Arrhythmias induced by dextrose-insulin challenge test in nondiagnostic Brugada ECG patterns.

INTRODUCTION: Dynamic ECG changes in Brugada syndrome (BrS) are influenced by several factors, may not be apparent, and can be unmasked by a drug test. METHODS AND RESULTS: Four of six patients with nondiagnostic Brugada ECG index patterns underwent a dextrose-insulin challenge test that resulted in J-ST segment elevation and triggered arrhythmias. CONCLUSION: Insulin action may be due in part to an outward shift in the K+ current at the end of action potential phase 1 and the dispersion of repolarization, leading to local re-entry with arrhythmogenicity. This effect is likely a phenomenon-specific to BrS.

[Recurrent aneurysm of sinus of Valsalva, the world's first case report]. / Aneurisma del seno de Valsalva recidivante, reporte del primer caso mundial.

An aneurysm of the sinus of Valsalva is a rare cardiac anomaly (0.09% of cases in autopsy studies) . This article describes the case of a male patient, 58 years old with a history of smoking and surgery for the correction of sinus of Valsalva aneurysm 31 years before, with no record of approach or type of surgery. His condition began five months before his admission with atypical chest pain. Echocardiographic diagnosis of severe aortic regurgitation, finding recurrent aneurysm of sinus of Valsalva. Surgery was performed with primary closure of the defect and aortic valve replacement with mechanical prosthesis, issuing a favorable postoperative. We present a case of which there are no reports in the current literature.

Un aneurisma del seno de Valsalva es una anomalía cardiaca muy poco frecuente (0.09 % de casos en series de autopsia).1 Se presenta el caso de un paciente del sexo masculino, de 58 años con antecedente de tabaquismo, cirugía de corrección de aneurisma del seno de Valsalva hace 31 años, no hay registro de abordaje, ni del tipo de cirugía practicada. Su padecimiento se inició cinco meses previos a su ingreso con dolor torácico atípico. Diagnóstico por ecocardiograma de insuficiencia aórtica severa, hallazgo de aneurisma del seno de Valsalva recidivante. Se realizó cirugía con cierre primario del defecto y reemplazo valvular aórtico con prótesis mecánica, cursando con postoperatorio favorable. En este artículo presentamos un caso del cual no hay reportes en la literatura actual.

Manejo actual de la hipertensión arterial con olmesartán: Primera experiencia clínica en pacientes mexicanos / Current management of arterial hypertension with olmesartan: Clinical experience in Mexican patients

Se realizó un estudio multicéntrico, observacional, abierto no controlado para evaluar la eficacia de olmesartán en dosis de 20 y 40 mg administrados una vez al día en pacientes mexicanos con hipertensión arterial sistémica. Participaron 39 cardiólogos de 22 ciudades de la República Mexicana y se incluyeron a 350 pacientes (57% mujeres y 43% hombres), con edad promedio de 59.25 ± 13.53 años, rango de 24 a 92 años. Los valores promedio de la presión arterial sistólica en la visita inicial y final fueron de 152.8 ± 16.3 mmHg y 125.8 ± 10.9 mmHg y de la presión arterial diastólica fue 89.7 ± 11.3 mmHg y 77.0 ± 7.8 mmHg respectivamente. De acuerdo con la prueba t de Student, la disminución resultó estadísticamente significativa (p < 0.01). Para obtener estos resultados se administraron dosis de 20 mg en 36% de los pacientes y 40 mg en 64%. Se observó respuesta de eficacia global al tratamiento en 88% de los pacientes tratados. Se tomó como respuesta adecuada al tratamiento, presiones menores a 140/90 mmHg o reducción mayor a 10% de las cifras de tensión arterial, en relación con los valores basales al término de doce semanas de tratamiento. Se presentaron eventos adversos no significativos con tasa menor a 4.2% de los pacientes, la mayoría considerados como eventos adversos ya conocidos del medicamento. Podemos concluir que el uso de olmesartán probó ser un antihipertensivo eficaz y seguro en el tratamiento de la hipertensión arterial sistémica en pacientes mexicanos.

A multicentre, observational, open-label, non-controlled trial was performed to evaluate the efficacy of Olmesartan at doses of 20 and 40 mg administered once daily in Mexican patients with arterial hypertension. Thirty nine cardiologists from 22 cities of the Mexican Republic participated, 350 patients were included (57% women and 43% men), with mean age of 59.25 ± 13.53 years within a range of 24 to 92 years. The mean values of systolic blood pressure at the initial and final visit were 152.8 ± 16.3 mmHg and 125.8 ± 10.9 mmHg, and those for diastolic blood pressure were 89.7 ± 11.3 mmHg and 77.0 ± 7.8 mmHg, respectively. According to t Student's test, the reduction was statistically significant (p < 0.01). To achieve these results, doses of 20 mg were administered to 36% of patients and 40 mg to 64%. An efficacy response to treatment was observed in 88% of the patients treated. Blood pressures lower than 140/90 mmHg or a reduction greater than 10% of the blood pressure figures relative to baseline values at the end of twelve weeks of treatment were considered an adequate response to treatment. Non-significant adverse events occurred at a rate lower than 4.2% of patients. Most were considered as known adverse events of the drug. We can conclude that the use of Olmesartan, proved to be an effective and safe antihypertensive drug in the treatment of systemic arterial hypertension in Mexican patients.