Recomendaciones para el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST / The recommendations regarding non-ST segment elevation acute coronary syndrome have been reviewed

Se han revisado las recomendaciones referentes al síndrome coronario agudo (SCA) sin elevación del segmento ST. Estas recomendaciones están diseñadas para ayudar a los médicos de las unidades de cuidados intensivos cuando hacen las primeras evaluaciones de estos pacientes. Fundamentalmente son para ayudar al diagnóstico precoz, la estratificación de riesgo y el tratamiento inicial. La necesidad para un tratamiento individualizado es en este momento uno de los objetivos primarios en el abordaje del SCA, con o sin elevación del segmento ST, y ésta es la razón por la que creemos que las recomendaciones deben ser de una naturaleza predominantemente práctica dado que afectan la toma de decisiones en la práctica diaria de la medicina (AU)

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine (AU)

[The recommendations regarding non-ST segment elevation acute coronary syndrome have been reviewed. SEMICYUC. Spanish Society for Intensive Medicine, Critical Care and Coronary Units]. / Recomendaciones para el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. SEMICYUC. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine.

Does angina the week before protect against first myocardial infarction in elderly patients?

Mortality rates for coronary artery disease are greater in elderly patients. Although prodromal angina occurring shortly before an acute myocardial infarction (MI) has protective effects against ischemia, this effect has not been well documented in older patients. This study investigated whether angina 1 week before a first MI provides protection in this group of patients. A total of 290 consecutive elderly (>64 years old, n = 143) and adult patients (<65 years old, n = 147) with a first MI were examined to assess the effect of preceding angina on the short- and long-term prognosis. Elderly patients with a history of prodromal angina were less likely than those without angina to experience in-hospital death, heart failure, or the combined end point of in-hospital death and heart failure (6% vs 20.4%, p = 0.02; 10% vs 23.7%, p = 0.07; 14% vs 32.3%, p = 0.01, respectively). Left ventricular function was more frequently depressed (ejection fraction <40%) in elderly patients without (44.8%) than with (26%, p = 0.04) preinfarction angina, and the incidence of arrhythmias (complete heart block and ventricular fibrillation) was greater in the former group (16.1% vs 4%, p = 0.03). Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of in-hospital death and heart failure in older patients (odds ratio 0.28, p = 0.009). The occurrence of angina 1 week before a first MI may confer protection against in-hospital adverse outcomes, and may preserve left ventricular function in older patients.

[Risperidone and concept of bipolar neuroleptic]. / Rispéridone et concept de neuroleptique bipolaire.

We present a review of the stimulant properties of risperidone, analyzing them according to the model of bipolar neuroleptic proposed in 1979 by Colonna and Petit. The bipolar neuroleptics (pimozide, sulpiride) present stimulant properties at low dose and sedative effects at high dose whereas monopolar neuroleptics (levomepromazine, chlorpromazine) present from the low dose sedative effects. The stimulant properties might arise from a preferential blockade of the presynaptic dopaminergic receptors, giving and enhancement of the dopaminergic transmission. Risperidone might follow the bipolar model; we review the stimulant effects in laboratory animals and in clinical settings, showing exacerbation of manic symptoms and a possible antidepressive effect. These properties could be due to the capacity to increase the cerebral monoamines by the 5-HT2A and alpha 2 antagonism. Risperidone could be used in the treatment of clinical syndromes combining depressive and psychotic symptoms.

A possible dopaminergic mechanism in the serotonergic antidepressant-induced sexual dysfunctions.

The administration of antidepressant serotoninergic medication is associated with the presentation of sexual dysfunctions. This seems to be mediated by the activation of the 5-HT2 receptors. Segraves (1995) has proposed that the inhibition of noradrenergic transmission by serotonin may be the mechanism which causes the antidepressant-induced sexual dysfunctions. The inhibition which the 5-HT2 receptors carry out on dopaminergic transmission leads us to propose this mechanism as also participating in the antidepressant-induced sexual dysfunctions.

[Combination of risperidone and serotonergic antidepressants in refractory obsessive-compulsive disorder]. / Combinación de risperidona y antidepresivos serotoninérgicos en el trastorno obsesivo compulsivo refractario.

We present the use of risperidone as a potentiation strategy of the serotonergic antidepressants in four patients suffering from refractory obsessive-compulsive disorder. There were an important improvement in three patients. Adding risperidone to serotonergic antidepressants causes complex interactions between serotonergic, dopaminergic and noradrenergic systems, that could lay to the clinical improvement. These and other similar cases make necessary controlled studies. Adding risperidone to serotonergic antidepressants in patients suffering from refractory obsessive-compulsive disorder might be an effective strategy with low risk for secondary effects and without the presence of tics or psychotic symptoms.