Diagnosticar un síndrome de Brugada: el papel de la atención primaria / Diagnosing a Brugada syndrome: the role of primary care

Presentamos el caso de un varón de 36 años sin antecedentes de interés, que tras una micción sufre una pérdida de conciencia y es diagnosticado de síndrome de Brugada tipo I. El síndrome de Brugada es una entidad clínica asociada a síncopes recurrentes que predomina en varones sin cardiopatía estructural. Se trata de una cardiopatía eléctrica que predispone a presentar arritmias ventriculares y muerte súbita. El 70% son esporádicos y el 30% presentan mutaciones en el gen de la subunidad alfa del canal del sodio cardiaco (herencia autosómica dominante). Electrocardiográficamente presenta una elevación del segmento ST en precordiales V1-V3 con punto J elevado que estimula una R’ dando la apariencia de BRD. Se han descrito 3 patrones distintos, demostrándose que el tipo 1 (como el caso que nos ocupa) se asocia con muerte súbita en el seguimiento, por lo que no son necesarios otros estudios complementarios para realizar el diagnóstico(AU)

We present the case of a 36 year-old man with no previous medical history of interest. This man suffered a loss of consciousness before urination and was diagnosed with Brugada Syndrome I. Brugada Syndrome is a clinical diagnosis associated with recurrent syncope. It is predominant in men without structural heart disease. It is a heart disease with risks of electric ventricular arrhythmias and sudden death. The syndrome is sporadic in 70% of patients and a 30% have mutations in the alpha subunit of the sodium channel gene (autosomal dominant inheritance). Electrocardiograms show an elevation in the ST segment from v1 to v3 and in the J-point that stimulates R’, giving the appearance of a right bundle branch block. Three different patterns have been described. Type I (as in this case) is associated with sudden death so no further studies are needed to make the diagnosis(AU)

[Descriptive study of patient compliance in pharmacologic antihypertensive treatment and validation of the Morisky and Green test]. / Estudio descriptivo del cumplimiento del tratamiento farmacológico antihipertensivo y validación del test de Morisky y Green.

OBJECTIVE: To ascertain the degree of correct use of a course of medication in a sample of patients with high blood pressure attending Primary Attention consultation, and to validate the Morisk and Green completion test. DESIGN: This is a transversal observational study carried out in two stages, which aims to analyse the variable rate of correct following of instructions. The sample was selected at random. SITE. The study was carried out within the framework of Primary Care. PATIENTS: The sample was drawn from patients with high blood pressure under treatment by medication, including 96 patients of whom only 86 completed the study. MAIN MEASUREMENTS AND RESULTS: Measurement of the actual incidence of correct use was carried out by means of counting the pills in the patients' homes, and the theoretical incidence of correct use by means of the Morisky and Green Test. We class those who take between 80-110% of the prescribed pills as completing the course correctly. We found: 18.6% took less medication (Margin of reliability (MR) 95%: 10, 3-26.8%), 23% took more than they should (MR 95%: 14.4-32, 2%) and 58.1% took medication as instructed (MR 95%: 48-68%, without significant differences either by sex or age. The test's sensitivity in detecting those who complied with instructions was 52%, and specificity was 44.4%. CONCLUSIONS: 1. The number of over-consumers is particularly notable. 2. Responses to the test do not show any relationship with correct use of medication in this study. 3. In our view the test could only be used in a hypothetical population where there were no over-consumers.