Rev Esp Cardiol
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Review Comparative Study
[Investigation methods in clinical cardiology. VI. Evaluation of results (outcomes) and its clinical relevance in cardiology: with a special reference to the quality of life].
Over the last decade, changes in health care delivery and concern with costs and with dramatic variations in practice between regions, institutions and even physicians at the same institution have led the administrators and health politicians to focus on the outcomes of medical care. The Agency for Health Care Policy and Research was established with the objective of fostering research on the outcomes of medical interventions and on the development of guidelines. The Agency supports studies based not only on standard outcomes such as mortality and morbidity, but also on quality of life and patient satisfaction. ⋯ Nevertheless, apparently valid studies of cardiovascular diseases and interventions using health related quality of life as an outcome measures have been reported where such measures have provided information about undesirable side effects of medications and the impact of the intervention on the health related quality of life. Moreover, some of these studies have identified different patterns of health care as leading to different quality of life outcomes. Thus, quality of life measurement appears as a technology which holds promise for the future assessment of clinical effectiveness.
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We present the case of a patient who suffered a cardiac penetrating trauma due to a 6-cm long steel splinter. He was self-admitted to the emergency room and was asymptomatic. Cardiac trauma was diagnosed by the presence of a foreign body in his chest X-ray. ⋯ Transesophageal echocardiography was performed during surgery in order to define the position of the foreign body and to discard lesions due to multidirectional injury. Lesions were repaired and the patient was discharged with no complications. This case report illustrates the possibility of survival after cardiac penetrating trauma, and the role of echocardiography in the diagnosis and surgical repair of this type of trauma.
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Case Reports
[Thrombus in the thoracic aorta as cause of peripheral embolism diagnosed using transesophageal echocardiography].
The authors report the cases of two patients, with no risk factors for thromboembolism, in whom a mobile thrombus of the thoracic aorta was diagnosed by transesophageal echocardiography, after an episode of systemic embolism. The outcomes of the two cases were very different. ⋯ This patient underwent surgery, and the thrombus was removed. These cases illustrate the value of transesophageal echocardiography in the detection of embolic source.
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Hypertensive cardiomyopathy is nowadays the most precious, prevalent and fatal condition of all cerebral, renal and arterial complications that leads to arterial hypertension. Left ventricular hypertrophy is the basis of the macroscopic structural damage that belongs to this entity. ⋯ At present, it is obvious that we need to take better advantage of resources to diagnose hypertensive cardiopathy, and that the cost of explorations are lower must imply an agreement between cardiologists and general practitioners. In this article, we review the resources available at general practice level for the efficient diagnosis of the complications produced by hypertensive cardiopathy.
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Amiodarone is an antiarrhythmic agent very often used in clinical practice in spite of its large array of adverse effects. We report one patient case with acute hepatitis following intravenous amiodarone treatment and its possible etiology. Our conclusion is the importance of a strict control of parameters in the hepatic functions in patients who require amiodarone therapy.