[Intramyocardial dissecting haematoma: an unusual form of cardiac rupture]. / Hematoma disecante intramiocárdico: una forma poco frecuente de rotura cardíaca.

The intramyocardial dissecting haematoma is an unusual rupture of the left ventricular wall, complicating acute myocardial infarction. The mechanism is an hemorrhagic dissection among the spiral myocardial fibres creating a neocavitation limited by the myocardium. It appears in 9% of left ventricular wall ruptures, complicating acute myocardial infarction. Diagnosis is often difficult and in most of the cases it is post-mortem. We present the case report of a 69 year old patient who suffered a posterolateral acute myocardial infarction treated with primary PTCA/Stent plus AAS, clopidogrel, unfractioned heparin bolus and GP IIb- IIIa inhibitors. In the following few hours he suffered this unusual form of cardiac rupture that took him into cardiogenic shock and finally led to his death. The pathophysiology, diagnosis and management of this lethal complication of acute myocardial infarction (90% mortality in the medically treated group) which is only effectively treated by surgery are also reviewed.

[Sudden death in a normal heart. Idiopathic ventricular fibrillation. Review of the literature concerning one case]. / Muerte súbita en un corazón normal. Fibrilación ventricular idiopática. Revisión de la literatura a propósito de un caso.

Idiopathic ventricular fibrillation is that which is produced in the absence of structural cardiac disease and of other identifiable causes of ventricular fibrillation such as cardiotoxicity, electrolytical alterations or hereditary predisposition. The case of a healthy male, aged 37, who was asymptomatic until the day he was admitted to hospital where he showed numerous episodes of ventricular fibrillation without any previous triggering, is discussed. In the examination no cause was found to explain this, and an automatic defibrillator was implanted. The requirements for its diagnosis, risk stratification and the usefulness of the tests employed, as well as the treatments proposed are discussed.

[Myocardial Infarction in the population aged 25-74 in Navarra. Incidence, lethality and treatment in the period 1997-98. IBERICA study]. / El infarto de miocardio en la población de 25-74 años de Navarra. Incidencia, letalidad y tratamiento en el periodo 1997-98. Estudio IBERICA.

The principal aim of this study was to determine the incidence of Myocardial Infarction in the population aged 25-74 in Navarra, lethality after 28 days, and the characteristics of the treatment applied in the hospitals during the years 1997-1998. A search was conducted for possible cases of heart attack in the hospital services responsible for attending to them, by means of a review of clinical histories. The lethal cases that did not reach the hospitals were researched through the statistical bulletins of deaths, with the information on these deaths completed through the family doctors. 1,059 coronary events were registered, which corresponded to a crude rate of attack of 238 cases per 100,000 amongst men and 59 cases per 100,000 amongst women. Amongst the male patients who reached hospital alive, 50% were smokers, 41% showed hypercholesterolaemia, 35.9% were hypertense and 16% were diabetic. Amongst the women, who showed a higher average age, arterial hypertension was the most frequent risk factor, with 66%. During hospitalisation thrombolysis was carried out on 39.2% of the patients, primary or rescue angioplasty on 4.6%; aspirin or other anticoagulants were administered to 94.2%, beta-blockers to 60.6% and IECA to 37.4%. This study has shown that the frequency of Myocardial Infarction in Navarra is lower than that registered in many European and North American countries, and is concordant with the low rates of mortality due to this cause. Global analysis of the data shows that a high implementation of the care guidelines for this disease with respect to the use of efficient therapies could be observed in the years 1997 and 1998. Nonetheless, with the exception of the use of anticoagulants, hospital variability has been observed in the use of thrombolytic therapy and adjuvant therapies such as the beta-blockers or ACE Inhibitor, and in the use of diagnostic techniques such as arteriography.

[Risk factor prevalence and drug treatment in coronary patients at hospital discharge. Results of a national multicenter registry (3C Program)]. / Prevalencia de los factores de riesgo y tratamiento farmacológico al alta hospitalaria en el paciente coronario. Resultados de un registro multicéntrico nacional (Programa 3C).

INTRODUCTION AND OBJECTIVES: Based on the results of clinical trials the guidelines of international societies recommend secondary prevention in patients. Several surveys have shown that the application of these guidelines in clinical practice is not adequate. The aim of this study was to determine the practical application of the recommendations of these guidelines and drug prescription in patients with coronary heart disease on hospital discharge. METHODS: We included 3,215 coronary patients (myocardial infarction, angina and post-revascularization) discharged from 25 Spanish hospitals. We studied the prevalence of risk factors and the medical treatment on discharge in relation to gender, age, and clinical diagnosis. RESULTS: We found a significantly higher prevalence of risk factors, except for smoking, in women. With regards to age and diagnosis neither was, the prevalence uniform, with an increase in hypertension and diabetes being predominantly seen in the elderly as well as angina patients. Fifty-six point three percent of the patients showed a total cholesterol greater than 200 mg/dl and 88% demonstrated a LDL-cholesterol greater than 100 mg/dl. The prevalence of hypercholesterolemia and low HDL was higher among women. The prescription of betablockers and lipid-lowering drugs is low, especially in women and in patients over the age of 64 years. CONCLUSIONS: The registry of data concerning some risk factors in patient clinical files is poor. The prevalence of risk factors is higher in women. The prescription of betablockers and lipid-lowering drugs was lower than recommended, mainly among women and patients older than 64 years. There is a need for improvement in secondary prevention in coronary patients on hospital discharge.

[Retrospective analysis of a large number of patients over 70 years old, subject to percutaneous coronary angioplasty or to surgery]. / Análisis retrospectivo de una cohorte de pacientes mayores de 70 años sometidos a angioplastia coronaria percutánea o a cirugía.

INTRODUCTION: The number of patients of advanced age with symptomatic coronary illness that need surgical or percutaneous revascularisation is increasing. The aim of the present paper is to gain knowledge of the evolution of patients over 70 years of age subjected to myocardial revascularisation. MATERIAL AND METHODS: We compare two groups of patients, in a non-aleatory manner, subjected to angioplasty (N=65) and to surgery (N=75). The average age was 74.12 +/- 3.5 (70-85) and 71.97 +/- 1.9 (70-79) years respectively. The number of unhealthy vessels was greater in the surgical group (1.84 +/- 0.8 vs 2.65 +/- 0.8). RESULTS: The number revascularised vessels is greater and revascularisation more complete in the surgical group (1.14 +/- 0.4 vs 2.59 +/- 0.9) and (76% vs 49%). There is no difference in mortality in both groups. The functional degree during the evolution is worse for the angioplasty group and besides more antianginous medicines are used in treatment (1.92 +/- 1.2 vs 1.26 +/- 0.8) and they are subjected more frequently to a new revascularisation. CONCLUSIONS: Both the sick rate and the mortality of the procedure was similar in both groups. Both procedures are valid therapeutic alternatives and are acceptably safe with these patients. Surgery is more complete and is carried out on a group of patients with greater coronary distress. There are no differences in life expectancy amongst the patients treated with either of the techniques. During the follow-up period the functional degree of the surgical group is better and there are more patients treated with monotherapy.

Supraventricular arrhythmia as the cause of sudden death in hypertrophic cardiomyopathy.

Electrophysiological studies with simultaneous echocardiographic control and invasive measurement of intravascular pressures were carried out in a 13-year-old boy with hypertrophic cardiomyopathy who was hospitalized after an episode of aborted sudden death. Ventricular stimulation did not induce ventricular tachycardia, but atrial stimulation induced atrial fibrillation, atrial flutter and non-sustained ventricular tachycardia. Atrial stimulation (S1) at 200 beats.min-1 (10-15 s) also induced significant repolarization abnormalities in the 5-10 post-stimulation beats. Akinesia of the ventricular septum and posterior wall without opening of the mitral valve was documented by echocardiography. A complete anterior systolic motion, not observed under basal conditions, was detected in the first post-stimulation beat. Atrial stimulation at rates over 120 beats.min-1 caused a drop in systolic blood pressure, a rise in pulmonary artery pressure, and a decrease in cardiac output. Despite therapy with propranolol and amiodarone, the patient died suddenly.

Cardiac echinococcosis and systemic embolism. Report of a case.

We report the case of a 13-year-old boy who, previously in a healthy condition, was admitted to hospital with an acute ischemia of the lower half of the trunk following a slight traumatism. During the surgical operation it was noticed that the embolized material corresponded to hydatid vesicles. The patient died as a result of irreversible anaphylactic shock after the operation. The autopsy revealed the presence of a hydatid cyst in the posterior wall of the left atrium which had ruptured into the atrial cavity. The immediate exeresis of the cardiac cyst is suggested, when it is noticed that the embolized material is made up of hydatid vesicles located in the left cavities of the heart.