A patient with antecedents of ischemic cardiopathy is presented. Echocardiographic exploration revealed the presence of an accessory cavity in connection with the left ventricle behind the basal ...segment of the posterior left ventricular wall, the characteristics of which were compatible with a ventricular pseudoaneurysm. The Doppler study (both conventional and color coded) allowed us to determine the multiphasic characteristics of the flow between both cavities, and its relation with the variations of volume of the same, as well as with the transmitral and aortic flows. The filling of the pseudoaneurysm was observed to begin before initiation of the ejection through the aorta. Initiation of emptying towards the left ventricular cavity took place in the late systole, and there was a new flow inversion towards the pseudoaneurysm in the early diastole coinciding with the rapid ventricular filling, and therefore before producing the atrial contraction.
Summary Background The use of intravascular catheters (IVCs) in intensive care units (ICUs) has been well assessed in recent years. However, a high proportion of these devices are placed in patients ...outside the ICU, particularly in internal medicine departments (IMDs), where data on the quality of care are scarce. Aim To assess the use and management of IVCs in IMDs in Spain. Methods We performed a point prevalence study of all adult inpatients on 47 IMDs from hospitals of different sizes on one day in June 2013. A local co-ordinator was appointed to assess patients and collect data from each site. Findings Out of the 2080 adult patients hospitalized on the study day, 1703 (81.9%) had one or more IVCs (95.4% of which were peripheral devices). Infection was detected at the insertion site in 92 catheters (5.0%); 87 patients (5.2%) had signs of sepsis, but only one case was considered to be catheter-related. The local co-ordinators estimated that 19% of the catheters in place were no longer necessary. A daily record of the need for a catheter was available in only 40.6% of cases. Conclusion Our study shows clear opportunities for improvement regarding catheter use and care in Spanish IMDs. Strategies similar to those applied in ICUs should be implemented in IMDs.
