Cardiovascular safety in drugs development: a aole for endothelial function tests.

As drug development becomes a long and demanding process, it might also become a barrier to medical progress. Drug safety concerns are responsible for many of the resources consumed in launching a new drug. Despite the money and time expended on it, a significant number of drugs are withdrawn years or decades after being in the market. Cardiovascular toxicity is one of the major reasons for those late withdrawals, meaning that many patients are exposed to unexpected serious cardiovascular risks. It seems that current methods to assess cardiovascular safety are imperfect, so new approaches to avoid the exposure to those undesirable effects are quite necessary. Endothelial dysfunction is the earliest detectable pathophysiological abnormality, which leads to the development of atherosclerosis, and it is also an independent predictor for major cardiovascular events. Endothelial toxicity might be the culprit of the cardiovascular adverse effects observed with a significant number of drugs. In this article we suggest the regular inclusion of the best-validated and less invasive endothelial function tests in the clinical phases of drug development, in order to facilitate the development of drugs with safer cardiovascular profiles.pre-print236 K

Planificación, Desarrollo y Dirección de un Congreso Nacional de Cardiología para Estudiantes de Medicina. ¿Qué se puede aprender?

Some singularities of the medical degree program might alter the development of new training and teaching activities that involve the active participation of undergraduate students. As a result of the initial experience in conducting the first edition of a national congress for medical students in Francisco de Vitoria University (Madrid, Spain), the difficulties encountered during its planning and direction are detailed. The solutions adopted are presented with the aim of facilitating the organization of future similar events.Algunas de las singularidades que presenta el plan de formación del grado en Medicina podrían alterar los planes de desarrollo de nuevas actividades formativas y docentes que impliquen la participación activa de los alumnos de pregrado. Fruto de la experiencia inicial en el organización de la primera edición de un congreso nacional para estudiantes de Medicina en la Universidad Francisco de Vitoria (Madrid, España), se detallan algunas de las dificultades encontradas durante su planificación y dirección, exponiéndose las soluciones tomadas, en un intento de facilitar futuras nuevas convocatorias de eventos similares

Ritmo acelerado de la unión auriculoventricular.

post-print1913 K

Accordion music from the heart: dynamic coronary artery compression.

A 35-year-old woman was admitted to our hospital with unstable angina. During her last holidays, she had suffered an anterior myocardial infarction (MI). Her available medical records described a totally occluded mid left anterior descending (LAD) coronary artery treated with two overlapped stents. The new coronarography revealed a very tight systolic coronary stenosis at the proximal edge of the stents, secondary to severe dynamic shortening of the LAD in an accordion-like fashion.pre-print1757 K

Complex anatomy difficulting left atrial appendage closure.

Left atrial appendage closure is a useful technique for patients at high thromboembolic risk and contraindications for oral anticoagulation therapy. However, it can be challenging when anatomical difficulties are encountered. We present a unique case of atypical appendage uptake and how we completed the procedure.peer-reviewed409 K

Colchicine for the primary prevention of cardiovascular events.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the clinical benefit and harms of colchicine as primary prevention of cardiovascular outcomes in the general population.pre-print346 K

Expectativas de supervivencia tras la reanimación cardiopulmonar. Predicciones y deseos de los cardiópatas.

La supervivencia al alta tras una parada cardiorrespiratoria (PCR) intrahospitalaria es menor del 25%, presentando cerca del 30% de los supervivientes, secuelas neurológicas significativas1. Las preferencias de los pacientes respecto a la reanimación cardiopulmonar (RCP) están relacionadas con la percepción que tienen de su probabilidad de éxito2,3. Un excesivo optimismo de nuestros pacientes respecto a maniobras como la RCP podría afectar a sus expectativas, condicionando de esta forma el desarrollo de las órdenes de no reanimar o de los documentos de voluntades anticipadas en el ámbito de la enfermedad cardiovascular. Nuestro objetivo principal es conocer el pronóstico que otorgan a la PCR intrahospitalaria los pacientes cardiológicos y valorar su posible influencia en sus deseos de reanimación.pre-print214 K

Percutaneous treatment in acute coronary syndromes

Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharmacological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations