Oscar H Del Brutto1, Robertino M Mera2, Ernesto Peñaherrera3. 1. 1 School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador. 2. 2 Vanderbilt University Medical Center, Nashville, TN, USA. 3. 3 Department of Cardiology, Luis Vernaza Hospital, Guayaquil, Ecuador.