Alconero Camarero AR, Fernéndez Gutiérrez R, Pérez Mena S, Sola Villafranca JM. Registros de enfermería y marcapasos temporal transvenoso. Enferm Cardiol 2000; 19:18:22.

The use of temporal pacemakers in Intensive Cardiological Care Units has been incremented in the last years, which is why nurses in these units must keep a high level of knowledge in order to detect and act on any complication which is derived from this procedure.
The main target was to revise complications during and after the implantation of a temporal pacemaker as well as to appraise the nursing records which had been made.
A retrospective study of cases was carried out through revision of clinical patient records and nursing records of pacients who needed a provisional pacemaker during 1997. The total number of implantations was 70, of which 40 patient records were analysed.   Absence of records in the following parameters have been observed in the nursing records analysed: realization of insertion techniques, venous tract of selection, type of electrocatheter, parameters of the pacemaker and immediate and later complications.
Among the main conclusions we wish to highlight the importance of the accomplishment of adequate nursing records which should agree with the attention paid. Moreover, the existence of a protocol of performance improves and speeds up the nursing procedure.

Honrubia Gonzálvez E.  Un caso clínico para la reflexión. Enferm Cardiol 2000; 19:23-26.

The treatment with neuro-estimulation of posterior cords of the intractable ‘Angor Pectoris’ was introduced by Mannheimer in 1980. The clinical effects which have been observed with this treatment are the following: an improvement in the capacity to realise physical exercise and an increase in daily activity, a fall in the episodes of angina, a fall in the taking of nitrites, a fall in the ST depression, placebo effect and, consequently, an improvement in the quality of life of the anginal pacient.  It has been proved that this treatment produces an improvement in the coronary flow, it increases the flow and, at the same time, it forces the consumption of myocardial oxygen to descend as well as making the ventricular function more efficient. In spite of the general fear that avoiding pain as a symptom of alarm in the non-monitorised cardiological processes could improve mortality in pacients, latest research demonstrate that a loss in security is not produced because there is no improvement in the ischemical processes, no arrhythmia episodes appear, acute myocardial infarction is not favoured and the only complication which we may find has to do with physical reasons if movility of the electrode is produced.  The criteria of inclusion of pacients are defined: Angor, class III-IV NYHA without a response to an adequate pharmacological therapy or possibility of revascularization, a significant coronary ischemical pathology with a diagnostic for angiography and/or a significant alteration of ECG of effort. The criteria of exclusion are a short span of life, driving dysfunctions or contra-indications to the implantation technique.  In this case, the technique is non-traumatic and percutaneous. The insertion is made at a T6-T8 thoracal level, bringing the tip of the cable through radioscopic control at a T1-T2 level. The result is a paresthesia in the prechordal region, upper limbs and it can even be done in an atypical place if it is convenient.  The efficiency of this technique in each pacient is related to the number of angor crisis, the antianginose medication and its efficiency in the control of episodes, the improvement in the capacity to do physical exercise, hospital entrances and his/her perception of the improvement in the quality of life.  The cost-benefit adequancy is generally manifested through the decrease in the number of P.U. entrances, hospital entrances and domiciliary attention.

Cano Moreno A, Taberner Andrés R, Taberner Andrés MJ.  Desconexión de la ventilación mecánica en el postoperatorio de cirugía cardíaca. Enferm Cardiol 2000; 20:27-31.

Cano Moreno A, Taberner Andrés R, Taberner Andrés MJ.

Disconection of mechanical ventilation in the postoperative of cardiac surgery.

Since this service of cardiac surgery was created in the Hospital General Universitario in Valence (Spain) in 1992, it has been over 3,200 pacients who have been operated in this unit.  From this position, it is our wish to pose this article, in a descriptive tone, to tell about our experience in the handling of this type of pacient, the protocol and foundation for the weaning.   Mechanical ventilation (MV) is the procedure of artificial breathing that employs a mechanical device to help or substitute the ventilating function which, at the same time, may improve oxigenation and have an influence on the pulmonary mechanism.  We shall start form the principle that states that Mechanical Ventilation (MV) pursues three main targets, which are the following:
—To increase the gaseous interchange.
—To diminish the effort of breathing muscles.
—To withdraw the MV as soon as possible in order to avoid complications which may derive from it.

Jiménez P, Arribas B, Encinas A, Navarro F, San José L. Sexualidad y cardiopatía isquémica. Enferm Cardiol 2000; 19:32-36.

Jiménez P, Arribas B, Encinas A, Navarro F, San José L.

The aim of the present study is to evaluate to what extent does coronary disease affect the patient when restarting and maintaining his/her sexual activity, as well as anxiety, doubt and lack of information about this topic.  This study was carried out by the "Fundación Jiménez Díaz" in Madrid, in the period comprised between May, 98 and January,  99.  The research was done among pacients who were registered in hospital during this period and who had suffered an IAM or an angina at least six months before the survey was carried out and who were not over 70 years old or suffered from any other pathology that could have an influence on this aspect.
The areas of study were the following:
—Degree of Sexual satisfaction.
—Influence of medication.
—Information given.
—Changes of behaviour in their sexual habits.
The main results of the study indicate the following aspects:
—The degree of sexual satisfaction diminishes.
—They think that medication is an influence.
—Patients do not receive any information.
-—The majority think that this topic must be treated before leaving hospital.
—The sexual aspect is the most affected one and it is followed by the laboral aspect.

Mañas Segura A, Casajús Pérez G. Disfunción endotelial en el corazón trasplantado.  Enferm Cardiol 200; 19:37-39.

Mañas Segura A, Casajús Pérez G.

The histological study of endomyocardic biopsy (EMB) (in 1973) allowed the detection and  treatment of rejection before this was clinically relevant, which implied a splendid improvement in the results of cardiological transplant (CT). But it is in 1981, when cyclosporine A (C and A) starts to be used as a basis for immunosuppresive therapy, when enthusiasm towards CT resurges worldwide. CT changes from an experimental treatment to a habitual therapeutic reality.   However, there are pacients who, occassionally, develop a severe dysfunction of the graft, which may, sometimes, be fateful, even though no appreciation of rejection may be observed in the biopsy. This phenomenon, which is called ‘White Graft disease’, usually presents an unfavourable response to the habitual immunosuppresive treatment, it is often associated to hemodynamic compromise and it constitutes the first cause of late death in heart transplanted patients.  The White Graft disease (WGD) is a difuse affection of coronary arteries which is characterised by a proliferation of the intima, with a vascular endothelium that is morphologically normal. The WGD is present to a certain degree in all pacients after the first year of CT. The pathogeny is not definitively established nowadays, but it seems that the endothelial disfunction favours this proliferation.  The endothelium, contrary to widespread consideration, is not a passive barrier, which protects the vascular luminal surface and the flat vascular musculature, but it plays an active role in the maintenance of the vascular tone and the regulation of blood flow.  This complex activity depends on the balance between vasodilatative and vasoconstrictive substances of the flat muscle, synthesised by endothelial cells. Endothelial dysfunction provokes an alteration in this balance. The endothelium loses its vasodilatative capacity.  The endothelial function or state may be analysed through its answer to acetylcholine infusion. If endothelial function is normal, the acetylcholine provokes an arterial vasodilatation, while if there is a dysfunction we can observe a vasoconstriction which increases its importance depending on the degree of dysfunction.

Muñoz Izquierdo A, Peiró Andrés A. Estrategia general de búsqueda bibliográfica: Cuarto paso: Traducción de la consulta al lenguaje documental. Enferm Cardiol 2000; 19:40-44.

Muñoz Izquierdo A, Peiró Andrés A.

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