Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba / Diagnosis of peripheral vascular disease. Usefulness of the ankle-brachial index for screening

Debido a la elevada prevalencia de la enfermedad arterial periférica (EAP), que con frecuencia es asintomática, y sus graves repercusiones pronósticas, se recomienda la criba diagnóstica de los pacientes con alto riesgo de sufrirla: a) pacientes de edad > 70 años; b) pacientes de 50-69 años con historia de tabaquismo o diabetes mellitus; c) pacientes de 40-49 años con diabetes mellitus y al menos otro factor de riesgo de arteriosclerosis; d) síntomas compatibles con claudicación al esfuerzo o dolor isquémico en reposo; e) pulsos anormales en las extremidades inferiores; f) enfermedad arteriosclerosa en otros territorios, o g) pacientes con un score de Framingham entre el 10 y el 20%. Tanto la anamnesis como la exploración física tienen un valor para el diagnóstico de la enfermedad limitado porque, aunque son muy específicos, su sensibilidad es muy baja. Existen múltiples pruebas diagnósticas para valorar la presencia y la severidad de la enfermedad vascular periférica, entre las que cabe destacar el índice tobillo-brazo, las determinaciones de la presión segmentarias, los estudios de ecografía-Doppler y la angiografía mediante resonancia megnética, tomografía computarizada o de sustracción digital. En la actualidad se considera que el índice tobillo-brazo es el método no invasivo que presenta mejor rendimiento diagnóstico, ya que se trata de una prueba incruenta, fácil de realizar a la cabecera del paciente y con una elevada sensibilidad (superior al 90%) (AU)

Because peripheral arterial disease is highly prevalent, frequently silent, and has serious prognostic implications, it is recommended that diagnostic screening should be carried out in individuals at a high risk. This includes: a) those aged >70 years; b) those aged 50-69 years with a history of smoking or diabetes; c) those aged 40-49 years with diabetes mellitus and at least one other risk factor for atherosclerosis; d) those with symptoms indicating claudication on exercise or ischemic pain at rest; e) those with abnormal pulses in the lower extremities; f) those with atherosclerosis in other vascular territories; and g) those with a Framingham score of 10-20%. Neither anamnesis nor physical examination is of much value for disease diagnosis; although they are very specific, their sensitivity is very low. A large number of different diagnostic techniques are available for investigating the presence and severity of peripheral vascular disease, including ankle-brachial index measurement, segmental limb pressure measurement, Doppler ultrasonography, and various forms of angiography involving magnetic resonance imaging, computed tomography or digital subtraction imaging. At present, the ankle-brachial index is the non-invasive method that gives the best diagnostic performance. It is simple, inexpensive and has a high sensitivity (i.e. greater than 90%) (AU)

The fully automatic external cardioverter defibrillator: reality of a new meaningful scenario for in-hospital cardiac arrests.

Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.