¿Es posible la rehabilitación cardíaca en Extremadura? / No disponible

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Pericarditis constrictiva tras un infarto de miocardio inferoposterior / Constrictive pericarditis after inferoposterior myocardial infarction

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Ateroembolia tras angiografía coronaria / Atheroembolia after coronary angiography

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Hipertrofia ventricular izquierda medioventricular y aneurisma apical del ventrículo izquierdo: ¿un síndrome con entidad propia? / Left midventricular hypertrophy and apival aneurysm of the left ventricle: a syndrome with real entity?

Una paciente de 67 años ingresa en nuestro hospital por infarto agudo de miocardio inferior. La ventriculografía izquierda reveló la presencia de una obliteración sistólica medioventricular importante y un aneurisma en el ápex del ventrículo izquierdo (VI), y la coronariografía una estenosis ligera de la arteria coronaria derecha. La coexistencia de hipertrofia ventricular izquierda medioventricular y un aneurisma apical del VI es extraordinariamente infrecuente. Se revisa la literatura y los posibles mecanismos etiopatogénicaos de esta asociación anatomoclínica (AU)

Doppler transmitral flow pattern is an independent prognostic factor in acute myocardial infarction.

We analyzed the transmitral flow pattern on admission in 95 patients with acute myocardial infarction. Nineteen patients had a restrictive pattern, defined as a peak early to peak atrial filling wave ratio greater than 1.6, plus an early wave deceleration time shorter than 180 ms. Restrictive pattern, compared with nonrestrictive one, was associated with the development of heart failure (42 versus 11%, p = 0.001) and greater in-hospital mortality (32 versus 7%, p = 0.002). After multivariate analysis, it remained significantly predictive of death (p = 0.028). We conclude that a restrictive pattern of left ventricular filling in patients with acute myocardial infarction is an independent predictor of early outcome.

[Clinical and electrocardiographic characteristics of masquerading bifascicular block]. / Características clínicas y electrocardiográficas del bloqueo bifascicular disfrazado.

INTRODUCTION: Masquerading bundle branch block is a right bundle branch block with a left anterior hemiblock which appears similar to a left bundle branch block in the frontal plane leads. MATERIAL AND METHODS: We have followed 22 patients with such a pattern in the electrocardiogram for 3 years. RESULTS: Thirteen patients (59%) developed high degree atrioventricular block. During this period, there were 4 deaths, 3 from heart failure and 1 due to sepsis. CONCLUSIONS: We conclude that progression to high degree atrioventricular block is quite common in the presence of this kind of branch block. It is frequently associated to advanced heart failure, so the prognosis is usually poor.

[Circulatory arrest after combined intravenous drugs for the treatment of orthodromic circular tachycardia of Wolff-Parkinson-White syndrome]. / Parada circulatoria tras uso combinado de fármacos intravenosos para tratar una taquicardia circular ortodrómica de un síndrome de Wolff-Parkinson-White.

Antiarrhythmic drugs administered intravenously run the risk of producing a hemodynamic collapse even when used by expert and well trained hands. The arrhythmias in the focal point of a preexcitation syndrome constitute a very special situation in which extreme caution must be used when using intravenous drugs, because the conduction through accessory channels can vary, depending on multiple factors. We describe a case of a patient with an accessory atrioventricular pathway and orthodromic tachycardia who developed cardiac arrest by wide QRS tachycardia after receiving intravenous amiodarone.

[Severe digoxin intoxication in a 15-year-old girl treated with Fab antidigoxin]. / Intoxicación severa por digoxina en una joven de 15 años tratada con Fab antidigoxina.

A 15-year-old-female admitted after ingesting 5 milligrams of digoxin, presented atrial tachycardia with 2.0 degree atrioventricular block and frequent ventricular premature complexes. Serum digoxin determination at admission was 16 ng/ml. Two hours following the administration of 2 amp of Fab antidigoxin (160 milligrams) the arrhythmias disappeared and remained asymptomatic until discharge.

Sinus tachycardia and J wave masquerading as atrial flutter.

The admission electrocardiogram (ECG) from a patient with severe heart failure was considered diagnostic of atrial flutter with 2:1 atrioventricular conduction. Slowing of the heart rate revealed sinus tachycardia with prominent 'J' waves that had been previously thought to be 'F' waves.

The initial electrocardiogram pattern is a strong predictor of outcome in acute myocardial infarction.

We analyzed the significance of the initial electrocardiogram on the clinical outcome of 205 consecutive patients with a first myocardial infarction. Three different patterns of the electrocardiogram were defined: (A) Tall symmetric T waves in the involved leads; (B) ST segment elevation > 0.1 mV in two or more adjacent leads; and (C) ST segment elevation together with distortion of the terminal portion of the QRS complex in two or more adjacent leads. Twelve patients were considered to have an initial 'A' electrocardiogram, 151 an initial 'B' electrocardiogram, and 42 an initial 'C' electrocardiogram. Four factors were significantly related to mortality: age, ST, Killip class and electrocardiographic pattern. The mortality rate was 0% in group A, 7.9% in group B, and 26.2% in group C (P = 0.0019). Patients with type C electrocardiograms had a significantly worse Killip classification and a significantly higher sum of ST segment elevation. Among patients with inferior infarction, the mortality rate was 1.4% in type B vs. 24.1% in type C (P = 0.0005). Among patients with anterior infarction, the mortality rate was 13% in type B vs. 30.8% in type C (P = 0.089). We conclude that the pattern of the initial electrocardiogram is a strong predictor of outcome in acute myocardial infarction, especially if it is inferior.

[Variant angina pectoris related to the treatment of migraine]. / Angina variante en relación con el tratamiento de la migranña.

A 54 years-old man with a history of migraine, suffered from chest pain together with ST-segment elevation related to the intake of drugs against migraine attacks. The coronary arteriography showed normal coronary arteries. We suggest coronary artery spasm as the most probable cause of ischemia. We conclude that vasoactive drugs against migraine must be utilized with caution, or even avoided in patients with chest pain suggestive of myocardial ischemia.

[The prognosis for elderly patients admitted to a coronary unit for myocardial infarct: the changes over a decade]. / Pronóstico de los ancianos ingresados en la unidad coronaria por infarto de miocardio: cambios en una década.

INTRODUCTION AND AIM: New therapies have been added that improve prognosis of patients with myocardial infarction. Our purpose was to know if elderly patients reach benefit from these therapeutic changes. METHODS: We have analyzed the clinical data of 227 patients older than 70 who were admitted in our coronary care unit: 78 admitted in 1980-81 and 14 admitted in 1990-91. RESULTS: Although differences were not significant, in 1990-91 there were more women (36% versus 28%), less smoking (24% versus 33%), more patients with previous infarction (19% versus 12%), more hypertension (53% versus 43%), less anterior infarcts (38% versus 45%) more non Q infarcts (11% versus 1%), and less bundle branch block (21% versus 31%). In 1990-91, pacemakers were used less often (13% versus 27%, p = 0.03), thrombolytic therapy was given to 16 patients (10.7%), and the mortality rate was a little inferior (22% versus 30%, not significant). Female sex, not being a smoker, Killip class and bundle branch block were significantly related to mortality. After a multivariate analysis in which these factors we included, the date of admission resulted an independent predictor of mortality, with an odds ratio of 1990-91 to 1980-81 of 0.43 (p = 0.039). CONCLUSIONS: The management of patients older than 70 with myocardial infarction has improved, with a significantly lesser risk of dead after multivariate analysis, despite that thrombolysis has been scarcely applied.