[Therapeutic options in cardiogenic shock]. / Opciones terapéuticas en el shock cardiogénico.

Cardiogenic shock continues to be a clinical situation which is related with high mortality. Although its etiology is varied, the most frequent cause is an acute myocardial infarction. The poor prognosis of cardiogenic shock can be favourably modified with the diagnosis of the underlying cause followed by the stabilization of the patient and early revascularization. Early treatment with inotropic or vasopressor drugs improves the condition of most patients and the use of circulatory assistance, such as the intraaortic balloon, lead to an acceptable hemodynamic situation in 80% of cases. However, they do not significantly modify the mortality rates. In addition, thrombolytic therapy does not appear to be effective for this kind of patients. Only revascularization methods have proved to be effective; surgery is the only option where ventricular septal, free wall, or papillary muscle rupture occurs, resulting in survival rates of between 50 and 60% with coronary artery by-pass surgery. Angioplasty is frequently successful in reperfusion of the infarct-related artery; the survival rate in these cases is approximately 70%, according to the different series published. As the mortality rate is exceedingly high (70-90%) when conventional therapy is used; when appropriate diagnostic and therapeutic means are available and when the patient's condition is recoverable, the attitude should be aggressive and coronary angiography and angioplasty applied as soon as possible. In centers where these means are not available, once measures have been taken to achieve the stabilization of the patient, the most suitable procedure is to transfer him or her to a hospital in which qualified staff and such treatment methods are available.

[Usefulness of exercise echocardiography for the diagnosis of ischemic heart disease]. / Utilidad de la ecocardiografía de esfuerzo en el diagnóstico de la cardiopatía isquémica.

INTRODUCTION AND PURPOSE: The purpose was assessing the usefulness of exercise digitalized echocardiography for the diagnosis of ischemic heart disease. PATIENTS AND METHODS: Eighty-eight patients, with suspected artery coronary disease, underwent both a exercise echocardiography with treadmill Bruce protocol and a coronary arteriography, within a period less than 2 months, without changes in their clinical evolution. Fifty-eight patients shown significant coronary lesions (> or = 50%). RESULTS: The exercise echocardiography showed a high sensitivity (74%), significantly greater (p < 0.01) than exercise electrocardiography alone. The sensitivity was fixed by the level of exercise done, reaching 91% when submaximal exercise was achieved, and by the severity and extension of coronary disease, being of 68.5% for a single-vessel, 80% for two-vessel and 100% for three-vessel. The specificity was 87%, considering the lesions lesser than 50% as not significant, and it was 100% when the coronary arteries without disease were taken into account. CONCLUSIONS: Exercise echocardiography can be a rutinary method for the diagnosis of ischemic heart disease, and it shows a high sensitivity and specificity, greater than exercise electrocardiography alone.