[Reduction in the rates of restenosis after coronary angioplasty with simvastatin and probucol]. / Reducción en las tasas de reestenosis después de una angioplastia coronaria con simvastatina y probucol.

INTRODUCTION AND OBJECTIVES: The restenosis rates after coronary angioplasty persist as an important problem even though multiple drug therapies and different devices have been tried. The reduction of the cholesterol and low density lipoproteins levels (and their oxidation) have proved to have a beneficial effect on atherosclerosis evolution. Both the lipid lowering and antioxidant agents have caused a reduction in the neointimal formation generated with the angioplasty balloon in animals, and their combination to improve endothelial dysfunction in humans. The aim of the present study is to prove whether the whole administration of two potent agents such as simvastatin and probucol, which reduce the lipid levels and their oxidation, are able to lessen the restenosis related process. PATIENTS AND METHODS: Thirty five consecutive patients with coronary angioplasty with no stent to whom 20 mg simvastatin and 500 mg probucol bid were given (group-A) were studied in a prospective non-randomized study. They were compared to a historic group of 40 patients under the standard treatment (group-B). Both groups were angiographically evaluated to determine the restenosis percentage. A lipid profile was performed on group-A patients. RESULTS: The restenosis occurred in 4 (11.4%) in group-A and in 17 (42.5%) in group-B patients and in 4 (10.0%) and 18 (39.1%) lesions respectively (p < 0.01). A new PTCA was performed on 2 (5.7%) group-A patients vs 13 (32.5%) in group-B (p < 0.01). There was a reduction in residual stenosis (34.2 +/- 19.7% vs 48.8 +/- 23.5%, p < 0.01) and a greater minimum luminal diameter (1.76 +/- 0.59 vs 1.46 +/- 0.70 mm, p < 0.05) in group-A than in group-B patients. CONCLUSIONS: Although studies with more patients are required, a combined lipid lowering and antioxidant therapy could achieve a reduction in angioplasty coronary restenosis.

[The appearance of giant negative T waves in anterior acute myocardial infarct with a Q wave is associated with minor myocardial damage and a minor extension of coronary disease]. / La aparición de ondas T negativas gigantes en un infarto agudo de miocardio anterior con onda Q se asocia a un menor daño miocárdico y una menor extensión de la enfermedad coronaria.

INTRODUCTION AND OBJECTIVE: The early inversion of T waves in patients with acute myocardial infarction has recently been related to a better left ventricular function and a more favourable evolution, contrary to what happens in the unstable angina. On the other hand, the significance of the appearance of deep negative T waves in the early phase of some acute myocardial infarction is not known. The aim of this study is to evaluate its relation with the existing myocardial damage and the underlying coronary artery disease extension in anterior some with Q wave. METHODS: 48 patients with a first anterior Q-wave acute myocardial infarction, thrombolized or not, admitted to hospital with an evolution of less than 24 hours, and with a coronariography performed before discharge were analyzed. Giant negative T waves were defined as those which were 8 mm or more from baseline. RESULTS: 17 of the 48 patients presented giant negative T waves (T-group) and 31 did not (N-group). In the T-group patients, the size of the negative T wave was 11.29 +/- 2.86 mm and the number of precordial leads with negative T waves was 4.35 +/- 1.57. There were no differences between both groups in variables such as sex, coronary risk factors, and other basal characteristics. The T-group patients were younger, had lower peak-CK, CK-MB and LDH levels and presented greater recovery of R waves during the follow-up, the differences being significant with the N-group patients. The left ventricular ejection fraction was higher (56.3 +/- 13.4 vs 42 +/- 12%; p < 0.001) and the number of affected coronary vessels was lower in the T-group (1.12 vs 1.64; p < 0.01); there were no differences in the localization or severity of coronary lesions, nor in the frequency of postinfarction myocardial angina. None of the patients in the T-group were Killip > I, while this situation occurred in 38.7% of the N-group patients. CONCLUSIONS: The appearance of giant negative T waves in the acute or early phase of Q-wave anterior acute myocardial infarction is associated with a smaller infarct size, lower functional deterioration and less extension of the underlying coronary disease.

[Ventricular tachycardia in a patient with mid-ventricular hypertrophic myocardiopathy and apical aneurysm]. / Taquicardias ventriculares sostenidas en un paciente con miocardiopatía hipertrófica medioventricular y aneurisma apical.

A case is presented of a 77-year-old patient who was admitted with a pattern of sustained ventricular tachycardia and diagnosed with midventricular hypertrophic myocardiopathy with apycal aneurysm. Under treatment with amiodarone at low doses, the patient is asymptomatic with no recurrence of the arrhytmias at one year. The association of midventricular hypertrophic myocardiopathy with apycal aneurysm and of those with sustained ventricular tachycardia are reviewed in conjunction with their treatment.

[Subtotal thyroidectomy. A treatment to keep in mind in amiodarone-induced thyrotoxicosis]. / Tiroidectomía subtotal. Un tratamiento a tener en cuenta en la tirotoxicosis inducida por amiodarona.

Amiodarone is an antiarrhythmic drug, frequently used in cardiology, which may produce secondary effects on the thyroid function. These effects can range from subtle changes in peripheral hormones without clinical manifestations, to severe forms of hypothyroidism or hyperthyroidism. The evolution of amiodarone-induced-hyperthyroidism can be mild, requiring only the withdrawal of the drug, or very severe, requiring an aggressive therapy with multiple drugs which may in some cases be fatal in spite of this therapy. Recently, the increase in the usage of this drug has produced reports of severe amiodarone-induced-thyrotoxicosis requiring surgery in some cases (subtotal or total thyroidectomy). A case of amiodarone-induced-thyrotoxicosis in its more aggressive form, which required intensive pharmacological treatment ultimately combined with surgery, is presented here.

[Conventional stress test in patients with dilated cardiomyopathy. Variables with prognostic value. Correlations with non-invasive and invasive tests]. / Prueba de esfuerzo convencional en pacientes con cardiomiopatía dilatada. Variables con valor pronóstico. Correlaciones con pruebas no invasivas e invasivas.

The variables of conventional stress testing were studied to determine their prognostic value and their correlations with other tests, in 34 patients with dilated cardiomyopathy divided into a first group of 20 in-patients admitted because of acute pulmonary edema (GI), and a second group of 14 stable out-patients (GII), with a mean follow-up of 3 years. The GI-patients had data of more evolved disease as reflected by a lower fractional shortening (13.5 +/- 4.6 vs 17.8 +/- 3.9%; p < 0.05). The only variables with prognostic capacity were functional aerobic incapacity (FAI), and systolic arterial pressure reached on exercise (SAPE), this being applicable only to GI-patients (FAI: 19.6 +/- 17.34 vs 46 +/- 26.4% in alive vs patients who died respectively; p < 0.05) (SAPE: 155 +/- 23.21 vs 127.14 +/- 24.9 mmHg, respectively; p < 0.05). Also a good correlation between the cardiac rate reached on exercise and the cardiothoracic index on chest X-ray was found (p = 0.0001), again, for GI-patients only. The presence of ventricular arrhythmias (VA) on stress testing had a very good correlation with a Holter VA-score (p < 0.0001), this being applicable for both GI and GII patients. The correlations with haemodynamic variables obtained by, basal or post-dobutamine infusion, right catheterism were not good by and large, except between FAI and systemic resistances. It is conclude that: 1) Conventional stress testing provides variables of prognostic value in dilated cardiomyopathy patients but only in those with more evolved disease. These variables are the FAI and the SAPE. 2) The presence of VA during exercise predicts their presence in daily life, and in this case at an earlier phase of the disease. 3) There are not good correlations between the haemodynamic and stress testing variables except in the case of systemic resistances and FAI.

[Pulmonary thromboembolism with mobile thrombus in the right atrium. Presentation of a case diagnosed with bidimensional echocardiography and review of the literature]. / Tromboembolismo pulmonar con trombo móvil en aurícula derecha. Presentación de un caso diagnosticado por ecocardiografía bidimensional y revisión de la literatura.

A case is presented of a pulmonary thromboembolism secondary to detachment of an elongated and mobile thrombus in right atrium, identified by bidimensional echocardiography in a patient without previously identified cardiac pathology. The presence of pulmonary thromboembolism in this patient was confirmed by lung angiography. In-spite of anticoagulant treatment, the patient died four days later due to massive pulmonary embolism, before a surgery could be carried out, coinciding with the disappearance of the right atrium thrombus by bidimensional echocardiography. The echocardiographic characteristics of right atrium thromboembolisms are described as well as their differential diagnosis and the most appropriate therapeutic attitude in these cases based in a literature review.