[Angiographic correlates of the high-risk criteria for conventional exercise testing and the Duke treadmill score]. / Correlación angiográfica de los criterios de alto riesgo para ergometría convencional y el índice de Duke.

OBJECTIVE: To compare the sensitivity, the specificity, the positive and negative predictive value and the predictive accuracy of the Duke Treadmill Score, the Spanish Society of Cardiology (SEC) and American College of Cardiology/American Heart Association (ACC/AHA) high-risk criteria for exercise testing in the detection of left main disease, three vessel disease and two vessel disease involving the proximal left anterior descending artery. PATIENTS AND METHOD: A cohort of 199 patients (age 75 years) consecutively admitted to hospital for unstable angina was studied. All patients underwent an exercise stress test and coronariography. RESULTS: The SEC high-risk Criteria showed a sensitivity of 69.2% and a specificity of 49.0%. The ACC/AHA high-risk Criteria demonstrated a sensitivity of 98.1% and a specificity of 23.8% and the Duke Treadmill Score presented a sensitivity of 30.8% and a specificity of 90.5%. In patients with moderate risk in the Duke Treadmill Score we found a sensitivity of 62.9% and a specificity of 39.8% for the SEC high-risk criteria, while the ACC/AHA high-risk Criteria presented a sensitivity of 100.0% and a specificity of 5.8%. CONCLUSIONS: The ACC/AHA high-risk Criteria showed a higher sensitivity while the Duke Treadmill Score presented a higher specificity for the detection of left main disease, three vessel disease and two vessel disease involving the proximal left anterior descending artery. The ACC/AHA and SEC high-risk Criteria were found to be very useful in the group of patients with moderate risk in the Duke Treadmill Score.

[Lipoprotein (a) as a predictor of severity of coronary artery stenosis documented by angiography in male coronary patients under 50 years old]. / La lipoproteína (a) es predictora de severidad angiográfica en varones menores de 50 años con inicio clínico de enfermedad coronaria.

OBJECTIVE: To determine the relationship between lipoprotein (a) seric levels with the age of coronary artery disease debut and the severity of coronary lesions in a group of male patients less than 50 years old. PATIENTS AND METHODS: We studied a group of 230 male patients, younger than 50 who were consecutively admitted to the hospital because of an ischemic coronary event. During hospitalization, the lipoprotein (a) in plasma was measured in all patients. They were distributed in two groups according to age at time of coronary disease clinical presentation with a cut off age of 40. A group of 142 patients underwent a cardiac catheterism and coronariography due to clinical or electrical unstability. RESULTS: The lipoprotein (a) levels were related with the number of diseased vessels. In this way lipoprotein (a) levels were 12 mg/dl (1.5-75) in those patients showing a normal coronariography; 27 mg/dl (2. 5-96) in those with one vessel disease; 34 mg/dl (7-90) in those with two vessels affected and 63 mg/dl (2-116) in the case of three-vessel disease, with statistical significance of p = 0.003. No significant differences in lipoprotein (a) levels were found when the age of coronary artery disease presentation was taken into account. In this way lipoprotein (a) levels were 31 mg/dl (2-97) in patients younger than 40 years of age, in comparison to 33 mg/dl (2-94) in those older than 40. CONCLUSIONS: In our community male patients with a diagnosis of coronary artery disease and less than 50 years old showed a relationship between lipoprotein (a) levels and the severity and number of coronary vessel diseases. However, an association between lipoprotein (a) levels with the age of coronary disease presentation was not evident.

[Guideline for the education of the specialist in cardiology in Spain. Comisión Nacional de la Especialidad de Cardiología]. / Guía de formación del especialista en cardiología en España. Comisión Nacional de la Especialidad de Cardiología.

This article presents the program for training in cardiology. The document was elaborated by the National Committee of the Specialty of Cardiology, from the Ministry of Health and Ministry of Education, and describes the theoretical and practical aspects of training in cardiology prevailing at present in Spain.

[The etiology and associated risk factors in a sample of 300 patients with atrial fibrillation]. / Estudio de la etiología y factores de riesgo asociados en una muestra de 300 pacientes con fibrilación auricular.

PURPOSE: To analyze the etiology and the prevalence of risk factors in patients with atrial fibrillation. PATIENTS AND METHODS: Applying an unpaired case controlled study, we examined 300 consecutive patients (143 men) with atrial fibrillation and a mean age of 66 +/- 8 years. This group is compared with a control group of 700 patients (mean age 64 +/- 12 years). RESULTS: In the group with atrial fibrillation the etiology in 32% was arterial hypertension, in 20% coronary heart disease, in 13% valvular heart disease, in 11% heart failure, in 4% hyperthyroidism and in 20% idiopathic. 50% presented hypertension, 29% tobaccoism, 26% left ventricular hypertrophy, 20% consumption of alcohol, 19% hypercholesterolemia and 16% diabetes. Compared with the control group, patients with atrial fibrillation had coronary heart disease (p < 0.05), VHD (p < 0.01), myocardiopathy (p < 0.05), HT (p < 0.001), left ventricular hypertrophy (p < 0.001), diabetes (p < 0.01) and alcohol consumption (p < 0.01) more frequently. In the multivariant analysis heart failure (odds ratio 2.1 [1.2-3.3]), the valvular heart disease (odds ratio 2.2 [1.4-3.5]), the coronary heart disease (odds ratio 1.8 [1.2-2.6]), the arterial hypertension (odds ratio 1.7 [1.2-2.3]), the left ventricular hypertrophy (odds ratio 2.6 [1.7-3.8]), the diabetes (odds ratio 1.9 [1.2-2.9]) and alcoholic habits (odds ratio 2 [1.3-3.9]) were independent risk factors for atrial fibrillation in our population. CONCLUSIONS: Atrial fibrillation in our study, is more frequent in patients with arterial hypertension, coronary heart disease or valvular heart disease. There are other risk factors such as arterial hypertension, diabetes and consumption of alcohol too, the modification of which could diminish the risk of the appearance of atrial fibrillation.

[Primary cardiac tumors: a review of 29 cases]. / Tumores cardíacos primários: revisión de 29 casos.

A series of 29 cardiac tumors were operated in Asturias Central Hospital between 1974 and 1994. There were 23 benign and 6 malignant tumors. Among the benign neoplasms, 22 were myxomas and 1 lipoma; there were 6 remalignant tumors, one pulmonary artery sarcoma, two rhabdomyosarcoma, one mesothelioma and two lymphomas. We review the clinical findings of these patients. Long-term results were excellent in patients with benign lesions, and only one recurrence was found. In patients with malignant tumors, surgical procedures were only palliative and aimed at prolonging life; hence, prognosis remained unchanged.

[Reversible dilated cardiomyopathy and hyperthyroidism]. / Miocardiopatía dilatada reversible e hipertiroidismo.

Thyrotoxicosis may precipitate atrial fibrillation, myocardial ischemia or heart failure if underlying heart disease is present. However, reversible dilated cardiomyopathy is rare. We report a case of a 51-year-old man with thyrotoxicosis and dilated cardiomyopathy that was reversed with antithyroid treatment.

[Restrictive cardiac involvement in a patient with dyserythropoietic anemia and secondary hemochromatosis]. / Afectación cardíaca restrictiva en una paciente con anemia diseritropoyética y hemocromatosis secundaria.

We report a case of a 63 year old woman diagnosed with dyserythropoietic anemia who was admitted to our hospital with congestive heart failure. Iron's metabolism disturbance, CT-Scan and magnetic resonance imaging allowed us to make the diagnosis of acquired hemochromatosis due to multiple transfusions. The echocardiographic study was compatible with a myocardial restrictive pattern caused by iron deposits.

[Left coronary artery with anomalous origin and course]. / Arteria coronaria izquierda con origen y trayecto anómalos.

We report a 45 year-old patient with angina and positive exercise test. In the coronary arteriography that left coronary artery rose from a vascular structure that connected the aorta to the middle of the left anterior descending coronary artery. In the right coronary artery there was a 90% stenosis. An ACTP was made in this stenosis. The patient displayed no symptoms eight months after the procedure. We have not found in the literature and anomaly of the left coronary artery similar to what was found in this patient.

[Ventricular tachycardia secondary to phenylpropanolamine poisoning: apropos a case]. / Taquicardia ventricular secundaria a intoxicación por fenilpropanolamina: a propósito de un caso.

We report a case of a 17-years-old patient with an accidental ingestion of high doses of phenylpropanolamine. Nine hours after the ingestion she presented ventricular bigeminy and an episode of non sustained ventricular tachycardia. No cardiovascular disease was demonstrated.

[A retroaortic anomalous left coronary artery]. / Coronaria izquierda anómala retroaórtica.

We report a 67-years-old patient with angina pectoris and positive treadmill test. In the coronary arteriography the left coronary artery arose from the right coronary sinus of Valsalva through an independent ostium and followed a retroaortic course. Coronary artery disease was no demonstrated, so we thought that the myocardial ischaemia shown in the treadmill test, was due to the anomalous origin of the left coronary artery. Surgical treatment was recommended.

Infective endocarditis of an interventricular patch caused by Acinetobacter haemolyticus.

A case of infective endocarditis caused by Acinetobacter haemolyticus affecting and interventricular patch is reported. The patient, a 21-year-old man with a Fallot's tetralogy who had undergone cardiovascular surgery several years before, received imipenem and gentamicin for 6 and 4 weeks respectively and showed a good response without needing surgical treatment. Endocarditis by Acinetobacter species is very unusual and, to our knowledge, this is the first reported case of infective endocarditis caused by A. haemolyticus. As the clinical characteristics and the response to antibiotics appear to be similar to those reported for infective endocarditis by Acinetobacter lwoffi, prosthetic infective endocarditis by A. haemolyticus is apparently not always an indication for surgical treatment.

[A suicide attempt with oral verapamil: a case report]. / Intento de autólisis con verapamilo oral: presentación de un caso.

We report a case of a 29-years-old patient who tried to commit suicide by taking a high dose of verapamil (22 pills containing 240 mg, each, equivalent to 5.28 g). Ten hours after the ingestion he presented a complete atrioventricular heart block which was resolved with medical treatment presenting a normal ECG 36 hours later. To our knowledge this is the only published case of intoxication caused by such a high dose of verapamil.

[Recurrent pericarditis with effusion caused by Q fever. Presentation of a case]. / Pericarditis recidivante con derrame por fiebre Q. Presentación de un caso.

We present a case report of recurrent pericarditis with pericardial effusion and high levels of Coxiella burnetti antibodies (phase II), excluding other possible etiologies. The rarity of this disorder is commented and the necessity of be considered this etiological possibility in a second time, particularly in patients who are susceptible to suffer Q-Fever disease.