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#78 De: Mario Heņin <mariohenin@arnet.com.ar>  
Enviado: Jueves, 09 de Marzo de 2000 02:14 p.m.
Asunto: FORO DE EDUCACION CONTINUA/CONTINUAL EDUCATION FORUM
NOVEDADES DEL FORO
_____________________
El 31 de Marzo de 2000 finaliza el PCVC, pero todo el material cientifico acumulado en sus paginas web quedara publicado para futuras consultas.
A partir del 1ro de abril de 2000 el PCVC sera reemplazado por el FORO DE EDUCACION CONTINUA, que seguira hasta Setiembre de 2001, fecha en la que comenzara el Segundo Congreso Virtual de Cardiologia (SCVC).
La estructura fundamental del FORO DE EDUCACION CONTINUA se construira en base a los Foros actuales, entre los que se cuenta  coronary-pcvc, continuandose con las discusiones de diversos aspectos de la especialidad y la presentacion de casos.
El unico cambio apreciable para los suscriptos a coronary-pcvc, sera que las actividades seran solo en espaniol, dado que no sera posible mantener las traducciones durante ese periodo.
Cordialmente,

NEWS FROM THE FORUM
------------------------------
On March 31st, 2000, the FVCC will end, but all the scientific material gathered in its web pages will remain published for future consults.
Since April 1st, 2000, the FVCC will be replaced by the CONTINUAL EDUCATION FORUM, that will remain until September, 2001, when the Second Virtual Congress of Cardiology (SVCC) will begin.
The main structure of the CONTINUAL EDUCATION FORUM will be built upon the base of the current Forums, including coronary-pcvc.
Discussions about several aspects of the specialty and presentation of cases will continue.
The only important change for those who have subscribed to coronary-pcvc, will be that the activities will be only in Spanish, since it will not be possible to make translations for that period.
Cordially,
Dr Mario Heņin
Moderator
Resistencia,(Chaco)
Argentina

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#79 De: Mario Heņin <mariohenin@arnet.com.ar>  
Enviado: Lunes, 13 de Marzo de 2000 06:02 p.m.
Asunto: Casos para chat en Espaniol, el 30 de Marzo/Cases for chat in Spanish, March 30th
Sponsored by: Agilent Technologies
Amigos de la Lista:
Enviamos el resumen de dos casos clinicos -un infarto agudo de miocardio y una angina inestable- a los efectos que envien preguntas que ustedes harian a los Dres.Alfredo Piombo y Hugo Londero , que el dia jueves 30 de Marzo participaran en una sesion de Chat sobre "LA VISION DEL CARDIOLOGO CLINICO  Y EL INTERVENCIONISTA EN LOS SINDROMES CORONARIOS AGUDOS".
Aclaramos que NO se trata de un ateneo, sino que los casos sirven de marco de referencia para realizar preguntas de tipo conceptual.
Las preguntas deben ser enviadas a la direccion:
chat-pcvc@pcvc.sminter.com.ar
donde tambien se daran las instrucciones respectivas para participar de la sesion, horarios. etc. Aclaramos que la sesion de chat se realizara unicamente en idioma espaniol.
Cordialmente,
Dr Mario Heņin
Moderador- Coronary-pcvc
Resistencia,(Chaco)
Argentina
_____________________ooo___________________
Primer caso:
Infarto Agudo de Miocardio.
HZ, femenino, 84 aņos
Comienza con nauseas, sudoracion y disnea a las 11:30 horas.
A las 12:30 ingresa a Guardia constatandose supradesnivel del ST en cara inferior y anterior. Pasa urgente a UCO.
La paciente no referia prodromos. No tenia antecedentes de ningun tipo con excepcion de ser hipertensa medicada con 5 mg de amlodipina.
Colecistectomia.
No tenia antecedentes de dislipemia, diabetes ni tabaquismo
Examen fisico:
Peso 65 Kg TA: 155/95 Pulso regular 66 por minuto. Afebril, 18 resp por minuto.
Semiologia de cuello, ap. respiratorio, auscultacion cardiaca, abdomen, ex. neurologico, pulsos perifericos: absolutamente normales
ECG: Ritmo sinusal 62x min.
Supradesnivel ST en D2, D3, aVF, V3 a V6, V3R y V4R.
Infradesnivel ST en V1, V2, D1 y aVL.
q D3 y aVF
T neg D1, aVL, V1 y V2
No hay mejoria sintomatica ni del ECG con la infusion de NTG.
Se deriva a la sala de Cateterismo.
Se constata obstruccion proximal 100% de la CD. DA y Cx: normales.
Se practica PTCA con balon exitosa (TIMI III) quedando con obstruccion residual del 20%. Intraprocedimiento presenta hipotension y
bradicardia con buena respuesta a los expansores y atropina.
Evoluciona asintomatica con disminucion progresiva del infradesnivel, quedando con T neg en D2, D3 y aVF.
Curva enzimatica tipica.
ECO: aquinesia inferopostero lateral e hipoquinesia infero medial.
===========================================================================
Segundo caso:
Angina Inestable.
Paciente XX, 41 anios, sexo masculino.
Factores de riesgo coronario: Dislipemia, Hipertension Arterial, Sedentarismo, Obesidad, Antecedentes de Tabaquismo y fuertes Antecedentes Heredo-familiares.
El 21 febrero de 2000 inicia los sintomas con un episodio de Angina de Pecho de 5 minutos de duracion en ocasion de un esfuerzo pequenio. Consulta a un cardiologo que le efectua un ECG, que no muestra alteraciones, y lo medica con Beta Bloqueantes y Aspirina.
A pesar del tratamiento evoluciona con episodios anginosos en reposo de breve duracion. El dia 24 de febrero es internado por un episodio de dolor precordial prolongado asociado a hipertension. El electrocardiograma intradolor muestra infra-desnivel del segmento ST de V1 a V4. Es medicado con Nitritos Intravenosos.
El día 27 es derivado al Instituto de Cardiologia y Cirugia Cardiovascular.
Durante el traslado presenta cuatro episodios anginosos no prolongados.
El ECG de ingreso muestra ondas T negativas de V2 a V6 y en DI y aVL.
La Troponina y las Enzimas Cardiacas eran normales.
Durante la internacion en Unidad Coronaria continuo con episodios de dolor precordial a pesar del tratamiento con Aspirina, Beta
Bloqueantes, Nitroglicerina endovenosa y Heparina Fraccionada por via subcutanea.
El dia 28 de febrero se efectuo coronariografia que mostro una lesion unica, proximal de arteria Descendente Anterior, subtotal, de tipo excentrico con imagen de trombo endoluminal. En el mismo procedimiento se decidio el tratamiento por angioplastia. Previo a la intervencion se administro 300 mg de Clopidogrel, un bolo de 26 mg de abciximab y se comenzo una infusion endovenosa de 10 microgramos/minuto por 12 horas. Se efectuo Angioplastia Coronaria con implante de un stent de tipo tubular de 18 mm de longitud, que fue expandido hasta 4.5 mm de diametro a 16 atmosferas. El procedimiento fue exitoso y el paciente fue dado de alta 24 hs mas tarde tratado con Clopidogrel 75 mg, Aspirina y Bloqueantes Beta.

Friends of the List:
We send the summary of two clinical cases -an acute myocardial infarction and an unstable angina- so that you may send questions that you would ask to Drs. Alfredo Piombo and Hugo Londero, who on Thursday, March 30th, will take part in a Chat session about "POINT OF VIEW FROM CLINICAL AND INTERVENTIONAL CARDIOLOGISTS IN ACUTE CORONARY SYNDROMES".
We want to make it clear that this is NOT an athenaeum, instead the cases help as reference to make questions of a conceptual kind.
The questions must be addressed to:
chat-pcvc@pcvc.sminter.com.ar
where the corresponding instructions will be also provided, in order to participate in the session, timetables, etc. We clarify that the chat session will be made only in Spanish.
Cordially,
Dr Mario Heņin
Moderator- Coronary-pcvc
Resistencia,(Chaco)
Argentina
_____________________ooo___________________
First case:
Acute Myocardial Infarction.
HZ, female, 84 years old
She begins with nausea, perspiration, and disnea at 11:30hs.
At 12:30 she is admitted in the Emergency Room, with ST elevation in inferior and anterior sides. She enters ICU urgently.
The patient does not express prodromes. She has no history of any kind, but for hypertension under medication with 5mg of amlodipine.
Cholecystectomy.
She does not have history of dyslipidemia, diabetes, or smoking.
Physical examination:
Weight: 65Kg AT: 155/95 Regular pulse 66 per minute. She has no fever, 18 breaths per minute.
Neck semiology, respiratory apparatus, cardiac auscultation, abdomen, neurological examination, peripheral pulses: absolutely normal.
ECG: Sinus rhythm 62x min.
ST elevation in D2, D3, aVF, V3 to V6, V3R and V4R.
ST depression in V1, V2, D1 and aVL.
qD3 and aVF
Neg T D1, aVL, V1 and V2
There is no improvement in symptoms or in ECG with NTG infusion.
She is sent to Catheterization.
Proximal obstruction in a 100% is observed on the right coronary artery. LADA and Cx artery: normal.
Successful PTCA is performed with balloon (TIMI III). She has residual obstruction in a 20%. Intra-procedure presents hypotension and bradycardia with good response to expanders and atropine.
She evolves without symptoms with progressive decrease of depression, remaining with neg T in D2, D3, and aVF.
Typical enzymatic curve.
ECHO: inferior-posterior-lateral akinesia, and inferior-medial hypokinesia.
=======================================================================
Second case:
Unstable Angina.
Patient XX, 41 years old, male.
Coronary risk factors: dyslipidemia, hypertension, sedentary life, obesity, history of smoking and strong hereditary-family history.
On February 21st, 2000, he begins symptoms with a 5-minute Chest Angina episode, while doing  a small effort. He consults with a cardiologist who makes an ECG, that does not display alterations, and medicates him with Beta Blockers and Aspirin.
In spite of the treatment, he evolves with brief angina episodes during rest. On February 24th, he is admitted due to a long episode of precordial pain associated to hypertension. The intra-pain electrocardiogram shows ST segment depression of V1 to V4. He is medicated with iv Nitrites.
On February 27th, he is sent to the "Instituto de Cardiologia y Cirugia Cardiovascular".
During transfer he presents four angina episodes, not long.
ECG on admittance shows negative T waves of V2 to V6 and in DI to aVL.
Troponin and Cardiac Enzymes were normal.
During admittance in Coronary Unit he continues with episodes of precordial pain in spite of the treatment with Aspirin, Beta Blockers, endovenous Nitroglycerin and fractionated Heparin by subcutaneous via.
On February 28th, a coronary angiography was performed, and it displayed just one lesion, proximal of Descending Anterior artery, subtotal, of the eccentric type with image of endoluminal thrombus. In the same procedure treatment by angioplasty was decided.
Prior to intervention 300mg of Clopidogrel were administered, a 26mg bolus of abciximab and a 10 micrograms/minute endovenous infusion was administered for 12 hours. Coronary angioplasty was performed with implantation of a tubular stent, 18mm of length, which was expanded until 4.5mm of diameter in 16 atmospheres. The procedure was successful, and the patient was dismissed 24hs later, under treatment with Clopidogrel 75mg, Aspirin and Beta Blockers.

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Mar/29/2000