Aspectos clínicos y electrocardiográficos de la pericarditis aguda / Clinical and electrocardiographic aspects of acute pericarditis

El diagnóstico diferencial entre pericarditis aguda e infarto agudo del miocardio puede constituir un desafíodiagnostico para el médico de urgencia, ya que el dolor precordial y los marcadores bioquímicos pueden noser siempre distintivos. La presente revisión enfatiza los elementos electrocardiográficos diferenciadores entres ambas entidades. La elevación difusa del ST y el desnivel del PR con elevación especialmente en aVR,son pistas electrocardiograficas claves que orientan al diagnóstico de pericarditis.

Einthoven: El hombre y su invento / Einthoven: the man and his invention

Einthoven, a Dutch physician, was awarded the Nobel Prize for Physiology or Medicine for his discovery of the mechanism of the electrocardiogram. He was born on May 21, 1860, in Semarang, on the island of Java. In 1878 entered the University of Utrecht in the Netherlands, as a medical student, where he also became a keen sportsman. In 1885, he was appointed Professor of Physiology at the University of Leiden, where he began to work using first a capillary electrometer. Later, Einthoven invented a new galvanometer to generate electrocardiograms using a fine quartz string coated in silver and published his findings in 1901 and 1903. Einthoven is remembered by most of his colleagues and clinical peers as a very modest person who was hospitable and honest. He died at the age of sixty seven.

El médico y los conflictos de intereses / The physician and the conflict of interest

Conflicts of interest are frequent in medical practice. They occur when a secondary interest unduly influences professional medical judgment, over and above the patients' benefit, his first real interest. Most of these secondary interests come from particular businesses of the physicians or their relationships with the industry. They may become a threat to the confidence that is established in the patient-physician relationship or to the medical profession as a whole. These conflicts of interest vary in types and magnitude and are not recognized by physicians on most occasions. Solutions are inevitably related to the honesty and integrity of each physician. Due to the absence of specific national ethical references, it is necessary to discuss the issue and conclude recommendations that guide interns, residents, clinicians, researchers, medical educators, medical and scientific associations to resolve these types of conflicts (Rev Méd Chile 2003; 131: 1463-8).

Resultados inmediatos y seguimiento a 2 años luego de valvuloplastía percutánea en estenóticos mitrales considerados malos candidatos para comisurotomía quirúrgica / Immediate and late results of mitral balloon valvuloplasty in patients who are poor candidates for surgical valvuloplasty

Los pacientes portadores de Estenosis Mitral (EM) considerados malos candidatos a comisurotomía mitral (CM) generalmente son mayores de 40 años con patología agregada, valvulopatías asociadas, cardiomegalia severa, fibrilación auricular y la válvula está muy engrosada, poco móvil, con o sin calcio y engrosamiento importante del aparato subvalvular. Con el fin de evaluar la valvuloplastía Mitral percutánea (VMP) en este tipo de pacientes analizamos los resultados inmediatos y a 22 ñ 1 meses en 27 pacientes considerados no candidatos a CM por su anatomía valvular desfavorable y patología agregada que contraindicaba la cirugía. 9, (33%) presentaben contraindicación quirúrgica: 2 caquexias severas, 3 cirrosis hepática y 4 falla ventricular derecha refractaria. Después de la VMP el área mitral aumentó de 0,92 ñ 0,17 cm* a 2.03 ñ 0,14 cm* (p < 0,0005), hubo un fracaso técnico, 2 resultados insuficientes y 1 fallecimiento debido al procedimiento. Durante el seguimiento el área ecocardiográfica varió de 1.98 ñ 0,1 cm* a 1,72 ñ 0,1 cm* (p < 0,05), hubo 2 fallecimientos de causa mitral importante. Al final del seguimiento 19 pacientes (70%) mantenían una mejoría sintomática importante, el área mitral en rango de estenosis leve y ninguno estaba en tratamiento anticoagulante. Los 3 pacientes fallecidos (11%) tenían contraindicación quirúrgica. Concluimos que la VMP es útil y razonablemente segura para el tratamiento de las EM con contraindicación quirúrgica o indicación de recambio valvular

Valvuloplastía mitral percutánea como tratamiento de elección de la estenosis mitral: resultados inmediatos y seguimiento alejado / Balloom mitral valvuloplasty as a treatment of choice for mitral stenosis: immediate and long term results

We evaluated 77 patients with sympytomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 20 echocardiography. The mean age of the 72 treated patiens was 38 ñ 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had sever weight loss and 13 pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 ñ 0.34 to 2.38 ñ 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 ñ 5 months (range 8 to 27, 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis