González R

Effect of primary coronary angioplasty on left ventricular function and myocardial perfusion as determined by Tc-99m sestamibi scintigraphy☆

There is little information available regarding the changes in the size of acute myocardial infarction (AMI) and the evolution of left ventricular (LV) function over time after primary angioplasty. 1 The evaluation of these parameters could give additional insight into the mechanisms of myocardial recovery and the possible additional benefits of adjunctive therapy to primary angioplasty. The size of the AMI can be quantified by using single-photon emission computed tomographic imaging (SPECT) scintigraphy with technetium-99m (Tc-99m) sestamibi. 2‐ 4 In this study, we evaluated the changes in LV function and in the size of the AMI with SPECT scintigraphy in patients with AMI treated with primary angioplasty. To accomplish this, SPECT was performed at the time of admission, at 72 hours, and at 3 months after primary angioplasty. ••• We studied 24 consecutive patients with AMI who were admitted to the emergency room at our institution, in whom primary angioplasty was indicated. A signed informed consent was obtained in all cases. Diagnosis of AMI was based on the classic criteria of chest pain and ST-segment elevation

Terapia de resincronización en pacientes con insuficiencia cardiaca: experiencia acumulada de 10 años

1m m in

Tormenta eléctrica en síndrome de Brugada tratada exitosamente con infusión de isoproterenol

2 contiguous electrocardiographic leads. We studied patients with a first AMI who came to the emergency room within 6 hours of the onset of chest pain. Patients with prior infarction, cardiogenic shock, and those in whom coronary angiography revealed patency of the infarct-related artery (Thrombolysis In Myocardial Infarction 3 flow) were excluded. Primary angioplasty was considered to be successful when grade 3 Thrombolysis In Myocardial Infarction flow was obtained with a residual stenosis ,30%. All patients were given aspirin, and those who had stent implantation received ticlopidine or clopidogrel. Intravenous heparin in a bolus of 10,000 IU was given before angioplasty, with subsequent dosing as needed to maintain an activated coagulation time of about 300 seconds. Before primary angioplasty and during the chest

Pérdida de resincronización biventricular: Causa inhabitual. Caso clínico

BACKGROUND Multiple randomized trials support the clinical benefits of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and ventricular dyssynchrony. Since the year 2000 this therapy has been increasingly used in Chile. AIM To describe the clinical characteristics and follow-up of HF patients undergoing CRT in a single Chilean university hospital during the last 10 years. PATIENTS AND METHODS All patients undergoing CRT between 2000 and 2010 in our university hospital were included. Clinical and echocardiographic data were extracted from medical records and mortality causes were obtained from the National Identification Service. RESULTS A total of 252 patients underwent CRT during the study period. Seventy five percent were in New York Heart Associatin (NYHA) functional class III and mean ejection fraction was 29 ± 10%. Complete left bundle branch block was present in 55% and 20% had permanent atrial fibrillation (AF). Mean survival was 86% at 1 year and 82% of patients in NYHA class III-IV improved at least one functional class. Survival was poorer in patients with ischemic etiology (hazard ratio (HR) 1.48), functional class IV (HR 2.2), right bundle branch block (RBBB) (HR 3.1) and AF (HR 3.4). No survival differences were observed between patients with and without an implanted cardiodefibrillator. CONCLUSIONS This series show good clinical outcomes, comparable to those reported in randomized trials. Predictors of worse survival included an ischemic etiology, functional class IV, RBBB and AF. Patients with a defibrillator had no better survival, which could be relevant in countries with limited health care resources.

Fulguración con radiofrecuencia de haces paraespecíficos derechos

We report A 22 years old male who experienced several episodes of syncope within a time frame of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, which normalized the ECG pattern and avoided the recurrence of arrhythmias. The patient was implanted with an automated defibrillator and discharged 3 days after admission.We report a 22-year-old male who experienced several episodes of syncope within a timeframe of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, normalizing the ECG and avoiding further arrhythmia recurrences. The patient was implanted with an automated defibrillator and discharged 3 days after admission.

Usefulness of continuous electrocardiographic monitoring in the differential diagnosis of syncope

Cardiac resynchronization therapy is a non-pharmacologicaltreatment for patients with dilated cardiomyophaty and congestive heart failure. The success ofthis therapy depends of permanent biventricular stimulation. We report an 84 year-old man,with intermittent loss of biventricular pacemaker stimulation despite having adequate sensingand stimulation thresholds in the right atrium and both ventricles. The problem was solved aftercorrecting some programming parameters (Rev Med Chile 2006; 134: 887-92).(