[Duration of complete atrioventricular block complicating inferior wall infarction treated with fibrinolysis]. / Duración del bloqueo auriculoventricular completo en el infarto inferior tratado con fibrinólisis.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the duration of complete atrioventricular block complicating inferior wall acute myocardial infarction after the administration of fibrinolytic therapy. PATIENTS AND METHOD: From 1 January 1992 to 31 January 2002 a total of 449 patients were admitted directly to our hospital with inferior wall acute myocardial infarction in the first 6 hours; 282 of them (64%) received fibrinolytic therapy. Complete atrioventricular block appeared in 39 of these 282 patients (13.8%, group A). Of the 167 patients who did not receive thrombolytic therapy, complete atrioventricular block appeared in 13 (8%, control group). We compared the two groups by analyzing the duration of heart block, time to appearance, hemodynamic repercussion, and treatment required. RESULTS: On admission, 38% of the patients in group A and 61% (P=NS) of those in the control group had complete atrioventricular block. Median duration of the block was 75 minutes (10 minutes to 48 hours) in group A and 24 hours (15 minutes to 9 days) in the control group (P=.004). After fibrinolytic therapy was administered, median duration of the block was 45 minutes (5 minutes to 48 hours). A temporary pacemaker was implanted in 43% of the group A patients and 84.6% of the control group patients (P=.01). CONCLUSION: Complete atrioventricular block appears as a complication of inferior myocardial infarction within the first hours after the event. Duration of the block seems to be shorter in patients treated with fibrinolytic therapy.

Duración del bloqueo auriculoventricular completo en el infarto inferior tratado con fibrinólisis / Duration of complete atrioventricular block complicating inferior wall infarction treated with fibrinolysis

Introducción y objetivos. El objetivo de nuestro estudio es determinar la duración del bloqueo auriculoventricular completo (BAVC) en el transcurso de un infarto agudo de miocardio (IAM) de localización inferior tras la administración de tratamiento fibrinolítico. Pacientes y método. Entre el 1 de enero de 1992 y el 31 de enero de 2002 consultaron en primera instancia en nuestro centro 449 pacientes con IAM de localización inferior en las primeras 6 h de evolución. El 64% (282 pacientes) recibió fibrinólisis. En este grupo, 39 (13,8%) pacientes presentaron BAVC (grupo A). En los 167 pacientes no tratados con trombólisis, 13 (8%) casos presentaron BAVC (grupo control). Se comparan ambos grupos y se analizan la duración y presentación del bloqueo, la repercusión hemodinámica y la conducta terapéutica seguida. Resultados. En el 38% de los pacientes del grupo A había BAVC en el momento del ingreso frente al 61% de los del grupo control (p = NS). La duración mediana del bloqueo fue de 75 min (10 min-48 h) en el grupo A y de 24 h (15 min-9 días) (p = 0,004) en el grupo control. Una vez realizada la fibrinólisis, el BAVC tuvo una duración mediana de 45 min (5 min-48 h). Se implantó un marcapasos provisional en 17 pacientes del grupo A (43%) y en 11 del grupo control (84,6%) (p = 0,01). Conclusión. El BAVC en el IAM de localización inferior aparece precozmente. La duración del bloqueo parece ser menor al realizar la fibrinólisis

Introduction and objectives. The aim of this study was to determine the duration of complete atrioventricular block complicating inferior wall acute myocardial infarction after the administration of fibrinolytic therapy. Patients and method. From 1 January 1992 to 31 January 2002 a total of 449 patients were admitted directly to our hospital with inferior wall acute myocardial infarction in the first 6 hours; 282 of them (64%) received fibrinolytic therapy. Complete atrioventricular block appeared in 39 of these 282 patients (13.8%, group A). Of the 167 patients who did not receive thrombolytic therapy, complete atrioventricular block appeared in 13 (8%, control group). We compared the two groups by analyzing the duration of heart block, time to appearance, hemodynamic repercussion, and treatment required. Results. On admission, 38% of the patients in group A and 61% (P=NS) of those in the control group had complete atrioventricular block. Median duration of the block was 75 minutes (10 minutes to 48 hours) in group A and 24 hours (15 minutes to 9 days) in the control group (P=.004). After fibrinolytic therapy was administered, median duration of the block was 45 minutes (5 minutes to 48 hours). A temporary pacemaker was implanted in 43% of the group A patients and 84.6% of the control group patients (P=.01). Conclusion. Complete atrioventricular block appears as a complication of inferior myocardial infarction within the first hours after the event. Duration of the block seems to be shorter in patients treated with fibrinolytic therapy

Necrotizing vasculitis: a cause of aortic insufficiency and conduction system disturbance.

Cardiac involvement in vasculitis syndromes is uncommon. We describe a 50-year-old male who presented with progressive dyspnea and myalgies. Echocardiogram revealed significant thickening of aortic root, aortic cusps, and anterior mitral valve leaflet, with severe aortic regurgitation that required aortic valve replacement. Furthermore, this patient suffered progressive atrioventricular block that needed implantation of a pacemaker. The study performed disclosed the presence of necrotizing vasculitis positive for perinuclear antineutrophil cytoplasmic antibody.

Guías de práctica clínica de la Sociedad Española de Cardiología sobre requerimientos y equipamiento de la unidad coronaria / Guidelines of the Spanish Society of Cardiology on Requirements and Equipment of the Coronary Care Unit

Los autores plantean el cambio conceptual y en la dinámica asistencial ocurridos en los últimos años en la unidad coronaria. Se exponen los criterios de planificación y organización funcional y jerárquica, así como los argumentos asistenciales básicos para su desarrollo. Las unidades coronarias no deben constituirse de manera aislada sino integradas en el servicio de cardiología, y siempre deben estar dirigidas por un cardiólogo. La unidad coronaria se concibe cada vez más como una unidad de cuidados intensivos para pacientes con cardiopatías agudas o crónicas agudizadas. Se indican las características de su estructura física y equipamiento, así como las del área de cuidados intermedios y de las recientemente creadas camas de dolor torácico. Por último, se comentan los recursos humanos y los criterios de admisión y alta en la unidad coronaria (AU)