Aneurisma coronario secundario a enfermedad de Kawasaki en paciente adulto: caso Clínico / Coronary aneurysm secondary to Kawasaki disease in an adult: report of one case

Kawasaki disease (KD) can be a primary cause of an acute coronary syndrome in young adults, with or without a history of KD during childhood. We report a 31year old female, admitted for acute chest pain. She had negative T waves on DIII and AVF leads of the electrocardiogram. Troponins were positive. A cardiac magnetic resonance was compatible with an acute inferior myocardial infarction. In the coronary angiography she had a calcified complete occlusion of the proximal right coronary artery. The left coronary artery had no visible lesions. A computed angiogram showed an extensive calcified and thrombotic aneurysm of the right coronary artery, compatible with Kawasaki disease (KD). The patient was discharged seven days after admission in good conditions.

Aneurisma apical en paciente con miocardiopatía hipertrófica / Apical aneurysm in a patient with hypertrophic cardiomyopathy

We report a 51-year-old asymptomatic male, with type II diabetes, referred to our outpatient clinic due to ST and T alterations on the precordial leads on the electrocardiogram. The echocardiogram showed apical akinesia and left ventricular hypertrophy. There were no angiographic lesions in the coronary angiography. In the left ventriculography, a hyperdynamic left ventricle with suspected left ventricular hypertrophy and an apical aneurysm were found. The cardiac magnetic resonance confirmed those findings, without late gadolinium enhancement. According to the European Cardiology Society Risk Score, the patient had a low sudden death risk. However, this score does not consider the presence of an aneurysm as risk factor for sudden death, but it is considered in the 2017 ACC/AHA Heart Rhythm Society Guidelines, as a major risk factor. Therefore a defibrillator was implanted, and he was discharged on permanent oral anticoagulation.

Angioplastia con stents liberadores de rapamicina en diabéticos tipo 2: Experiencia del Hospital DIPRECA / Angioplasty stenting with Sirolimus (Rapamycin) eluting stents in type 2 diabetic patients

Background: Drug-eluting stents have been developed to reduce the rates of restenosis after coronary angioplasty. Several studies have demonstrated that rapamycin eluting stents are reliable and effective. Aim: To report the experience in our Health Centre with rapamycin-eluting stents. Patients and methods: Forty two stents with rapamicine were implanted to 32 diabetic patients, between June 2002 and December 2004. After the procedure, subjects were clinically followed-up for an average period of 19.9+9.9 months, evaluating functional capacity, angina pectoris, dyspnea, need for hospital admission, acute coronary events and cardiac death. In those subjects clinically suspected to have restenosis, a coronary angiography was performed. Results: Twenty-nine subjects (90.6 percent) remained asymptomatic, two subjects (6.3 percent) developed angina pectoris but restenosis was ruled out, and one subject (3.1 percent) died. Conclusions: The use of rapamycin-eluting stents in these patients was safe and successful with no evidence of clinic restenosis. These positive results are similar to those reported in the Diabetes Study.

Resultados del primer registro chileno de angina inestable: características clínicas, perfil de riesgo y tratamiento / Results of the first Chilean registry of unstable angina: clinical features, risk profile and treatment

Background: From January 2000 to June 2002, the first Chilean registry of unstable angina was carried out, with the participation of 15 hospitals. Aim: To report the clinical and demographic features of 600 patients with unstable angina, their risk profile and prognosis. Material and methods: The inclusion criteria for this prospective registry were a history of recent onset of chest pain (<48 hours) or a change in the character of previous angina, associated to ischemic electrocardiographic changes and/or positive markers of myocardial damage. Results: Mean age of the patients was 65 years and 37 percent were women. Among coronary risk factors, 63 percent had hypertension, 27percent had diabetes, 52percent had dyslipidemia, 31percent smoked and 21percent had a family history of atherosclerosis. On admission 94percent of patients had chest pain, associated to ST segment depression in 44 percent, negative T waves in 28 percent and positive markers of myocardial damage in 30percent. Fifty seven percent received intravenous nitroglycerin, 47 percent received oral nitrates, 69 percent beta blockers and 15 percent, calcium antagonists. Antithrombotic therapy included aspirin in 96 percent, heparin in 74percent, ticlodipine or clopidogrel in 19 percent and IIb/IIIa inhibitors in 12percent. A coronary angiogram was performed in 52percent, angioplasty in 25percent and coronary bypass surgery in 13percent. Hospital mortality was 2.6percent. The incidence of new ischemic events was: myocardial infarction in 2.8percent recurrent ischemia in 9.5percent and refractory ischemia in 2percent. The incidence of adverse events increased according to a higher risk profile. Conclusions: The demographic and clinical features, treatment and mortality of these patients are similar to those reported in international registries, with a low mortality rate.

Función diastólica de ventrículo izquierdo: evaluación comparativa entre ventriculografía radioisotópica y angiografía contrastada / Diastolic dysfunction on the left ventricle: a comparison of radioisotopic and angiograhic evaluation in patients with coronary artery disease

La evaluación de la función diastólica del ventrículo izquierdo (FDVI), que clásicamente se ha derivado del estudio hemodinámico invasivo, ha adquirido una gran importancia clínica en los últimos años. Diversas cardiopatías pueden presentar alteraciones del llenado ventricular, en forma aislada o antes de su evolución hacia la disfunción sistólica. Sin embargo, el estudio invasivo de la FDVI no es fácil. En nuestro medio existe aún poca experiencia con los métodos no invasivos disponibles en la actualidad para el estudio del diástole, entre los cuales se encuentra la ventriculografía radioisotópica (VRI). Se presentan los resultados de la evaluación del llene diastólico del v. izquierdo mediante VRI gatillada y análisis de Fourler, en un grupo de 14 cardiópatas coronarios con función sistólica conservada. Se determina en la ventriculografía contrastada la velocidad máxima de llene del v. izquierdo (VMax), la que se compara favorablemente con los datos obtenidos del estudio isotópico (VMax) y el tiempo en alcanzarla (TVMax). El 86% de los pacientes tiene disfunción diastólica. El grado de correlación entre ambas técnicas es aceptable (r = 0,61) y el nivel de concordancia es alto (86%). De acuerdo a estos resultados, consideramos que la ventriculografía isotópica es una herramienta útil, fácil y reproducible en el estudio seriado del llene ventricular