Vasoespasmo tras quimioterapia con 5-fluorouracilo / Coronary vasospasm after 5-fluorouracil chemotherapy

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[Clinical practice guidelines of the Spanish Society of Cardiology on unstable angina/infarction without ST elevation]. / Guías de práctica clínica de la Sociedad Española de Cardiología en la angina inestable/infarto sin elevación ST.

This paper up-dates the Clinical Guidelines for Unstable Angina/Non Q wave Myocardial Infarction of the Spanish Society of Cardiology. Due to the increased efficacy of adequate management in the early phases, it has been considered necessary to include recommendations for the pre Hospital and Emergency department phase. Prehospital management. Patients with thoracic pain compatible with myocardial ischemia should be transferred to Hospital as quickly as possible and an ECG tracing performed. Initial management includes rest, sublingual nitroglycerin and aspirin. In the Emergency department. Immediate clinical attention and accessibility to a defibrillator should be available. If ECG tracing discloses ST elevation reperfusion strategy is to be implemented immediately. If no ST elevation is present, the probability of myocardial ischemia and risk factor evaluation is essential for adequate management. A simplified risk stratification classification is presented, that also determines the most adequate site for admission: Coronary Care Unit if high risk factors are present, Cardiology ward for the intermediate risk patient and ambulatory treatment if low risk. Management in Coronary Care Unit. Includes routine ECG monitoring and analgesia. Antithrombotic and anti ischemic treatment include new indication for GP IIb-IIIa and Low molecular weight heparins. Coronary arteriography and revascularisation are recommended, if refractory or recurrent angina, left ventricles dysfunction or other complications are present. Management in the ward is based on adequate chronic medical treatment, risk stratification, and secondary prevention strategy. Coronary arteriography before discharge must be considered in the light of the result of non-invasive tests.

[The surgical treatment of sustained ventricular tachycardias. The short- and midterm results in the era of the implantable defibrillator and the heart transplant]. / Tratamiento quirúrgico de las taquicardias ventriculares sostenidas. Resultados a corto y medio plazo en la "era" del desfibrilador implantable y del transplante cardíaco.

BACKGROUND: The surgical treatment of refractory ventricular tachycardia has been shown to be effective. Its use has been limited by a high perioperative mortality. OBJECTIVE: To study the extent to which the introduction of new therapeutic options, i.e. the implantable defibrillator and cardiac transplantation, improves patient selection and results of direct antiarrhythmic surgery. PATIENTS AND METHODS: We analyzed 24 consecutive patients operated upon for ventricular tachycardia (study population). At the same time, 42 patients were treated with implantable defibrillator and 11 patients, with symptomatic ventricular arrhythmias, underwent cardiac transplantation (reference population). RESULTS: The clinical characteristics of the study population (age, functional class, ejection fraction) were significantly different from those of both reference groups. Nine patients (38%) were operated upon because of electrical instability and/or contraindication for other therapeutic options despite of having criteria of high surgical risk. There was one perioperative death (4.2%) and no other early arrhythmic recurrences. Persistence of inducibility occurred in 5 cases (22%). During follow up (35 +/- 22 months) there was a single arrhythmic recurrence. Three patients died of nonarrhythmic causes. Presently, 16 patients are in I or II NYHA functional class. CONCLUSIONS: 1) Direct surgery remains as a useful tool in the treatment of ventricular tachycardia; 2) clinical differences among groups caused by the individual selection of the three therapeutic options preclude comparison of their results, and 3) the introduction of other therapeutic approaches, although resulting in only partial improvement of patient selection, leads to acceptable short and mid-term results of direct antiarrhythmic surgery.