Journal of the American College of Cardiology, Nov 1, 1997
Objectives. The aim of the present study was to ascertain whether the degree of accessibility to ... more Objectives. The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. Background. The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. Methods. A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospital's cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. Results. Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. Conclusions. Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.
El género Gyromitra, específicamente la Gyromitra esculenta (GE), es la que mejor representa a es... more El género Gyromitra, específicamente la Gyromitra esculenta (GE), es la que mejor representa a este síndrome. Otras setas responsables del mismo son la Gyromitra fastigiata, Gyromitra ambigua,
Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countri... more Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countries in Europe and elsewhere. New policies are necessary to prevent transmission in those countries but the long, often undetected chronic period of the early stages of the disease also renders epidemiological studies important. The main objective of our study was to determine the presence of clinical, electrocardiogram (ECG) and echocardiographic abnormalities in a population of Latin American migrants infected with Trypanosoma cruzi at the moment of diagnosis. We performed a hospital-based observational study of 100 adult patients with newly diagnosed Chagas infection between January 2005 and December 2009. Thirtyseven patients were classified within the Brazilian Consensus on Chagas cardiomyopathy early cardiac stages (A or B1) and 49 presented pathological findings (stage B2) according to the Panamerican Health Organization Classification. Overall, 49 patients showed ECG and/or echocardiographic alterations. The presence of ECG and ecocardiographic alterations were significantly associated (p=0.038). The most frequent ECG and echocardiographic findings were right bundle branch block (12 cases) and impaired left ventricular wall relaxation (24 cases), respectively. In conclusion, ECG and echocardiographic alterations coherent with Chagas cardiomyopathy were found in a large proportion of newly diagnosed Latin American migrants infected with T. cruzi. In the mid-term, Chagas disease might become an important cause of chronic cadiomyopathy in our attendance area.
Journal of the American College of Cardiology, Dec 1, 1999
The study assessed whether varying accessibility of patients with unstable angina (UA) to coronar... more The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. BACKGROUND The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. METHODS A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. RESULTS Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p ϭ 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p Ͻ 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). CONCLUSIONS The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.
European Journal of Echocardiography, Dec 11, 2009
Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, inter... more Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, interventional procedures, or trauma. Spontaneous cases are supposed to be associated with left atrial wall pathology. We present a case of a 53-year-old male who was admitted for prolonged chest pain, with transthoracic and transesophagic echocardiography documentation of a left atrial mass in close proximity to a mitral annular calcification. Tissue characterization with cardiac magnetic resonance suggested the aetiology of the mass, which was confirmed histologically.
The aim of this study was to assess the clinical course of unstable angina and the prognostic val... more The aim of this study was to assess the clinical course of unstable angina and the prognostic value of clinical and electrocardiographic variables measured during admission in a prospective, multicenter cohort study with 6-month follow-up. The population corresponds to 4 general teaching hospitals in Catalonia, Spain. The clinical course was analyzed in 839 consecutive patients aged up to 80 years with primary unstable angina, without myocardial infarction or previous coronary bypass. The main outcome measures were cardiac mortality and nonfatal myocardial infarction. Patients involved in the present analysis belonged to the Resources Used in Acute Coronary Syndromes and Delays in Treatment (RESCATE) study. Six-month overall mortality, cardiac mortality, and nonfatal myocardial infarction rates were 4.6%, 4.1%, and 3.9%, respectively. Six-month cardiac mortality or myocardial infarction rate did not differ among clinical forms of presentation. Peripheral artery disease (RR 3.5, 95% confidence interval [CI] 1.88 to 6.50, p ؍ 0.0001), ST-T-wave electrocardiographic changes on admission (RR 2.22, 95% CI 1.13 to 4.36, p ؍ 0.0203), and age >65 years (RR 1.74, 95% CI 1.04 to 2.91, p ؍ 0.0356) independently predicted 6-month cardiac mortality or nonfatal myocardial infarction. Their positive predictive values were 21%, 10%, and 11%, respectively, whereas their negative predictive value was >93% in all cases. Prevalences were 9%, 70%, and 41%, respectively. In this prospective study, patients with unstable angina without prior myocardial infarction have a relatively low, although not negligible, 6-month severe complication rate. Stratification risk can easily be established with clinical and electrocardiographic characteristics measured during admission. Their absence almost rules out future adverse events, while their presence does not necessarily imply bad prognosis. ᮊ1999 by Excerpta Medica, Inc.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
The echocardiographic (echo) features of idiopathic hemochromatosis (IH) were studied in 22 patie... more The echocardiographic (echo) features of idiopathic hemochromatosis (IH) were studied in 22 patients. Results were compared with a control group of 22 patients without heart disease. Statistically significant increases in left ventricular (LV) mass, end-diastolic and end-systolic diameters of the left ventricle and in left atrial dimension were observed in patients with IH; significant changes of systolic function indexes (decrease in fractional shortening and ejection fraction and increase in distance of the E point to the septum) were seen as well. These echo abnormalities were mainly seen in patients with abnormal electrocardiograms. In 11 patients with IH, iron removal therapy was carried out by means of periodic phlebotomies. In patients with impaired LV function at the beginning of therapy, comparison between measurements of the initial echo and posttreatment echo showed significant improvement in LV diameters, fractional shortening, ejection fraction, distance from the E point to the septum, LV mass and left atrial dimension.
To examine whether increases in heart rate might be a common trigger of angina at rest, changes i... more To examine whether increases in heart rate might be a common trigger of angina at rest, changes in heart rate, blood pressure and rate-pressure product during pain were compared with the ischaemic threshold (heart rate with ST segment shift &gt; = 1 mm), determined by atrial pacing, in 272 patients with unstable angina. During an average of 5.9 +/- 5.2 episodes of angina, heart rate was comparable to control values (77.0 +/- 14.5 vs 75.2 +/- 11.5, beats.min-1, ns) and significantly lower than the ischaemic threshold (147.9 +/- 22.9, P &lt; 0.00001). The rate-pressure product was also lower (955 +/- 183 vs 2033 +/- 369, x 10, P &lt; 0.00001). Heart rate during rest angina was lower than the ischaemic threshold even when we considered only patients with ST depression during pain (n: 71, 81.4 +/- 16.0 vs 132.8 +/- 21.4, P &lt; 0.00001), those with three-vessel disease (n: 43, 79.9 +/- 15.9 vs 136.9 +/- 22.0, P &lt; 0.00001), or those with a low ischaemic threshold (= &lt; 130 beats.min, n: 78, 77.0 +/- 14.9 vs 118.3 +/- 10.7, P &lt; 0.00001). In 154 patients in whom a second pacing test was performed the response was reproducible in 137 cases (89%). Thus, heart rate barely changes during angina at rest in patients with unstable angina and is consistently much lower than the ischaemic threshold. These findings support the concept that increases in heart rate are an unlikely trigger of ischaemia at rest, even in patients with markedly reduced coronary reserve.
El Tricholoma equestre (TE) es una seta ampliamente diseminada por todo el mundo y hasta épocas r... more El Tricholoma equestre (TE) es una seta ampliamente diseminada por todo el mundo y hasta épocas recientes estaba considerada como un buen comestible. Era muy popular en numerosos países. En España se la conoce popularmente como “seta de los caballeros”, en Cataluña como “groget” o “verderol”, en Francia como “bidaou”, en Alemania como “gruenling”, en Suecia como “riddarmusseron”, en Finlandia como “keltavalmuska”, en Japón como “shimokoshi” y en los Estados Unidos como “yellow knigth”. Sin embargo, en los últimos 12 años se han publicado diversos estudios clínicos y experimentales realizados por investigadores franceses, polacos y finlandeses, que relacionan el consumo de esta seta con un síndrome de rabdomiolisis y en algunos casos con afectación de la musculatura cardíaca, con una mortalidad potencial del 25%.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
Results: At 1 year after surgery, weight was reduced from 146 33 to 95 19 kg (p < 0.001), and ... more Results: At 1 year after surgery, weight was reduced from 146 33 to 95 19 kg (p < 0.001), and BMI went from 51 4 to 33 6 kg/m 2 (p < 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ...
Journal of the American College of Cardiology, Nov 1, 1997
Objectives. The aim of the present study was to ascertain whether the degree of accessibility to ... more Objectives. The aim of the present study was to ascertain whether the degree of accessibility to coronary angiography and revascularization results in differing usages or outcomes, or both, in the setting of a high coverage national health system. Background. The selective use of coronary angiography and revascularization procedures in the management of acute myocardial infarction (MI) remains controversial. Methods. A cohort of 1,460 consecutive patients with a first MI admitted to four referral teaching hospitals (one with tertiary facilities) were followed up for 6 months after admission. Only patients initially admitted to each of the study hospitals were retained for analysis in the original hospital's cohort. End points were 6-month mortality and readmission for reinfarction, unstable angina, heart failure or severe ventricular arrhythmia. Results. Patients admitted to the tertiary hospital were more likely to undergo coronary angiography (adjusted relative risk 4.22, 95% confidence interval [CI] 3.37 to 5.45) than those admitted to the nontertiary sites (use rate: 22.1% for nontertiary care, 55.5% for tertiary care). Revascularization procedures were performed in 21.2% of patients in the tertiary hospital and in 8.3% in the nontertiary hospitals (p < 0.0001). Median delay for emergency coronary angiography was shorter in the tertiary hospital (within 1 vs. 2 days, p < 0.0001). Six-month mortality or readmission rates were similar (23.7% and 24.7% for tertiary and nontertiary care, respectively). After adjustment for comorbidity and disease severity, the relative risk of death or readmission for the tertiary hospital was 1.03 (95% CI 0.69 to 1.53) times that of the nontertiary hospitals. Conclusions. Selective use of coronary angiography and revascularization procedures may be as effective as less restricted use in the management of acute MI.
El género Gyromitra, específicamente la Gyromitra esculenta (GE), es la que mejor representa a es... more El género Gyromitra, específicamente la Gyromitra esculenta (GE), es la que mejor representa a este síndrome. Otras setas responsables del mismo son la Gyromitra fastigiata, Gyromitra ambigua,
Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countri... more Following Latin American migration, Chagas disease has inevitably appeared in non-endemic countries in Europe and elsewhere. New policies are necessary to prevent transmission in those countries but the long, often undetected chronic period of the early stages of the disease also renders epidemiological studies important. The main objective of our study was to determine the presence of clinical, electrocardiogram (ECG) and echocardiographic abnormalities in a population of Latin American migrants infected with Trypanosoma cruzi at the moment of diagnosis. We performed a hospital-based observational study of 100 adult patients with newly diagnosed Chagas infection between January 2005 and December 2009. Thirtyseven patients were classified within the Brazilian Consensus on Chagas cardiomyopathy early cardiac stages (A or B1) and 49 presented pathological findings (stage B2) according to the Panamerican Health Organization Classification. Overall, 49 patients showed ECG and/or echocardiographic alterations. The presence of ECG and ecocardiographic alterations were significantly associated (p=0.038). The most frequent ECG and echocardiographic findings were right bundle branch block (12 cases) and impaired left ventricular wall relaxation (24 cases), respectively. In conclusion, ECG and echocardiographic alterations coherent with Chagas cardiomyopathy were found in a large proportion of newly diagnosed Latin American migrants infected with T. cruzi. In the mid-term, Chagas disease might become an important cause of chronic cadiomyopathy in our attendance area.
Journal of the American College of Cardiology, Dec 1, 1999
The study assessed whether varying accessibility of patients with unstable angina (UA) to coronar... more The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. BACKGROUND The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. METHODS A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. RESULTS Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p ϭ 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p Ͻ 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). CONCLUSIONS The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.
European Journal of Echocardiography, Dec 11, 2009
Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, inter... more Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, interventional procedures, or trauma. Spontaneous cases are supposed to be associated with left atrial wall pathology. We present a case of a 53-year-old male who was admitted for prolonged chest pain, with transthoracic and transesophagic echocardiography documentation of a left atrial mass in close proximity to a mitral annular calcification. Tissue characterization with cardiac magnetic resonance suggested the aetiology of the mass, which was confirmed histologically.
The aim of this study was to assess the clinical course of unstable angina and the prognostic val... more The aim of this study was to assess the clinical course of unstable angina and the prognostic value of clinical and electrocardiographic variables measured during admission in a prospective, multicenter cohort study with 6-month follow-up. The population corresponds to 4 general teaching hospitals in Catalonia, Spain. The clinical course was analyzed in 839 consecutive patients aged up to 80 years with primary unstable angina, without myocardial infarction or previous coronary bypass. The main outcome measures were cardiac mortality and nonfatal myocardial infarction. Patients involved in the present analysis belonged to the Resources Used in Acute Coronary Syndromes and Delays in Treatment (RESCATE) study. Six-month overall mortality, cardiac mortality, and nonfatal myocardial infarction rates were 4.6%, 4.1%, and 3.9%, respectively. Six-month cardiac mortality or myocardial infarction rate did not differ among clinical forms of presentation. Peripheral artery disease (RR 3.5, 95% confidence interval [CI] 1.88 to 6.50, p ؍ 0.0001), ST-T-wave electrocardiographic changes on admission (RR 2.22, 95% CI 1.13 to 4.36, p ؍ 0.0203), and age >65 years (RR 1.74, 95% CI 1.04 to 2.91, p ؍ 0.0356) independently predicted 6-month cardiac mortality or nonfatal myocardial infarction. Their positive predictive values were 21%, 10%, and 11%, respectively, whereas their negative predictive value was >93% in all cases. Prevalences were 9%, 70%, and 41%, respectively. In this prospective study, patients with unstable angina without prior myocardial infarction have a relatively low, although not negligible, 6-month severe complication rate. Stratification risk can easily be established with clinical and electrocardiographic characteristics measured during admission. Their absence almost rules out future adverse events, while their presence does not necessarily imply bad prognosis. ᮊ1999 by Excerpta Medica, Inc.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
The echocardiographic (echo) features of idiopathic hemochromatosis (IH) were studied in 22 patie... more The echocardiographic (echo) features of idiopathic hemochromatosis (IH) were studied in 22 patients. Results were compared with a control group of 22 patients without heart disease. Statistically significant increases in left ventricular (LV) mass, end-diastolic and end-systolic diameters of the left ventricle and in left atrial dimension were observed in patients with IH; significant changes of systolic function indexes (decrease in fractional shortening and ejection fraction and increase in distance of the E point to the septum) were seen as well. These echo abnormalities were mainly seen in patients with abnormal electrocardiograms. In 11 patients with IH, iron removal therapy was carried out by means of periodic phlebotomies. In patients with impaired LV function at the beginning of therapy, comparison between measurements of the initial echo and posttreatment echo showed significant improvement in LV diameters, fractional shortening, ejection fraction, distance from the E point to the septum, LV mass and left atrial dimension.
To examine whether increases in heart rate might be a common trigger of angina at rest, changes i... more To examine whether increases in heart rate might be a common trigger of angina at rest, changes in heart rate, blood pressure and rate-pressure product during pain were compared with the ischaemic threshold (heart rate with ST segment shift &gt; = 1 mm), determined by atrial pacing, in 272 patients with unstable angina. During an average of 5.9 +/- 5.2 episodes of angina, heart rate was comparable to control values (77.0 +/- 14.5 vs 75.2 +/- 11.5, beats.min-1, ns) and significantly lower than the ischaemic threshold (147.9 +/- 22.9, P &lt; 0.00001). The rate-pressure product was also lower (955 +/- 183 vs 2033 +/- 369, x 10, P &lt; 0.00001). Heart rate during rest angina was lower than the ischaemic threshold even when we considered only patients with ST depression during pain (n: 71, 81.4 +/- 16.0 vs 132.8 +/- 21.4, P &lt; 0.00001), those with three-vessel disease (n: 43, 79.9 +/- 15.9 vs 136.9 +/- 22.0, P &lt; 0.00001), or those with a low ischaemic threshold (= &lt; 130 beats.min, n: 78, 77.0 +/- 14.9 vs 118.3 +/- 10.7, P &lt; 0.00001). In 154 patients in whom a second pacing test was performed the response was reproducible in 137 cases (89%). Thus, heart rate barely changes during angina at rest in patients with unstable angina and is consistently much lower than the ischaemic threshold. These findings support the concept that increases in heart rate are an unlikely trigger of ischaemia at rest, even in patients with markedly reduced coronary reserve.
El Tricholoma equestre (TE) es una seta ampliamente diseminada por todo el mundo y hasta épocas r... more El Tricholoma equestre (TE) es una seta ampliamente diseminada por todo el mundo y hasta épocas recientes estaba considerada como un buen comestible. Era muy popular en numerosos países. En España se la conoce popularmente como “seta de los caballeros”, en Cataluña como “groget” o “verderol”, en Francia como “bidaou”, en Alemania como “gruenling”, en Suecia como “riddarmusseron”, en Finlandia como “keltavalmuska”, en Japón como “shimokoshi” y en los Estados Unidos como “yellow knigth”. Sin embargo, en los últimos 12 años se han publicado diversos estudios clínicos y experimentales realizados por investigadores franceses, polacos y finlandeses, que relacionan el consumo de esta seta con un síndrome de rabdomiolisis y en algunos casos con afectación de la musculatura cardíaca, con una mortalidad potencial del 25%.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
Results: At 1 year after surgery, weight was reduced from 146 33 to 95 19 kg (p < 0.001), and ... more Results: At 1 year after surgery, weight was reduced from 146 33 to 95 19 kg (p < 0.001), and BMI went from 51 4 to 33 6 kg/m 2 (p < 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ...
Uploads
Papers by Luis Seres