Desensibilización rápida en pacientes con hipersensibilidad a aspirina sometidos a angioplastía coronaria: Reporte de cuatro casos / Rapid aspirin desensitization in patients with a history of aspirin hypersensitivity requiring coronary angioplasty: Report of four cases

Background: Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Utilidad de isosorbide sublingual en la reversibilidad de la hipertensión pulmonar reactiva, en pacientes candidatos a trasplante cardíaco / Usefulness of sublingual isosorbide to assess the reversibility of pulmonary hypertension in cardiac transplant candidates

Background: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative. Aim: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure. Patients and Methods: Prospective evaluation of patients referred for cardiac transplant evaluation. Patients underwent right catheterization for hemodynamic measurements at baseline and after repeated doses of 5 mg sublingual isosorbide every 5 minutes until observing a decrease in pulmonary vascular resistance decrease or symptomatic hypotension. Results: Twenty one patients, 18 men, age 49±15 years, were studied. Fourteen (66%) were transplanted. The mean sublingual isosorbide dose was 15±5 mg. After isosorbide administration, there was a significant decrease in mean arterial pressure (80±8.5 to 71±6.6 mmHg, p <0.0001), mean pulmonary artery pressure (38±11 to 26±7.8 mmHg, p <0.0001), systemic vascular resistance (1540±376 to 1277±332 dyn*s/cm5 p <0.001), pulmonary vascular resistance (3.5±2.2 to 2,5±1.6 Wood Units, p <0.05) and transpulmonary gradient (13±7 a 10±4 mmHg, p <0.004). The cardiac output increased from 3.96±0.7 to 4.38±0.9 L/min, p=0.05. The relation between pulmonary and systemic vascular resistance before and after isosorbide was 0.17 and 0.15, respectively (p=0.04). One transplanted patient with partial reversibility of pulmonary hypertension developed acute right heart failure. Conclusions: Sublingual isosorbide administration is useful and well tolerated to evaluate the reversibility of pulmonary hypertension prior cardiac transplant.

Respuesta cardiovascular al ejercicio a gran altura en trabajadores crónicamente expuestos a hipoxia hipobárica intermitente / Cardiovascular response to exercise at high altitude in chronically exposured workers to intermittent hypobaric hypoxia

The isottonic work perfomance was assessed in 34 workers aged 35 ñ 5.8 years old that had working of four days at 4500 m over the sea level and resting periods of other four days at the sea level during at least two years. Subjects were assessed in one occasion at the sea level, and at the first and fourth day of the working shift at 4500 m over the sea level. resting arterial oxygen saturation in theses three periods was 97 ñ 1.1, 88 ñ 18 and 91 ñ 1.1 percent respectively (p<0.01) and markedly decreased during maximal and submaximal exercise at 4500 m over sea level. Evercise duration in the three periods was 931 ñ 210, 775 ñ 105 and 778 ñ 105 seg respectively (p<0.001). Heart rate in the resting period was at least 10 percent higher and maximal and submaxilmal rates were lower at the high altitude. No differences in blood pressure or packed red cell volume were observed. Exercise duration correlated inversely with age (r=-0.49 p=0.03) and directly with maximal heart rate (r=0.44 p=0.009) at the sea level. No correlation between aerobic capacity and other measured parameters was observed. These results show no differences in the cardiovascular response to exercise between the first and fourth day of stay at high altitude in workers chronically exposed to intermittent hypobaric hypoxia

Taponamiento cardíaco hemorrágico sin rotura cardíaca en el curso de infarto del miocardio: caso clínico / Hemorrhagic cardiac tamponade without cardiac rupture during an evolving myocardial infarction: case report

Cardiac tamponade during acute myicardial infarction is a lif threatening complication that can be confounded with right ventricular infarction. The most frequent cause of this complication is cardiac rupture. We report here a patient with acute myocardial infarction that developed cardiac tamponade on day 7, after receiving late systemic thrombolysis. The diagnosis was suspected with echocardiography and confirmed with hemodynamic measurements. The tamponade was partially relieved with pericardiocentesis but afterwards required emergency surgery. No cardiac rupture was found but an hemorragic infarction. We conclude that in this case the hemorragic tamponade was probably related both to late thrombolysis and to post infarction pericarditis

Remodelamiento miocárdico post infarto del miocardio: desde los datos experimentales a la prevención de insuficiencia cardíaca / Myocardial remodeling post myocardial infarction: from experimental data to prevention of heart failure

Structural and biochemical modifications of the myocardium (remodeling) occur after acute myocardial infarction. An important part of this process of myocardial remodeling takes place in the intersticial compartment which is comjposed mainly of fibrillar collagen. These remodeling changes are associated with modifications in left ventricular geometry and function that could be deletereous and have significant clinical manifestations. Some salutatory effects of the treatment are related to modifications of the process of intersticial remodeling. Clinical studies with calcium channel antagonists, nitrtes and, specially converting enzyme inhibitors have shown significant in the degree of ventricular dilation, hemodynamics and exercise tolerance as a comapred to palcebo treated patients. Ongoing clinical studies will provide us with more definite information on the effects of converting enzyme inhibitors on long term prongnosis as vell as on myocardial remodeling after acute myocardial infarction

Comparación de los efectos clínicos y neurohumorales de Milrinona y Captopril en pacientes con insuficiencia cardíaca crónica / Clinical and neuroendocrine response of Milrinone vs. Captopril in heart failure

En el presente estudio hemos comparado los efectos de Milrinona (M), un nuevo fármaco inótropo, positivo con un inhibidor de enzima convertidora, Captopril (C), en la condición clínica y respuesta adrenérgica al esfuerzo físico leve en pacientes con insuficiencia cardíaca congestiva (ICC) en CF III. El estudio randomizado, cruzado y doble ciego evaluó los efectos de M, 10 mg c/6 hr. o C 50 mg c/8 hr. durante 9 semanas, comparados con placebo, en 16 pacientes con ICC (6 de causa isquéemica, 10 por miocardiopatíia dilatada), que recibían digital y diuréticos. Se determinó un score clínico (SC), que incluía síntomas, examen físico y Rx. tórax, (rango 0-14), la fracción de eyección radio isotópica (FE) y la actividad de renina plasmática (ARP). La noradrenalina plasmática (NAD) se midió en reposo (r) y a iguales niveles de esfuerzo físico leve (e) (6 min. Naughton, VO2 8-9 ml/kg/min.). El score clínico mejoró en forma significativa y similar por efectos de ambas drogas (5.2+-0.4 a 4.4+-0.5, 4.1+-0.4 respectivamente, p<0.01). Lo mismo ocurrió con la fracción de eyección de VI que aumentó de 23.6+-2.6% por efecto de milrinona y a 28.6+-3.2% por efecto de captopril, (p<0.01). La respuesta neurohumoral fue diferente ya que no hubo modificaciones de la ARP o NAD en reposo y esfuerzo por efecto de Milrinona. La ARP aumentó (1.6+-0.5 a 5.3+-1.5 ng/ml/hr y la NAD en esfuerzo disminuyó (1228+-158 a 820+-100 pg/ml) por efecto de Captopril (p<0.01). La elevación de ARP y la menor respuesta adrenégica al esfuerzo físico observada con C confirma un diferente efecto humoral con respecto de M e indican que favorece una mejor adaptación al esfuerzo físico en pts. con ICC