Search

Severe stenosis of the subclavian artery is a rare clinical finding, even more so for bilateral existence of the condition. Subclavian artery stenosis leads to erroneously normal or even low blood pressure values when measured at the brachial artery on the ipsilateral side. The poor control of blood pressure may cause cardiovascular complications such as heart failure and acute pulmonary edema without the patient having high blood pressure in the arms. Widespread clinical reliance on a sole brachial measurement of blood pressure, particularly in the emergency room setting, may result in inappropriate clinical management in patients with conditions that alter brachial blood pressure. We report a case of acute diastolic heart failure secondary to hypertensive emergency hidden due to bilateral stenosis of both subclavian arteries in a patient with severe atherosclerosis, cerebrovascular disease, and symptoms of subclavian steal syndrome.

This paper presents a numerical study of an innovative floating wind turbine developed by ESTEYCO S.A.P. as part of an intensive R&D roadmap initiated ten years ago. The concept is called TELWIND, an evolved spar concept composed by a telescopic tower and two independent concrete bodies: the upper tank (acting as buoyancy body) and lower tank (acting as ballasting body), connected by suspension tendons. An ad-hoc numerical model has been developed by IHCantabria, calibrated and validated, based on a set of large scale laboratory tests performed at the Cantabria Coastal and Ocean Basin (CCOB), located at IHCantabria, Santander, Spain. The inhouse numerical model is a fully coupled model which comprehends three main modules: i) Hydrodynamic model that analyses the coupled hydrodynamics of floater and ballast. ii) Mooring and tendon module, and iii) Aerodynamic model. The full description of the numerical model is summarized, as well as the validation procedure followed. Finally, the validation of the numerical model is shown.

Parkinson's disease (PD) patients have most frequently heart failure. The cause of this increased prevalence is not known. We designed a study to assess the cardiac function and cardiac structure in patients with PD compared to a control group. Methods Cross-sectional study with 50 PD patients and 50 healthy matched controls. We performed electro and echocardiograms to all patients and controls. The measurements were blind. In addition, we performed a neurological assessment. Results PD patients had higher left ventricular mass index (114.2 ± 38.4 vs. 94.1 ± 26.4 g/m2; P = 0.003) and higher left atrial volume (30.1 ± 7.9 vs. 26.7 ± 6.2 ml/m2; P = 0.01). PD was an independent risk factor for elevated left ventricular filling pressures (OR = 2.7, CI 95% 2.2-6.3; P = 0.004). Concentric remodeling and left ventricular hypertrophy were associated with more advanced Hoehn and Yahr stages. Moreover, patients with more dysautonomia symptoms showed more left ventricular hypertrophy. Finally, PD group had longer QT interval than control group regardless of the drugs. Conclusions PD is significantly associated with increased concentric left ventricular hypertrophy and diastolic dysfunction. Advanced stages of PD are associated with a more severe cardiac affection. These findings can explain the increase of heart failure in PD patients. Cardiomyopathy could be a non-motor parkinsonian symptom.

A 53-year-old man underwent percutaneous coronary intervention of a chronic total occlusion of the circumflex artery. A mini-crush stent technique with two drug-eluting stents was performed. To the best of our knowledge, this is the first case of coronary artery aneurysm affecting a bifurcated chronic total occlusion treated with a two-stent technique.

We have carefully read the article by Jolly et al.1 We congratulate the authors for the effort of pooling individual data from the most important trials regarding thrombus aspiration (TA). It confirms that routine TA should not be performed in this context. However, we would like to make some considerations. We agree that after the TAPAS trial (Thrombus Aspiration During Primary Percutaneous Coronary Intervention),2 TA became part of routine practice, and was probably overused. However, results of the TASTE (Thrombus Aspiration During ST-Segment Elevation Myocardial Infarction)3 and TOTAL (Randomized Trial of Primary PCI With or Without Routine Manual Thrombectomy)4 trials, which drive the bulk of the overall effect …

Poisoning by ingestion of ‘Jamaican Stone’, a kind of cardioactive steroid, is extremely rare. However, mortality is very high. For this reason, when it occurs, an early and accurate diagnosis represents a critical challenge for clinicians. We present an unusual case of electrical storm caused by this substance. Resumo: O envenenamento por ingestão de «pedra jamaicana», um tipo de esteroide cardioativo, é extremamente raro. Contudo, dado esta situação se associar a uma mortalidade muito elevada, o diagnóstico precoce e rigoroso desta situação pode ser clinicamente crucial. É retratado um caso pouco comum de tempestade arrítmica causada por esta substância. Keywords: Jamaican Stone, Cardenolides, Bufadienolides, Cardioactive steroids, Palavras-chave: Pedra jamaicana, Cardenolídeos, Bufadienolídeos, Esteroides cardioativos

Drug-coated balloons (DCBs) constitute one of the therapeutic tools used in percutaneous coronary interventions (PCIs) of both stent restenosis and "de novo" coronary lesions, mainly in bifurcations and small vessels. Diabetic patients represent an unfavorable subgroup because of their higher

Nickel is the most frequent allergen in patients with allergic contact dermatitis and nickel allergy has been associated with recurrent in-stent restenosis. However, it is often misdiagnosed because of a low suspicion threshold. It should be discarded in patients with recurrent in-stent restenosis, especially if their medical history reveals prior contact dermatitis. It is also noteworthy and rarely specified that even newer generation stents that use novel metal alloys also contain low amounts of nickel. To avoid the implantation of new stents containing this metal, when percutaneous coronary intervention is indicated, drug eluting balloons or bioresorbable vascular scaffolds associated with small doses of steroids could provide good alternatives of treatment. To the best of our knowledge, this is the first description of this therapeutic alternative in such an exceedingly rare clinical scenario.

Background: There are few data on the prognostic significance of the wall motion score index compared with left ventricle ejection fraction after an acute myocardial infarction. Our objective was to compare them after the hyperacute phase. Methods: Transthoracic echocardiograms were performed in 352 consecutive patients with myocardial infarction, after the first 48 hours of admission and before hospital discharge (median 56.3 hours (48.2–83.1)). We evaluated the ability of the wall motion score index and left ventricular ejection fraction to predict the combined endpoint (mortality and rehospitalization for heart failure) as a primary objective and the independent events of the combined endpoint as a secondary objective. Results: In 80.7% of patients, the wall motion score index was high despite having an ejection fraction >40%. No patient had an ejection fraction 1.8 proved to be the most powerful predictor of the composite endpoint (hazard ratio: 8.5; 95% confidence interval 3.7–18.8; p40%). Conclusions: Both variables provide important prognostic information after a myocardial infarction. Beyond the hyperacute phase, wall motion score index is a more powerful prognostic predictor, especially in subgroups with less myocardial damage.

A complete hydrodynamic study of a Multi Use Platform designed to harvest energy from waves and wind is presented. The steps given in the study, and presented in this paper are: (i) the design of the platform, (ii) the laboratory tests performed at the Cantabria Coastal and Ocean Basin, (iii) the development of a new in-house time domain numerical model that integrates all components and (iv) the first validation cases of the numerical model. The development of time domain numerical model that coupled the behaviour of the platform and the OWCs based in Cummins equation is presented. The model includes nonlinear friction forces and a quasi-static approach to model the mooring system. The obtained system is extended to include the variation of the pressure inside each chamber. The effect of the wind turbine in the movements and power production of the platform is studied using also a quasi-static approach.

There is a growing interest from offshore and energy industry towards floating wind turbines. Since these systems are exposed to harsh metocean conditions, accessibility for inspection and maintenance purposes becomes of primary importance for a safe and cost-effective long-term operation. It is here proposed a methodology for evaluating the accessibility of a floating wind platform, by means of walk-to-work vessels. Two access means are considered: a catamaran equipped with fender and an offshore supply vessels with a motion-compensated gangway. The system composed by the platform and the vessel is modelled as a constrained multi-body system in the frequency domain. This allows to calculate transfer functions for the vessel motions and the contact forces. For given a short-term sea state the maximum crest height of a response variable is calculated assuming that crests heights are Rayleigh distributed, and compared to some threshold to determine whether the platform is accessible or not. For the catamaran, access is possible when the fender does not slip against the landing structure mounted on the floating platform; for the supply vessel, when the relative motions at the gangway tip do not exceed the compensation limits of the hydraulic system. Accessibility is calculated for a sample semisubmersible wind turbine located off the coast of Portugal using hindcast data for the period 1980–2013. Findings indicate that the catamaran and the supply vessel can ensure access for 20% and 76% of the time respectively. However, results are strictly dependent on the vessel types and the walk-to-work constraints.

A reduction in radiation doses at the catheterization laboratory, maintaining the quality of procedures is essential. Our objective was to analyze the results of a simple radiation reduction protocol at a high-volume interventional cardiology unit.We analyzed 1160 consecutive procedures: 580 performed before the implementation of the protocol and 580 after it. The protocol consisted in: the reduction of the number of ventriculographies and aortographies, the optimization of the collimation and the geometry of the X ray tube-patient-receptor, the use of low dose-rate fluoroscopy and the reduction of the number of cine sequences using the software "last fluoroscopy hold".There were no significant differences in clinical baseline features or in the procedural characteristics with the exception of a higher percentage of radial approach (30.7% vs 69.6%; p0.001) and of percutaneous coronary interventions of chronic total occlusions after the implementation of the protocol (2.1% vs 6.7%; p=0,001). Angiographic success was similar during both periods (98.3% vs 99.2%; p=0.2). There were no significant differences between both periods regarding the overall duration of the procedures (26.9 vs 29.6min; p=0.14), or the fluoroscopy time (13.3 vs 13.2min; p=0.8). We observed a reduction in the percentage of procedures with ventriculography (80.9% vs 7.1%; p0.0001) or aortography (15.4% vs 4.4%; p0.0001), the cine runs (21.8 vs 6.9; p0.0001) and the dose-area product (165 vs 71 Gyxcm(2); p0.0001).With the implementation of a simple radiation reduction protocol, a 57% reduction of dose-area product was observed without a reduction in the quality or the complexity of procedures.

Left main coronary artery (LMCA) disease is encountered in approximately 6% of coronary angiograms and in 4% of acute coronary syndromes (ACS). The survival of patients with LMCA disease presenting with acute ACS it's lowest in those with cardiogenic shock. Percutaneous coronary intervention (PCI)

Pacemaker-induced superior vena cava syndrome (SVCS) is a rare but incapacitating adverse event that can occur years after implantation. Inasmuch as it is a rare disease, there is no consensus about its treatment. The most widely used option is balloon angioplasty and venous stent implantation, with preservation of the lead or previous extraction and subsequent reimplantation after the procedure, which is associated with new episodes of thrombosis. The epicardial implantation reduces the risk of thrombosis. We report a case of pacemaker-induced SVCS for which we used a hybrid approach for epicardial lead implantation and electrode extraction, balloon angioplasty, and stent implantation.

Resumen Los eventos cardiovasculares asociados al consumo de heroina son infrecuentes y se relacionan con la via intravenosa. Se presenta un caso de un varon de 39 anos, consumidor de heroina inhalada, que sufrio un infarto de miocardio evolucionado. El cateterismo coronario reflejo una oclusion subaguda de la arteria descendente anterior, que requirio implante de un stent farmacoactivo. Algunos estudios observacionales retrospectivos sugieren que el consumo de opiaceos por via oral o inhalada incrementa el riesgo de enfermedad coronaria e infarto, de ahi la importancia de la prevencion cardiovascular en este grupo de pacientes.

Drug coated balloons (DCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions(PCI) of both stent restenosis and "de novo" coronary lesions, mainly in bifurcations and small vessels. Nowadays, their results at a long-term follow up are unclear. The main

Paclitaxel coated balloons (PCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions (PCI). Sequent Please® (SPB) and In-Pact Falcon® (IFB) are PCB widely used that differ in several features such as the drug carrier. Their results at a long-term follow-up

Desde 1999 no se habia realizado ninguna revision de las Guias de actuacion clinica de la Sociedad Espanola de Cardiologia en Cardiologia Nuclear, por lo que en este articulo exponemos las indicaciones clase I y IIa de la American College of Cardiology/American Heart Association/American Society of Nuclear Cardiology (ACC/AHA/ASNC) con nivel de evidencia A o B, junto con las 27 indicaciones consideradas adecuadas por el Comite de expertos de la American College of Cardiology Foundation/American Society of Nuclear Cardiology (ACCF/ASNC) y los comentarios que hemos considerado oportuno anadir los firmantes de este articulo.

Stent fractures are a rare finding that have been associated with stent thrombosis and restenosis. The majority of descriptions affect to first generation drug eluting stents. Angiographic diagnosis is difficult and should be suspected in patients with risk factors when an angiographic separation of struts is visualized. Intracoronary imaging techniques are very useful and can confirm the diagnosis. We present a case of very late zotarolimus eluting stent thrombosis probably favoured by stent fracture and discontinuation of prasugrel.

An 84 years-old male was admitted for stable angina and an early positive treadmill test. He presented an angiographic severe ostial stenosis of the left main (LM) with no other significant lesions. Intravascular ultrasound image (IVUS) showed a fibro-calcified plaque with a minimal luminal area (MLA) of 3.9 mm2 (Figure1A-asterisk) and a reference diameter of 5.8 mm. A percutaneous coronary intervention (PCI) was scheduled the following day.

In this work, it is evaluated the accessibility of a floating platform, by means of a catamaran vessel equipped with a fender. The two bodies are modelled as a constrained multi-body system in the frequency domain. Transfer functions are calculated for the motions and forces of the system. Access is possible when no slip conditions occur at the fender, and when the relative rotations between the two bodies are within certain tolerance limits. Four response variables are defined to impose such conditions. In a short-term sea state the extreme maximum crest height of these variables is computed, assuming that response crest heights follow a Rayleigh distribution. Each of the extreme values is compared to a specific threshold, to determine whether access is possible or not. Accessibility is calculated for a sample platform located off the coast of Scotland using hindcast data for the period 1980-2013. Average accessibility resulted to be 23.7%. A strong seasonality is ascertained, together with a large variation of accessibility, due to the variability of wave climate. The authors would like to acknowledge the projects “OceaNET”, which received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 607656, and “Plataformas multiuso para aplicaciones offshore” of the University of Cantabria (code: 56.JS05.64061).

Coronary artery perforation (CAP) is a rare but potentially fatal complication of percutaneous coronary intervention. Polytetrafluoroethylene-covered stents prevent blood leakage between struts with a high rate of success. However, they lack elasticity and rapid and correct deployment is difficult. They have also a higher rate of stent restenosis and thrombosis. For these reasons, optimal deployment is essential.Although severe CAP needs an emergent solution, after stabilizing the patient, intracoronary imaging techniques may be useful to ensure correct expansion and reduce further adverse events.We present a case that shows the potential role of intravascular ultrasound in the resolution of a CAP. Resumo: A perfuração da artéria coronária (PAC) é uma complicação rara, mas potencialmente fatal da intervenção coronária percutânea (ICP). Os stents revestidos com politetrafluoroetileno impedem o leakage do sangue entre os suportes com uma elevada taxa de sucesso. No entanto, a falta de elasticidade e o posicionamento rápido e correto são difíceis. Apresentam também uma taxa mais elevada de reestenose de stent e de trombose. Por este motivo, é fundamental um posicionamento otimizado.Embora a PAC necessite de uma solução emergente, após estabilizar o doente, as técnicas intracoronárias imageológicas podem ser úteis para assegurar a expansão correta e reduzir eventos adversos adicionais.Apresentamos um caso que revela o papel potencial da ultrassonografia intravenosa na resolução de uma PAC. Keywords: Coronary artery perforation, Covered stents, Intravascular ultrasound, Palavras-chave: Perfuração da artéria coronária, Stents revestidos, Ultrassonografia intravenosa

Myocarditis is a disease whose diagnosis is based on the detection of inflammation. It is usually made by the finding of myocardium damage markers (usually troponin and CPK). Inflammation can also be detected in image tests. However, the low sensitivity and specificity of echocardiogram (which can be performed as a routine) make it less useful. We present a case in which the diagnosis was made by image (Cardiac Magnetic Resonance) which helped to clarify the evolution and the prognosis. The aim of this case is to show the importance of image technics in the diagnosis of myocarditis, while biomarkers alone can underestimate the inflammation and therefore the risk.

Los bloqueos de rama dependientes de la frecuencia suelen estar relacionados con el aumento de la frecuencia cardiaca (bloqueo de rama taquicardico-dependiente o en fase 3). Menos comunmente, son causados por la reduccion de la frecuencia cardiaca (bloqueo de rama bradicardico-dependiente o en fase 4). El bloqueo en fase 3 es la presentacion mas frecuente de los trastornos de la conduccion intraventricular paroxisticos, documentada en varias publicaciones. Sin embargo, no son tan numerosos los articulos que describen el bloqueo de rama en fase 4 y, raras veces, ambos mecanismos coexisten en el mismo paciente. En esta presentacion se describe el caso de un paciente ingresado con un infarto agudo de miocardio en el que se detectaron trastornos de la conduccion intraventricular paroxisticos, tanto taquicardico-dependientes como bradicardico-dependientes.

Nowadays, current practice guidelines do not recommend a percutaneous coronary intervention (PCI) treatment for complex anatomical coronary lesions (Syntax score ≥ 32) that involve left main coronary artery (LMCA). Nevertheless, PCI could be of choice in selected surgical high-risk patients. The

Left main coronary artery (LMCA) acute occlusion is uncommon (0.8% of primary percutaneous coronary interventions -PCI-) with very poor prognosis. In this situation, primary PCI is a complex procedure because of hemodynamic and electrical instability of patients with a high mortality. The main