S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100001 Carta del editor Speranza Sánchez Mario O , 09 1999 1999 1 1 1
S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100002 Carta del presidente Tortós Guzmán Jaime E , 09 1999 1999 1 2 2
S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100003 Placas ateroscleróticas de aorta torácica: una entidad poco diagnosticada de enfermedad tromboembólica Lanzoni Rodríguez Allan Parajeles Vindas Alexander ,CCSS Hospital Rafael Angel Calderón Guardia ,Hospital Clínica Bíblica San José Costa Rica 09 1999 1999 1 3 8 Manning WJ Role of transesophageal echocardiography in the management of thromboembolic stroke Am J Cardiol 1997 80 Petersen P Thromboembolic complications in atrial fibrilation Stroke 1990 21 Kronzon Y Tunick PA Atheromatous disease of the thoracic aorta: pathologic and clinical implications Ann lntern med 1997 126 Tunick PA Kronzon Y Protruding atheroscierotic plaque in the aortic arch of patients with systemic embolization: a new finding seen by transesophageal echocardiography Am Heart J 1990 120 Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke N Engl J Med 1996 334 Tunick PA Perez JL Kronzon Y Protruding atheromas in the thoracic aorta and systemic embolization Ann lntern Med 1991 115 Tunick PA Rosenzweig BP Katz ES Freedberg RS Perez JL Kronzon Y High risk vascular events in patients with protruding aortic atheromas:: a prospective study J Am Coll Cardiol 1994 23 Daniel WG Erbel R Kasper W Visser CA Engberding R Sutherland GR Safety of transesophageal echocardiography: A multicenter survey of 10,419 examinations Circulation 1991 83 Adams HP Kapelle U Biller J lschemic stroke in young adults:: experience in 329 patients enrolled in the lowa registry of stroke in young adults Arch Neurol 1995 52 Brickner E Cardioembolic stroke Am J Med 1996 100 Bogousslavsky J Regli F lschemic stroke in aduits younger than 30 years of age: cause and prognosis Arch Neurol 1987 44 Donnan G lnvestigation of patients with stroke and transient ischaemic attacks Lancet 1992 339 Provenzale JM Barboriak DP Brain infarction in young adults:: etiology and imaging findings Am J Roentg 1997 169 Khatibzadeh M Mitusch R Stierle U Gromoll B Sheikhzadeh A Aortic atheroscierotic plaques as a source of systemic embolism J Am Coll Cardiol 1996 27 Horowitz DR Tuhrim S Budd J Goldman ME Aortic plaques in patients with brain ischemia:: diagnosis by trnsesophageal echocardiography Neurology 1992 42 Karalis DG Chandrasekan K Victor MF Ross JJ Mintz GS Recognition and embolic potencial of intraaortic atheroscierotic debris J Am Coll Cardiol 1991 17 Autore C Cartoni D Piccininno M Multiplane transesophageal echocardiography and stroke Am J Cardiol 1998 81 Hausmann D Gulba D Bargheer K Niedermayer J Comess KA Daniel WG Succesful thrombolysis of al aortic-arch trhrombus in a patient after mesenteric embolism N Engl J Med 1992 327 Freedberg RS Tunick PA Culliford AT Tatelbaum RJ Kronzon Y Disapperance of a large intraaortic mass in a patient with prior systemic embolization Am Heart J 1993 125 Bansal RC Pauis GL Shankei SW Blue digit syndrome: transesophageal echocardiographic identification of thoracic aortic plaque-related thrombi and successful outcome with wafarin J Am Soc Echocardiogr 1993 6 Craig WR Dressler FA Vaughn RN Castello R Dolan M Labovitz AJ Mobile aortic debris in patients with cerebral ischemia: serial morphologic changes seen on repeat transesophageal echocardiography J Am Soc Echocardiogr 1996 9 Culliford AT Tunick PA Katz ES Kronzon Y Galloway AC Ribakove GH lnitial experience with removal of protruding atheroma from the aortic arch: diagnosis by transesophageal echo, operative technique and follow-up J Am Coll Cardiol 1993 21
S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100004 Electrofisiología intervencionista: procedimientos diagnósticos y terapéuticos en arritmias cardíacas Araya Gómez Vivien ,Instituto del Corazón San José Costa Rica 09 1999 1999 1 9 19 Singer I lnterventional Electrophysiology lnterventional Electrophysiology 1997 First edit Edit. Williams Wilkins Estella J Manual de Electrocardiografia Manual de Electrocardiografia 1972 4° Madrid Edit. Graficesa Krikier D Clín Cardiol NA 1987 3 Kirk J Invención y reinvención de la estimulación eléctrica cardiaca Cín Cardiol NA 1992 4 Cobb FR Successfull surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White-Syndrome Circulation 1968 38 Sunid N Haines D Biophysics and Pathology of Catheter Energy Delivery Systems Progress Cardiovascular Diseases 1995 XXXVII Guidelines for Clinical Electrophysiology and Catheter Ablation Procedures Circulation 1995 92 Strauss HC Premature atrial stimulation as a key to understanding of sinoatrial conduction in man Circulation 1973 47 Narula OS A new method for measurement of sinoatrial conduction time Circulation 1978 58 Vanderpol incidence and clinical significance of induced ventricular tachycardia Am J Cardiol 1980 45 Morady F Evaluación del síncope con el estudio electrofisiológico Cín Cardiol NA 1986 3 lturralde P Araya-Gómez V Colín L A new ECG algorithm for the localization ofaccessory pathways using only the polarity of the QRS complex J Electrocardiology 1996 29 Guidelines for implantation of Cardiac Pacemakers and Antiarrhythmia Devices Circulation 1998 97 Turquieh F Freedman R Bradycardia Pacing:: Which Device and When? Bradycardia Pacing:: Which Device and When? 1997 Santini M Alexidou G Ansalone G Relation of prognosis in sick sinus syndorme to age, conduction defects and modes of permanent pacing Am J Cardiol 1990 65 Araya V López L Hermosillo JA El marcapaso DDD por vía transvenosa Arch lnst Cardiol Méx 1995 65 O'Nunain S Ruskin JN Cardiac Arrest Lancet 1993 341
S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100005 Síndromes coronarios agudos e inhibidores de las glicoproteinas llb llla Rodríguez Antonio Calzada Norberto Pichel Daniel Núñez Percy Arrocha Alberto Motta Jorge ,Hospital Paitilla Ciudad de Panamá Panamá 09 1999 1999 1 22 28

El papel protagónico de las plaquetas en la patogénesis de los síndromes coronarlos agudos es cada vez más evidente. El manejo farmacológico de los mismos era inicialmente orientado a contrarrestar un proceso trombático fibrino-específico sin considerarse la importante participación de las plaquetas en la fisíopatología de los mismos. Desde 1994 se integran al tratamiento los inhibidores de las glicoproteínas Ilb llla como antiplaquetarios específicos, obteniéndose una disminución significativa en la morbi-mortalidad cardio vascular. Queremos presentar nuestra experiencia preliminar con el uso de estos fármacos en pacientes de alto riesgo.

Antiplatelet agents play an important role in the management of acute coronary syndromes. Recently, glycoprotein llb/llla inhibitors have appeared in the therapeutic armamentarium. Our initial experience with small number of patient already give a good idea about the complementary role of the these agents in the management of complicated acute coronary syndromes. We demonstrated their usual and accepted indications and the potential future role as thrombolitic agents.

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S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100006 Shock cardiogénico Obón Arellano Alfonso ,Clínica Burstin San José Costa Rica 09 1999 1999 1 29 37 Antman E Braunwald E Acute Myocardial infarction Braunwald Heart Disease Braunwald Heart Disease 1997 5th O'gara P Fuster V Primary Pump Failure Atherosclerosis and Coronary Artery Disease Atherosclerosis and Coronary Artery Disease 1996 Antman E Braunwald E Acute Myocardial infaction Principies of Internal Medicine Principies of Internal Medicine 1998 14th Klein Ll Cardiogenic Shock Parrillo Current Therapy in Critical Care Medicine Parrillo Current Therapy in Critical Care Medicine 1997 3 th Ryan Jt Anderson J Antman ACC/AHA. 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S1409-414219990001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41421999000100007 Heparinas de bajo peso molecular en el tratamiento de los síndromes coronarios agudos (SCA) Speranza Sánchez Mario Sáenz MadrigaI Manuel Eduardo ,Hospital Clínica Bíblica San José Costa Rica 09 1999 1999 1 38 42

Los síndromes coronarios agudos (SCA) están comprendidos entre la angina crónica estable y el infarto agudo del miocardio (IAM) en el espectro clínico de la enfermedad arterial coronaria (EAC), pero biológicamente refleja la EAC en su forma más peligrosa. Mientras que la mortalidad por IAM ha caído en los últimos años la frecuencia de hospitalización por angina inestable (Al) continúa en aumento, esto probablemente refleje un incremento en el número total de sobrevivientes con EAC más compleja, quienes han sobrevivido más tiempo debido a los avances en el tratamiento de la misma. Por lo tanto es probable que el problema de los (SCA) sea más frecuente en el futuro. Nuevas modalidades diagnósticas y terapéuticas hacen posible ser más precisos en el control de los pacientes y así lograr mejorar la sobrevida, prevenir el IAM, reducir la estancia hospitalaria y las complicaciones secundarias de la isquemia crónica. El tratamiento antitrombótico con heparina regular más aspirina reduce la frecuencia de eventos isquémicos en pacientes con SCA. Las Heparinas de Bajo Peso Molecular son una nueva clase de anticoagulantes que están reemplazando a la heparina regular en muchas indicaciones, tienen un efecto anticoagulante más predecible que la heparina, son más fáciles de administrar y en general no necesitan de monitoreo de laboratorio. En ésta revisión se resume y comentan los principales hallazgos en éste tema.

The acute ischemic syndrome falls between chronic stable angina and acute myocardial infarction (MI) in the clinical spectrum of coronary artery diseatse (CAD), but biologically reflects CAD in its most dangerous form. While the death rate from Mi has fallen in recent years, the rate of hospitalization for unstable angina continues to rise, this likely reflects an increase in the total number of CAD survivors with complex coronary disease, who are living longer due to advances in CAD management. lt is therefore likely that unstable angina will become an even more frequent problem in the future. Newer diagnostic and treatment modalities make it possible to target more precisely the underlying biologic insult in unstable angina patients and therby improve survival, prevent MI, reduce hospital length of stay and prevent disability and subsequent ischemia-related long-term complications.The antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events in patients with unstable coronary artery disease. Low-molecular-weight heparin are a new class of anticoagulants that are replacing heparin for many indications, has a more predictable anticoagulant effects than standard unfractionated heparin, is easier to administer, and does not require monitoring. This review aims to summarize and to comment on the principal findings of this topic.

 Síndromes coronarios agudos heparina regular heparinas de bajo peso molecular Acute ischemic syndrome unfractionated heparin low-molecular-weight heparin Pepine Carl J Schofield Richard S New Trends in the Managment of Unstable Angina Cardiology Special Edition 1999 5 ^s°1 Gurfinkel Enrique P Heparina de Bajo Peso Molecular Versus Heparina Regular o Aspirina en el Tratamiento de Angina Inestable e lsquemia Silenciosa J Am Coll Cardiol 1995 26 Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease Lancet 1990 336 Cohen M Adams PC Parry G Combination antithrombotic therapy in unstable rest angina and non Q wave infarction in non prior aspirin users. Primary end points analysis from the ATACS trial Circulation 1994 89 Armstrong Paul W Heparin in Acute Coronary Disease - Requiem for a Heavyweight? New Eng J Med 1997 337 Guide to Anticoagulant Therapy Guide to Anticoagulant Therapy Frishman William H Sonnenblick Edmund H Cardiovascular Pharmacotherapeutics Cardiovascular Pharmacotherapeutics 1997 chapter 17 McGraw-Hill Companies Hirsh Jack Heparin and Low-Molecular-Weight Heparin Chest 1998 114 Cohen M Demers C Gurfinkel EP A comparasion of low molecular weight heparin with unfractionated heparin for unstable coronary artery disease New Eng J Med 1997 337 Fragmin during lnstability in Coronary Artery Disease Lancet 1996 347 Klein W Buchwald A Hillis SE Comparison of low molecular weigth heparin with unfractionated heparin acutely and with placebo for 6 weeks in the managment of unstable coronary artery disease study (FRIC) Circulation 1997 96 Hirsh Jack Heparin and Low-Molecular-Weigth Heparin Chest 1998 114 Early lnvasive vs Early Noninvasive Manangement in Unstable Coronary Artery Disease: ACC'99 CME Online Early lnvasive vs Early Noninvasive Manangement in Unstable Coronary Artery Disease: ACC'99 CME Online Annual Scientific Session March 7- 10, 1999 Henrik Toss Walientin Lars lnfluences of Sex and Smoking Habits on Anticoagulant Activity in Low Molecular Weigth Heparin Treatment of Unstable Coronary Artery Disease Am Heart J 1999 137 ^s1