Caracterización de pacientes portadores de marcapasos definitivo en el Hospital Regional de La Serena / Characterization of patients with definitive pacemaker in Hospital Regional de La Serena

INTRODUCCIÓN: La implantación de marcapasos definitivo se realiza en portadores de alteraciones en la generación del impulso cardíaco y/o con trastornos de la conducción. OBJETIVO: Caracterizar el perfil clínico-epidemiológico de los pacientes portadores de marcapasos definitivo en la Unidad de Cardiología del Hospital Regional de La Serena, en el período julio - septiembre de 2011. MATERIAL Y MÈTODO: Estudio descriptivo, de corte transversal. Se revisaron 103 fichas clínicas de pacientes marcapaso definitivo mediante muestreo aleatorio en la Unidad de Cardiología del Hospital Regional de La Serena. Se incluyeron pacientes mayores de 15 años con trastornos en generación del impulso y/o conducción irreversible. Se recopilaron y analizaron datos mediante Microsoft Excel 2007, identificándose características como sexo, edad, ruralidad, comorbilidades, manifestaciones clínicas, presencia o ausencia de Enfermedad de Chagas y cardiopatía específica. Se consideró significativo un p<0,05. RESULTADOS: Del total de 103 pacientes, 47,1 por ciento fueron mujeres. La edad promedio fue 74,5 +/- 12 años. La ruralidad fue de 49,51 por ciento Las manifestaciones clínicas más frecuentes fueron síncope (37,24 por ciento), disnea (32,34 por ciento) y mareos (24,46 por ciento). Del total de pacientes, 22 por ciento presentaron serología positiva para Tripanosoma Cruzi, 38 por ciento negativa y 40 por ciento sin serología. DISCUSIÓN: La principal causa de indicación de marcapasos definitivo fue el bloqueo auriculoventricular completo, correlacionándose con la literatura. No se encontró significancia estadística entre la severidad de la clínica y tipo de trastorno de la conducción. Se observó significancia estadística en la asociación entre ruralidad y serología para Tripanosoma Cruzi positiva y/o sin serología.

INTRODUCTION: The implant of definitive pacemaker is indicated in electrical impulse generation disorders and/or hearth electrical conduction abnormalities. OBJETIVE: Characterize clinically and epidemiologically the profile of patients with definitive pacemaker in the Cardiology Unit of the La Serena Regional Hospital, between July and September 2011. MATERIAL AND METHOD: Descriptive transversal cut study. 103 medical records of DPM diagnosed patients were analyzed by simple random sampling in the Cardiology Unit of the La Serena Regional Hospital. Patients with electrical impulse generation disorders and/or hearth electrical conduction abnormalities aged > 18 years old were included. Data collecting and analyzing were realized by Microsoft Excel 2007. The studied variables included: sex, age, rurality, disease, clinical symptoms, presence or absence of Chagas Disease and cardiopathies. Odss Ratio (OR) was calculated in significant differences situations in order to evaluate risk associated. A p< 0.05 was considered significant. RESULTS: Of the total of patients, 47.1 percent was women. The average age was 74.5 +/- 12 years. Rurality condition was 49.51 percent Most frecuent clinical symptoms were syncope (37.24 percent), dyspnoea (32.34 percent), dizziness (24.46 percent).Of 103 patients, 22 percent tested positive for Tripanosoma Cruzi, 38 percent tested negative and 40 percent without serology test. DISCCUSSION: The main definitive pacemaker indication was Complete Atrioventricular block, wich agree the literature. The association between clinical severity and hearth conduction abnormality type was not significant. We observed statistically significant differences between rurality condition and positive and/or without serologic test for Tripanosoma Cruzi.

Taquicardia ventricular idiopática originada en el ventrículo izquierdo / Idiopathic ventricular tachicardia originated at left ventricle

Patients and methods: We report six patients (five male), aged 35 years old as a mean, with idiopathic left ventricular tachycardia that were subject to conventional electrophysiological studies with atrial and ventricular simulation programs and radiofrequency fulguration, between December 1993 and May 1996. Results: The mean lapse of disease was 24 months and five patients received antiarrytmic medications previously. All tachycardias had a morphology with an image of right bundle branch block. Radiofrequency fulguration was done after obtaining a satisfactory pace mapping of at least 11 of the 12 superficial EKG derivations. The procedure was successful in five patients and two had a relapse. One of the relapsed patients was successfully fulgurated again. Conclusions: Radiofrequency fulguration for idiopathic ventricular tachycardias is a safe and effective therapeutic procedure

Insuficiencia renal aguda en pacientes con y sin sepsis: pronóstico y evolución / Acute renal failure in septic and non septic patients: prognostic and evolution

The purpose of this prospective study was to determine whether the course and prognosis of acute renal failure (ARF) in patients with and without sepsis are different. 252 (8 percent) of 3086 consecutive patients admited to a medical surgical intensive care unit (ICU) developed ARE. One hundred forty-nine (59 percent) were septic and 103 (41 percent) were non-septic. No differences were founded between groups regarding the incidence of oliguria, hyperkalemia, hypercatabolism, gastrointestinal bleeding, duration of oliguria and renal deficit, severity of azotemia, dialysis requirements and duration of stay in the hospital. There were statistically significant differences between septic and non septic patients with respect to hyponatremia (67.8 vs 54.4 percent, p<0.04), respiratory failure (68 vs 54 percent, p<0.04), and thrombocytopenia (64 vs 48 percent, p<0.02). Mortality in septic patients was higher than in non-septics (56 vs 42.7 percent, p<0.009). Factors associated with increased mortality in ARF septic patients were respiratory failure, metabolic acidosis and oliguria while in the non-septics they were hepatic dysfunction, hyperkalemia, respiratory failure and infection acquired during the course of renal failure. We conclude that ARF developing in septic patients has a higher mortality than that of non-septic patients, whereas the incidence of hypercatabolism and oliguria was not different between both groups