Impacto de la pandemia por COVID-19 sobre los tiempos de atención al infarto agudo de miocardio / Impact of the COVID-19 pandemic on acute myocardial infarction care times

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Sustained benefit of left ventricular remodelling after valve replacement for aortic stenosis.

BACKGROUND: Valve replacement for aortic stenosis (AS) determines negative ventricular remodelling. We used cross sectional and Doppler echocardiography to check how rapidly it occurs and to assess if these changes are sustained over time. METHODS: We evaluated in 34 patients subjected to aortic valve replacement for AS morphological and functional (ejection fraction and E:A ratio) left ventricular data by echocardiography prior to surgery and 2 postoperative studies: early after surgery (pQ1) and at mid-term evolution (pQ2). RESULTS: Left ventricular mass index was reduced at pQ1 (from 152 +/- 47 g/m2 to 113 +/- 31 g/m2; p < 0.01) as well as end-diastolic (from 51.3 mm to 48.3 mm; p < 0.03), end-systolic (from 32.2 mm to 29.4 mm; p < 0.02), interventricular septum (from 12.9 mm to 10.3 mm; p < 0.01), and posterior wall (from 12.5 mm to 11 mm; p < 0.01) dimensions. Left ventricular ejection fraction (from 61.2% to 65.2%; p < 0.04) and E:A ratio (from 0.94 to 0.98; p < 0.01) increased significantly at pQ1. There were no significant differences in measurements between pQ1 and pQ2. CONCLUSIONS: Aortic valve replacement surgery leads to a rapid negative left ventricular remodelling during the first 7 months, including a decrease in myocardial hypertrophy and an improvement in systolic and diastolic function. These beneficial hemodynamic changes are sustained for at least 3 years.

Síndrome metabólico. Concepto y fisiopatología / Metabolic syndrome. Characteristics and pathophysiology

En la fisiopatología del síndrome metabólico (SM) se imbrican alteraciones en el metabolismo glucolipídico, estados proinflamatorios y protrombóticos. El vínculo entre todas ellas se atribuye a la resistencia insulínica (RI), favorecida por el aumento de ácidos grasos libres, muchas veces relacionado con el sobrepeso. Este estado provoca trastornos en la utilización de glucosa celular, así como desregulación de su producción hepática. El metabolismo lipídico presenta también las consecuencias de la RI, que desembocan en las alteraciones características del SM: hipertrigliceridemia e hipocolesterolemia HDL. La hipertensión se relaciona con diferentes mecanismos como consecuencia de alteraciones en la vía de la insulina y en la regulación del sistema nervioso vegetativo. Además de las repercusiones en el desarrollo de la aterosclerosis, últimamente se han relacionado el SM y la RI con otras enfermedades, como el hígado graso no alcohólico y el síndrome del ovario poliquístico (AU)

The pathophysiology of metabolic syndrome involves altered glucose and lipid metabolism, and proinflammatory and prothrombotic states. All of these abnormalities appear to be linked to insulin resistance, which is associated with an increase in the free fatty acid level, usually due to obesity. This condition disturbs cellular glucose management and hepatic synthesis. In addition, lipid metabolism is also impaired by insulin resistance. In these circumstances, hypertriglyceridemia and HDL hypocholesterolemia both develop. Moreover, hypertension is related to altered insulin regulation and impaired autonomic nervous system activity. In addition to the well-demonstrated relationship with atherosclerosis, recently metabolic syndrome has also been associated with steatohepatitis and polycystic ovary syndrome (AU)

Síndrome metabólico y diabetes mellitus / Metabolic syndrome and diabetes mellitus

La diabetes mellitus (DM) es una enfermedad metabólica crónica que está adquiriendo en los últimos años proporciones de auténtica epidemia. Se asocia frecuentemente con obesidad, alteraciones del metabolismo lipídico y proteínico, así como con hipertensión arterial y otros factores de riesgo cardiovascular, lo que constituye el síndrome metabólico. La DM tipo 2 (DM2) es un factor de riesgo importante para la enfermedad coronaria y la aterosclerosis precoz. Su etiopatogenia es multifactorial y está muy relacionada con la resistencia insulínica (RI), que es el proceso fisiopatológico común al conjunto de factores de riesgo cardiovascular. Respecto a la prevención y el tratamiento de la DM2, es fundamental la modificación del estilo de vida, con especial hincapié en la alimentación equilibrada y la introducción del ejercicio físico aeróbico en la vida cotidiana. Cuando las pautas higiénico-dietéticas no son suficientes, se debe recurrir a fármacos que actúen sobre la diana de la resistencia insulínica, como la metformina y las tiazolidinas (AU)

Diabetes mellitus is a chronic metabolic disease that has acquired the nature of an epidemic in recent years. It is frequently associated with obesity, abnormalities of the lipid and protein metabolism, high blood pressure, and other cardiovascular risk factors, which are often clustered together in the metabolic syndrome. Type 2 diabetes mellitus is an important risk factor for coronary disease and premature atherosclerosis. It has a multifactorial pathogenesis and it is closely linked to insulin resistance, which is also involved in the pathophysiology of cardiovascular risk factors associated with metabolic syndrome. One fundamental intervention for the prevention and treatment of type 2 diabetes mellitus is lifestyle modification, in particular the adoption of a balanced diet and the inclusion of aerobic physical activity in daily life. When these measures are insufficient, the use of drugs that target insulin resistance, such as metformin and thiazolidinediones, is necessary (AU)