[Tako-Tsubo syndrome in a patient with exacerbated bronchial asthma]. / Síndrome Tako-Tsubo en una paciente con exacerbación de asma bronquial.

Transient apical ballooning syndrome without coronary stenosis or Tako-Tsubo syndrome was described a few years ago in a Japanese population. Although new cases and series have been gradually defining its physiopathology, there is much doubt about its etiology. We describe the case of a 74-year-old Caucasian woman, with a background of hypertension, type 2 diabetes mellitus and hyperthyroidism with tracheal compression, intrinsic asthma and depression syndrome. She had an acute attack of bronchospasm and chest pain. The electrocardiogram on admission showed Q-waves and ST segment elevation in precordial leads and elevated serum cardiac markers. The coronariography found no evidence of significant lesions in the vascular tree. Ventriculography showed an apical ballooning that was also found in the echocardiography. The evolution of the clinical picture with disappearance of the symptoms and normalization of the electrocardiogram and echocardiogram lead to the diagnosis of Tako-Tsubo syndrome. We believe that this new clinical entity may have a catecholamine-mediated neurogenic mechanism as the etiopathogenic substrate and that our clinical case could support this hypothesis.

Síndrome Tako-Tsubo en una paciente con exacerbación de asma bronquial / Tako-Tsubo syndrome in a patient with exacerbated bronchial asthma

El síndrome de disquinesia apical transitoria sin lesiones coronarias o síndrome Tako-Tsubo se ha descrito hace unos años, pero persisten dudas sobre su etiología, aunque la presentación de nuevos casos y series lo ha ido definiendo poco a poco. Describimos el caso de una mujer de 74 años, con historial previo de hipertensión arterial, diabetes mellitus tipo 2, bocio hipertiroideo con compresión traqueal, asma intrínseco y síndrome depresivo, que presentó exacerbación de su asma, con dolor torácico. A su ingreso en el hospital el electrocardiograma mostraba ondas Q y elevación del segmento ST en derivaciones precordiales; asimismo se observó elevación de los marcadores enzimáticos cardíacos. La angiografía coronaria demostró la ausencia de anomalías, presentando una disquinesia apical, observada igualmente en el ecocardiograma. La evolución del cuadro clínico con desaparición de la sintomatología y normalización del electrocardiograma y ecocardiograma llevaron al diagnóstico de síndrome Tako-Tsubo. Creemos que esta nueva entidad clínica puede tener una base etiopatogénica neurogénica mediada por catecolaminas y el caso presentado apoya dicha tesis (AU)

Transient apical ballooning syndrome without coronary stenosis or Tako-Tsubo syndrome was described a few years ago in a Japanese population. Although new cases and series have been gradually defining its physiopathology, there is much doubt about its etiology. We describe the case of a 74-year-old Caucasian woman, with a background of hypertension, type 2 diabetes mellitus and hyperthyroidism with tracheal compression, intrinsic asthma and depression syndrome. She had an acute attack of bronchospasm and chest pain. The electrocardiogram on admission showed Q-waves and ST segment elevation in precordial leads and elevated serum cardiac markers. The coronariography found no evidence of significant lesions in the vascular tree. Ventriculography showed an apical ballooning that was also found in the echocardiography. The evolution of the clinical picture with disappearance of the symptoms and normalization of the electrocardiogram and echocardiogram lead to the diagnosis of Tako-Tsubo syndrome. We believe that this new clinical entity may have a catecholamine-mediated neurogenic mechanism as the etiopathogenic substrate and that our clinical case could support this hypothesis (AU)

Prevalencia de fibrilación auricular en mayores de 65 años de una zona de salud / Prevalence of auricular fibrillation in the over-65s of a health area

Objetivo. Conocer la prevalencia de fibrilación auricular en mayores de 65 años. Diseño. Estudio descriptivo, transversal, mediante la realización de entrevista personal y electrocardiograma. Emplazamiento. Zona de salud La Solana. Talavera de la Reina (Toledo). Participantes. Toda la población con edad igual o superior a 65 años (1.206 sujetos). Mediciones principales. Realización de entrevista estructurada, estudio de la historia clínica del paciente, toma de presión arterial y realización de electrocardiograma con medición estandarizada. Resultados. Prevalencia de fibrilación auricular del 5,6 por ciento. Distribución por sexo: 4,5 por ciento en varones y 6,4 por ciento en mujeres (p = 0,060; OR ajustada: 1,5). Prevalencia de fibrilación auricular por grupos de edad: 3,9 por ciento de 65 a 74 años; 7,8 por ciento de 75 a 84 años, y 18,2 por ciento en mayores de 85 años (p = 0,0001; OR ajustada: 2,14). Conclusiones. Alta prevalencia de fibrilación auricular en mayores de 65 años con respecto a población general. La prevalencia aumenta con la edad. El sexo no presenta significación estadística en el grupo de con edades comprendidas entre 65 y 74 años, y sí para aquellos pacientes mayores de 85 años, donde la prevalencia es mayor para el sexo femenino (AU)

[Prevalence of auricular fibrillation in people over 65 years of age in a health area]. / Prevalencia de fibrilación auricular en mayores de 65 años de una zona de salud.

AIMS: To find the prevalence of auricular fibrillation in over-65s. DESIGN: Descriptive cross-sectional study through face-to-face interview and electrocardiogram. SETTING: La Solana Health District, Talavera de la Reina (Toledo). PARTICIPANTS: The entire population aged 65 or over (1206 people). Main measurements. Structured interview, study of patients clinical history, taking of blood pressure, and electrocardiogram with standardised measurement. RESULTS: 5.6% prevalence of auricular fibrillation. Distribution according to gender: 4.5% in men and 6.4% in women (p = 0.060; adjusted OR, 1.5). Prevalence of auricular fibrillation by age groups: from 65 to 74, 3.9%; from 75 to 84, 7.8%; over 85, 18.2% (p = 0.0001; adjusted OR, 2.14). CONCLUSIONS: There is greater prevalence of auricular fibrillation in the over 65s than in the general population. Prevalence increases with age. Gender has no statistical significance in the 65 to 74 age group, though it has in the over-85 group, in whom auricular fibrillation is more prevalent in women.

Aneurisma de arteria coronaria e infarto agudo de miocardio secundario a traumatismo torácico / Coronary artery aneurysm and acute myocardial infarction after chest trauma

El aneurisma coronario secundario a traumatismo torácico no penetrante es extremadamente raro. Describimos el caso de un varón de 29 años que sufrió un infarto agudo de miocardio (IAM) traumático asintomático tras accidente de tráfico. El electrocardiograma (ECG) mostró un IAM antero-lateral transmural y la coronariografía demostró la existencia de un aneurisma sacular postraumático de la arteria coronaria descendente anterior. En los pacientes con traumatismo torácico y cambios ECG y enzimáticos sugestivos de IAM puede estar indicado realizar una angiografía coronaria para descartar un aneurisma coronario. (AU)

[The quality of the discharge reports from the internal medicine services of Castilla-La Mancha (a structural evaluation)]. / Calidad de los informes de alta de los Servicios de Medicina Interna de Castilla-La Mancha (valoración de la estructura).

UNLABELLED: The discharge report is one of the final outputs of the health care activity. We have tried to analyze several aspects related to its quality. For this purpose, we conducted a cross-sectional study analyzing 800 reports of patients admitted in the services of Internal Medicine at 6 hospitals of Castilla-La Mancha during the year 1991. We must stress the absence of discharge reports for death patients and the failure to record drug allergies (69.9%), medical history (10.4%) and time of evolution of the disease (16.9%), as well as treatment in 17 reports out of 781 and follow-up review after discharge in 12.8%. CONCLUSIONS: Discharge reports have a low scientific content and the production of this type of records is not a routine practice in the case of death patients.

[Quality of discharge reports prepared by the services of internal medicine in Castilla-La Mancha (assessment of clinical data)]. / Calidad de los informes de alta de Castilla-La Mancha en los servicios de medicina interna (valoración de la información clínica).

We analyzed several aspects of the quality (at the level of clinical data) of discharge reports prepared by the Services of Internal Medicine in the hospitals of Castilla-La Mancha, taking into account that these are the end written products of the health care activity. We analyzed 800 reports and we found terms such as "probably, not discarded" in the clinical judgment in 150 reports out of 794 and abbreviations in 370 out of 792. 10.8% of the reports written at discharge (86 out of 794) were waiting for the results, reflecting thus severe shortcomings in the clinical data of these reports, that must be corrected in our area.

[Cardiovascular risk factors in a natural population. Study of Talavera de la Reina. Evaluation of smoking]. / Análisis de factores de riesgo cardiovascular en una población natural. Estudio de Talavera de la Reina. Evaluación del tabaquismo.

The Study of Talavera de la Reina analyzes the presence of several cardiovascular risk factors (CVRF) in this city, by means of a cross-sectional study of the population within 1989 and 1990. In this paper, the results on tobacco consumption, as well as the correlation between tobacco consumption and several anthropometric and biochemical parameters, some of which are independent CVRF theirselves, are presented. Seven hundred and two people were evaluated, 332 men and 370 women, with ages between 20 and 79 years, and were randomized according to the current population census. We have carried out a survey to assess smoking habits; physical examination to measure weight and height, systolic and diastolic arterial pressure, blood analysis including total cholesterol, C-HDL, triglycerides and glucose. C-LDL was obtained using the Friedewald-Fredickson formula. Smoking habits among the younger female population is almost equal to male population. Compared by age groups and similar sex, no significant differences were observed related to anthropometric and biochemical parameters between smokers and non-smokers. The lipidic profile of non-smokers against moderate/heavy smokers (smoking 10 or more gr/day) was compared. The presence of an atherogenic profile in 30 to 39-year-old men and in 40 to 49-year-old women was verified, as well as the lower C-HDL levels among younger smokers of both sexes. This provides tobacco with an added value, as it increases the impact of other CVRF in key ages for the pathogenicity of arteriosclerosis.

[Myocardial infarct in diabetes mellitus patients. A long-term follow-up]. / Infarto de miocardio en pacientes con diabetes mellitus. Seguimiento a largo plazo.

The acute phase and long-term evolution of 249 patients diagnosed as having acute myocardial infarction and admitted to our hospital during the period 1981 to 1983, were studied. They were classified in 2 groups: A (non-diabetic patients) and B (diabetic patients). Several variables were analysed in order to determine the differences between both groups. The most accentuated being: diabetic patients, female sex, old age, blood hypertension history, cardiac failure, re-extended infarction. The inter-hospital mortality was higher in group B, mainly as a result of cardiogenic shock and left cardiac failure. An out-patients follow-up of acute phase survivors was carried out, between 1 to 96 months, with mean follow-up of 46.7 month in group A and 38.4 in group B, at 8 years the actuarial rate being 77.3% and 55.9% respectively. We conclude that diabetic patients with myocardial infarction register a higher long- and short-time mortality.

Atrioventricular nodal dysfunction in patients with atrial septal defect. Abnormalities of conduction and reciprocal rhythms.

Electrophysiologic studies were performed in 17 unselected patients (mean age, 20 years) with atrial septal defect (ASD) of the ostium secundum type. In nine (52.9 percent) signs were found of atrioventricular (A-V) nodal dysfunction, in seven (41.1 percent) prolonged A-H interval, and in three (17.6 percent) prolonged effective refractory period of A-V node and in five (29.4 percent) A-V nodal tachycardia and reentry. Three of the four cases showed anterograde conduction (Ae-H interval) faster than retrograde conduction (H-A3 interval) during the tachycardia. In one patient with reentry a similar phenomenon was observed. In the remaining patient the conduction time was reversed (Ae-H longer than H-Ae). In two patients infrahisian and intrahisian block (first and second degree) with persistence of the tachycardia was observed. Patent or latent abnormalities in A-V node function are a frequent finding in patients with ASD. In the sinus node, any kind of significant abnormality can be found.