RESUMEN
Introducción: La opinión de expertos (de distintas especialidades) sobre la triple terapia antihipertensiva a dosis fijas en la práctica clínica puede variar. Material y métodos: Encuesta online con aspectos controvertidos del tratamiento triple realizada por un panel de expertos en hipertensión arterial (HTA) empleando un método Delphi modificado en 2 rondas. Resultados: Participaron 158 expertos: Medicina Interna (49) Nefrología (26) y Cardiología (83). Se consensuaron (acuerdo) 27/45 ítems (60%); 7 ítems presentaron diferencias estadísticamente significativas. Se consensuó: los factores predictivos de la necesidad de tratamiento combinado y su eficacia frente al aumento de dosis de un tratamiento previo, y las ventajas de la triple terapia (prescripción/adherencia/costes/control) frente a la combinación libre. Conclusiones: El presente consenso ofrece una visión amplia del uso clínico de la triple terapia en HTA moderada-severa y resistente/de difícil control
Introduction: The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. Materials and methods: Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. Results: The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. Conclusions: This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT
Asunto(s)
Humanos , Hipertensión/tratamiento farmacológico , Antihipertensivos/uso terapéutico , Quimioterapia Combinada/métodos , Pautas de la Práctica en Medicina , Enfermedades Cardiovasculares/prevención & control , Resultado del TratamientoRESUMEN
INTRODUCTION: The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. MATERIALS AND METHODS: Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. RESULTS: The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. CONCLUSIONS: This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT.
Asunto(s)
Antihipertensivos/uso terapéutico , Consenso , Hipertensión/tratamiento farmacológico , Comités Consultivos/organización & administración , Técnica Delphi , Quimioterapia Combinada , Encuestas de Atención de la Salud , Humanos , EspañaRESUMEN
La obesidad y el sobrepeso constituyen la principal causa modificable de diabetes tipo 2 (DM2). En el momento del diagnóstico de la diabetes tipo 2 se debe establecer el grado de obesidad según el índice de masa corporal y, en los pacientes con sobrepeso, determinar el perímetro de la cintura. El adecuado tratamiento de la DM2 requiere un abordaje simultáneo del sobrepeso/obesidad y el resto de factores de riesgo cardiovascular, como la hipertensión, la dislipemia o el tabaquismo. Las intervenciones no farmacológicas (dieta, ejercicio) con beneficio demostrado en la prevención y tratamiento del paciente con DM2 y sobrepeso/obesidad deben seguir un enfoque individualizado y multidisciplinario, con programas estructurados dotados de recursos específicos. La ganancia de peso asociada al tratamiento antidiabético puede dificultar el control glucémico, comprometer la adherencia al tratamiento, empeorar el perfil de riesgo vascular de los pacientes y limitar los beneficios cardiovasculares del tratamiento. Por ello, es importante evitarla; una medida que resulta coste-efectiva. Los fármacos antidiabéticos con beneficios sobre el peso corporal también han demostrado su beneficio en pacientes con un índice de masa corporal<30kg/m2. Globalmente, el tratamiento del paciente con DM2 y obesidad dependerá tanto del grado de obesidad como de la comorbilidad asociada. Los ensayos clínicos de intervención en DM2 deben contemplar objetivos combinados que incluyan no solo el control glucémico, sino otras variables como el riesgo de hipoglucemia y el efecto del tratamiento sobre el peso corporal (AU)
Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight (AU)
Asunto(s)
Femenino , Humanos , Masculino , Diabetes Mellitus/epidemiología , Diabetes Mellitus/prevención & control , Obesidad/complicaciones , Obesidad/epidemiología , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Sobrepeso/epidemiología , Hipoglucemia/epidemiología , Hipoglucemia/prevención & control , Factores de Riesgo , Peso Corporal/fisiología , Sobrepeso/prevención & control , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Hiperlipidemias/epidemiología , Hiperlipidemias/prevención & control , Contaminación por Humo de Tabaco/prevención & control , Fumar/efectos adversos , ComorbilidadRESUMEN
Obesity and excess weight are the main preventable causes of type 2 diabetes (DM2). When diagnosing type 2 diabetes, clinicians should establish the degree of obesity according to the body mass index (BMI) and, for patients with excess weight, measure the waist circumference. The proper treatment of DM2 requires a simultaneous approach to excess weight/obesity and the other cardiovascular risk factors, such as hypertension, dyslipidaemia and smoking. Nondrug interventions (e.g., diet and exercise) have proven benefits in preventing and treating patients with DM2 and excess weight/obesity and should follow an individual and multidisciplinary approach, with structured programs equipped with specific resources. Weight gain associated with antidiabetic treatment can hinder glycaemic control, compromise treatment adherence, worsen the vascular risk profile and limit the cardiovascular benefits of treatment. Therefore, it is significant to avoid weight gain, a measure that can be cost-effective. Antidiabetic drugs with benefits in body weight have also demonstrated their benefit in patients with BMIs <30. In general, the treatment of patients with DM2 and obesity will depend both on the degree of obesity and the associated comorbidity. Clinical trials on DM2 intervention should consider combined objectives that include not only glycaemic control but also other variables such as the risk of hypoglycaemia and the effect of treatment on body weight.
Asunto(s)
Antihipertensivos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Neprilisina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Quimioterapia Combinada , Humanos , Tetrazoles/uso terapéutico , Valina/uso terapéutico , ValsartánRESUMEN
La publicación en EE. UU. de la guía de 2013 de American College of Cardiology/American Heart Association para el tratamiento del colesterol elevado ha tenido gran impacto por el cambio de paradigma que supone. El Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología han revisado esa guía, en comparación con la vigente guía europea de prevención cardiovascular y de dislipemias. El aspecto más destacable de la guía estadounidense es el abandono de los objetivos de colesterol unido a lipoproteínas de baja densidad, de modo que proponen el tratamiento con estatinas en cuatro grupos de riesgo aumentado. En pacientes con enfermedad cardiovascular establecida, ambas guías conducen a una estrategia terapéutica similar (estatinas potentes, dosis altas). Sin embargo, en prevención primaria, la aplicación de la guía estadounidense supondría tratar con estatinas a un número de personas excesivo, particularmente de edades avanzadas. Abandonar la estrategia según objetivos de colesterol, fuertemente arraigada en la comunidad científica, podría tener un impacto negativo en la práctica clínica y crear cierta confusión e inseguridad entre los profesionales y quizá menos seguimiento y adherencia de los pacientes. Por todo ello, el presente documento reafirma las recomendaciones de la guía europea. Ambas guías tienen aspectos positivos pero, en general y mientras no se resuelvan las dudas planteadas, la guía europea, además de utilizar tablas basadas en la población autóctona, ofrece mensajes más apropiados para el entorno español y previene del posible riesgo de sobretratamiento con estatinas en prevención primaria (AU)
The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention (AU)
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Humanos , Masculino , Femenino , 35145 , Centers for Disease Control and Prevention, U.S./legislación & jurisprudencia , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/metabolismo , Guías de Práctica Clínica como Asunto/normas , Prevención Primaria/métodos , España/etnología , Estados Unidos/etnología , Centers for Disease Control and Prevention, U.S./historia , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/prevención & control , Consenso , Prevención Primaria/instrumentaciónRESUMEN
Objetivos: Valorar el papel del SPET miocárdico de perfusión y de la ventriculografía isotópica en la miocardiopatía hipertrófica (MH).Material y Métodos: A una serie consecutiva de 101 pacientes (54 ñ 15 años de edad, 50 mujeres, 55 obstructivos), diagnosticados por ecocardiograma-Doppler de MH, se les practicó un SPET miocárdico de perfusión con 99mTctetrofosmina y una ventriculografía isotópica. El seguimiento medio desde el momento del diagnóstico fue de 9,9 ñ 6,7 años (entre 1 y 28 años). Resultados: El 36 por ciento de los pacientes presentaron defectos de perfusión (15 defectos fijos y 21 defectos reversibles). En las MH no obstructivas se observó un mayor número de pacientes con defectos fijos (p = 0,01) y en los pacientes con defectos fijos se observó una mayor incidencia de ondas Q patológicas en el ECG (p = 0,01), mayores volúmenes ventriculares (p < 0,05), menor fracción de eyección (p = 0,001) y un tiempo a la velocidad máxima de llenado ventricular superior (p < 0,05). Cuatro pacientes fallecieron, 15 presentaron síncope, en 18 se indicó la implantación de marcapasos y en 6 miectomía. La fracción de eyección fue más alta en los pacientes que presentaron síncope (p = 0,034) mientras que ninguna variable isotópica fue predictora de mortalidad ni de indicación de marcapasos o miectomía. Conclusiones: Ni la tomogammagrafía miocárdica de perfusión ni la ventriculografía isotópica aportan información pronóstica en la MH, aunque en los pacientes con síncope se observan valores de fracción de eyección más elevados. Los pacientes con defectos fijos presentan mayor proporción de ondas Q patológicas en el ECG, mayores volúmenes ventriculares y fracción de eyección más baja en la ventriculografía isotópica, lo cual indica una evolución hacia la forma dilatada de la MH (AU)
Asunto(s)
Persona de Mediana Edad , Adulto , Masculino , Femenino , Humanos , Ventriculografía con Radionúclidos , Tomografía Computarizada de Emisión de Fotón Único , Circulación Coronaria , Volumen Sistólico , Progresión de la Enfermedad , Perfusión , Marcapaso Artificial , Pronóstico , Estudios Retrospectivos , Estudios de Seguimiento , Cardiomegalia , Corazón , Cardiomiopatía Hipertrófica , Cardiomiopatía Dilatada , Prueba de EsfuerzoRESUMEN
OBJECTIVE: To evaluate the role of myocardial perfusion SPET and radionuclide ventriculography in patients with hypertrophic cardiomyopathy (HC). METHODS: Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in a consecutive series of 101 patients (54 15 years, 50 women, 55 with dynamic obstruction) diagnosed of HC by echo. Follow-up from the diagnosis was 9,9 6,7 years (1 to 28 years). RESULTS: Thirty six percent of patients had perfusion defects (non reversible in 15 and reversible in 21). In non obstructive HC higher number of patients with non reversible defects (p = 0.01 was obseved and in patients with no reversible defects higher incidence of pathologic Q waves in ECG (p = 0.01), Higher ventricular volumes (p < 0.05), lower ejection fraction (p = 0,0001) and longer time to peak emptying velocity (p < 0.05). There were 4 cardiac deaths, 15 syncopes, 18 pacemakers and 6 myectomy. Ejection fraction was higher in patients with syncope (p = 0,034) and there was no isotopic variable predictive of mortality, pacemaker or myectomy. CONCLUSIONS: Neither SPET nor radionuclide ventriculography have a prognostic role in patients with HC, but patients with syncope have higher values of ejection fraction. Patients with non reversible defects have higher rate of pathologic Q waves in ECG, higher ventricular volumes and lower ejection fraction. This is indicative of evolution to dilated form of HC.
Asunto(s)
Cardiomegalia/diagnóstico por imagen , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Circulación Coronaria , Corazón/diagnóstico por imagen , Ventriculografía con Radionúclidos , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Cardiomegalia/complicaciones , Cardiomegalia/mortalidad , Cardiomegalia/terapia , Cardiomiopatía Dilatada/etiología , Cardiomiopatía Dilatada/mortalidad , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/mortalidad , Cardiomiopatía Hipertrófica/terapia , Progresión de la Enfermedad , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Corazón/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Perfusión , Pronóstico , Estudios Retrospectivos , Volumen SistólicoAsunto(s)
Países Desarrollados , Países en Desarrollo , Enfermedades de las Válvulas Cardíacas/etiología , Síndrome Antifosfolípido/complicaciones , Enfermedades de las Válvulas Cardíacas/inducido químicamente , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Cardiopatía Reumática/etiologíaRESUMEN
BACKGROUND: In patients with heart failure, beta-adrenergic blocking agents reduce overall and cardiovascular mortality. This meta-analysis aimed at clarifying their effect on sudden death, the magnitude of their benefit according to the cause of heart failure, and whether there is any difference between vasodilating and nonvasodilating agents. METHODS: Randomized, clinical trials were included if they evaluated a beta-adrenergic blocking agent without intrinsic sympathomimetic activity, included a control group receiving placebo or standard treatment, evaluated mortality on an intention-to-treat basis, and lasted at least 8 weeks. RESULTS: Twenty-one trials with 5,849 patients (3,130 receiving beta-blockers) were included. Median length of treatment was 6 months. Most patients had mild or moderate heart failure and were treated with angiotensin-converting enzyme inhibitors, diuretics, and digitalis. The beta-blockers significantly reduced overall mortality, cardiovascular mortality, and mortality due to pump failure and sudden death by 34% to 39%. The decrease in overall mortality in patients with ischemic heart disease (IHD) (30%) was no different from that among patients with non-IHD (26%) (P = .08). The reduction in overall mortality was greater with vasodilating than with nonvasodilating agents (45% vs 27%; P = .007), particularly in patients without IHD (62%), compared with those with IHD (22%; P =.03). CONCLUSIONS: In patients with heart failure, beta-blockers reduce total and cardiovascular mortality at the expense of a decrease in mortality due to pump failure and sudden death. The magnitude of the benefit is similar in patients with IHD and in those with non-IHD. Vasodilating beta-blockers have a greater effect on overall mortality than nonvasodilating agents, particularly in patients with non-IHD.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Muerte Súbita Cardíaca/prevención & control , Insuficiencia Cardíaca/tratamiento farmacológico , Vasodilatadores/uso terapéutico , Estudios Cruzados , Muerte Súbita Cardíaca/etiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Hospitalización , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Tasa de SupervivenciaRESUMEN
INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of myocardial SPET in patients with hypertrophic cardiomyopathy (HC). PATIENTS AND METHODS: One hundred and six consecutive patients (aged 53 +/- 12 years, 50 women, 66 with dynamic obstruction) with an echocardiographic diagnosis of HC were studied with exercise-rest myocardial SPET with 99mTc-tetrofosmin. Forty-six (43%) of these patients had chest pain and in 31 (29%) a coronary angiography was performed. Fifty-six per cent of the patients were treated with beta-blockers and 23% with verapamil. RESULTS: Angina during the exercise test was observed in only 8% of the patients. Perfusion defects were observed in 35% of the patients. Only 8 (26%) out of the 31 patients with angiography had coronary artery disease (stenosis > 50%). When fixed and reversible defects were considered as positive, the sensitivity was 50%, the specificity was 65%, the positive predictive value was 33% and the negative predictive value was 79%. CONCLUSIONS: Myocardial perfusion defects can be observed in more than one third of medically treated patients with HC. Only a quarter of catheterized patients, even with chest pain, have associated coronary artery disease. The accuracy of SPET for the diagnosis of coronary artery disease in hypertrophic cardiomyopathy is low. Thus, the value of this technique is limited in these patients.
Asunto(s)
Cardiomegalia/diagnóstico por imagen , Anciano , Cardiomegalia/fisiopatología , Circulación Coronaria/fisiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón ÚnicoAsunto(s)
Arritmias Cardíacas/etiología , Electrocardiografía , Insuficiencia Cardíaca/complicaciones , Infarto del Miocardio/complicaciones , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/fisiopatología , Muerte Súbita Cardíaca , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Pronóstico , Factores de RiesgoRESUMEN
We report a patient with refractory angina in the postoperative period of a coronary artery bypass grafting. Ischemia was due to a large side branch of the left internal mammary artery causing steal phenomenon that was treated with transcatheter coil embolization.
Asunto(s)
Angina de Pecho/terapia , Embolización Terapéutica , Anastomosis Interna Mamario-Coronaria , Complicaciones Posoperatorias/terapia , Anciano , Humanos , Masculino , Isquemia Miocárdica/etiología , Isquemia Miocárdica/terapiaRESUMEN
Connective tissue diseases encompass a wide group of nosologic entities of unknown etiology, characterized by multisystemic organ involvement, sharing an immunologic pathogenetic mechanism, producing a variety of inflammatory manifestations, and whose primary lesion is always a diffuse vasculitis. Any part of the cardiovascular system may be involved, including the pericardium, the myocardium, the endocardium and valves, the coronary arteries, the aorta, the pulmonary vasculature, the peripheral arteries, veins, arterioles, venules, and the capillary beds of almost every organ subsystem. Pathologic studies disclose a high prevalence of heart involvement, but the presence and extent of pathologic findings correlate poorly with clinical manifestations. With the advent of echocardiography-Doppler, milder and earlier cases are now recognized. Although these patients continue under the care of rheumatologists and internists, when cardiac involvement arises, cardiologists must be aware of the characteristics, outcome and management of connective tissue diseases.
Asunto(s)
Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/patología , Cardiopatías/etiología , Cardiopatías/patología , HumanosRESUMEN
INTRODUCTION: Determination of pulmonary to systemic blood flow ratio (QP/QS) is considered to be important for the management of patients with atrial septal defect. The QP/QS provides information on shunt severity and is usually determined by three methods: oximetry, first-pass radionuclide angiocardiography and Doppler echocardiography. The aim of the present study was to assess the accuracy and concordance level of these three methods in QP/QS quantification in atrial septal defects. PATIENTS AND METHODS: Sixty-four adult atrial septal defects patients in whom QP/QS was determined by these three methods with a 6 month interval were studied. Nuclear and echocardiographic post-surgical studies were repeated in 36 patients. RESULTS: QP/QS values determined by the three techniques had a low correlation between them: oximetry (r = 0.52; SEE = 0.74); radionuclide angiocardiography (r = 0.40; SEE = 0.79) and Doppler echocardiography (r = 0.72; SEE = 0.57). Radionuclide angiocardiography underestimated QP/QS > 3 (-0.61 +/- 1.21; p < 0.01). Only in 33% of studies there concordance (differences < 0.5) among the three methods and in 58% between two methods. Right ventricular dilatation and tricuspid regurgitation influenced radionuclide accuracy. Nevertheless, the correlation between this technique and echocardiography was satisfactory when the 36 post-surgical were included (r = 0.75); both techniques agreed in the diagnosis of the two cases with residual post-surgical shunt. CONCLUSIONS: Inter-method disparity in QP/QS quantification is high and no method can be used as a gold standard; clinical decisions therefore based on QP/QS quantification by one technique alone are ill-advised.
Asunto(s)
Defectos del Tabique Interatrial/fisiopatología , Adulto , Anciano , Circulación Coronaria , Ecocardiografía Doppler , Femenino , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/diagnóstico por imagen , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Oximetría , Estudios Prospectivos , Circulación Pulmonar , Ventriculografía de Primer PasoRESUMEN
OBJECTIVES: This study was designed to determine the efficacy of intravenous amiodarone in the management of recent-onset atrial fibrillation. BACKGROUND: The optimal approach for acute atrial fibrillation has not been established. Amiodarone is a unique antiarrhythmic agent with activity in both supraventricular and ventricular tachyarrhythmias, but its value for the restoration of sinus rhythm in patients with recent-onset atrial fibrillation has not been demonstrated. METHODS: Sample size was calculated to detect a 25% increase in reversion rate with amiodarone with a statistical power of 80%. One hundred consecutive patients with recent-onset (<1 week) atrial fibrillation and not taking antiarrhythmic agents were randomized to receive either intravenous amiodarone, 5 mg/kg body weight in 30 min followed by 1,200 mg over 24 h, or an identical amount of saline. Both groups received intravenous digoxin, 0.5 mg initially, followed by 0.25 mg at 2 h and 0.25 mg every 6 h thereafter, to complete 24 h while the ventricular rate was >100 beats/min. Amiodarone and digoxin blood levels were determined. Both groups were homogeneous regarding underlying heart disease, time from onset to treatment, initial ventricular rate and left atrial size. RESULTS: By the end of the 24-h treatment period, 34 patients (68%, 95% confidence interval [CI] 53% to 80%) in the amiodarone group and 30 (60%, 95% CI 45% to 74%) in the control group had returned to sinus rhythm (p = 0.532). Mean times (+/-SD) of conversion were 328 +/- 335 and 332 +/- 359 min, respectively (p =0.957). Among patients who did not convert to sinus rhythm, treatment with amiodarone was associated with a slower ventricular rate (82 +/- 15 beats/min in the amiodarone group vs. 91 +/- 23 beats/min in the control group, p = 0.022). After restoration of sinus rhythm, atrial fibrillation recurred during a 15-day follow-up period in 4 (12%) of 34 patients (95% CI 3% to 27%) in the amiodarone group and in 3 (10%) of 30 (95% CI 2% to 26%) in the control group (p = 0.861). CONCLUSIONS: Intravenous amiodarone, at the doses used in this study, produces a modest but not significant benefit in converting acute atrial fibrillation to sinus rhythm.
Asunto(s)
Amiodarona/administración & dosificación , Antiarrítmicos/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Thrombosis is an infrequent complication in mechanical valve prostheses carrying a vital risk for the patient. The performance of transesophageal echocardiography (TEE) is high in differentiating the thrombosis from other causes of flow obstruction and is fundamental for establishing treatment. Fibrinolysis is an effective alternative treatment to surgery when the latter carries a high risk. In the case herein reported TEE provided a rapid and precise diagnosis and allowed to prove the resolution of the prosthetic thrombosis following fibrinolytic treatment.
Asunto(s)
Ecocardiografía Transesofágica , Fibrinolíticos/uso terapéutico , Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Trombosis/diagnóstico por imagen , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Persona de Mediana Edad , Inducción de Remisión , Trombosis/tratamiento farmacológico , Trombosis/etiologíaRESUMEN
Dual chamber pacing may be used as an alternative in the treatment of selected patients who are refractory to conventional medical treatment of hypertrophic obstructive cardiomyopathy. When programming the pacemaker it is essential to know the value of the atrio-ventricular interval which is able to cause the greatest reduction in the left ventricle outflow tract pressure gradient. We have used isoproterenol to calculate the parameter mentioned above. This allowed us to know the optimum value, not only in non-active conditions, but also reproducing the changes in the pressure gradient in different physiological situations.