S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100001 Speranza Sánchez Mario O , 04 2000 2000 2 2 2
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100002 Variabilidad de la frecuencia cardíaca en individuos sanos costarricenses Gutiérrez Sotelo Oswaldo ,Universidad de Iberoamérica Facultad de Medicina Cátedra de Fsiología Humana San José Costa Rica 04 2000 2000 2 2 10

Introducción. El análisis de la variabilidad de la frecuencia cardíaca (VFC), refleja la influencia autonómica sobre el corazón pudiendo ser predictivo de mortalidad. Consiste en el análisis de las variaciones de los intervalos RR. Este estudio analizó la VFC en individuos sanos costarricenses. Materiales y Métodos. Fueron elegidos adultos asintomáticos. En la adquisición de datos se utilizó una derivación electrocardiográfica estándar y se calcularon variables tanto en Dominio de Tiempo como en Dominio de Frecuencia. Se compararon los resultados desde registros de 5 minutos y de 10 minutos y se compararon diferentes grupos etáreos dividiéndose a la población en grupos: 18 a 29 años, 30 a 39 y 40 y también entre &lt; 25 años y 25. Resultados. Se estudiaron 48 individuos, 25 mujeres y 23 varones (rango 18 y 53). No se encontró diferencias en los valores promedio según el tiempo de registro del trazado electrocardiográfico. Sí se encontraron entre grupos 18 a 29 versus 40 años y &lt;25 vs 25 en el NN50 (231.432 vs 34.500, p = 0.004 en el primer grupo y 237.250 vs 53.250, p<0.001 en el segundo), el %NN50 (30.732 vs 5.2, p=0.003 y 31.444 vs 9.742, p=0.001 respectivamente), LF (457.338 vs 173.393, p=0.045 y 466.816 vs 259.361, p=0.042 respectivamente) y HF (750.667 vs 239.865, p=0.068 y 766.834 vs 248.436, p=0.010 respectivamente) sin diferencias, como era de esperar en la relación LF/HF. Conclusiones. Este estudio aporta valores de referencia para comparaciones futuras o para valoración individual del tono autonómico. Las diferencias entre grupos de edades distantes sugiere que la edad fisiológicamente ocasiona un progresivo incremento en el tono simpático sobre el parasimpático y una disminución de los componentes del espectro. Esta hipótesis requiere mayor investigación.

Introduction. Heart rate variability analysis evaluate the autonomic influence over the heart and therefore, is a predictive tool of mortality. It consists in the analysis of the variations in RR intervals. This study assessed heart rate variability in healthy costarrican people. Materials and Methods. We included adult healthy volunteers. For data adquisition we used a single electrocardiographic lead and calculate time and frequency domain variables. We compared results between 5 minutes versus 10 minutes samples and between age groups: 18 to 29 years old, versus 30 to 39 versus 40 or &lt; 25 years old versus 25. Results. We studied 48 subjects, 25 women and 23 men (range 18 y 53). We do not obtained differences between time of data adquisition samples but find differences between 18-29 vs 40 and &lt;25 vs 25 age groups in NN50 (231.432 vs 34.500, p = 0.004 in the fisrt group, 237.250 vs 53.250, p<0.001, the second, %NN50 (30.732 vs 5.2, p=0.003 and 31.444 vs 9.742, p=0.001 respectively, LF (457.338 vs 173.393, p=0.045 and 466.816 vs 259.361, p=0.042 respectively) and HF (750.667 vs 239.865, p=0.068 and 766.834 vs 248.436, p=0.010 respectively). Conclusions. This study support reference values for comparision or to individual autonomic tone evaluation. Differences between distant age groups suggest that aging increases progressively simpathetic tone over parasimpathetic tone or a decrease in bands of the spectrum. This hypotesis need further investigation.

 Variabilidad de la frecuencia cardíaca Tono autonómico Edad Autonomic Tone Heart Rate Variability Aging Jimenez RA Myerburg RJ Crawford MH Sudden Cardiac Death: Magnitude of the problem, Substrate/Trigger Interaction, and Populations at Risk Cardiac Arrhythmias and related Sindromes: Current Diagnosis and Management Cardiac Arrhythmias and related Sindromes: Current Diagnosis and Management 1993 11 Philadelphia WB Saunders Heart Rate Variability: Standard of Measurement, Physiological Interpretation and Clinical Use Circulation 1996 93 Kleiger RE Miller JP Bigger JT Moss AJ Decreased Heart Rate Variability and its Association with increased Mortality After Acute Myocardial Infarction Am J Cardiol 1987 59 Freeman R Saul JP Roberts MS Spectral Analysis of Heart Rate in Diabetic Autonomic Neuropathy Arch Neurol 1991 41 Soejima K Akaishi M Suzuki Y Meguro T Yoshikawa T Mitamura H Handa S Ogawa S Age-corrected heart rate variability as an index of the severity of heart failure in patients with left ventricular dysfunction Eur Heart J 1994 ^s15 Gunzzetti S Iosa D Pescis M Effects of Simpathetic Activation on Heart Rate Variability in Chagas' patients J Autonom Nerv Syst 1990 3079 Bigger JT Heart Rate Variabilility Analisys J Amb Monit 1994 7 Dubner S Bozovich G Gutiérrez O Perrone S Favaloro R Evaluación de la Variabilidad de la Frecuencia Cardíaca en Receptores de Trasplante Cardiaco Ortotópico: Su Comparación con Normales Diagnóstico Evaluación de la Variabilidad de la Frecuencia Cardíaca en Receptores de Trasplante Cardiaco Ortotópico: Su Comparación con Normales Diagnóstico 1993 11 Buenos Aires Gutiérrez OJ Variabilidad de la frecuencia cardiaca: Aplicaciones en cardiología Acta Médica Costarricense 1999 Kamen PW Tonkin AM Application of the Poincaré plot to Heart Rate Variability: A New Measure of Functional Status in Heart Failure Aust NZ J Med 1995 25 Ferrara N Davia K Abete P Rengo F Harding SE Alterations in Beta-adrenoreceptor Mechanisms in the Aging Heart: Relationship with Heart Failure Aging (Milano) 1997 9 Effects of Aging on Neuroendocrine Activation in Subjects and Patients in the Presence an Abcense of Heart Failure with Left Ventricular Dysfunction Am J Cardiol 1996 77 A Randomizad Trial of Propranolol in Patients with Acute Myocardial Infarction: I.Mortality Results JAMA 1982 247 Packer M Do Beta-blockers prolong survival in chronic heart failure? Eur Heart J 1998 19 ^sB Yamasaki Y Kodama M Matsuhisa M Kishimoto M Ozaki H Tani A Ishida Y Kamada T Diurnal Heart Rate Variability in Healthy Subjects: Effects of Aging and Sex Differences Am J Physiol 1996 27
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100004 La comunicación interventricular Castro B Abdon ,CCSS Hospital Nacional de Niños San José Costa Rica 04 2000 2000 2 21 26 Castro A Cardiopatías congénitas Rev Méd.Nal Niñs 1979 Moss Adams Heart disease in infants, children and adolescents Heart disease in infants, children and adolescents 1995 Fiftth edition Williams and Wilkins Castañeda A Jonas R Mayer Hanley Cardiac surgery of the neonate and infant Cardiac surgery of the neonate and infant 1994 W.B Saunders Company Silverman Norman Pediatric Echocardiography Pediatric Echocardiography 1993 Baltimore^eMaryland Williams and Wilkins García Fernández MA Doppler cardiaco Doppler cardiaco 1988 Madrid Interamericana-McGraw Hill
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100005 Accidente vascular cerebral: ¿es el accidente vascular cerebral una enfermedad tratable? Chaves Sell Franz ,Hospital Clínica Bíblica San José Costa Rica 04 2000 2000 2 27 33 Health Conditions in the Americas 1994 Health Conditions in the Americas 1994 1994 1 Washington DC PAHO, Sei Publ Whisnant JP Changing Incidence and Mortality Rates for Stroke J Stroke Cerebrovascular Disease 1992 2 Wolf PA D'Agnostino RB Belanger AJ Kannel WB Probability of stroke: a risk profile from the Framingham Study Stroke 1991 22 Bonita R Epidemiology of Stroke Lancet 1992 339 Shinton R Beevers G Meta-analysis of relation between cigarrette smoking and stroke Brit Med J 1989 298 Davis P Hachinski V Epidemiology of Cardiovascular Disease.Neuroepidemiology CRC Press 1991 Sacco RL Elemberg JH Mohr JP Infarcts of undetermined cause: The NINCDS Stroke Data Bank Ann Neurol 1989 25 Adams HP Kappelle LJ Biller J Gordon DL Love BB Gomez F Heffner M Ischemic stroke in young adults: Experience in 329 patients enrolled in the Iowa Registry of Stroke in Young Adults Arch Neurol 1995 52 A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) Lancet 1996 348 ^s9038 Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis N Engl J Med 1991 325 Kay R Wong KS Yu YL Chan YW Tsoi TH Ahuja AT Chan FL Fong KY Law CB Wong A Woo J Low-molecular-weight heparin for the treatment of acute ischemic stroke N Engl J Med 1995 333 The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke Lancet 1997 349 Hacke W Kaste M Fieschi C Intravenous thrombolysis with rTPA for acute hemispheric stroke ECASS. JAMA 1995 274 Tissue plasminogen activator of acute ischemic stroke N Eng J Med 1995 333 Tissue plasminogen activator for acute ischemic stroke N Engl J Med 1995 333 Intracraneal hemorrage after intravenous t-PA therapy for ischemic stroke Stroke 1997 N ov 28 ^s11 Wardlow Lancet 1997 350 Joseph P Broderick M.D AAN: Annual Meeting AAN: Annual Meeting 1998 Mineapolis^eMinnesota Adams HP Brott TG Crowell RM Guidelines for the management of patients with acute ischemic stroke: A statement for Healthcare Professionals from a Special Writing Group of the Stroke Council, American Heart Association Stroke 1994 25
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100006 Ecocardiografía con estrés farmacológico Esquivel Alfaro María Lidiette ,CCSS Hospital Mexico San José Costa Rica 04 2000 2000 2 35 46 1996 Berman DS Kiat H Van train KF García E Fiedman J Maddahi J Tc-99m sestamibi imaging in the assessment of chronic coronary artery disease Sem Nucl Med 1991 21 Fintel DL Links JM Brinker JA Frank TL Parker M Becker LC Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging the diagnosis of coronary artery disease: a receiver operating characteristic analysis J Am Coll Cardiol 1989 6 Kiat H Maddahi J Yoy LT Comparison of technetium 99m methoxy isobutyl isonitrilo with thallium evaluation of coronary artery disease by planar and tomografic methods Am Heart J 1989 117 Sherif FN Zoghbi W Stress echocardiography for the assessment of myocardial ischemia and viability Curr Probl Cardiol 1996 21 Rahhimtoola SH The hibernating myocardium Am Heart J 1989 117 Brundage Bh Massie BM Botvinick EH Improved regional ventricular function after successful surgical revascularization J Am Coll Cardiol 1984 3 Cohen M Charney R Hershman R Fuster V Gorlin R Reversal of chronic ischemic dysfunction after transluminal coronary angioplasty J Am Coll Cardiol 1988 12 Dilsiazian V Bonow R Current diagnostic thecnique of assessing myocardial viability in patients with hibenating and stunned myocardium Circulation 1993 87 Krautz RF Kennedy JW Ultrasonic determination of left ventricular wall motion in normal man: studies at rest and after exercise Am Heart J 1970 79 Crawford MH White DH Wray AK Echocardiographic evaluation of ventricular size and performance during handgrip and supine and upright bycicle exercise Circulation 1979 59 Mason SJ Weiss JL Weisfeldt M Exercise echocardiography: detección of wall motion abnormalities during ischemia Circulation 1979 59 Wann LS Faris JV Childress RH Exercise cross sectional echocardiography in ischemic heart disease Circulation 1979 60 Zuel W Gueret P Meerbaum S Quantitative two-dimentional ecocardiography during bycicle exercise in normal subjects Am J 1981 47 Maurer G Nanda NC Two dimentional ecocardiographic evaluation of exercise induced left and right ventricular asynergy: Correlation with thallium scanning Am J Cardiol 1981 48 Limacher MC Quiñones MA Poliners LS Detection of coronary artery disease with exercise two-dimentional echocardiography: description of a clinically applicable method and comparison with radionuclide ventriculography Circulation 1983 67 Siu SCB Weyman A Weyman A Left ventricle III: Coronary artery disease- Clinical manifestations and complications Principles and practice of echocardiography Principles and practice of echocardiography 1994 2nd Philadelphia Lea and Febiger Popp R Agastson A Amstrong W Nanda N Pearlman A Rokowsky H Recomendations for training in performance and interpretation of stress echocardiography J Am Soc Echocardiogr 1998 11 Amstrong W Pellikka P Ryan T Crouse L Zoghbi W Stress Echocardiography: Recommendations for performance and interpretation of stress echocardiography J Am Soc Echocadiogr 1998 11 Zoghby WA Use of adenosine echocardiography for diagnosis of coronary artery disease Am Heart J 1991 122 Becker LC Conditions for vasodilator- induced coronary steal in experimental myocardial ischemia Circulation 1978 57 Leppo JA Comparison of pharmacologic stress agents Nucl Cardiol 1996 3 Lewandodowsky T Amstrong W Back D Reduced time by early Identification of patients requiring atropine during dobutamine stress echocardiography J Am Soc Echocardiogr 1998 11 Cohen J Ottenweller J George A Comparison of dobutamine and exercise echocardiography for detecting coronary artery disease Am J of Cardiology 1993 72 Geleijnse ML Fioretti PM Roelandt JR Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography J Am Coll Cardiol 1997 30 Segars DS Brown SE Sawada SG Ryan T Feigenbaum H Dobutamine stress echocardiography: correlation with coronary lession severity as determined by quantitative angiography J Am Coll Cardiol 1992 Bach DS Muller W Gross BJ False positive dobutamine stress echocardiograms: characterization of clinical, echocardiografic and angiographic findings J Am Coll Cardiol 1994 24 Marwick T D' Hondt AM Baudhuim T Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: combination with echocardiography or scintigraphy, or both? J Am Coll Cardiol 1993 22 Makeuchi M Araky M Makashima Y Comparison of dobutamine stress echocardiography and stress thallium 201 single-photon emission computed tomography for detecting coronary artery disease J Am Soc of Echocardiography 1993 5 Mc Neil AJ Fioretti PM el-Siad EM Enhanced sensibility for detection of coronary artery disease by addition of atropine to dobutamine stress echo-cardiography Am J Cardiol 1992 70 Senior R Lahiri A Enhanced detection of myocardial ischemia by stress dobutamine echocardiography utilizing the biphasic response of wall thickening during low and high dose dobutamine infusion J Am Coll Cardiol 1995 26 Beleslin B Ostojic M Stepanovic J Stress echocardiography in the detection of myocardial ischemia: head to head comparison of exercise, dobutamine and dipyridamole tests Circulation 1994 90 Sawada SG Segars DS Ryan T Echocardiographic detection of coronary artery disease during dobutamine infusion Circulation 1991 83 Trippi JA Kops G Lee KS The feasibility of dobutamine stress echocardiography in the emergency department with telemedicine tnterpretation J Am Soc Echocardiogr 1996 9 Geleijnse ML Elhendy A van Domburg RT Conel JH Roelandt J Fioretti PM Prognostic implications of normal dobutamine stress echocardiogram in patients with with chest pain J Am Soc Echocardiogr 1998 11 Sckolnick D Panchal V Finenberg N Corya B Segars D Feingenbaum H Sawada S Dobutamine Echocardiography predicts cardiac death after myocardial infarction J Am Soc Echocardiogr 1998 11 Elhndy A van Domburg RT Nierop P Geleijnse M Bax JJ Jaroslaw D Impaired systolic blood pressure response to dobutamine stress testing: A marker of more severe funcional abnormalities in patients with myocardial infarction J Am Soc of Echocardiogr 1998 11 Davila-Román VG Waggoner AD Sicard AG Dobutamine stress echocardiography predicts surgical outcome in patients with aortic aneurysm and peripheral vascular disease J Am Coll of Cardiol 1993 21 Poldermans D Fioretti PM Foster T Dobutamine stress echocardiography for the assessment of perioperative cardiac risk patients undergoing major vascular surgery Circulation 1193 87 Piérdad LA de Landsheere CM Berthe C Rigo P Kulbertus HE Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolitic therapy: Comparison with positron emission tomography J Am Coll Cardiol 1990 15 Marzullo P Parodi O Reisenhofer B Sambuceti G Picano E Distante A Value of rest thallium/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability Am J Cardiol 1993 71 Schulz R Miyazaki S Miller M Consequences of regional inotropic stimulation of ischemic myocardium on regional myocardial blood flow and function in anesthetized swines Circ Res 1989 111 Baer F Voth E Deutsch H Schneider C Schicha H Sechtem U Assessment of viable myocardium by dobutamine transesophageal echocardiography and comparison with flourdesoxyglucose positron emission tomography Cigarroa CG de Filippi CR Brickner ME Alvarez LG Wait MA Grayburn PA Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization Circulation 1993 88 Mertes H Sawada SG Ryan T Symptoms adverse effects, and complications associated with dobutamine stress echocardigraphy: experience in 1118 patients Circulation 1993 88 Secknus MA Marwick TH Evolution of dobutamine echocardiography protocols and indications: safety and side effects in 3011 studies over 5 years J Am Coll Cardiol 1997 29 Weidmann B Lepique C Jansen W Stoiber W Taucher M Myocardial Infarction as a complication of dobutamine Stress Echocardiography J Am Soc Echocardiogr 1997 10 Daniels C Orsenelli D Cardiac rupture with dobutamine stress echocardiography J Am Soc Echocardiogr 1997 10 Cornell JH Balk AH Boersma E Safety and feasibility of dobutamine-atropine stress ecocardiography in patients with left ventricular disfunction J Am Soc Echocardiogr 1996 9 Picano E Mathias W Pingitore A Bigi R Previtali M On behalf of the echo dobutamine international cooperative study group. Safety and tolerability of dobutamine-atropine stress echocardiography: a prospective multicenter study Lancet 1994 344 Verani MS Mahmarian JJ Hixson JB Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise Circulation 1990 82 Tawa CB Baker WB Kleiman NS Trakhtenbroit A Desir R Zoghbi WA Comparison of adenosine echocardiography with and without isometric handgrip to exercise echocardiography in the detection of ischemia in patients with coronary artery disease J Am Soc Echocardiogr 1996 9 Marwick T Willermart B D Hondt AM Selection of the optimal non exercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion: comparison of dobutamine and adenosine using echocardiography and 99m Tc-MIBI single photon emission computed tomography Circulation 1993 87 Fitzgerald GA Dipyridamole N Engl J Med 1987 316 Verani MS Pharmacologic myocardial perfusion imaging J Myocard ischemia 1993 5 Klabunde RE Dipyridamole inhibition of adenosine metabolism in human blood Eur J Pharmacol 1983 93 Homma S Callahan RJ Ameer B Usefulness of oral dipyridamole suspension for stress thallium imaging in the detection of coronary artery disease Am J Cardiol 1986 57 Gould KL Noninvasive assessment of coronary stenosis by myocardial perfusion imaging during pharmacologic coronary vasodilation. I. Physiologic basis and experimental validation Am J Cardiol 1978 41 Gould KL Lipscomb K Hamilton GW Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional ditribution during coronary hyperemia as measures of coronary flow reserve Am J Cardiol 1974 33 Gross GJ Waltier DC Coronary steal in four models of single or multiple vessel obstruction in dogs Am J Cardiol 1981 48 Patterson RE Kirk ES Coronary mechanisms in dogs with one vessel oclusion and other arteries normal Circulation 1983 67 Picano E Lattanzi F Massini M High dose dipyridamole echocardiography test in effort angina pectoris J Am Coll Cardiol 1986 8 Cheirif JB Zoghbi WA Bolli R Assessment of regional myocardial perfusion by contrast echocardiography. II.Detection of changes in transmural and subendocardial perfusion during dipyridamole induced hiperemia in a model of critical coronary stenosis J Am Coll Cardiol 1989 14 Picano E Marini C Pirelli S Safety of intravenous high-dose dipyridamole echocardiography: The Echo-Persantine International Cooperative Study Group Am J Cardiol 1992 70 Dagianti A Penco M Agati Stress echocardiography: comparison of exercise, dipyridamol, and dobutamine in detecting and predicting the extent of coronary artery disease J Am Coll Cardiol 1995 26
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100007 Estudios de perfusión en cardiología, un enfoque clínico Rodriguez Antonio Nuñez Percy Pichel Daniel Motta Jorge Arrocha Alberto Calzada Norberto ,Centro Médico Paitilla Ciudad de Panamá Panamá 04 2000 2000 2 47 56 Wackers FJT Thallium 201 Myocardial scintigraphy in acute myocardial infarction and ischemia Seminar Nuclear Med 1980 10 Abbate LA Biagen A Michelassi E Myocardial kinetics of thallium and potassium in man Circulation 1979 60 Weich HF Strauss HW PIHB. The extraction of Thallium 201 by myocardium Circulation 1977 56 Turner JD Shwartz KM Logic JR Detection of residual jeopardized myocardial infarction by exercise testing with Thallium 201 myocardial scintigraphy Circulation 1980 61 Ritchie JL Zaret BL Strauss HW Myocardial imaging with Thallium 201, a multicenter study in patient with angina pectoris or acute myocardial infarction Am J Cardiol 1978 42 Osbakken MD Okada RD Boucher CA Comparison of exercise perfusion and ventricular function imaging: An analysis of factors affecting the diagnostic accuracy of each technique J Am Coll Cardiol 1984 3 De Pasquale EE Nody AC De Puy E Quantitative rotational Thallium 201 tomography for identifying and localizing coronary artery disease Circulation 1988 77 Detrano R Janosi Lyons KP Factors affecting sensitivity and specificity of Diagnostic test Am J Med 1988 84 Mahmarian JJ Verani MS Exercise Thallium 201 perfusion scintigraphy in the Assesment of coronary artery disease Am J Cardiol 1991 67 Hung J Chaitman BR Lam J Noninvasive diagnostic test choices for the evaluation of coronary artery disease in woman: A multivariate comparison of exercise electrocardiography and exercise thallium 201 myocardial perfusion scintigraphy J Am Coll Cardiol 1984 4 Hockings B Saltissi S Croft DN Effect of beta adrenergic blockade an Thallium 201 myocardial perfusion imaging Br Heart J 1983 49 Iskandrian AS Heo J Kong B Lyons E Effects of exercise level on the ability of Thallium 201 tomography imaging in detecting coronary artery desease: Analysis of 461 patients J Am Coll Cardiol 1989 4 McCarthy DM Blood DK Sciacca RR Single dosis myocardial perfusion imaging with Tallium 201 application in patient with nondiagnostic electrocardiography stress test Am J Card 1979 43 Esquivel L Pollock SG Beller GA Effect of the degree of effort on the sensitiivity of the exercise Thallium 201 stress test in symptomatic coronary artery desease Am J Cardiol 1983 63 Brown KA Osbakkaen M Boucher RD Positive exercise Thallium 201 test in patient with less 50% coronary stenosis, angiography and clinical predictor Am J Cardiol 1985 55 Eng C Patterson RE Horowitz SF Coronary colateral function during exercise Circulation 1982 66 Rigo P Bailey IK Griffith LSC Valeu and limitation of segmental analysis of stress Thallium 201 myocardial imaging for localization of coronary artery disease Circulation 1980 61 Fintel DJ Links JM Brinker JA Improved diagnostic performance of exercise Thallium 201 SPECT over planes imaging in the diagnosis of coronariy artery disease. A receiver operating characteristic analysis J Am Coll Cardiol 1989 13 Wacker FJ Lie KI Liem KL Thallium in unstable angina pectoris Circulation 1978 57 Dilsizian V Thallium 201 reinjection after stress redistribution imaging improve detection of ischemic myocardium: A qualitative and quantitative spect study J Am Coll Cardiol 1990 15 Dilsizian V Smeltzer WR Freedman NMT Enhanced detection of ischemic but viable myocardium by the reinjection of Thallium 201 after stress redistribution imaging N Engl J Med 1990 323 Ragosta M Beller GA Watson DD Quantitative planar rest redistribution Thallium 201 imaging in detection of myocardial viability and prediction of improvement in left ventricular function after corinary bypass surgery in patient with severily depressed left ventricular funtion Circulation 1993 37 Medrano R Mahmarian JJ Ashmore RF The enhaced detection of myocardial viability with Thallium 201 reinjection after nitroglycerin. A randomized,double blind, parallel, placebo controlled trial using quantitative tomography (Abstr) Circulation 1992 86 Wilde P Walker P Watt I Thallium 201 myocardial imaging: Recent experience using a coronary vasodilator Clin Radiol 1982 33 Josephson MA Brown G Hetcht HS Non invasive detection and localization of coronary stenosis in patient: Comparison of resting dypiridamol and exercise Thallium 201 myocardial perfusion imaging Am Heart J 1982 103 Chan Sy Brunken Rc Czernin J Comparison of maximal myocardial blood flow during adenosina infusion with that of intravenous dipyridamol in normal men J Am Coll Cardiol 1992 20 Verani MS Adenosine Thallium 201 myocardial perfusion scintigraphy Am Heart J 1991 122 Verani MS Pharmacologic stress myocardial perfusion imaging Curr Prob Cardiol 1993 18 Bellardinelli L Linden J Berne RM The cardiac effect of adenosine Prog Cardiovasc Dis 1989 32 Siffring PA Gupta NC Mohiuddin SM Myocardial uptake and clearance of Thallium 201 in healthy subject: Comparison of adenosina induce hyperemia and Exercise stress Radiology 1989 173 Verani Ms Mahmarian JJ Hixson JB Diagnostic of coronary artery disease by controlled coronary vasodilation with adenosina and Thallium 201 scintigraphy in patient unable to do exercise Circulation 1990 82 Crea F Pupita G Galassi AR Role of adenosina in pathogenesis of anginal pain Circulation 1990 81 Watt Ah Reid PG Stephen MR Adenosine induced respiratory stimulation Depende on site of infusion. Evidence for an action on the carotid body? Br. J. Clin Pharmacol 1986 22 Nishimura S Kimball KT Mahmarian JJ Angiography and hemodynamic determinants of myocardial ischemia during adenosina Thallium 201 and scintigraphy in coronary artery disease Circulation 1993 87 Gupta NC Esterbrooks DJ Hilleman DE Comparison of adenosina and exercise Thallium 201 single-photon emission computed tomography (SPECT) myocardial Perfusion imaging J. Am Coll Cardiol 1992 19 Nguyen T Heo J Ogylby JD Single photon emission computed tomography with Thallium 201 during adenosina induced coronary hyperemia-correlation with coronary arteriography, exercise Thallium imaging and two dimentional echocardiography J Am Coll Cardiol 1990 16 Nishimura S Mahmarian JJ Boyce TM Equivalence between adenosina and exercise Thallium 201 myocardial tomography: A multicenter prospective crossover trial J Am Coll Cardiol 1992 20 Carvallo PA Chiu ML Kronauje JF Subcelular distribution and analysis of technetium 99 MIBI in isolated perfused rat heart J Nucl Med 1992 33 Taillefer R Primeau M Costi P Technetium 99 sestamibi, myocardial perfusion Imaging in detection of coronary artery disease. Comparison between initial (3hour) and (3hour) post-exercise image J Nucl Med 1991 32 Diamond Ga Forrester JS Analysis of probability as an aid in the clinical diagnostic of coronary artery disease N Engl Med 1979 300 Diamond Ga Forrester JS Hirsh M Staniloff HM Vas R Berman D Swan JJC application of conditional probability analysis to the clinical diagnostic of coronary artery disease J Clin Invest 1980 65 Rozamki A Diamond GA Forrester JS Berman D Morris D Swan HJC comparison of alternative referent standards of cardiac normality. Implication for diagnostic testing Ann Inter Med 1984 101 Maddahi J Jiat H Van train K Prigent F Friedman TD Garcia E Alazraki N De Puy G Nichols K Berman D Myocardial perfision imaging with technetium 99 Sestamibi SPECT in the evaluation of coronary artery disease Am J Cardiol 1990 66 Kiat H Middahi J Roy LT Comparison of technetium 99 methoxy-isonitrile and Thallium 201 for evaluation of coronary artery disease by planar and tomography methods Am Heart J 1989 117 Kiat H Van Train KF Muddahi J Development and prospective application of quantitative two day stress-rest Tc 99 methoxy isobutyl isonitrilo spect for the diagnosis Of coronary artery disease Am Heart J 1990 120 Kahn JK McGhie I Akers MS Quantitative rotational timography with Thallium 201 and Tc99 2 methoxy isobutyl-isonitrilo and patient with coronary Artery disease Circulation 1989 79 66 Technetium-99 myocardial perfusion imaging agent and their relation to Thalliun 201 Oct. 16,1990 Verani MS Toroudi MD Mahmarian JJ Quantification of myocardial infarction During coronary occlusion and myocardial salvage after reperfusion using cardiac imaging with Tc-99 Sestamibi J Am Coll Cardiol 1988 12
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100008 Choque cardiogénico: certezas y perspectivas Sztejfman Carlos Escolar Esteban Bettinotti Marcelo DeLuca Carlos ,Sanatorio Mitre Departamento de Hemodinamia Villa del Parque Capital Federal Argentina 04 2000 2000 2 57 62 Goldberg RJ Gore JM Alpert JS Osganian V De Groot J Bade J Chen Z Frid D Dalen JE Cardiogenic shock after acute myocardial infarction: Incidence and mortality from community-wide perspective, 1975-1988 N, Engl, J, Med 1991 325 Gitt AK Schiele R Taubert G Wagner S Glunz HG Limbourg P Senges J Prognosis of cardiogenic shock in non selected patients with acute myocardial infarction: results of the MITRA STUDY Eur Heart J 1998 19 Steg PG Deneve M Hélft G Gibier A Bertrand M. RENATIM - 2: a french national registry of PTCA for acute myocardial infartion (Abstr) Eur Heart J 1998 19 Bochoeyer A Mauro V Charask A Evolución del Shock Cardiogénico y Estrategias de Reperfusión en el Infarto, Agudo de Miocardio en la República Argentina Revista Argentina de Cardiología 1998 66 Holmes DR Bates ER Kleinman NS Contemporary reperfusion therapy for cariogenic shock: the GUSTO-1 trial experience JACC 1995 26 Hochman JS Boland J Sleeper LA Current spectrum of cardiogenic shock effect of early revascularization on mortality: Results of an International Registry Circulation 1995 91 Leor J Goldbourt U Reicher-Reiss H Kaplinsky E Behar s Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome Am J Med 1993 94 Bengston JR Kaplan AJ Pieper KS Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era JACC 1992 20 Holmes DR Hochman JS Berger PB Cardiogenic shock in patients with acute ischemic syndrome with and without ST segment elevation Cardiogenic shock in patients with acute ischemic syndrome with and without ST segment elevation Alonso DR Pathophisiology of cardiogenic shock: Quantification of myocardila necrosis, clinical, pathologic and electrocardiographic correlations Circulation 1973 48 Effectiveness of intravenous thrombolitic treatment in acute myocardial infarction Lancet 1986 1 Holmes ER Bates ER Kleiman NS Sadowski Z Horgan JHS Morris DC Califf RM Berger PB Topol EJ Contemporany reperfusion therapy for cardiogenic shock: The Gusto 1trial experience J Am Coll Cardiol 1995 26 lndications for fibrinolitic therapy in suspected acute myocardial infarction Lancet 1994 343 Lee L Bates ER Pit B Walton J Laufer N O'Neill WW Percutaneous transluminal coronary angioplasty improves survival in acute miocardial infarction complicated by cardiogenic shock Circulation 1988 78 Berges PB Holmes DR Stelobius A lmpact of an aggressive invasive catheterización and revascularization strategy on mortality in patients with cardiogenic shock in the GUSTO trial Circulation 1997 Lee L Erbel ER Pitt B Walton JA Laufer N O'Neill VVW Multicenter registry of angioplasty therapy of cardiogenic shock: initial and long term survival J Am Coll Cardiol 1991 17 Perez Castellano N Serrano JA Elizaga E García DE López Sendon JL Delcan JL Efficacy of invasive strategy for the management of the post-infarction cardiogenic shock JACC 1988 31 Bettinotti M Sosa Liprandi A lglesias R Gonzalez M Daru V Sosa Liprandi Ml Sztejfman C Utilidad de la angioplastia coronaria en el infarto agudo de miocardio complicado con shock cardiogénico Revista Argentina de Cardiología 1997 63 Antoniucci D Valenti R Santoro G Bolognese L Trapani M Moschi G Fazzini P Systematic direct angioplasty and stent. Supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infacrtion: in-hospital and long term survival J Am Coll Cardiol 1998 31 Suarez de Lazo J Medina A Pan M Hernandez E Romero M Segura J Melian F Pavlovic D Wanguement F Amat M lntracoronary stent treatment in the early phase of cardiogenic shock Eur Heart J 1998 19
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100009 Puente miocárdico coronario: resolución quirúrgica de un caso Robelo Pentzke Bayardo J Pucci Coronado Juan J Induni López Eduardo Mendez Jiménez Edgar Díaz Picado Heiner Soto Pacheco Longino ,CCSS Hospital Mexico San José Costa Rica 04 2000 2000 2 63 67

El Puente Miocárdico Coronario es una anomalía anatómica que produce un síndrome raro el cual se presenta con isquemia, sin la necesaria existencia de arterioesclerosis coronaria. Esta anomalía es poco diagnosticada en nuestro medio, pudiendo ser responsable de algunas de las muertes súbitas en pacientes sobre todo jóvenes. Exponemos el caso de un paciente referido a nuestro Servicio de Cirugía de Tórax y Cardiovascular con dicho padecimiento, quien fue sometido a tratamiento quirúrgico con excelentes resultados.

Coronary myocardial bridging is an anatomic anomaly presenting with ischemic symptoms not due to arterioesclerotic disease but to a milking effect of the contracting muscle. This condition is seldome diagnosed in our country and is a possible cause of sudden death, particularily in young patients. Here we present the case of a young male refered to our service who was treated surgicaly and is currently asymptomatic.

 Puente Miocárdico Coronario Sístole diástole isquemia coronaria Coronary myocardial bridging Systole diastole coronary disease Agirbasli M Martin GS Stout JB Jennings HS Lea JW Dixon JH Myocardial bridge as a cause of thrombus formation and myocardial infarction in a young athlete Clin Cardiol 1997 20 ^s12 Yetman AT McCrindle BW MacDonald C Freedom RM Gow R Myocardial bridgingin children with hypertrophic cardiomyopathy- a risk factor for sudden death The New England J of M 1998 339 ^s17 Morales AR Romanelli R Boucek RJ The mural left anterior descending coronary artery, strenous exercise and sudden death Circulation 1980 622 Feld H Guanadino V Hollander G Greengart A Lichstein E Shani J Esercise- induced ventricular tachycardia in association with a myocardial bridge Chest 1991 99 Irvin RG The angiographic prevalence of myocardial bridging in man Chest 1982 81 Ge J Erbel R Rupprecht HJ Comparison of intravascular ultrasound and angyography in the assessement of myocardial bridging Circulation 1994 89 Karger S Basel AG Myocardial bridge muscle on left anterior descending coronary artery differs from subepicardial myocardium of the left ventricle in dogs Acta Anatomica 1996 157 ^s3 Noble J Grondin P Bourassa MG Succesful periarterial muscle resection for myocardial bridging and milking effect on the left anterior descending artery The American Journal of Cardiology Feb. 1 97 39 Schwarz ER Klues HG von Dahl J Klein I Kregs W Hanrath P Functional, angyographic and intracoronary doppler flow characteristics in symptomatic patients with myocardial bridging: effect of short-term intravenous beta-blocker medication J Am Coll Cardiol 1996 27 Vogt PR Dubach P Turina MI Muscle bridging of the left anterior descending coronary artery Circulation 1996 93
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100010 , 04 2000 2000 2 69 71
S1409-414220000001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422000000100003 Cardiología intervencionista en arritmias cardíacas: experiencia inicial Gutiérrez Oswaldo Araya Vivien Cruz Flory ,Clínica de Arritmias San José Costa Rica 04 2000 2000 2 11 20

Introducción. La cateterización del corazón en electrofisiología se ha venido utilizando con fines diagnósticos y para establecer el recorrido anatómico de las taquicardias supraventriculares o ventriculares y así detectar zonas críticas suceptibles de ablación. El objetivo de este estudio es brindar una revisión de los casos realizados desde febrero de 1999 hasta la fecha, en el país. Materiales y Métodos. Se incluyeron pacientes que tuvieran las indicaciones usuales para realizar estudio electrofisiológico diagnóstico o procedimientos de ablación por catéter. Se colocaron múltiples catéteres intracardíacos para el registro y estimulación de las cámaras cardíacas así como para la aplicacion de radiofrecuencia. Resultados. Se realizaron 19 estudios (5 diagnósticos y 14 terapéuticos), edades entre 16 y 86 años, 6 hombres y 12 mujeres. Los estudios diagnósticos se realizaron en 3 pacientes con síncope, uno con taquicardia ventricular sostenida y uno con extrasistolia ventricular frecuente. Los procedimientos terapéuticos se realizaron en 3 pacientes con reentrada intranodal (éxito 100%), en 10 con vías accesorias o síndrome de Wolff-Parkinson-White (éxito de 90%) y en una se realizó ablación del nódulo Aurículoventricular (100%) por crisis de fibrilación auricular de alta respuesta ventricular. Ocurrió recidiva en un caso (seguimiento de 2 a 38 semanas) y una complicación en otro (derrame pericárdico). Conclusiones. Estos procedimientos de Cardiología Intervencionista en Arritmias Cardíacas son seguros, aportan información diagnóstica relevante y/o tratamiento curativo con alta tasa de éxito y baja tasa de recurrencia en pacientes con diversos trastornos del ritmo cardíaco.

Introduction. Electrophysiological cardiac catheterization have been used for diagnostic purposes and for detection of anatomic circuits of different taquiarrhythmias, suitable for ablation procedures. The objetive of this study is to show performed cases to date. Material and Methods. We included patients with current indications for electrophysiological studies or catheter ablation procedures. We used multiple intracardiac electrodes for signal adquisition and chamber stimulation and to apply radiofrequency energy. Results. We made 19 procedures (5 diagnostic and 14 therapeutic), ages between 16 and 86 years old, 6 men and 12 women. Diagnostic studies were made in 3 patientes with syncope, one with sustained ventricular tachycardia and one with frequent ventricular ectopy. Ablation procedures were made in 3 patients with atrioventricular node reentrant tachycardia (100% success), 10 with accessory pathways (90% success) and one of the atriventricular node because fast response atrial fibrillation paroxisms. We had one recurrence (follow-up 2 to 38 weeks) and one complication (pericardial efussion). Conclusions. These procedures are safe, supplies important diagnostic information and curative therapy with high sucsess rate and low complication rate in patients with different cardiac rythm disorders.

 Josephson ME Clinical Cardiac Electrophysiology: Techniques and Interpretations Clinical Cardiac Electrophysiology: Techniques and Interpretations 1994 Lea & Febiger Jackman WM Wang X Friday KJ Catheter Ablation of Accesory Pathways (Wolff-Parkinson-Syndrome) by Radiofrequency Current N Engl J Med 1991 324 Guidelines for Clinical Intracardiac Electrophysiological and Catheter Ablation Procedures Circulation 1995 92 Araya V Electrofisiología intervencionista: procedimientos diagnósticos y terapéuticos en arritmias cardiacas Revista Costarricense de Cardiología 1999 1 Gutiérrez O Estudio Electrofisiológico: Principios Básicos y aplicaciones Revista Peruana de Cardiología 1998 1 Gonzáles-Zuelgaray J Gonzáles-Zuelgaray J Ablación por catéter Arritmias Cardíacas Arritmias Cardíacas 1996 Buenos Aires Edit. Intermédica Scheinman MM Patterns of catheter ablation practice in the United States: results of the 1992 NASPE survey PACE Pacing Clin Electrophysiol 1994 17 Yeung-Lai-Wah JA Alison JF Lonergan L High success Rate of Atrioventricular Node Ablation with Radiofrequency Energy J Am Coll Cardiol 1991 18