Cardiovascular considerations on recreational scuba diving. SEC-Clinical Cardiology Association/SEC-Working Group on Sports Cardiology consensus document.

The practice of recreational scuba diving has increased worldwide, with millions of people taking part each year. The aquatic environment is a hostile setting that requires human physiology to adapt by undergoing a series of changes that stress the body. Therefore, physical fitness and control of cardiovascular risk factors are essential for practicing this sport. Medical assessment is not mandatory before participating in this sport and is only required when recommended by a health questionnaire designed for this purpose. However, due to the significance of cardiovascular disease, cardiology consultations are becoming more frequent. The aim of the present consensus document is to describe the cardiovascular physiological changes that occur during diving, focusing on related cardiovascular diseases, their management, and follow-up recommendations. The assessment and follow-up of individuals who practice diving with previous cardiovascular disease are also discussed. This document, endorsed by the Clinical Cardiology Association of the Spanish Society of Cardiology (SEC) and the SEC Working Group on Sports Cardiology of the Association of Preventive Cardiology, aims to assist both cardiologists in evaluating patients, as well as other specialists responsible for assessing individuals' fitness for diving practice.

Pronóstico intrahospitalario de la hemoglobina en pacientes con síndrome coronario agudo / Influence of hemoglobin level on in-hospital prognosis in patients with acute coronary syndrome

Introducción y objetivos. En pacientes con síndrome coronario agudo (SCA), la anemia es un hallazgo frecuente. Nuestro objetivo fue valorar el pronóstico intrahospitalario de las cifras de hemoglobina al ingreso y de su caída durante éste. Métodos. Estudio retrospectivo de 542 pacientes ingresados durante el año 2005 en la unidad coronaria por SCA de alto riesgo. Se registraron los valores de hemoglobina al ingreso y al menos cada 24 h después. Se definió anemia según criterios de la Organización Mundial de la Salud. Se evaluó la relación entre la hemoglobina al ingreso y su caída con la muerte por todas las causas o el shock cardiogénico durante el ingreso hospitalario mediante un análisis de regresión logística. Resultados. En el seguimiento (mediana, 7 días) la incidencia de shock o muerte fue del 6,9% (37 pacientes); 147 (27,1%) pacientes presentaron anemia al ingreso, que se incrementó a 266 (49,1%) pacientes durante la estancia en la unidad (p < 0,0001). Tras ajustar por diversas variables, tanto la hemoglobina al ingreso (odds ratio [OR] = 1,4; intervalo de confianza [IC] del 95%, 1,1-1,8 [por cada g/dl de descenso de hemoglobina con respecto a las cifras normales]; p = 0,003) como una caída de la hemoglobina > 1,8 g/dl (OR = 5,4; IC del 95%, 1,5-18,8; p = 0,009) se relacionaron de forma independiente con la incidencia de eventos adversos. Conclusiones. En pacientes con SCA de alto riesgo, tanto las cifras de hemoglobina al ingreso como el descenso de la hemoglobina > 1,8 g/dl se asociaron con un mayor riesgo de muerte por todas las causas o de shock cardiogénico (AU)

Introduction and objectives. Many patients with acute coronary syndrome (ACS) suffer from anemia. The objective of this study was to determine the influence of the admission hemoglobin level and the post-admission fall in hemoglobin level on short-term prognosis during hospitalization. Methods. This retrospective study involved 542 high-risk ACS patients who were admitted during 2005. The hemoglobin level was recorded on admission and at least every 24 hours thereafter, with anemia being defined according to WHO criteria. Logistic regression modeling was used to assess the relationship of the admission hemoglobin level and the fall in hemoglobin level to all-cause mortality and cardiogenic shock during hospitalization. Results. During follow-up (median time, 7 days), the incidence of cardiogenic shock or mortality was 6.9% (37 patients). Anemia was present in 147 patients (27.1%) at admission, increasing to 266 patients (49.1%) during hospitalization (P<.0001). After adjusting for a range of variables, independent associations were found between the occurrence of adverse events and both the admission hemoglobin level (odds ratio [OR]=1.4 for each 1 g/dL below normal; 95% confidence interval [CI], 1.1-1.8; P=.003) and a fall in hemoglobin level >1.8 g/dL (OR=5.4; 95% CI, 1.5-18.8; P=.009). Conclusions. In high-risk ACS patients both the admission hemoglobin level and a subsequent fall in hemoglobin level >1.8 g/dL were associated with an increased risk of all-cause mortality or cardiogenic shock (AU)

[Transient left midventricular dyskinesia: clinical features of a new variant]. / Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante.

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in takotsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions.

Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante / Transient Left midventricular dyskinesia: clinical features of a new variant

Presentamos 5 casos consecutivos de discinesia medioventricular transitoria, una variante recientemente descrita de discinesia apical transitoria. Se trata de un síndrome que presenta similitudes con la anterior en cuanto a características clínicas, pronósticas y probablemente etiopatogénicas. Los pacientes, la mayoría en relación con un episodio física o emocionalmente estresante, acudieron a urgencias con un cuadro compatible con infarto agudo de miocardio que incluía discinesia/acinesia de los segmentos medios en la ventriculografía. Las alteraciones ventriculares se resolvieron de manera temprana y completa. Las arterias coronarias no mostraron alteraciones en ningún caso. Su existencia denota que no sólo las porciones apicales, afectas en el síndrome tako-tsubo, pueden alterarse de manera reversible. La aparición de nuevas variantes abre nuevos interrogantes sobre la relación de sistema nervioso, catecolaminas y lesión miocárdica reversible

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in tako-tsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions

Anemia. Infarto de miocardio. Influence of Hemoglobin Level on In-Hospital Prognosis in Patients With Acute Coronary Syndrome.

INTRODUCTION AND OBJECTIVES: Many patients with acute coronary syndrome (ACS) suffer from anemia. The objective of this study was to determine the influence of the admission hemoglobin level and the post-admission fall in hemoglobin level on short-term prognosis during hospitalization. METHODS: This retrospective study involved 542 highrisk ACS patients who were admitted during 2005. The hemoglobin level was recorded on admission and at least every 24 hours thereafter, with anemia being defined according to WHO criteria. Logistic regression modeling was used to assess the relationship of the admission hemoglobin level and the fall in hemoglobin level to allcause mortality and cardiogenic shock during hospitalization. RESULTS: During follow-up (median time, 7 days), the incidence of cardiogenic shock or mortality was 6.9% (37 patients). Anemia was present in 147 patients (27.1%) at admission, increasing to 266 patients (49.1%) during hospitalization (P<.0001). After adjusting for a range of variables, independent associations were found between the occurrence of adverse events and both the admission hemoglobin level (odds ratio [OR]=1.4 for each 1 g/dL below normal; 95% confidence interval [CI], 1.1-1.8; P=.003) and a fall in hemoglobin level >1.8 g/dL (OR=5.4; 95% CI, 1.5-18.8; P=.009). CONCLUSIONS: In high-risk ACS patients both the admission hemoglobin level and a subsequent fall in hemoglobin level >1.8 g/dL were associated with an increased risk of all-cause mortality or cardiogenic shock.