[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing]

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.

Catheter ablation of repetitive monomorphic ventricular tachycardia from left ventricular outflow tract guided by unipolar mapping

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.

Cardiomyopathies and oxidative stress

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.

[Non-invasive diagnosis of a right coronary artery-right ventricle fistula by Doppler echocardiography]

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.