S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200001 Atención Médica: "un problema de todos" Speranza S. Mario O. , 08 2003 2003 5 03 03
S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200002 Diagnóstico y manejo de la endocarditis infecciosa Poveda Fernández Jonathan Soriano Fallas Tatiana Cañas Coto Alejandro Rodríguez Leonardo ,CCSS Hospital Calderón Guardia San José Costa Rica ,Ministerio de Salud ,Cleveland Clinic Foundation USA 08 2003 2003 5 05 16

La sospecha temprana, el diagnóstico precoz y el tratamiento agresivo son fundamentales para el manejo de la endocarditis infecciosa. Actualmente, los organismos que causan ésta enfermedad han cambiado respecto a los que antiguamente se describían en la literatura. Además, los métodos diagnósticos han avanzado hacia un reconocimiento más temprano de la misma. Se comentan las nuevas guías clínicas y ecocardiográficas que se han establecido para el seguimiento de estos pacientes. En este artículo se presentan las manifestaciones clínicas que presenta la endocarditis infecciosa hoy en día. Además, se reconoce la ecocardiografía como herramienta indispensable para el diagnóstico y manejo de la enfermedad. Se amplian los conceptos sobre las diferencias diagnósticos que se pueden obtener de un ecocardiograma transtorácico y uno transesofágico. Se presentan, además, los hallazgos que se deben buscar en cada uno de estos exámenes y cómo estos mismos se pueden utilizar para el seguimiento del paciente. Se revisa, en detalle, los organismos nuevos y atípicos que se empiezan a presentar en esta enfermedad; y las complicaciones que se ven relacionadas a los mismos. Las complicaciones atípicas de este padecimiento también son abordadas, así como el tratamiento para los agentes etiológicos más frecuentes.

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The Multicenter Metformin Study Group N Engl J Med 1995 333 Mather KJ Verna S Anderson TJ improved endothelial function with metformin in type 2 diabetes mellitus J Am Coll Cardiol 2001 37 Misbin RI Green l Stadel BV Lactic acidosis in patients with diabetes treated with etformin N Engl J Med 1998 338 Saltiel AR Olefsky JM Thiazolidinediones in the treatment of insulin resistance and type II diabetes Diabetes 1996 45 Spiegelman BM PPAR- : adipogenic regulator and thiazolidinedione receptor Diabetes 1998 47 Suter SL Nolan JJ Wallace P Metabolic effects of new oral hypoglycemic agent CS-045 in NIDDM subjects Diabetes Care 1992 15 Marx N Sukhova G Murphy C Macrophages in human atheroma contain PPAR gamma: differentiation-dependent peroxisomal proliferator-activated receptor gamma expression and reduction of MMP-9 activity through PPAR activation in mononuclear phagocytes in vitro Am J Pathol 1998 153 Gralinski MR Rowse PE Breider MA Effects of troglitazone and pioglitazone on cytokine-mediated endothelial cell proliferation in vitro J Cardiovasc Pharmacol 1998 31 Marx N Schonbeck U Lazar MA Peroxisome proliferator-activated receptor gamma activators inhibit gene expression and migration in human vascular smooth muscle cells Circ Res 1998 83 lwamoto Y Kosaka K Kuzuya T Effects of troglitazone: a new hypoglycemia agent in patients with NIDDM poorly controlled by diet therapy Diabetes Care 1996 19 Gale EAAM Lessons from the glitazones: a story of drug development Lancet 2001 357 Ragucci E Zonszein J Frishman W Pharmacotherapy of Diabetes Mellitus: implications for the Prevention and Treatment of Cardiovascular disease Heart Dis 2003 5 ^s1 Consensus Development Conference on Guidelines for Glycemic Control Endocr Pract 2002 8 ^s1 Turner RC Cull CA Frighi V Glycemic control with diet, sufonylurea, metformin, or insulin in patients with type 2 diabetes mellitus. 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A review of its pharmacological properties and therapeutic use in non-insulin-dependent diabetes mellitus Drugs 1995 49 Moses R Slobodniuk R Boyages S Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes Diabetes Care 1999 22 Horton ES Clinkingbeard C Gatlin M Nateglinide alone and in combination with metformin improves glycemic control by reducing mealtime glucose levels in type 2 diabetes Diabetes Care 2000 23 Coniff RF Shapiro JA Seaton TB Multicenter, placebo controlled trial comparing acarbose (BAY g 5421) with placebo, tolbutamide, and tolbutamide-plus-acarbose in non-insulin-dependent diabetes mellitus Am J Med 1995 98 Rosenstock J Brown A Fischer J Efficacy and safety of acarbose in metformin-treated patients with type 2 diabetes Diabetes Care 1998 21 lwamoto Y Kosaka K Kuzuya T Effect of combination therapy of troglitazone and sulphonylureas in patients with type 2 diabetes who were poorly controlled by sulfonylurea therapy alone Diabet Med 1996 13 Kipnes MS Krosnick A Rendell MS Pioglitazone hydrochloride in combination with sulfonylurea therapy improves glycemic control in patients with type 2 diabetes mellitus: a randomized, placebocontrolled study Am J Med 2001 111 Rosenstock J Schwartz SL Clark CM Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine and NPH insulin Diabetes Care 2001 24 Malone JK Woodworth JR Arora V improved postprandial glycemic control with Humalog Mix75/25 after a standard test meal in patients with type 2 diabetes mellitus Clin Ther 2000 22 Maim,berg K Ryden L Efendic S Randomized trial of insulinglucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study):effects on mortality at one year J Am Coll Cardiol 1995 26 Maim,berg K Prospective randomized study of intensive insulin treatment on long term survival after myocardial infarction in patients with diabetes mellitus Br Med J 1997 314 Rossetti L Glucose toxicity; the implications of hyperglycemia in the pathophysiology of diabetes mellitus Clin lnvest Med 1995 18 Ilkova H Glaser B Tunckale A induction of long-term glycemic control in newly diagnosed type 2 diabetes patients by transient intensiva insulin treatment Diabetes Care 1997 20 Yki-Jarvinen H Combination therapies with insulin in type 2 diabetes Diabetes Care 2001 24 Jaber LA Nowak SN Slaughter RR lnsulin-metformin combination therapy in obese patients with type diabetes J Clin Pharmacol 2002 42 Johnson JL Wolf SL Kabadi UM Efficacy of insulin and sulfonylurea combination therapy in type II diabetes. 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S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200005 Ruptura del septum ventricular post infarto agudo del miocardio Rodríguez Jerez Warner Preinfalk Lavagni Giselle Arauz Chavarría Jorge , 08 2003 2003 5 39 43

La ruptura del septum interventricular (CIV) es una complicación grave del infarto agudo del miocardio y tiene un alto índice de mortalidad. El diagnóstico rápido, medidas adecuadas en el manejo médico como el uso de balón de contrapulsación intra aórtico y la corrección quirúrgica pronta son algunos de los esfuerzos que se han realizado para mejorar la sobrevida y disminuir el tiempo de recuperación de los pacientes, posterior a un evento de este tipo. Dentro de los factores de riesgo para la comunicación interventricular post infarto destacan la edad avanzada, sexo femenino, el infarto de cara anterior, y la ausencia de tabaquismo. En este artículo se presenta el caso de una paciente de la Unidad Coronaria del Hospital San Juan de Dios y se hace revisión del tema.

 ruptura trombolisis infarto del miocardio Topaz O Taylor AL Interventricular septal rupture complicating acute myocardial infarction: from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management Am J Med 1992 93 Shapira I lsakov A Burke M Almog C Cardiac Rupture in patients with acute myocardial infarction Chest 1987 92 Rhydwen G R Charman S Schifield PM lnfluence of thrombolytic therapy on the patterns of ventricular septal rupture after acute myocardial infarction Postgrad Med J 2002 78 Crenshaw BS Granger CB Birnbaum Y Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction Circulation 2000 101 An Internacional Randomized Trial Comparing four thrombolytic strategies for Acute Myocardial lnfarction N Engl J Med 1993 329 Radford MJ Johnson RA Daggert WM Ventricular septal rupture: a review of clinical and physiologic features and an analysis of survival Circulation 1981 64 Prétre R Ye Q Grünenfelder J Zund G Turina Mi Role of Myocardial Revascularization in postinfarction Ventricular Septal Rupture Ann Thorac Surg 2000 69 Becker AE van Mantgem JP Cardiac tamponade: a study of 50 hearts Eur J Cardiol 1975 3 Birnbaum Y Fishbein MC Blanche C Siegel RJ Ventricular Septal Rupture after Acute Myocardial lnfarction N Engl J Med 2002 347 Mann JM Roberts WC Acquired ventricular septal defect during acute myocardial infarction: analysis of 38 unoperated necropsy patients and comparison with 50 unoperated necropsy patients without rupture Am J Cardiol 1988 62 Lemery R Smith HC Giuliani ER Gersh BJ Prognosis in Rupture of the Ventricular Septum after Acute Myocardial infarction and Role of Early Surgical intervention Am J Cardiol 1992 70 Smylle JH Sutherland GR Geuskens R Dawkins K Conway N Roelandt JR Doppler color flow mapping in the diagnosis of ventricular septal rupture and acute mitral regurgitation after myocardial infarction J Am Coll Cardiol 1990 15 Vargas Barron J Sahn DJ Valdes-Cruz LM Clinical utility of two-dimensional Doppler techniques for estimating pulmonary to systemic blood flow ratios in children with left to right shunting atrial septal defect, ventricular septal defect or patent ductus arteriosus J Am Coll Cardiol 1984 3 Ryan TJ Antman EM Brroks NH Update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Comitee on Management of Acute Myocardial lnfarction) J Am Coll Cardiol 1999 19 99 34 Gray RJ Sethna D Matioff JM The role of cardiac surgery in acute myocardial infarction. I. With mechanical complications Am Heart J 1983 106 Fox AC Glassman E lsom OW Surgically remediable complications of myocardial infarction Prog Cardiovasc Dis 1979 21 Killen DA Piehler JM Borkon AM Gorton ME Reed WA Early Repair of Postinfarction Ventricular Septal Rupture Ann Thorac Surg 1997 63 Giuliani ER Danielson GK Pluth JR Odyniec NA Wallace RB Postinfarction ventricular septal rupture: surgical considerations and results Circulation 1974 49 David TE Dale L Sun Z Postinfarction Venbtricular Septal Rupture:	Repair by Endocardial Patch with infarct Exclusion J Thorac Cardiovasc Surg 1995 110 Massetti M Babatasi G Le Page O Bhoyroo S Saloux E Khayat A Postinfarction Ventriculae Sepatl Rupture: Early repair through the right atrial approach J Thorac Cardiovasc Surg 2000 119 Lee EM Roberts DH Waish KP Transcatheter closure of a residual postmyocardial infarction ventricular septal defect with the Amplatzer septal occluder Heart 1998 80
S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200006 Enfermedad de Kawasaki y Aneurisma Sacular Gigante de la Arteria Descendente Anterior: reporte de un caso Mas Romero Carlos Bouzid Jiménez Yamilah ,CCSS Hospital Nacional de Niños Servicio de Cardiología Pediátrica San José Costa Rica ,CENDEISS Sistema de Estudios de Post-grado 08 2003 2003 5 45 48

La enfermedad de Kawasaki se caracteriza por una vasculitis generalizada, de singular gravedad cuando afecta las arterias coronarías, lo cual ocurre hasta en el 40 % de los casos no tratados. El tratamiento combinado de aspirina con gammaglobulina intravenosa precoz y a altas dosis ha conseguido disminuir la incidencia de la patología coronaría. A continuación se presenta el caso de una niña de 9 años de edad, con cuadro clínico de enfermedad de Kawasaki complicada con un aneurisma sacular gigante de la arteria coronaría izquierda. Los hallazgos ecocardiográficos y angiográficos se analizan y se revisa la literatura al respecto.

 Enfermedad de Kawasaki aneurisma coronaria gigante Kawasaki T Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Clinical observation of 50 patients Jpn J Allergy 1967 16 The Etiology and pathogenesis of Kawasaki's disease-how are we to an answer? Curr Op lnfect Dis 1997 10 Kawasaki's syndrome Pediatrics in Review 1996 17 Late Prognosis and Therapy Rheum Dis Clin of North Am 1994 17 Curtis N Zheng R Lamb JR Levin M Evidence for a superantigen mediated process in Kawasaki disease Arch Dis Child 1995 72 Leung DYM Meissner HC Fulton DR Murray DL Kotzin BL Schlievert PM Toxic shock syndrome toxin-secreting Staphylococcus aureus in Kawasaki disease Lancet 1993 342 Endocarditis and Kawasaki Disease. "Diagnosis and therapy of Kawasaki Disease in children" Circulation 1993 87 Yanagawa H Yashiro M Nakamura Y Sakata K Kawasaki T Intravenous gammaglobulin treatment of Kawasaki disease in Japan: Results of a nationwide survey Acta Paediatr 1995 84 Fujimara T Fujimara H Ueda T Nishioka K Hamashima Y Comparison of macroscopic postmortem angiographic and 2-dimensional echocardiographic finding oí coronary aneurysm in children with Kawasaki disease Am J Cardiol 1986 57 Tsuda E Kamiya T Ono Y lncidence of stenotic lesions predicted by acute phase changes in coronary arterial diameter during Kawasaki disease: threshold for coronary aneurysm causing stenosis Circulation 2002 106 Kaichi S Tsuda E Fujita H Detection of calcification by electron beam computed tomography in patients with coronary artery lesions due to Kawasaki disease: relationship between the acute coronary artery dilatation and the later appearance of calcification Circulation 2002 106 Beiser AS Takahashi M Baker AJ A predictive instrument for coronary artery aneurysms in Kawasaki disease Am J Cardiol 1998 81 Susuki A Kamiya T Tsuda E Natural history of coronary artery lesions in Kawasaki disease Prog. Pediatr Cardiol 1997 6 Kato H Ichinose E Kawasaki T Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases J Pediatr 1986 108 Dajani Adnan S Guidelines for long - term Management of Patients with Kawasaki Disease. AHA / Scientific Statement Circulation 1994 89 Kitamura S Kameda Y Seki T Kawachi K Endo M Takeuchi Y Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease. A multicenter cooperativa study J Thorac Cardiovasc Surg 1994 107 Checchia PA Pahl E Shaddy RE Shulman ST Cardiac transplantation for Kawasaki disease Pediatrics 1997 100
S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200007 Aneurisma del Septum Interauricular: presentación de un caso clínico diagnosticado con Ecocardiografía bidimensional a color Lanzas Rodríguez Roger A. ,C.C.S.S. Hospital Regional Dr. Tny Facio Castro Costa Rica 08 2003 2003 5 50 52 Sancho Pellicer A Labrador Fuster J Aneurismas del tabique interauricular. Presentación de tres casos Rev. Esp Cardiol 2000 56 Silver MD Dorsey JD Aneurysms of the septum primum in adults Arch Pathol Lab Med 1978 102 Hanley PC Tajik AJ Hynes JK Edwards WD Reeder GS Hagler DJ Diagnosis and clasification of atrial septal aneurysm by two dimensional echocardiography: report of 80 consecutive cases J Am Coll Cardiol 1985 6 Ruiz de Larrea Lasarte J.R Cuadrado A Aneurisma del Septo auricular asociado a comunicación interauricular: Estudio de 12 casos con ecocardiografía bidimensional-color Rev. Esp Cardiol 1993 46 Mas JL Zuber M Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. French a study group on patent foramen ovale and atrial septal aneurysm Am Heart J 1995 130 Gallet B Malergue MC Adams C Atrial septal aneurysm: A potential cause of systemic embolism Br Heart 1985 53 Belkin RN Hurwitz BJ Kisslo J Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events Stroke 1987 18 Mugge A Daniel WG Angermann C Spes C Khandheria BK Kronzon I Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography Circulation 1995 91 Mas JL Arquizan C Lamy C Zuber M Cabanes L Derumeaux G Coste J Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm or both N Engl J Med 2001 345 Natanzon A Goldman MD Patent foramen ovale: anatomy versus pathophysiology- Which determines stroke risk? J Am Soc Echocardiogr 2003 16 Olivares-Reyes A Chan S Lazar EJ Bandlamudi K Narla V Ong K Atrial Septal aneurysm: a new classification in two hundred five adults J Am Soc Echocardiogr 1997 10
S1409-414220030002 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422003000200008 Araya Gómez Vivien ,Centro Cardiológico Integral 08 2003 2003 5 53 53