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Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease., (Copyright: © 2019 Permanyer.)

Unlabelled: Acute myocarditis (AM) is associated with viral infections: Coxsackie and ECHOviruses among others. Autoimmunity has been proposed as a pathogenic mechanism. Benefit of classic immunosuppression (prednisone-azathioprine) or immunomodulation (monomeric-human IgG) is still uncertain., Objective: To review incidence and clinical approach to AM at a Cardiology referral center., Material and Methods: A 10-yeard period (1992-2003) is reviewed. A standard questionary was applied to 49 consecutive patients referred by clinicians with a diagnosis of AM., Results: AM was found in 17 women and 32 men, median age 24 and 28 years, respectively. They presented heart failure with dyspnea/ortopnea (70-47%), peripheral edema/jugular vein plethora (41-37%), chest pain, and tachycardia (50%), NYHA functional class was Ill-IV in 22. The EKG showed sinus tachycardia or conduction defects. Transthoracic echocardiograms in 47 cases showed EF (mean) of 41% with enlarged left ventricle diameter. Antivirus antibodies were present in 54% of those cases studied, Coxsackie or ECHOvirus were identified through a serologic assay. Twenty-nine (61%) of our cases developed dilated cardiomyopathy, three patients died. It is not possible to reach a conclusion regard to immunomodulation therapy, because it was applied to only 12 patients., Conclusions: At the Instituto Nacional de Cardiología "I. Chávez", AM depicts an incidence of 1/1,000 patients a year. It is necessary to standardize the clinical approach for diagnosis and treatment, progression to dilated cardiomyopathy and death during acute stage occurs in two-thirds of our patients.

Takayasu arteritis (TA) is a chronic disease that affects mainly the aorta. Its etiology is still unknown, nevertheless it predominates in women and initiates primarily in the youth. This disease seems to have two different stages, an early stage that is characterized by an inflammatory process and a later stage characterized by vascular occlusion. Unitl now, diagnosis and classification of TA are made clinically, based on ACR; criteria and imaging studies as computed tomography and aorta angiographies. Currently, new imaging, non invasive studies, such as magnetic resonance (MRI) and positron emission tomography (PET) are being used. PET technique could be helpful in the diagnosis and detection of inflammatory activity in patients with TA because of its capacity to detect increased metabolism. We present the case of a female patient with TA diagnosis, which demonstrated clinical inflammatory activity that was corroborated by laboratory studies, MRI and PET.

A significant correlation between autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and premature or accelerated coronary atherosclerosis was found. The objectives of the study were: a) evaluate myocardial perfusion in patients with rheumatic diseases by means of contrast echocardiography (CE) and to establish its usefulness as compared to the results obtained by nuclear medicine (NM) (reference method). b) evaluate the prevalence of alterations in subclinical myocardial perfusion in autoimmune diseases and to establish a strategy to evaluate the cardiovascular changes in this disease. Myocardial perfusion in 37 outpatients of the rheumatology department was evaluated by CE at rest and with pharmacological stress (dobutamine) and NM. The prevalence of alterations in the myocardial perfusion in autoimmune diseases by CE and NM, when these methods were analyzed independently or when both methods were used was 27%. The positive predictive value (PPV) and negative predictive value (NPV) of both tests was 80% and 93%, respectively, the sensitivity was 80% and the specificity was 93%. The prevalence of alterations of perfusion in the primary antiphospholipid syndrome (PAPS) was of 30%. In this patients it was found that when both diagnostic tests are performed, NM reaches a sensitivity of 100% if the CE is positive and an specificity of 100% when the CE is negative. We can conclude that it is important to determine the presence of subclinic coronary artery disease in patients with autoimmune disease by noninvasive studies such as Sestamibi SPECT and/or CE for assessment of myocardial perfusion in order to plan an adequate treatment and follow-up.

The World Health Organization (WHO) and several other international committees on the study of hypertension define that a patient with blood pressure between 140/90-150/95 mmHg must be treated. In the first stage of hypertension it is possible to modify it with life style changes, but if high blood pressure persists, then drug therapy must be evaluated carefully. Drug therapy management is individualized and based upon age, race, previous history of hypertension, and risks for target systemic organs. At the National Institute of Cardiology "Ignacio Chávez" in Mexico City there is a wide experience with drugs of several groups, and treatment is chosen to give the patient the greatest advantage and quality of life. Nursing requires a clear and precise knowledge of drug therapy in hypertension, as well as the understanding of its physiopathology to support in an effective way each one of the interventions. Through the Nursing process, Nurses direct their actions not only to the correct administration of drugs, but also, based on the patients background, to orient, inform, and educate the patient about disease to achieve a strict drug therapy compliance, in order to reach the main goal of the process, the which is the best quality of life possible.