[The induction of a septal infarct as a therapeutic alternative in hypertrophic obstructive cardiomyopathy: new observations apropos a case]. / Inducción de infarto septal como alternativa terapéutica en la miocardiopatía hipertrófica obstructiva: nuevas observaciones a propósito de un caso.

The hypertrophic cardiomyopathy may be associated with a variable degree of left ventricular outflow tract obstruction. There are several available therapeutic strategies for treatment: pharmacological, dual-chamber pacing, surgery and induced septal infarction. This last one is a novel technique with less experience in practice. We present the clinical case of a patient which showed persistent and severe obstruction in spite of the medications and dual-chamber pacing, and who underwent this novel technique. The results were optimal but new observations arise from this particular case.

[The acute and chronic effects of 50 mg of isosorbide 5-mononitrate with delayed action in patients with stable angina of effort]. / Estudio del efecto agudo y crónico de 50 mg de 5-mononitrato de isosorbida de liberación retardada en pacientes con angina de esfuerzo estable.

In 10 patients with stable effort angina and angiographically demonstrated coronary artery disease, serial exercise test were performed in order to assess the efficacy and duration of the anti-ischemic effects of a single dose (50 mg) of a sustained-release preparation of 5-isosorbide mononitrate (5-IMN). The possible presence of a tolerance phenomenon was also sought. The study was randomized, double-blind and placebo-controlled. Four hours after an acute dose of 5-IMN, time for -1 mm ST segment depression significatively increased as compared with basal test and placebo test (367 +/- 92 vs 199 +/- 87 and 250 +/- 78 sec respectively, p less than 0.0004). At the same test, total exercise time also increased from 282 +/- 92 sec (basal) and 323 +/- 91 sec (placebo) to 424 +/- 91 sec (p less than 0.008). At 12 hours test, total exercise time was also significantly increased as compared with basal test and placebo test (354 +/- 109 vs 282 +/- 92 and 291 +/- 90 sec respectively; p less than 0.01). These effects were not present when the patients were tested 24 hours after active drug administration. After daily administration of a single dose of 5-IMN during a 3 week period, 4 and 12 hours test demonstrated a persistent and significant anti-ischemic effect, similar to the acute figures. Thus, an acute dose of 50 mg of a sustained-release preparation of 5-IMN reveals significant anti-ischemic effects which remain 4 and 12 hours after drug administration. Chronic administration of the preparation for 3 weeks (single daily dose) is equally effective, without any evidence of tolerance phenomenon.

[Myocardial infarction due to buckshot lodged in the right coronary artery (author's transl)]. / Infarto de miocardio por perdigón alojado en arteria coronaria derecha.

A rare case of myocardial infarction produced by a buckshot lodged in the right coronary artery is presented. It resulted from a shotgun blast aimed at the right side of the chest. The patient was admitted to an Intensive Care Unit in a state of shock 1 hour after the accident. The diagnosis was suspected from the first moment because of ECG disturbances and it was later confirmed by coronary angiography. Hemodynamic studies were carried out simultaneously. The patient also presented hemothorax requiring pleural drainage. X-rays revealed a lung contusion with an intraparenchymatous hematoma the whole length of the projectile pathway. During the clinical course a slight hemopericardium was demonstrated by echocardiography; it was originally suspected on the basis of the X-rays. Drainage was not necessary. The patient left the Intensive Care Unit 7 days after entry and was discharged from the Hospital 5 days later. His clinical and hemodynamic condition was good and ECG indicate cicatrization of the myocardial infarction of the diaphragmatic face. The diagnosis and treatment of open or closed traumas of the thorax with similar cardiac involvement in emergency conditions are discussed. The authors prefer not to operate immediately in these cases.