[Quality control and improvement of the care provided to the patient with acute myocardial infarction. Implementation of a quality assurance program]. / Garantía y mejora de calidad de la atención al paciente con infarto agudo de miocardio. Implantación de un programa de calidad.

INTRODUCTION AND OBJECTIVES: Hospital care of patients with acute myocardial infarction involves a series of therapeutic measures and risk stratification which are a must since their efficacy has been clearly demonstrated. The aim of this study was to develop an internal program to guarantee and improve the quality of hospital care to acute myocardial infarction patients. METHODS: A medical audit was carried out for evaluation. Seven evaluation criteria considered as class I by the guidelines on the management of acute myocardial infarction patients were analyzed in the discharge report of 163 consecutive patients. Following analysis of the results corrective measures were implemented. In the second phase reevaluation of 40 patients was performed to determine the efficacy of the adopted measures. RESULTS: Following the first evaluation the use of AAS, IECAS and the beta-blockers was found to be correctly indicated in 95, 80 and 72% of the patients, respectively. A strategy of the adequate stratification of risk was carried out and ventricular function was evaluated in 93 and 96% of the cases. Correct hypolipemia treatment was indicated in 54% of the cases with an adequate diet being prescribed in 100%. Three months after the intervention, 40 new patients were evaluated with all the criteria analyzed being fulfilled in 100% of the cases. CONCLUSIONS: The use of evaluation techniques and improvement in the quality of health care provided to cases of acute myocardial infarction allows the determination of the care undertaken and its correction if necessary in order to follow the guidelines recommended for the care of these patients.

[Myocardiopathies (II). Genetic changes in the etiopathogenesis of hypertrophic myocardiopathy. The therapeutic prospects]. / Miocardiopatías (II). Alteraciones genéticas en la etiopatogenia de la miocardiopatía hipertrófica. Perspectivas terapéuticas.

The genetical characterization of any disease implies its immediate theoretic and practical reorganization since all the basic clinical aspects such as ethology, diagnosis, prognosis, prevention and finally treatment are affected. This can be the fact for hypertrophic myocardiopathy in the near future. Recently, mutations in some new genes causing this alteration, apart from those found in the beta-myosin heavy chain gene, have been identified. Hypertrophic cardiomyopathy could be classified etiopathogenetically as primary, if it is due to a genetic alteration in any of the components of the sarcomere, and secondary when the initial factor is external, although it will be eventually reflected in a malfunction of the sarcomere. Therefore hypertrophic cardiomyopathy could be defined as a myocardial disorder with and autosomic hereditary pattern which is characterized by a ventricular hypertrophy due to alterations in the cardiac sarcomere. Detected mutations so far, which have been admitted to be the primary alteration in this disease, are localized in the beta-myosin heavy chain gene (14q1), in the alpha-tropomyosin gene (15q2), in the cardiac troponin T gene (1q3), as well as in the chromosome 11 p13-q13 loci. Different authors have pointed out a possible epigenetic mechanism produced by endogenous or environmental secondary factors as responsible for hypertrophic myocardiopathy.(ABSTRACT TRUNCATED AT 250 WORDS)