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This study sought to determine if newer techniques significantly improve endocardial border definition in suboptimal acoustic windows, and the reproducibility of the evaluation of wall motion abnormalities according to the different techniques and degrees of expertise.We studied a total of 20 consecutive patients with poor ultrasound window, to assess, if the use of tissue harmonic imaging (2H) or contrast with second harmonic (Levovist ; 4 g i.v.), (2HC) improves endocardial border visualization. In order to analyze inter and intraobserver reliability with the different techniques, four observers with different degrees of expertise were each asked to assess the segmental wall motion score of 31 consecutive echocardiograms.The quality of the image was clearly superior with 2H and 2HC compared with 2D. This difference was larger in apex and lateral endocardial border from 0.9 and 1 to 1.5 and 1.64 (p0.001) with 2H. 2HC was found to slightly but significantly improve the endocardial definition in apex compared with 2H (1.64 vs 1.81; p = 0.016). The percentage of segments assessed for interobserver variability significantly improve with 2H and 2HC (2D = 50%, 2H = 75% and 2HC = 95%). Interobserver agreement with the different techniques between the experienced observers did not statistically differ. The less experienced observer presented a significantly lower interobserver reliability than those with experience, and did not improve with 2H and 2HC.a) Native tissue harmonic imaging and second harmonic imaging with contrast (Levovist ) significantly improves endocardial border visualization; b) the newer imaging techniques significantly improve performance (percentage of evaluated segments) without decreasing reliability, and c) experience in assessing wall motion is the main factor in interobserver agreement.

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

Repetitive monomorphic ventricular tachycardia from the left ventricular outflow tract is an uncommon arrhythmia. Successful catheter ablation has been previously reported in a few cases, but a large number of applications were usually needed when an approach based on either activation mapping or pace mapping was used. In our patient, the selection of the target point for application was based exclusively on unipolar mapping criteria of the ectopic beats, resulting in a short procedure with successful outcome.

High blood pressure is a well-known cardiovascular risk factor that is responsible for an elevated morbidity and mortality. However, although efficacious drugs for treatment and numerous and updated scientific training programs are available, the reality is that only a low percentage of patients are followed up in accordance with the rates which are presently considered normal. The purpose of these guidelines is to provide medical guidance for the prevention, detection and evaluation of hypertension, and to provide the best diagnosis and treatment. The factors involved in cardiovascular complications in the hypertensive patient are multiple. That is why this report places more emphasis in the individual cardiovascular risk stratification as part of the treatment strategy. The information obtained in the most recent studies published confirms the interest in achieving the greatest decrease in rates of blood pressure. This treatment to lower levels is especially useful in the high-risk subgroup. It maintains the necessity of nonpharmacological measures or lifestyle modifications in all patients with high blood pressure who either need or do not need drug therapy. All pharmacological groups may be used, but it is appropriate to choose the specific antihypertensive agent adapted to the clinical and individual situation with the use of low doses of drugs to initiate therapy and the use of appropriate drug combinations.

Cardiomyopathies are the group of diseases affecting the cardiac muscle. Although they have never been related to oxidative stress diseases, an analysis of the causes of these pathologies reveals the presence of a pro-oxidative agent or that the intracardiocytic balance between oxidation and antioxidation has been broken. In support of this hypothesis, we analyse the pro-oxidative factors which co-operate with other factors or by themselves to promote the development of this group of pathologies. We show also data demonstrating that the tissue and cellular damages are characteristic of an oxidative stress situation. Finally, we present evidence that in some cases of particular cardiomyopathies, the use of antioxidative strategies greatly improves the health of the patients. Therefore, we suggest that the use of antioxidants can be an alternative or complementary therapy in this group of diseases.

Severe thoracic trauma is a common cause of admission in Intensive Care Units; then heart injury is not a rare finding. We present a case of post-traumatic interventricular dissection and ventricular aneurysm secondary to thoracic trauma caused by traffic accident. We think that ventricular septum injury is a rare finding after chest trauma. Two-dimensional echo-cardiography is an essential procedure in the diagnosis of traumatic heart injury.

A six-year-old girl with an atypical continuous precordial murmur, was suspected of having a coronary arteriovenous fistula. A markedly dilated right coronary artery was revealed by two-dimensional echocardiography. The pulsed Doppler examination showed a diastolic retrograde flow in the ascending aorta, with a normal flow in the left ventricular outflow tract. With the sample volume in the right ventricle a continuous turbulent flow was observed. Color flow mapping showed a turbulent, systolic-diastolic flow in the right ventricle. The fistula was confirmed by cardiac catheterization.