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Some patients with unstable angina develop a deep T-wave inversion in ECG leads V1 to V4. It has been suggested that this special ECG pattern is associated with a severe stenosis of the left anterior descending (LAD) coronary artery. We have studied 73 of this patients. All of them had an LAD involvement, nearly always as severe atherosclerotic plaque and in 5% of the cases due to non-atherosclerotic alterations (milking or spasm). Angioplasty was performed in 33% and bypass surgery in 61%. In both cases the immediate results were good (0% and 4% respectively in-hospital mortality) as well as the outcome (12% restenosis and 0% late mortality respectively). The ECG signs disappeared in the year after.

Development of cardiovascular surgical techniques and more recently, balloon angioplasty, has resulted in a dramatic increase in the number of cardiac catheterizations performed. Previously, the usual policy was to admit the patient to the hospital for several days. Various series of patients submitted to ambulatory cardiac catheterizations have revealed that this procedure con be performed safely, with a potential reduction in hospital and patients costs, better utilization of medical beds and good image quality. In this study we present our initial experience in this kind of outpatient procedure.

Inappropriate activation or disbalance of vasomotor reflexes may have a close relationship with the pathogenesis of disautonomic syndromes, a frequent underlying cause of recurrent syncope. A combined approach of meticulous historical data, physical examination and selected laboratory procedures may delineate the most common causes of recurrent syncope. Tests of autonomic function may be particularly helpful in the diagnosis of this entity. They include some non-invasive maneuvers such as stimulation of carotid sinus, Valsalva maneuver or tilt-table test. Therapy for this syndrome includes pharmacologic agents, surgical and radiotherapeutic maneuvers and atrioventricular sequential pacing. In this work we will present an overall formulation of the diagnostic evaluation and a therapy approach of the patient presenting with this complaint.

Antihemostatic drugs are widely used in the treatment and prevention of ischemic heart disease. Fibrinolytic agents are prescribed in the early phase of acute myocardial infarction, to reduce its size and improve survival. Their use in unstable angina is still controversial. Anticoagulants have substantial benefit in myocardial infarction, unstable angina and primary prevention of coronary disease. Finally, antiplatelet agents are used in stable and unstable angina, myocardial infarction and high risk patients.

The incidence of myocardial infarction is higher in women that use oral contraceptives. The most important pathophysiologic mechanisms are: a) modification of coronary risk factors: the pill produces an elevation of both serum cholesterol and trygliceride levels, increase of blood pressure and decompensation of diabetes mellitus; b) blood coagulation disorders: oral contraceptives increase platelet aggregation and fibrinogen blood levels, therefore they have a considerable thrombogenic capacity. At this moment there are several update publications concerning this matter; however most of the mechanisms involved in the increase of coronary heart disease in this specific group still remain unclear.

Recurrent thrombosis, abortion and thrombocytopenia are the most frequent manifestation of antiphospholipid syndrome, which usually presents antibodies against some anionic phospholipids. A few years ago, this syndrome was considered as a manifestation of systemic lupus erythematosus; nowadays it is classified as an isolated systemic lupus erythematosus; nowadays it is classified as an isolated autoimmune disease. Hypotheses have been proposed to explain the origin of antiphospholipid antibodies, including infectious and autoimmune diseases with high titles of anticardiolipin antibodies. Genetic factors have also been involved. Laboratory tests of choice for the detection of anticardiolipin antibodies are RIA and ELISA tests; there are some structural differences among them depending on the underlying disease. Hypercoagulability and recurrent thrombosis are the main features of this entity; ischemic heart disease is in this context of outmost importance. Despite the lack of any clinically demonstrated association between antiphospholipid syndrome and ischemic heart disease, there are many "in vitro" studies that support this possibility.