Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca / Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery

Antecedentes: El electrocardiograma es la prueba más utilizada para evaluar el riesgo cardiovascular durante el periodo preoperatorio. El objetivo del presente estudio es evaluar la incidencia de alteraciones electrocardiográficas en la población general programada para cirugía no cardiaca y determinar si la edad ≥ 65 años o el índice de riesgo cardiaco revisado ≥ 1 suponen un factor de riesgo para presentar dichas alteraciones. Material y métodos: Durante un periodo de un mes se analizaron todos los electrocardiogramas (ECG) preoperatorios de la consulta de anestesia. Se recogieron datos epidemiológicos y se calculó el índice de riesgo cardiaco revisado. Se definieron como alteraciones electrocardiográficas mayores aquellas que precisaban seguimiento por Cardiología. Resultados: Se reclutaron 476 pacientes, de los cuales 40,8% eran ≥ 65 años, 32,6% tenían HTA, 14,4% DM y 27,9% dislipemia. Un 16,16% de los pacientes tuvieron un índice de Lee ≥ 1.El 80,5% de los pacientes presentaban un ECG normal, el 6,5% alteraciones menores y el 13%, alteraciones mayores. En el análisis multivariante, la edad ≥ 65 años y la presencia de HTA se mostraron como factores de riesgo independiente para presentar alteraciones en el ECG totales y mayores.El índice de Lee ≥ 1 no se asoció con un mayor riesgo de alteraciones electrocardiográficas.ConclusiónLos pacientes ≥ 65 años o aquellos con HTA tienen mayor riesgo de presentar alteraciones electrocardiográficas mayores, por lo que recomendamos incluir en estos el ECG como prueba diagnóstica preoperatoria de rutina en cirugía no cardiaca.(AU)

BackgroundThe electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period.The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations.Material and methods: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up.Results: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1.Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG.The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities.Conclusions: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.(AU)

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery. / Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

[Decision making in cardiology: methodology]. / Toma de decisiones en cardiología: metodología.

This article reviews the methods employed in usual clinical thinking for making decisions, the problems and limitations inherent in them and claims that a more frequent utilization of the so called "Evidence Based Medicine" methods is a more valid and efficient alternative for medical decision making. We also describe the theoretical basis and strategies used in the medical decision process; the specific concepts and basic components for building decision trees are also shown. Finally, a real case is presented and approached step by step: the statement of the decision problem, its possible alternatives, the allocation of probabilities to each outcome based on the best available evidence, and the calculations of the expected values (projected usefulness, cost-effectiveness) and sensitivity analysis by means of specific software for making decisions.

[Intravenous leiomyomatosis with cardiac extension]. / Leiomiomatosis intravenosa con extensión a cavidades cardíacas.

Intravenous leiomyomatosis is a very rare uterine neoplasm, characterized by histological benignity. In some cases, it could extend through the ovaric or iliac veins up to the vena cava and the right chambers of the heart. We report a patient with symptoms of right heart failure, who was diagnosed by transesophagic echocardiography of intravenous leiomyomatosis with extension to the right ventricle. Complete excision was achieved employing simultaneous sternotomy and laparotomy with echocardiographic intraoperative monitorization.