S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100001 Los 10 años Gutiérrez Sotelo Oswaldo Salazar Vargas Carlos Speranza Sánchez Mario O ,Hospital México Servicio de Cardiología San José Costa Rica ,Hospital Rafael A. Calderón G Servicio de Cirugía de Tórax y Cardiovascular San José Costa Rica ,Hospital Clínica Bíblica Revista Costarricense de Cardiología San José Costa Rica 06 2009 2009 11 03 05 Vargas Q Pacheco R Medicina Costarricense: Algunos problemas y perspectivas Rev Costarr Cardiol 2004 6 3
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100002 Polimorfismos del gen de la enzima convertidora de angiotensina (Inserción/Delección) y factores de riesgo asociados en pacientes con infarto agudo del mioicardio Salazar Sánchez Lizbeth Hidalgo Rodríguez Andrea Arauz Chavarría Jorge Méndez Lopez Max Cartín Brenes Mayra Ramos Alfaro Victoria ,Universidad de Costa Rica Centro de Investigación de Hemoglobinas Anormales y Trastornos Afines San José Costa Rica ,Caja Costarricense de Seguro Social Hospital San Juan de Dios Servicio de Cardiología ,Universidad de Costa Rica Escuela de Salud Pública 06 2009 2009 11 07 12

Introducción. Los factores clásicos de riesgo cardiovascular están ampliamente estudiados y estrechamente vinculados con el desarrollo de infarto agudo del miocardio, accidente vascular cerebral y enfermedad vascular periférica. Entre los factores genéticos que subyacen a estas condiciones están las mutaciones en el gen de la enzima convertidora de angiotensina. El principal objetivo de este estudio fue establecer la relación entre polimorfismos Inserción/Delección de la enzima conversora de angiotensina en una grupo de pacientes con cardiopatía isquémica. Métodos: Se realizó un estudio prospectivo de casos y controles en un grupo de pacientes con infarto agudo del miocardio referidos para coronariografía. Se obtuvo información clínica a partir de los expedientes clínicos y la entrevista personal. La obtención de ácido desoxirribunocleico y el análisis del polimorfismo de la enzima convertidora de angiotensina (Inserción / Delección), se realizaron con técnicas de biología molecular previamente descritas. Resultados: Se incluyeron en el estudio 33 casos y 67 controles. El 87.7% de los pacientes fueron de sexo masculino y el índice de masa corporal fue mayor en los casos (35.6) que en los controles (24.8). En el grupo de casos, el fumado (p<0.001), hipertensión (p<0.001) e hiperfibrinogenemia (p<0.001) fueron factores significativamente asociados a la presencia de enfermedad cardiovascular (OR: 16.78; OR: 5.63; y OR: 16.8, respectivamente). No se encontró asociación del genotipo DD entre los casos y controles, ni su asociación con la hipertensión arterial en los individuos estudiados; en cambio, sí se encontró asociación entre los niveles del fibrinógeno y del genotipo II (p< 0.005). Angiográficamente, la arteria descendente anterior fue el vaso coronario más frecuentemente afectado en este grupo. Conclusión: No se encontró asociación entre el genotipo DD de la enzima convertidora de angiotensina y la presencia de enfermedad cardiovascular. Este primer reporte ofrece la posibilidad de analizar otros polimorfismos de la enzima convertidora de angiotensina en enfermedades trombóticas y tromboembólicas.

Abstract Angiotensin converting enzime gene polimorphisms Insertion/Deletion and cardiovascular risk factors in patients with acute myocardial infarction Introduction Traditional cardiovascular risk factors are widely studied and closely linked with the development of acute myocardial infarction, stroke and peripheral vascular disease. The underlying genetic background includes the angiotensin converting enzyme gene mutations. The main objective of this study is to establish an association between the polymorphism Insertion/Deletion of angiotensin converting enzyme in a group of patients with coronary artery disease. Methods. We performed a prospective, case-control study, in a group of patients with acute myocardial infarction referred to our center for coronary angiogram. Clinical information was obtained from medical records and personal interviews. DNA collecting and analysis of angiotensin converting enzyme I / D polymorphism, were done by molecular biology techniques as previously described. Results. We included 100 individuals, 33 cases and 67 controls. The average age was 43.16 years old; 87.7% were male. Body mass index was higher in cases (35.6) than in controls (24.8). Smoking (p <0.001), hypertension (p <0.001) and highfibrinogen levels (p <0.001) were significant factors associated with cardiovascular disease (OR 16.78, OR 5.63 and OR: 16.8, respectively). No association was found in the DD genotype between cases and controls, nor with hypertensive patients. An association was found between the levels of fibrinogen and II genotype (p <0.005). Angiographically, the anterior descending coronary artery was the most frequently affected vessel in this group. Conclusion. There was no association between the DD angiotensin converting enyme genotype and the presence of the cardiovascular disease. This first report opens the possibility of analyzing other angiotensin converting enyme polymorphisms in other thrombotic and thromboembolic diseases.

 polimorfismo genotipo enzima convertidora de angiotensina sistema renina-angiotensina fibrinógeno enfermedad cardiovascular olymorphism genotype angiotensin-converting enzyme renin-angiotensin system cardiovascular disease fibrinoge Araya M Guzmán S Evolución de la mortalidad por enfermedad isquémica del corazón e infarto agudo del miocardio en Costa Rica, 1970-2001 Rev Panam Sal Public 2004 16 Campos H Mata L Siles X Prevalence of cardiovascular risk factors in rural and urban Costa Rica Circulation 1992 85 Niu T Chen Xiu Xu X Angiotensin Coverting Enzyme gene Insertion/ Deletion Polymorphism and Cardiovascular Disease Drugs 2002 62 Suzuki Y Ruiz-Ortega M Lorenzo O Ruperez M Esteban V Egido J Inflammation and Angiotensin II Int J Biochem Cel B 2003 35 Hernández D Lacalzada J Salido E Linares J Barragán A Lorenzo V Higueras L Martin B Regresion of left ventricular hipertrophy by lisinopril after renal transplantation: Rol of ACE gene polymorphism Kidney Int 2000 58 Thomas N Tomlinson B Chan J Renin-Angiotensin System gene polymorphisms, blood pressure, dyslipidemia, and Diabetes in Hong Kong Chinese: A significant association of the ACE insertion/deletion polymorphism with type 2 diabetes Diabetes Care 2001 24 Coates D Molecules in focus: The angiotensin-converting enzyme (ACE) Int J Biochem Cel B 2003 35 Carluccio M Soccio M De Caterina R Aspects of gene polimorfisms in cardiovascular disease: the renin-angiotensin system Eur J Clin Invest 2001 31 Sharma P Meta-analysis of the ACE gene in ischaemic stroke J Neurol Neurosurg Psychiatry 1998 64 Ledru F Blanchard D Battalglia S Jeunemaitre X Courbon D Guize L Guermonprez J Ducimetiere P Diebold B Relation Between severity of Coronary Artery Disease, Left Ventricular function, and Myocardial Infarction, and influence of the ACE I/D Gene Polymorphism Am J Cardiol 1998 82 Miller M Dykes DD Polesky HF A simple salting out procedure for extracting DNA from human nucleated cells Nucleic Acids Res 1988 16 Rigat B Humbert C Corvol P Soubrier F PCR detection of the insertion/ deletion polymorphism of the human angiotensin coverting enzyme gene (DCP 1) (dipeptidyl carboxipeptidase 1) Nucl Acids Res 1992 20 Odawara M Matsunuma A Yamashita K Mistyping frequency of the Angiotensin-Coverting Enzyme Gene Polymorphism and an improved method for its avoidance Hum Genet 1997 100 Cambien Poirer O Lecert L Evans A Cambou JP Arveiler D Deletion polymorphism and the angiotensin- converting enzyme gene is a potent risk factor for myocardial infarction Nature 1992 359 Lindpainter K Pfeffer MA Kreutz R Stampfer MJ Grodstein F A prospective evaluation of angiotensin-converting enzyme gene polymorphism and the risk of ischaemic heart disease N Engl J Med 1995 332 Jastrzebska M Widecka K Plasminogen activator inhibitor-1 (PAI-1) 4G/5G and the angiotensin-converting enzyme (ACE) I/D gene polymorphism and the fibrinolytic activity in patients with essential hypertension and dyslipidemia Pol Arch Med Wewn 2005 113 1 Tsung-Hsien Lin Herng-Chia Chiu Ho-Ming Su Suh-Hang Hank Juo Ya-Ting Lee Wen-Chol Voon Wen-Ter Lai and Sheng-Hsiung Sheu D-Allele of ACE Polymorphism is Associated With Increased Magnitude of QT Dispersion Prolongation in Elderly Chinese Circ J 2007 71 Pontremoli R Ravera M Viazzi F Nicolella C Berruti V Leoncini G Giacopelli F Bezante G P Sacchi G Ravazzolo R Deferrari G Genetic Polymorphism or the renin-angiotensin system and organ damage in essential hypertension Kidney Int 2000 57 Poirier O Georges JL Ricard S Arveiler D Ruidavets JB Luc G Evans A Cambien F Tiret L New polymorphisms of the angiotensin II type 1 receptor gene and their associations with myocardial infarction and blood pressure: the ECTIM study. Etude Cas-Temoin de l’Infarctus du Myocarde J Hypertens 1998 10 Paul M Poyan Mehr A Kreutz R Physiology of local renin-angiotensin systems Physiol Rev 2006 86 Lechin M Quiñones M A Omran A Hill R Qun-Tao Yu Rakowski H Wigle D Liew C C Sole M Roberts R Marian A J Angiotensin-I Converting Enzyme Genotypes and Left Ventricular Hypertrophy in Patients With Hypertrophic Cardiomyopathy Circulation 1995 92 Bautista LE Vargas CI Oróstegui M Gamarra G Population-based casecontrol study of renin-angiotensin system genes polymorphisms and hypertension among Hispanics Hypertens Res 2008 31 3
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100003 Prevalencia de Obesidad en pacientes hipertensos en el Servicio de Cardiología del Hospital México de Costa Rica Bogantes Pereria Eric Chavarría Víquez Jorge Arguedas Bolaños Doris ,Hospital México Servicio de Cardiología La Uruca 06 2009 2009 11 13 18

Resumen Introducción. El sobrepeso está asociado con un incremento en el riesgo de sufrir hipertensión arterial. Dada la alta prevalencia de obesidad en nuestra población, en este estudio se investigó y analizó la prevalencia de la obesidad en un grupo de pacientes hipertensos de la consulta externa del servicio de Cardiología del Hospital México, Costa Rica Materiales y métodos. Es un estudio retrospectivo, observacional donde se realizó el reclutamiento de un grupo de pacientes hipertensos de la "Clínica de Hipertensión Arterial" de nuestro centro, en quienes se evaluó el grado de sobrepeso y obesidad con la medición del índice de masa corporal y la circunferencia abdominal. Resultados: Se evaluaron 475 pacientes, 43 % estaban en el rango de sobrepeso y el 42% tenía algún grado de obesidad (85% en todo el grupo); el 56% de los pacientes presentaron presión arterial &#8805; 140/90mmHg. Uno de cada 4 hipertensos era portador de diabetes mellitus. Conclusión: La prevalencia de sobrepeso y obesidad en la población hipertensa fue de aproximadamente el 85%. La relación entre los valores de presión arterial y la prevalencia de otros factores de riesgo como diabetes mellitus es lineal.

Abstract Prevalence of Obesity at México Hospital in San José, Costa Rica outpatients Introduction. Increased body-mass index is associated with an elevated risk of systemic hypertension. Given the high prevalence of obesity in our country, we performed this study to determine the prevalence of obesity in a group of hypertensive patients from our Cardiology Department. Material and methods: this is an observational, retrospective study. We recruited a group of hypertensive patients from the "Clinic of Arterial Hypertension" of the Cardiology Department at the Hospital México of Costa Rica, in whom we assessed the degree of overweight and obesity by means of body mass index measurement and abdominal circumference. Results: Four hundred and seventy five patients were analyzed, 43% of them where in the range of overweight, and 42 % had some degree of obesity (85% in the entire group). One of every 4 hypertensive individuals had diabetes mellitus also. Fifty six percent of the patients had blood pressures &#8805; 140/90mmHg. Conclusion: The prevalence of overweight or obesity in our hypertensive population was aproximately of 85% in a third level complexity hospital in Costa Rica, and the relationship among the arterial pressure levels and the prevalence of other risk factors is linear.

 Obesidad hipertensión arterial circunferencia abdominal indice de masa corporal Obesity Body-mass index hypertension abdominal circumference Arguedas C Rojas R García L La obesidad y Riesgo Cardiovascular Rev Costarr Cardiol 2007 9 3 Overweight, obesity and health risk Arch Intern Med 2000 160 Wilson PWF D’Angostino RB Sullivan L Overweight and Obesity as determinant of cardiovascular risk Arch Intern Med 2002 Kenchaiah S Evans JC Levy D Obesity and the risk of heart failure N Eng J Med 2002 327 Calle E Thun MJ Petrelli JM Body-mass index and mortality in a prospective cohort of U.S. Adults N Eng J Med 1999 341 Quesada O La obesidad en el continuum de la enfermedad cardiovascular Actualización medica periódica 2006 64 Flegal KM Carroll MD Ogden CL Prevalence and trends in obesity among United States adults,1999-2000 JAMA 2002 288 Higgins M Kamel W Garrison R Hazards of obesity the Framingham experience Acta Med Scand 1998 723 Heron MP Smith BL Hyattsville MD Deaths: Leading causes for 2003. National Vital Statistics Reports National Center for Health Statistics, Natl Vital Stat Rep 2007 National Center for Health Statistics, Natl Vital Stat Rep 2007 55 Cortés J Proyecto Dr. Juan José Flores: Factores de Riesgo para la Enfermedad Cardiovascular en una Población de Adolescente en Costa Rica Proyecto Dr. Juan José Flores: Factores de Riesgo para la Enfermedad Cardiovascular en una Población de Adolescente en Costa Rica Carballo L Informe de resultados Comisión Interinstitucional Trazadora de Hipertensión Arterial Informe de resultados Comisión Interinstitucional Trazadora de Hipertensión Arterial 2006 Ministerio de Salud de Costa Rica Kabagambe EK Baylin A Campos H Nonfatal acute myocardial infarction in Costa Rica: modificable risk factors, population attributable risks, and adherence to dietary guidelines Circulation 2007 115 Lanas F Avezum A Yusuf S INTERHEART Investigators in Latin America. Risk Factors for acute myocardial infarction in Latin America: The INTERHEART Latin America Study Circulation 2007 115 Martínez J Efecto de la Actividad Física en la reducción del riesgo de enfermedad cardiovascular mediante el control del peso corporal Revi Costarr Cardiol 2007 10 Anthropometry procedures manual: National and Nutrition Examination Survey Anthropometry procedures manual: National and Nutrition Examination Survey 2000 Rabkin SW Chen Y Leiter L Canadian Heart Health Surveys Research Group: Risk factor correlates of body mass index CMAJ 1997 157 Brown CD Higgins M Donato KA Body mass index and the prevalence of hypertension and dyslipidemia Obes Res 2000 8 Chobanian AV Bakris GR Black HF Seventh. Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report JAMA 2003 289 Bogers R Bemelmans W Hoogenveen R Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels Arch Intern Med 2007 167 Yusuf S Hawken S Ounpuu S Obesity and the risk of infarction in 27000 participants from 52 countries: a case - control study. INTERHEART Lancet 2005 366 Silventoinen K Magnusson P Neovius M Does obesity modify the effect of blood pressure on the risk of cardiovascular disease? A population-based cohort study of more than one million Swedish men Circulation 2008 118 Ogden CL Carroll MD Curtin LR Prevalence of overweight and obesity in the United States. 1999- 2004 JAMA 2006 295 TOPHT-1: The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention phase 1 JAMA 1992 267 Kurth T Gaziano JM Berger K Body mass index and the risk of stroke in men Arch Int Med 2002 162 Poirier P Giles T Bray G Obesity and cardiovascular disease: Pathophysiology, evaluation, and effect of weight loss: An update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation 2006 113 Uretsky S Messerli FH Bangalore S Obesity paradox in patients with hypertension and coronary artery disease Am J Med 2007 120 10 Soham A Ottenbacher K Markides K The effect of obesity on disability vs. mortality in older Americans Arch Intern Med 2007 167 Romero-Corral A Montori V Somers V Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies Lancet 2006 368 Kenchaiah S Gaziano JM Vasar R Impact of obesity on the risk of heart failure and survival alter the onset of heart failure Med Clinic NA 2004 88 Kissebah AH Krakower GR Regional adiposity and mortality Physiol Rev 1994 74 Zhang C Rexrode K Van Dam R Abdominal Obesity and the risk of all cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women Circulation 2008 117 Pischon T Boeing H Hoffmann K General and abdominal adiposity and risk of death in Europe N Engl J Med 2008 359 Mosterd A Cost B Hoes AW The prognosis of heart failure in the general population: The Rotterdam Study Eur Heart J 2001 22 Stevens J Jianwen C Pamuk ER The effect of age on the association between body-mass index and mortality N Engl J Med 1998 338 Willett W Dietz W Colditz G Guidelines for Healthy Weight N Engl J Med 1999 341 6 Colditz GA Willett WC Rotnitzky A Weight gain as a risk factor for clinical diabetes mellitus in women Ann Intern Med 1995 122 Rimm EB Stampfer MJ Giovannucci E Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men Am J Epid 1995 141 Cutler JA Follman D Allender PS Randomized trials of sodium reduction: a overview American Journal of Clinical of Nutrition 1997 65 Scholze J Grimm E Hermann D Unger T Kintscher U Optimal treatment of obesity-related Hypertension: The Hypertension-Obesity-Sibutramine Study Circulation 2007 115 Massie BM Obesity and heart failure-risk factor or mechanism? N Eng J Med 2002 347 Shuldiner AR Yang R Gong DW Resistin, obesity and insulin resistance: The emergencing role of the adipocite as an endocrine organ N Engl J Med 2001 345 Arguedas JA Sobrepeso y Obesidad Actualización medica periódica 2003 18 Elmer P Obarzanek E Vollmer W Simons D Stevens V Rohm D Lin P Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial Ann Intern Med 2006 144 Harsha D Bray G Weight loss and blood pressure Hypertension 2008 51 Guías para la detección, diagnostico y tratamiento de la hipertensión arterial en el I nivel de atención Guías para la detección, diagnostico y tratamiento de la hipertensión arterial en el I nivel de atención 2002
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100004 Diseccion aórtica: estado actual Contreras Zúñiga Eduardo Zuluaga Martínez Sandra Ximena Gómez Mesa Juan Esteban Ocampo Duque Vanesa Urrea Zapata Cristian Andrés ,Universidad del Valle Fundación Valle del Lili Cali Colombia ,Angiografía de Occidente Cali Colombia ,Fundación Valle del Lili Clínica de Falla y Transplante Cardíaco Cali Colombia ,Servicio Nacional de aprendizaje Cali Colombia ,Clínica Sebastian de Belalcázar Cali Colombia 06 2009 2009 11 19 27

Resumen La disección aguda es la afección más común de la aórta torácica y es dos o tres veces más frecuente que la ruptura del aneurisma aórtico abdominal; de no tratarse, tiene una mortalidad del 90% a tres meses. En los últimos años, se han dado grandes avances en su diagnóstico oportuno y tratamiento adecuado, tanto médico como quirúrgico, con significativa disminución de la mortalidad. Su incidencia está aumentando en los países industrializados, quizá incluso esté infravalorada, debida al grupo de pacientes que fallecen antes de que se llegue a un diagnóstico definitivo.

Abstract Aortic dissection: state of the art Acute dissection is the most common disease of the thoracic aorta and it is two or three times more frequent than the rupture of abdominal aortic aneurysm; if it is not treated properly, it has a mortality rate of 90% to three months. In recent years, much progress has been made in timely diagnosis and appropriate treatment, both medical and surgical management, with significant reduction in mortality. Its incidence is increasing in industrialized countries, perhaps even being undervalued, because of the large number of patients who die before they reach a definitive diagnosis.

 Disección aorta arco aórtico aorta ascendente aortic dissection aortic arch ascending aorta Tasai TT Isselbacher EM Trimarchi S Bossone E Pape L Acute type B aortic dissection: does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD) Circulation 2007 116 ^s11 Kahn SL Dake MD Stent graft management of stable, uncomplicated type B aortic dissection Perspect Vasc Surg Endovasc Ther 2007 19 2 Ford PF Farber MA Role of endovascular therapies in the management of diverse thoracic aortic pathology Perspect Vasc Surg Endovasc Ther 2007 19 2 Khalil A Helmy T Porembka Aortic pathology: aortic trauma, debris, dissection, and aneurysm Crit Care Med 2007 35 ^s8 Senay S Alhan C Toraman H Karabulut S Dagdelen H Cagil H Endovascular stent-graft treatment of type A dissection: case report and review of literature Eur J Vasc Endovasc Surg 2007 34 4 Ince H Nienaber CA Etiology, pathogenesis and management of thoracic aortic aneurysm Nat Clin Pract Cardiovasc Med 2007 4 8 Ince H Nienaber CA Management of acute aortic syndromes Rev Esp Cardiol 2007 60 5 Evangelista M Kaji S Akasaka T Horibata Y Nishigami K Shono H Progress in the acute aortic syndrome Rev Esp Cardiol 2007 60 4 Kelly BS Brian S Evaluation of the elderly patient with acute chest pain Clin Geriatr Med 2007 23 2 Feldstein C Management of hypertensive crises Am J Ther 2007 14 2 Della H Aortic dissection RN 2007 70 3 Schulenburg M Management of hypertensive emergencies: implications for the critical care nurse Crit Care Nurs Q 2007 30 2 Santini F Mazzucco A Acute type A aortic dissection: an update on a still challenging disease J Cardiovasc Med 2007 8 2 Ladouceur M Fermanian C Lupoglazoff JM Edouard T Dulac Y Acar P Effect of beta-blockade on ascending aortic dilatation in children with the Marfan syndrome Am J Cardiol 2007 99 3 Ince H Nienaber CA Diagnosis and management of patients with aortic dissection Heart 2007 93 2 Siegal EM Acute aortic dissection J Hosp Med 2006 1 2 Chuter TA Gordon RL Reilly ML Endovascular treatment of thoracoabdominal aortic aneurysms J Cardiovasc Surg 2006 47 6 Ince H Nienaber CA Interventional strategies for treatment of aortic dissection J Cardiovasc Surg 2006 47 5 Shiga T Wajima Z Apfel CC Inoue T Ohe Y Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis Arch Intern Med 2006 166 13 Flachskampf F Frank A Lee Y Liang D Hsieh J Ko F Assessment of aortic dissection and hematoma Semin Cardiothorac Vasc Anesth 2006 101 Ahmad F Acute aortic syndrome: pathology and therapeutic strategies Postgrad Med J 2006 82967 Elliott W Phillips J Greenblatt LR Clinical features in the Management of selected hypertensive emergencies Prog Cardiovasc Dis 2006 48 5 Gupta R Kaufman S Cardiovascular emergencies in the elderly Emerg Med Clin North Am 2006 24 2 Scheetz L Aortic dissection Am J Nurs 2006 106 4 Ringstrom E Freedman J Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines Mt Sinai J Med 2006 73 2 Plestis K Mizrahi E Loubser P Kantis G Managing emergency hypertension in aortic dissection and aortic aneurysm surgery J Card Surg 2006 21 1 Atkins MD Black JH Cambria RP Aortic dissection: perspectives in the era of stent-graft repair J Vasc Surg 2006 43 ^sA Sato F Kitamura T Kongo M Okinaka T Onishi K Ito M Newly diagnosed acute aortic dissection: characteristics, treatment modifications, and outcomes Int Heart J 2005 46 6 Pollack ML ECG manifestations of selected extracardiac diseases Emerg Med Clin North Am 2006 24 1 Bhalla S CT of nontraumatic thoracic aortic emergencies Semin Ultrasound CT MR 2005 26 5 McGee EC Pham DT Gleason TG Chronic descending aortic dissections Semin Thorac Cardiovasc Surg 2005 17 3 Sandridge L Kern JA Acute descending aortic dissections: management of visceral, spinal cord, and extremity malperfusion Semin Thorac Cardiovasc Surg 2005 17 3 Szeto WY Gleason TG Operative management of ascending aortic dissections Semin Thorac Cardiovasc Surg 2005 17 3 Kasputin AJ Litt HI Diagnostic imaging for aortic dissection Semin Thorac Cardiovasc Surg 2005 17 3 Tang A Euerle B Emergency department ultrasound and echocardiography Emerg Med Clin North Am 2005 23 4 Haro LH Krajicek M Lobl JK Challenges, controversies, and advances in aortic catastrophes Emerg Med Clin North Am 2005 23 4 Tang GH Aortic root replacement surgery: indications, techniques and outcomes Expert Rev Cardiovasc Ther 2005 3 5 Falconi M Oberti P Krauss J Domenech A Cesareo V Bracco D Different clinical features of aortic intramural hematoma versus dissection involving the descending thoracic aorta Echocardiography 2005 22 8 Prisant LM Prassat N Aortic dissection J Clin Hypertens 2005 7 6 Sharma UK Gulati MS Mukhopadhyay S Aortic aneurysm and dissection: evaluation with spiral CT angiography JNMA J Nepal Med Assoc 2005 44 157 Klein DG Thoracic aortic aneurysms J Cardiovasc Nurs 2005 20 4 Prieto R Acute aortic dissection Rev Port Cardiol 2005 24 4 Jaramillo N Alviar C Disección de aorta: Aspectos básicos y manejo endovascular Rev Col Cardiol 2005 12 2 Borioni R Garafalo M De Paulis R Nardi P Scaffa R Chiariello L Abdominal Aortic dissections: anatomic and clinical features and therapeutic options Tex Heart Inst J 2005 32 1 Prisant LM Houghton JL Bottini PB Hypertensive heart disease J Clin Hypertens 2005 7 4 Stillman AE Stillman AE Halliburton SS White RD CT of the heart: principles, advances, clinical uses Cleve Clin J Med 2005 72 2 Vilacosta I San Roman JA Acute aortic syndrome Rev Esp Cardiol 2003 56 ^s1 Boyer JK Curr Opin Cardiol 2004 19 6 Tack W Schellemans C Vanderheyden M Acute type A aortic dissection in a cardiac allograft recipient: case report and review of the literature Heart 2004 90 11 Tan ME Chiappini B Win MD Surgery for acute type A aortic dissection: is advanced age a contraindication? Ann Thorac Surg 2004 78 2 Aziz S Ramsdale DR Acute dissection of the thoracic aorta Hosp Med 2004 65 3 Tuncel M Hypertensive emergencies: Etiology and management Am J Cardiovasc Drugs 2003 3 1 Knaut AL Cleveland JC Aortic emergencies Emerg Med Clin North Am 2003 21 4 Bhalla S Menias CO Heiken JP CT of acute abdominal aortic disorders Radiol Clin North Am 2003 41 6 Greenberg R Resch T Nyman U Lindh M Brunkwall J Brunkwall P Aortic dissections: new perspectives and treatment paradigms Eur J Vasc Endovasc Surg 2003 26 6 Matsunaga N Hayashi K Okada M Sakamoto I Magnetic resonance imaging features of aortic diseases Top Magn Reson Imaging 2003 14 3 Macura SJ Katarzyna J Choi SH Choi SJ Kim J Role of computed tomography and magnetic resonance imaging in assessment of acute aortic syndromes Semin Ultrasound CT MR 2003 24 4 Greenberg RJ Resch T Nyman U Lindh M Brunkwall J Brunkwall P Contemporary management of acute aortic dissection J Endovasc Ther 2003 10 3 Nienaber C Christoph A Kim A Eagle MD Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies Circulation 2003 108 5 Htay T Live three-dimensional transthoracic echocardiographic assessment of aortic dissection Echocardiography 2003 20 6 Zamorano JL Mayordomo J Evangelista A San Román JA Bañuelos C Imaging diagnosis in acute aortic syndromes Rev Esp Cardiol 2003 56 5 Anand R Difficulties in the diagnosis of acute aortic dissection Hosp Med 2003 64 4 Loose R Kodolitsch Y Csösz SK Koschyk DH Schalwat I Loose R Intramural hematoma of the aorta: predictors of progression to dissection and rupture Circulation 2003 107 8
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100005 Ablación del flúter típico con cartografía electromagnética Gutiérrez Sotelo Oswaldo Araya Gómez Vivien Abed Muhammad Quesada Alvarado Heberth ,Hospital Clínica Bíblica Servicio de Cardiología San José Costa Rica 06 2009 2009 11 29 32

Resumen Se presenta el caso de un paciente masculino de 33 años, portador de distrofia miotónica sin compromiso estructural miocárdico, pero con flúter atrial paroxístico refractario a fármacos antiarrítmicos. Se utilizó un sistema cartográfico electromagnético para la ablación por catéter del flúter, la cual fue exitosa.

Abstract Clinical case: Typical Flutter ablation with electromagnetic cartography We herein present the case of a 33 years old male patient with myotonic distrophy without structural cardiac involvement but with recurrent episodes of paroxysmal atrial flutter, refractory to antiarrhtythmic drugs. We used an electromagnetic mapping system and the flutter was successfully ablated.

 Olgin JE Zipes DP Libby P Bonow RO Mann DL Zipes DP Macroreentrant Atrial Tachycardias Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. 2007 Saunders, EUU Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. 2007 Saunders, EUU Blomström-Lundqvist C Scheinman MM Aliota EM ACC/AHA/ ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias-Executive Summary J Am Coll Cardiol 2003 42 Gutiérrez O Aplicaciones de la esimulación cardiaca: 50 años de aprendizaje. Comentario editorial Rev Costarr Cardiol 2008 1 Jackman WM Wang XZ Friday KJ Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current N Engl J Med 1991 324 González Torrecilla E Los sistemas navegadores en la electrofisiología actual Rev Esp Cardiol 2004 57
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100006 Insuficiencia Tricuspídea Primaria: Reporte de un caso y Revisión de la Literatura Chavarría Jorge Romero Luis Díaz Geiner Induni Eduardo ,Hospital México Servicio de Cardiología San José Costa Rica ,Hospital México Servicio de Cirugía de Torax y Cardiovascular San José Costa Rica 06 2009 2009 11 33 37

Resumen Se presenta el caso de una paciente femenina de 64 años, con dificultad respiratoria y edema de miembros inferiores. Se documentó falla ventricular derecha secundaria a insuficiencia tricuspídea por defecto en su valva septal. Se le realizó exploración quirúrgica, efectuandose una anuloplastia según técnica de De Vega , con excelente mejoría clínica en sus controles posteriores.

Abstract Primary tricuspid valve insufficiency: a case report and literature review We present the case of a 64 year old female patient, with shortness of breath and edema of the lower extremities due to right heart failure secondary to primary tricuspid regurgitation (septal leaflet valve dysfunction). A tricuspid valve annuloplasty was performed with a DeVega technique, with successful clinical resolution.

 Insuficiencia tricuspídea Hipertensión pulmonar Insuficiencia cardiaca derecha Tricuspid Regurgitation Pulmonary hypertension Right Heart Failure Libby P Bonow R Mann D Valvular Heart Disease Valvular Heart Disease 2007 8th ^ePhiladelphia Saunders Elsevier De Diego C Alberca P Marcos Cabrera JA Pathognomonic echocardiographic features of carcinoid syndrome Clin Cardiol 2006 M ar 29 3 Gonzalez R Zalaquet S Chamorro G Rotura de válvula tricúspide con insuficiencia masiva secundaria a traumatismo torácico cerrado: Caso clínico Rev. méd. Chile ago. 2 136 8 Boshoff D Mertens L Gewillig M Severe Tricuspid regurgitation 14 years after diagnosis of "transient neonatal tricuspid regurgitation" Heart 2001 86 Sugimoto T Masayoshi O Nobuchika O Influence of Functional Tricuspid Regurgitation on Right Ventricular Function Ann Thorac Surg 1998 66 Surós A Semiología Médica y técnica exploratoria Semiología Médica y técnica exploratoria 2001 8 Barcelona Editorial Masson Bonow RO Carabello BA Chatterjee K ACC/AHA 2006 guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 2006 A ug 48 3 Vahanian Alec Baumgartner Helmut Bax Jeroen Butchart Eric Dion Robert Filippatos Gerasimos Guidelines on the management of valvular heart disease: Task Force of the European Society of Cardiology European Heart Journal 2007 28 Brown M Li Sundt T Mi I I I Gersh B Ji Cohn Lh Valve Heart Disease Cardiac Surgery in the Adult Cardiac Surgery in the Adult 08 ^eNew York McGraw-Hill Brickner E Hillis D Lange R Congenital Heart Disease in Adults: Second of Two Parts. Review Article NEJM 2000 342
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100007 Taquicardia de Coumel: Descripción de un caso clínico Contreras Zúñiga Eduardo Zuluaga Martínez Sandra Ximena ,Universidad del Valle Cali Colombia ,Santa Casa do Misericordia Rio de Janeiro Brasil 06 2009 2009 11 39 41

Resumen Se presenta el caso de un hombre de 17 años, con taquicardia reciprocante permanente de la unión atrioventricular, que es una forma especial de taquicardia paroxística supraventricular, que se presenta en forma incesante y en la cual participa una vía accesoria de conducción lenta retrógrada. El paciente fue tratado con ablación por catéter con éxito.

Abstract Coumel´s tachycardia: a clinical case We report the case of a 17 years old male with a permanent form of junctional reciprocating tachycardia, which is a special form of paroxysmal supraventricular tachycardia, is presented in a ceaseless form and which an accessory slow retrograde pathway conduction participates. He underwent successful catheter ablation.

 taquicardia reciprocante permanente de la unión atrioventricular taquicardia de Coumel Permanent atrioventricular junctional reciprocating tachycardia Coumel’s tachycardia Vijayaraman P Alaeddini J Storm R Oren J Wood MA Ellenbogen KA Slow atroventricular nodal reentrant arrhythmias: clinical recognition, electrophysiological characteristis, and response to radiofrequency J Cardiovasc Electrophysiol 2007 18 Hucker WJ Nikolski VP Efimov IR Optical mapping of the atrioventricular junction J Electrocardiol 2005 38 ^s4 Hayes JJ Sharma PP Familiar atrioventricular nodal reentry tachycardia Pacing Clin Electrophysiol 2004 27 Wood KA Drew BJ Frequency of disabling symptoms in supraventricular tachycardia Am J Cardiol 1997 79 Mazgalev TN Tchou PJ Surface potentials from the region of the atrioventricular node and their relation to dual pathway electrophysiology Circulation 2000 1001 Wu J Zipes DP Mechanism underlying atrioventricular nodal conduction and the reentrant circuit of atrioventricular nodal reentrant tachycardia using optical mapping J Cardiovasc Electrophysiol 2002 13 Blomstrom-Lundqvist C Scheinman MM Aliot EM ACC/AHA/ ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias) Circulation 2003 108
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100008 Electrocardiograma del mes Araya Gómez Vivien ,Centro Cradiológico Integral 06 2009 2009 11 43 43
S1409-414220090001 Revista Costarricense de Cardiología Rev. costarric. cardiol 1409-4142 Asociación Costarricense de Cardiología S1409-41422009000100009 Fragmentos del pensamiento de George Bernard Shaw: Dramaturgo y filósofo irlandés, 1856-1950 , 06 2009 2009 11 44 44