[Usefulness of echocardiography in heart insufficiency: a prospective study of 100 patients]. / Utilidad de la ecocardiografía en la insuficiencia cardíaca: estudio prospectivo sobre 100 pacientes.

We prospectively evaluated 100 patients with heart failure, grades III and IV of the NYHA who were admitted to our Internal Medicine Service. In all cases a clinical diagnosis previous to the recording of the echocardiogram was made to evaluate the contributions of the latter. In 26 patients the echocardiogram gave information which had not been anticipated from the history and basic studies. This information resulted in a change of diagnosis in 21 cases and in the addition of a diagnosis with therapeutic and/or prognostic implications in 5 cases. It also permitted an approach to pathogenesis in the subgroup with preserved systolic function (36%), which were categorized as having diastolic dysfunction. On the other hand, the echocardiogram permitted the definition of the group of elderly patients, with heart failure and without previously known heart disease, which we considered as having senile heart disease.

Recurrent pericarditis. Relief with colchicine.

Recurrence is one of the major complications of pericarditis. Treatment of recurrence is often difficult, and immunosuppressive drugs or surgery may be necessary. We conducted an open-label prospective study of nine patients (seven men and two women; age, 18-64 years; mean age, 41.7 +/- 13.7 years). Patients were treated with colchicine (1 mg/day) to prevent recurrences. All patients had suffered at least three relapses despite treatment with acetylsalicylic acid, indomethacin, prednisone, or a combination. Pericarditis was classified as idiopathic in five patients, postpericardiotomy in two, post-myocardial infarction in one, and associated with disseminated lupus erythematosus in one. For statistical analysis, we conducted a paired comparison design (Student's t test). All patients treated with colchicine responded favorably to therapy. Prednisone was discontinued in all patients after 2-6 weeks (mean, 26.33 +/- 10.9 days), and colchicine alone was continued. After a mean follow-up of 24.3 months (minimum, 10 months; maximum, 54 months), no recurrences were observed in any patient; there was a significant difference between the symptom-free periods before and after treatment with colchicine (p less than 0.002). Our study suggests that colchicine may be useful in avoiding recurrence of pericarditis, although these results need to be confirmed in a larger, double-blind study.

[Electrocardiographic disturbances in the left spontaneous pneumothorax. A case report (author's transl)]. / Alteraciones electrocardiográficas en el neumotórax espontáneo izquierdo. Presentación de un caso.

Spontaneous pneumothorax is a relatively frequent acute medical problem. Acute chest pain, sudden dyspnea, and a sensation of discomfort are the usual clinical symptoms: these manifestations also occur in coronary occlusion, with which the condition my easily be misdiagnosed. This is especially true in cases of spontaneous pneumothorax of the left side because the ECG anomalies that arise could be erroneously confused with a coronary condition. The literature on the subject is reviewed and a case of left spontaneous pneumothorax is presented, pointing out the electrocardiographic disturbances: decrease of the amplitude of the QRS complex and R waves, inversion of the T wave in AVL and flattening of the T wave in most of the derivations, slight deviation of the electric axis of QRS toward the right, and phasic variation of voltage (very slight in this case). The importance of ECG studies in these cases is stressed in order to establish the differential diagnosis and avoid unnecessary delays in the application of the proper therapy.