[Practice guidelines of the Spanish Society of Cardiology on endocarditis]. / Guías de práctica clínica de la Sociedad Española de Cardiología en endocarditis.

Infectious endocarditis is a disease which mainly involves the cardiac valves. It has a bad prognosis and is caused by a great variety of microorganisms. Prophylaxis is important although the effectiveness and the best way to achieve it remain unclear. Recommendations are herein presented. The diagnosis is based on clinical, bacteriological, and echocardiographic findings mainly based on Duke's criteria. Transthoracic and transesophageal echography are not only of diagnostic value but are also a tool to determine the therapy to follow. Antibiotic therapy should be selected according to the organisms isolated and their in vitro susceptibility. Guidelines for empirical antibiotic therapy in cases of negative cultures are also included. Lastly, indications and time for surgery are discussed.

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure.

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years. Socioeconomic, demographic, electrocardiographic, echocardiographic, spirometric, and chest radiograph data were obtained at the initial examination. In a random sample of half the patients, ergometric, echocardiographic, and Holter records were obtained at entry and at 3 and 18 months. Patients were followed up for > or = 3 years. The end points were mortality, hospitalization for cardiac events, deterioration in quality of life, worsening of functional class, and need for digoxin or captopril in the captopril and digoxin groups, respectively. The trial had to be terminated prematurely owing to the difficulty in finding candidates free of angiotensin-converting enzyme (ACE)-inhibitor treatment. Baseline patient characteristics were similar in both groups. From the clinical point of view, only the 48-month mortality was relevantly lower (20.9 vs. 31.9%, respectively) among patients treated with captopril than that in those receiving digoxin (log rank test, p = 0.07). No statistically or clinically relevant differences were found in other end points or adverse effects. The results suggest but do not confirm the hypothesis that captopril treatment in mild to moderate heart failure might provide better long-term survival than digoxin.

[Primary pulmonary hypertension. Clinico-pathologic analysis]. / Hipertensión pulmonar primaria. Análisis clínico-patológico.

We present a case of primary pulmonary hypertension, confirmed by open lung biopsy. The interest of the case resides in the microscopic study of the specimen, and the patient's prognosis is discussed. The physiopathology of the disease is reviewed and the palliative therapeutic measures that can be adopted.

[Mitral valve aneurysm. Its diagnosis by transesophageal echocardiography]. / Aneurisma de la válvula mitral. Diagnóstico por ecocardiografía transesofágica.

Aneurysm of the mitral valve is a rare complication of infectious endocarditis. We report a 65-years-old woman with left heart failure and mitral regurgitation secondary to a mitral valve aneurysm. The diagnosis was made by transesophageal echocardiography.

[Coronary angioplasty: experience at the University Hospital of Madrid]. / Angioplastia coronaria: experiencia en el Hospital Universitario de Madrid.

The results of 963 consecutive coronary angioplasties, with 1.135 lesions attempted in 816 patients, were prospectively analyzed. Initial angiographic success (residual stenosis less than 50%) was achieved in 1.017 lesions (89.6%), and final success was obtained in 838/963 procedures (87%). Major complications included: emergency surgery in 4 cases (0.4%), acute myocardial infarction in 28 (2.9%), and death during hospitalization in nine (0.9%). Surgical stand-by was required only for cases with vital risk should the attempted vessel occlude. This criteria was present in 230 (23.8%) angioplasties. Coronary angioplasty was performed during the diagnostic procedure in 300 (31.1%) case, with final success in 264 (88%) of them. A exercise test was achieved before the procedure in 419 (50%) successful angioplasties and in 246 (58.7%) of them it was abnormal because of angina (with or without ST depression). After procedure, exercise could be performed in 780 cases (93%), and the result remained unchanged in only 44 (5.6%) (p less than 0.01). At discharge 780 (93%) patients with final success considered themselves clinically improved. In our experience, coronary angioplasty is a good myocardial revascularization technique, with high success, low rate of major complications, and that provides a good clinical outcome. Surgical stand-by may be unnecessary in prost of angioplasty procedures if patients selection is carefully done, also, this approach makes it possible to perform angioplasty at time of diagnostic catheterization.

Cardiac rate and hyperkinetic rhythm disorders in healthy elderly subjects: evaluation by ambulatory electrocardiographic monitoring.

We performed 24-hour ambulatory electrocardiographic (Holter) examinations in 50 retired hospital workers (30 men, 20 women), aged 58-85 years (mean age +/- SD: 65.9 +/- 4.6 years), with a normal clinical history, physical examination and baseline ECG. There was a significant difference between daytime and nocturnal mean heart rates (79.2 +/- 8.4 vs. 65.3 +/- 7.8 beats per minute), and between maximal (122.4 +/- 15.6 vs. 99.9 +/- 13.7) and minimal (57.9 +/- 10.8 vs. 51.3 +/- 8.0) diurnal and nocturnal heart rates. 92% of the subjects were shown to have supraventricular extrasystoles (SVE) in the 24 h recording, with 16% having more than 100 SVE/h. 68% had ventricular extrasystoles (VE), but only 6% had more than 100 VE/h. SVE were mainly diurnal, and VE were equally distributed between day and night. No other rhythm disturbances were found in this group of healthy elderly individuals.