Angiosarcoma cardiaco en imágenes / Cardiac angiosarcoma in images

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Recomendaciones de expertos en la mejora de la prevención efectiva del ictus isquémico en la fibrilación auricular no valvular: papel del rivaroxabán / Expert recommendations on improving effective ischemic stroke prevention in nonvalvular atrial fibrillation: the role of rivaroxaban

La fibrilación auricular aumenta de manera marcada el riesgo de ictus isquémico. A pesar de que los antagonistas de la vitamina K (AVK) reducen ese riesgo, tienen una eficacia limitada y numerosos inconvenientes que han hecho que durante años hubiese una proporción importante de pacientes con fibrilación auricular no anticoagulados. En cambio, no solo los ensayos clínicos, sino también los estudios en práctica clínica real y últimamente los estudios poblacionales, han demostrado que los anticoagulantes orales de acción directa (ACOD) tienen más eficacia y seguridad y un mejor beneficio clínico neto que los AVK. De hecho, en las regiones donde la prescripción de ACOD es mayor, está disminuyendo la incidencia de ictus isquémico, además de los costes generales asociados con la fibrilación auricular. A pesar de que en los últimos años ha aumentado la prescripción de ACOD, España es de los países con menores tasas de prescripción de toda Europa, lo que podría asociarse con mayores tasas de ictus isquémico. A pesar de que todas las guías posicionan los ACOD como de primera elección frente a los AVK para los pacientes con fibrilación auricular no valvular, en España, debido a las restricciones impuestas por el informe de posicionamiento terapéutico, con necesidad de visado, y también por la inercia terapéutica, es mayor la prescripción de AVK. Son necesarias medidas inmediatas para corregir esta situación, y así mejorar el pronóstico de nuestros pacientes

Atrial fibrillation markedly increases the risk of ischemic stroke. Although vitamin K antagonists (VKAs) reduce this risk, they have limited efficacy and several disadvantages, which has meant that over the years a substantial proportion of patients with atrial fibrillation have remained without anticoagulation. In contrast, clinical trials, studies in routine clinical practice and, more recently, population-based studies have all demonstrated that direct oral anticoagulants (DOACs) are more effective and safer than VKAs and also have a greater net clinical benefit. In fact, in regions where the DOAC prescription rate is high, the incidence of ischemic stroke has decreased, as have the overall costs associated with atrial fibrillation. Although the prescription of DOACs in Spain has increased in recent years, the country has one of the lowest prescription rates in Europe, which may be associated with a higher incidence of ischemic stroke. Despite clinical guidelines all recommending that DOACs should be used in preference to VKAs in patients with nonvalvular atrial fibrillation, more prescriptions are issued for VKAs in Spain, largely due to restrictions imposed by national statements on appropriate medicine use (including the need for approval), but also because of therapeutic inertia. Immediate action should be taken to correct this situation and to improve patients' prognoses

Intoxicación aguda por atropina de causa yatrógena / A case of acute iatrogenic atropine poisoning

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[Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?]. / Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.

Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente? / Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.