathology of extracardiac origin (I). Cardiac involvement in AIDS]. / Patología del corazón de origen extracardíaco (I). Afectación cardíaca en el sida.

A great variety of cardiac disorders have been reported in HIV-infected patients: pericarditis, myocarditis, cardiomyopathies, endocarditis, cardiac involvement through malignancies, pulmonary hypertension, arrhythmias and thromboembolic disease. In general, these disorders are asymptomatic and often diagnosed in echocardiographic studies or autopsies. Pericardial involvement is the most common disorder. Pericardial effusions are asymptomatic and non-specific in a great proportion, but in some instances opportunistic infections or malignancies may lead to cardiac tamponade and are associated with an increased risk of mortality. The etiopathogenesis of myocarditis and cardiomyopathies is uncertain. There is controversy about the role of HIV as the primary etiologic agent. Opportunistic infections, cardiotoxic substances, nutritional deficiencies and autoimmune reactions have also been implicated as etiologic agents of myocardial damage. Short-term prognosis worsens as clinical manifestations of heart failure appear. Valvular involvement usually presents as marantic or infectious endocarditis, the latter most frequently in IVDU. This article reviews the main cardiovascular manifestations in AIDS.

[Drug treatment of angina pectoris. Study Group on Angina Pectoris of the Ischemic Cardiopathy and Coronary Units Section of the Spanish Society of Cardiology]. / Tratamiento médico de la angina de pecho. Grupo de Estudio de Angina de Pecho de la Sección de Cardiopatía Isquémica y Unidades Coronarias de la Sociedad Española de Cardiología.

Medical treatment in angina pectoris is supported by: 1) slowing in coronary artery disease progression; 2) control of the angina episodes and the enhanced of the functional status, and, 3) prognosis improvement. The authors describe in this review, inside the own experience and the large body of evidence, the general measures and pharmacological treatment of both stable and unstable angina. There are included some therapeutic options in associated clinical conditions.