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OBJECTIVE: To study the association between vital exhaustion, anxiety and anger with acute coronary event; second, determine whether they are associated with each other, and third, if the joint interaction of two or more factors increases the risk for coronary event. METHOD: We conducted a case-control study with 165 patients, both sexes, between 35 and 75 years, 90 patients with acute ischemic coronary event and 75 controls hospitalized with an acute event of non-ischemic cardiac causes. RESULTS: Statistically significant differences between the control group and the ischemic coronary group for vital exhaustion was found (OR = 3.0 (1.6-5.5) p < 0.001 (chi2)). Psychosocial risk factors are associated each with p < 0.001: anxiety and vital exhaustion (Spearman Rho = 0.58), anger and vital exhaustion (Spearman Rho = 0.41) and anxiety and anger (Spearman Rho = 0.38). The simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event (p < 0.01). CONCLUSIONS: In this study we found a significative association between vital exhaustion and acute ischemic coronary event, psychosocial risk factors are associated with each other and simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event.

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OBJECTIVE: To study the association between vital exhaustion, anxiety and anger with acute coronary event; second, determine whether they are associated with each other, and third, if the joint interaction of two or more factors increases the risk for coronary event. METHOD: We conducted a case-control study with 165 patients, both sexes, between 35 and 75 years, 90 patients with acute ischemic coronary event and 75 controls hospitalized with an acute event of non-ischemic cardiac causes. RESULTS: Statistically significant differences between the control group and the ischemic coronary group for vital exhaustion was found (OR = 3.0 (1.6-5.5) p < 0.001 (chi2)). Psychosocial risk factors are associated each with p < 0.001: anxiety and vital exhaustion (Spearman Rho = 0.58), anger and vital exhaustion (Spearman Rho = 0.41) and anxiety and anger (Spearman Rho = 0.38). The simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event (p < 0.01). CONCLUSIONS: In this study we found a significative association between vital exhaustion and acute ischemic coronary event, psychosocial risk factors are associated with each other and simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event.

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OBJECTIVE: To study the association between vital exhaustion, anxiety and anger with acute coronary event; second, determine whether they are associated with each other, and third, if the joint interaction of two or more factors increases the risk for coronary event. METHOD: We conducted a case-control study with 165 patients, both sexes, between 35 and 75 years, 90 patients with acute ischemic coronary event and 75 controls hospitalized with an acute event of non-ischemic cardiac causes. RESULTS: Statistically significant differences between the control group and the ischemic coronary group for vital exhaustion was found (OR = 3.0 (1.6-5.5) p < 0.001 (chi2)). Psychosocial risk factors are associated each with p < 0.001: anxiety and vital exhaustion (Spearman Rho = 0.58), anger and vital exhaustion (Spearman Rho = 0.41) and anxiety and anger (Spearman Rho = 0.38). The simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event (p < 0.01). CONCLUSIONS: In this study we found a significative association between vital exhaustion and acute ischemic coronary event, psychosocial risk factors are associated with each other and simultaneous presence of vital exhaustion and anxiety increases the probability of an acute ischemic coronary event.

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Cardiac rehabilitation programs (CRP), include exercise training, medical advice and education related to cardiovascular pathologies, psychosocial support and behavioral characteristics. This approach shows a sustained positive impact over the cardiovascular risk factors, the physical training and the health-related quality of life of the patients and on adherence to dietary recommendations. During the 2004 the authors started the implementation of the Integral Teaching Program (ITP), focused to convalescent patients after a cardiovascular event and with the purpose to enter in a plan of cardiac rehabilitation and secondary preventions with exercise training programs and with a multidisciplinary approach. The aim of this report was to describe the results of the ITP in a cohort of patients submitted to cardiovascular surgery. In a second term, the impact of the ITP will be measured including the total and partial adherence to the different planes of cardiac rehabilitation programs and the management of vascular risk factors. Also it was studied the improvement in physiological outcomes and health-related quality of life in patients with acute myocardial infarction.

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Assessment of the teaching process, learning and evaluation of competences in health sciences, using simulators.

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OBJECTIVE: To determine the strength of the association between the Vital exhaustion syndrome (VES) and acute coronary ischemic events in hospitalized Argentinean sample. METHODS: VES was measured in 180 patients of both sexes, 90 admitted due to an acute coronary ischemic syndrome (AMI or unstable angina) and a control group of 90 admitted due to an acute non-coronary cardiac event. VES was evaluated with the Maastricht questionnaire during the first week of hospitalization. RESULTS: Dividing the sample in two categories: exhausted and non-exhausted, 57 (63,33%) of the coronary were exhausted, while among the non coronary group, 33 were exhausted (36,66%)(OR=3.1 (1.7-5.8)). The exhaustion score was: control mean score: 17,1 (sd 8,96); case mean score: 21,1 (sd10,60) p: 0.006. Dislipemia was another factor with a significant difference: control 27 (30%) case 44 (62%) OR= 2.2 (1.2-4.1) p=0.01. Logistic regression was performed, including an interaction model between DLP and exhaustion, and it did not show a significant effect. CONCLUSIONS: Our results indicate that in Argentina, among other countries as reported in the literature, VES is a psychological condition that is strongly and independent associated to acute coronary events.

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Objetivo: Determinar la fuerza de la asociación entre el Agotamiento Vital y eventos isquémicos coronarios agudos en una muestra de pacientes argentinos internados. Método: Se midió el Agotamiento mediante el cuestionario de Maastricht en 180 pacientes de ambos sexos, 90 casos con un evento corona río agudo y 90 controles con un evento agudo cardíaco no-isquémico. Se compararon ambos grupos por edad, sexo, estado civil, y educación, Diabetes, Hipertensión Arterial, Tabaquismo, y Dislipemia. Resultados: El 63,33 por ciento, 57 de los casos estaban agotados, en cambio, el 36,66 por ciento, 33 controles estaban agotados (OR= 3.1 (1.7-5.8) p

Objective: To determine the strength of the association between the Vital exhaustion syndrome (VES) and acute coronary ischemic events in hospitalized Argentinean sample. Methods: VES was measured in 180 patients of both sexes, 90 admitted due to an acute coronary ischemic syndrome (AMI or unstable angina) and a control group of 90 admitted due to an acute non-coronary cardiac event VES was evaluated with the Maastricht questionnaire during the first week of hospitalization. Results: Dividing the sample in two categories: exhausted and non-exhausted, 57 (63,33 percent) of the coronary were exhausted, while among the non coronary group, 33 were exhausted (36, 66 percent)(OR=3.1 (1.7-5.8) p<.OO1. The exhaustion score was: control mean score: 17,1 (sd 8,96); case mean score: 21,1 (sd 10,60) p: 0.006. Dislipemia was another factor with a significant difference: control 27 (30 percent) case 44 (62 percent) OR= 2.2 (1.2-4.1) p=O.01. Logistic regression was performed, including an interaction model between DLP and exhaustion, and it did not show a significant effect. Conclusions: Our results indicate that in Argentina, among other countries as reported in the literature, VES is a psychological condition that is strongly and independent associated to acute coronary events.(AU)

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Objetivo: Determinar la fuerza de la asociación entre el Agotamiento Vital y eventos isquémicos coronarios agudos en una muestra de pacientes argentinos internados. Método: Se midió el Agotamiento mediante el cuestionario de Maastricht en 180 pacientes de ambos sexos, 90 casos con un evento corona río agudo y 90 controles con un evento agudo cardíaco no-isquémico. Se compararon ambos grupos por edad, sexo, estado civil, y educación, Diabetes, Hipertensión Arterial, Tabaquismo, y Dislipemia. Resultados: El 63,33 por ciento, 57 de los casos estaban agotados, en cambio, el 36,66 por ciento, 33 controles estaban agotados (OR= 3.1 (1.7-5.8) p

Objective: To determine the strength of the association between the Vital exhaustion syndrome (VES) and acute coronary ischemic events in hospitalized Argentinean sample. Methods: VES was measured in 180 patients of both sexes, 90 admitted due to an acute coronary ischemic syndrome (AMI or unstable angina) and a control group of 90 admitted due to an acute non-coronary cardiac event VES was evaluated with the Maastricht questionnaire during the first week of hospitalization. Results: Dividing the sample in two categories: exhausted and non-exhausted, 57 (63,33 percent) of the coronary were exhausted, while among the non coronary group, 33 were exhausted (36, 66 percent)(OR=3.1 (1.7-5.8) p<.OO1. The exhaustion score was: control mean score: 17,1 (sd 8,96); case mean score: 21,1 (sd 10,60) p: 0.006. Dislipemia was another factor with a significant difference: control 27 (30 percent) case 44 (62 percent) OR= 2.2 (1.2-4.1) p=O.01. Logistic regression was performed, including an interaction model between DLP and exhaustion, and it did not show a significant effect. Conclusions: Our results indicate that in Argentina, among other countries as reported in the literature, VES is a psychological condition that is strongly and independent associated to acute coronary events.

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The authors present an integrating final summative evaluation for the obligatory final practice at the School of Medicine Favaloro University. The aim of this report was to describe the results of both the process and the model performed during 2007, as a pilot test realized at the School of Medicne - Favaloro University from Buenos Aires. Likewise, the results obtained and the integral evaluation of the experience served as a starting point to perform the final and definitive proposal to examinate the cohort of students suitable to be admitted during 2008. Both the institutional academic mark and the normative mark are presented and discussed

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Introducción: A los episodios de inestabilidad anginosa precipitados por causas secundarias que, no infrecuentemente, no pueden discernirse de razones primarias se les concede poca atención. El presente trabajo intenta responder si algunos biomarcadores pueden contribuir a identificar a aquellos individuos con angina IIIb de los conocidos como anginosos IIIa de la clasificación de Braunwald. Material y métodos: En total, participaron del ensayo 64 pacientes seleccionados. De éstos, 33 tuvieron diagnóstico final de angina inestable secundaria a hipertensión arterial y 21 de angina primaria, en tanto que 10 enfermos anginosos estables, referidos para la práctica de un estudio angiográfico diagnóstico, sirvieron de control. En todos ellos, en el momento de la admisión se obtuvieron alícuotas de sangre venosa para la determinación del péptido natriurético auricular tipo B (BNP) y de proteína C reactiva ultrasensible (hs-CRP), y luego se realizó un estudio angiográfico invasivo a fin de analizar la carga aterosclerótica con puntajes (scores)angiográficos. Resultados: Los pacientes con angina primaria tuvieron una extensión aterosclerótica mayor en la angiografía (p < 0,025), más vasos comprometidos (p = 0,029) y un porcentaje mayor de estenosis (p < 0,001) que los anginosos secundarios. Los pacientes controles presentaron valores de BNP de 133 pg/mL (41; 224) [mediana (percentiles 25 y 75] y de 1,6 mg/L (0,4; 3,6) de hs-CRP. Los anginosos primarios no difirieron de los controles: 129 (95; 231) y 4,0(2,0; 5,6) para BNP y hs-CRP, respectivamente. Los anginosos secundarios tuvieron valores de 73 (19; 325) y de 4,5 (2,2; 9,0), respectivamente. No hubo diferencias significativas entre ambos cuadros anginosos: p = 0,458 para BNP y p = 0,552 para hs-CRP. Conclusiones: Independientemente de la carga aterosclerótica elevada en los anginosos primarios, el BNP y la hs-CRP no reconocieron con precisión la inestabilidad clínica inducida por un accidente de placa de la inducida...(AU)

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Introducción: A los episodios de inestabilidad anginosa precipitados por causas secundarias que, no infrecuentemente, no pueden discernirse de razones primarias se les concede poca atención. El presente trabajo intenta responder si algunos biomarcadores pueden contribuir a identificar a aquellos individuos con angina IIIb de los conocidos como anginosos IIIa de la clasificación de Braunwald. Material y métodos: En total, participaron del ensayo 64 pacientes seleccionados. De éstos, 33 tuvieron diagnóstico final de angina inestable secundaria a hipertensión arterial y 21 de angina primaria, en tanto que 10 enfermos anginosos estables, referidos para la práctica de un estudio angiográfico diagnóstico, sirvieron de control. En todos ellos, en el momento de la admisión se obtuvieron alícuotas de sangre venosa para la determinación del péptido natriurético auricular tipo B (BNP) y de proteína C reactiva ultrasensible (hs-CRP), y luego se realizó un estudio angiográfico invasivo a fin de analizar la carga aterosclerótica con puntajes (scores)angiográficos. Resultados: Los pacientes con angina primaria tuvieron una extensión aterosclerótica mayor en la angiografía (p < 0,025), más vasos comprometidos (p = 0,029) y un porcentaje mayor de estenosis (p < 0,001) que los anginosos secundarios. Los pacientes controles presentaron valores de BNP de 133 pg/mL (41; 224) [mediana (percentiles 25 y 75] y de 1,6 mg/L (0,4; 3,6) de hs-CRP. Los anginosos primarios no difirieron de los controles: 129 (95; 231) y 4,0(2,0; 5,6) para BNP y hs-CRP, respectivamente. Los anginosos secundarios tuvieron valores de 73 (19; 325) y de 4,5 (2,2; 9,0), respectivamente. No hubo diferencias significativas entre ambos cuadros anginosos: p = 0,458 para BNP y p = 0,552 para hs-CRP. Conclusiones: Independientemente de la carga aterosclerótica elevada en los anginosos primarios, el BNP y la hs-CRP no reconocieron con precisión la inestabilidad clínica inducida por un accidente de placa de la inducida...(AU)

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Introducción: A los episodios de inestabilidad anginosa precipitados por causas secundarias que, no infrecuentemente, no pueden discernirse de razones primarias se les concede poca atención. El presente trabajo intenta responder si algunos biomarcadores pueden contribuir a identificar a aquellos individuos con angina IIIb de los conocidos como anginosos IIIa de la clasificación de Braunwald. Material y métodos: En total, participaron del ensayo 64 pacientes seleccionados. De éstos, 33 tuvieron diagnóstico final de angina inestable secundaria a hipertensión arterial y 21 de angina primaria, en tanto que 10 enfermos anginosos estables, referidos para la práctica de un estudio angiográfico diagnóstico, sirvieron de control. En todos ellos, en el momento de la admisión se obtuvieron alícuotas de sangre venosa para la determinación del péptido natriurético auricular tipo B (BNP) y de proteína C reactiva ultrasensible (hs-CRP), y luego se realizó un estudio angiográfico invasivo a fin de analizar la carga aterosclerótica con puntajes (scores)angiográficos. Resultados: Los pacientes con angina primaria tuvieron una extensión aterosclerótica mayor en la angiografía (p < 0,025), más vasos comprometidos (p = 0,029) y un porcentaje mayor de estenosis (p < 0,001) que los anginosos secundarios. Los pacientes controles presentaron valores de BNP de 133 pg/mL (41; 224) [mediana (percentiles 25 y 75] y de 1,6 mg/L (0,4; 3,6) de hs-CRP. Los anginosos primarios no difirieron de los controles: 129 (95; 231) y 4,0(2,0; 5,6) para BNP y hs-CRP, respectivamente. Los anginosos secundarios tuvieron valores de 73 (19; 325) y de 4,5 (2,2; 9,0), respectivamente. No hubo diferencias significativas entre ambos cuadros anginosos: p = 0,458 para BNP y p = 0,552 para hs-CRP. Conclusiones: Independientemente de la carga aterosclerótica elevada en los anginosos primarios, el BNP y la hs-CRP no reconocieron con precisión la inestabilidad clínica inducida por un accidente de placa de la inducida...

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BACKGROUND: Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought to investigate whether a major financial crisis may impact on the medical management and outcomes of acute coronary syndromes. METHODS: We analyzed the Argentine cohort of the international multicenter Global Registry of Acute Coronary Events (GRACE). The primary objective was to estimate if there was an association between the financial crisis period (April 1999 to December 2002) and in- hospital cardiovascular mortality, with the post-crisis period (January 2003 to September 2004) as the referent. Each period was defined according to the evolution of the Gross Domestic Product. We investigated the demographic characteristics, diagnostic and therapeutic procedures, morbidity and mortality. RESULTS: We analyzed data from 3220 patients, 2246 (69.8%) patients in the crisis period and 974 (30.2%) in the post-crisis frame. The distribution of demographic and clinical baseline characteristics were not significantly different between both periods. During the crisis period the incidence of in-hospital myocardial infarction was higher (6.9% Vs 2.9%; p value < 0.0001), as well as congestive heart failure (16% Vs 11%; p value < 0.0001). Time to intervention with angioplasty was longer during the crisis, especially among public sites (median 190 min Vs 27 min). The incidence proportion of mortality during hospitalization was 6.2% Vs 5.1% after crisis. The crude OR for mortality was 1.2 (95% C.I. 0.87, 1.7). The odds for mortality were higher among private institutions {1.9 (95% C.I. 0.9, 3.8)} than for public centers {1.2 (95% C.I. 0.83, 1.79)}. We did not observe a significant interaction between type of hospital and crisis. CONCLUSION: Our findings suggest that the financial crisis may have had a negative impact on cardiovascular mortality during hospitalization, and higher incidence of medical complications.

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AIMS: We have previously reported a significant benefit of vaccination against flu on the incidence of a single and composite end-point of death, myocardial infarction or recurrent ischaemia in patients with myocardial necrosis and planned percutaneous coronary interventions. To determine whether the observed benefits of vaccination against flu were maintained beyond the winter season a 1-year follow-up was conducted. METHODS AND RESULTS: During the winter season, we enrolled prospectively 200 myocardial infarction patients admitted in the first 72 h, and 101 planned angioplasty/stent patients (PCI) without unstable coronary artery disease, prior by-pass surgery, angioplasty or tissue necrosis. Only four patients failed to meet the inclusion criteria. Participants were randomly allocated to receive flu vaccination or remain unvaccinated on top of standard medication (control group). The study was conducted in hospitalized patients with the aim to test the potential beneficial effect of flu vaccination in a secondary prevention scenario. Under intention to treat analysis the incidence of the primary end-point cardiovascular death at 1 year was significantly lower among patients receiving vaccination, 6% as compared with controls, 17% (relative risk with vaccine as compared with controls, 0.34; 95% confidence interval (CI), 0.17 to 0.71; P=0.002). The triple composite end-point occurred in 22% of the patients in the vaccine group vs 37% in controls, hazard ratio 0.59, 95% CI 0.4 to 0.86) P=0.004. The beneficial effect was mainly detected in acute myocardial infarction patients (four events in the active arm vs 21 in the control group, P=0.0002 [95% CI 0.19, 0.07-0.53]), and Cox regression analyses revealed that there was a greater benefit with flu vaccination in patients at high risk according with the TIMI score, and those with non-ST-segment deviation myocardial infarction (95% CI: 0.13 [0.03-0.52]) CONCLUSIONS: Influenza vaccination may reduce the risk of death and ischaemic events in patients suffering from infarction and post-angioplasty during flu season. This effect was significantly evident at 1-year follow-up. Larger confirmatory studies are needed to evaluate the real impact on flu vaccination on outcome after acute coronary syndromes.

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Ischemic heart disease results from lack of oxygen and delayed removal of metabolites because of inadequate perfusion. The term ischemic heart disease refers to an abnormality of the heart in which there is ischemia of the myocardium. One of the clinical manifestations of schemic heart disease is stable chronic angina. Angina consists of ches pain thar is episodic, usually brief, and caused by transient myocardial ischemia. Angina is the most common symptom of ischemic heart disease and requires immediate attention as to the diagnosis and extent of disease...These considerations arte commented in the article

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Ischemic heart disease results from lack of oxygen and delayed removal of metabolites because of inadequate perfusion. The term ischemic heart disease refers to an abnormality of the heart in which there is ischemia of the myocardium. One of the clinical manifestations of schemic heart disease is stable chronic angina. Angina consists of ches pain thar is episodic, usually brief, and caused by transient myocardial ischemia. Angina is the most common symptom of ischemic heart disease and requires immediate attention as to the diagnosis and extent of disease...These considerations arte commented in the article

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