Classification of patients with suspected acute coronary syndrome according to the universal definition

Objective: to describe the clinical, imaging and laboratory characteristics of patients undergo ing coronary arteriography with a presumptive diagnosis of acute coronary syndrome between January 2017 and December 2019, as well as the frequencies of the types of infarction according to the universal definition. Methods: an observational, cross-sectional study of patients over the age of 18 undergoing coronary angiography at a university hospital in Bogotá. Statistical analysis was carried out using STATA software, calculating absolute frequencies, proportions, and measures of central tendency and dispersion, according to the behavior of the variables. Patients were classified according to the fourth universal definition of infarction, determining each respective frequency. Results: a total of 714 medical charts were analyzed, corresponding to 459 men and 255 women, with high blood pressure, dyslipidemia, obesity, diabetes and prior coronary disease being the most common cardiovascular risk factors. Altogether, 68.9% of the patients had an electrocardiogram with an abnormal reading, and only 43.8% of the patients had obstructive lesions, of whom 33.2% were patients with type I infarction. A 12.2% prevalence was found for type II infarction, and 17% for the MINOCA category. Inpatient mortality was 2.5%, mainly due to cardiogenic shock. Conclusions: patients with acute coronary syndrome were predominantly males with cardio vascular risk factors. In this study, most patients did not have obstructive lesions on arteriography. However, type I infarction was the most common type. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2350).

Objetivo: describir las características clínicas, imagenológicas y de laboratorio de pacientes llevados a arteriografía coronaria con diagnóstico presuntivo de síndrome coronario agudo, en el periodo comprendido entre enero de 2107 y diciembre 2019; así como las frecuencias de los tipos de infarto según la definición universal. Metodología: estudio observacional de corte transversal, de pacientes mayores de 18 años llevados a coronariografía, en un hospital universitario de Bogotá. Mediante el software STATA, se realizó el análisis estadístico, con cálculo de frecuencias absolutas, proporciones, medidas de tendencia central y dispersión según el comportamiento de las variables. Se realizó la clasificación de pacientes según la cuarta definición universal de infarto, identificando cada una de las frecuen cias respectivas. Resultados: se analizaron 714 historias clínicas, correspondientes a 459 hombres y 255 mu jeres, con hipertensión arterial, dislipidemia, obesidad, diabetes y enfermedad coronaria previa como factores de riesgo cardiovascular más frecuentes. El 68.9% de pacientes tuvo un electrocar diograma interpretado como anormal y solo 43.8% de pacientes tuvo lesiones obstructivas, de los cuales 33.2% correspondió a pacientes con infarto tipo I. Se encontró una prevalencia de 12.2% para infarto tipo II y del 17% para la categoría de MINOCA. La mortalidad intrahospitalaria fue de 2.5%, principalmente por choque cardiogénico. Conclusiones: la población masculina con factores de riesgo cardiovascular, predominó en la presentación del síndrome coronario agudo. Para este estudio, la mayoría de los pacientes no tuvo lesiones obstructivas en la arteriografía. Sin embargo, dentro de los tipos de infarto; el infarto tipo I fue el más frecuente. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2350).

Reynolds syndrome: a rare rheumatologic disease that internists should have in mind. case report

ABSTRACT Introduction: Reynolds syndrome (RS) is an autoimmune disorder characterized by overlapping primary biliary cirrhosis (PBC) and limited cutaneous systemic sclerosis (lcSSc). Some published cases do not report pulmonary arterial hypertension (PAH), and diagnoses are usually based on clinical, immunological and histological findings, mainly focused on dermatologic features, on those associated with Sjogren's syndrome, or on an interesting presentation of malignant thymoma; only one case of reported PAH was found, but it was an image report. Case Presentation: This paper reports the case of a 75-year-old woman who presented with some of the features mentioned above, severe PAH, dyspnea for one month and two weeks of purulent expectoration, as well as generalized pruritus, nasal telangiectasias, Raynaud phenomenon, sclerodactyly, and high levels of alkaline phosphatase and transaminases. Pulmonary arterial hypertension was documented through a transthoracic echocardiogram, and inmunoflorecence reported mitochondrial and centromere patterns of antinuclear-antibodies. Consequently, RS was diagnosed and phosphodiesterase type-5 inhibitors were started for PAH treatment resulting in the improvement of dyspnea. Conclusion: Dyspnea could be caused by many conditions, but in the presence of clinical and physical findings, it suggests an autoimmune disorder. Scleroderma should be considered and, additionally, PAH should be investigated since it is present in up to 10% of patients, conferring a worse prognosis. Internists should keep in mind that these disorders may be associated with other autoimmune diseases.