Pseudoaneurisma ventricular izquierdo incidental tras un infarto de miocardio

We present the clinical case of a 61-year-old man who presented in the emergency room with hematemesis. In the evaluation a large pseudoaneurysm in the lateral wall of the left ventricle secondary to a myocardial infarction of indeterminate time of evolution was incidentally found. Different imaging techniques were used to define the characteristics of the pseudoaneurysm and to plan the therapeutic approach. This clinical case is a good example of an incidental finding in a cardiac imaging test that can have a deep influence in the prognosis of a patient. Likewise, we hypothesized the association of an acute myocardial infarction secondary and stress gastritis.Presentamos un varón de 61 años que acude al servicio de urgencias por hematemesis. De forma incidental se detecta un pseudoaneurisma en la pared lateral del ventrículo izquierdo, consecuencia de un infarto de tiempo de evolución indeterminado. Las diferentes técnicas de imagen permitieron definir las características del pseudoaneurisma para establecer el mejor plan terapéutico. La importancia de este caso radica en que los hallazgos incidentales en las diferentes técnicas de imagen tienen relevancia en el pronóstico del paciente. Así mismo, se plantea la posible asociación entre la hematemesis y una gastritis por estrés secundaria al evento isquémico agudo

Effects Of Combined High-Intensity Aerobic Interval Training Program And Mediterranean Diet Recommendations After Myocardial Infarction (INTERFARCT Project): Study Protocol For A Randomized Controlled Trial

Exercise therapy has long been used for rehabilitation purposes after myocardial infarction (MI) and the benefit of regular physical exercise is also well-established. High-intensity interval training (HIIT) has been proposed to be more effective than continuous exercise for improving exercise capacity and health-related adaptations to low-volume (LV) and HIIT are also known. Furthermore, the Mediterranean diet (Mediet) has been widely reported to be a model of healthy eating for its contribution to a favorable health status and a better quality of life, reducing overall mortality. This study will investigate the effects of different HIIT programs (high-volume [HV] vs LV) and Mediet recommendations in clinical condition, cardiorespiratory fitness, biomarkers, ventricular function, and perception of quality of life after MI, and compared to an attention control group that is recommended to Mediet and physical activity without supervision sessions.The trial is supported by the Hospital Santiago Apostol (Miranda de Ebro, Burgos, Spain) and the Department of Physical Education and Sport (University of the Basque Country, UPV/EHU)

Low-volume high-intensity aerobic interval training is an efficient method to improve cardiorespiratory fitness after myocardial Infarction: PILOT STUDY FROM THE INTERFARCT PROJECT

Purpose: To analyze the changes in cardiorespiratory fitness (CRF) and body composition following 2 different (low-volume vs high-volume) high-intensity aerobic interval training (HIIT) programs with Mediterranean diet (Mediet) recommendations in individuals after myocardial infarction (MI) and compared with an attention control group (AC). Methods: Body composition and CRF were assessed before and after a 16-wk intervention in 70 participants (58.4 ± 8.5 yr) diagnosed with MI. All participants received Mediet recommendations and were randomly assigned to the AC group (physical activity recommendations, n = 14) or one of the 2 supervised aerobic exercise groups (2 d/wk training): high-volume (40 min) HIIT (n = 28) and low-volume (20 min) HIIT (n = 28). Results: Following the intervention, no significant changes were seen in the AC group and no differences between HIIT groups were found in any of the studied variables. Only HIIT groups showed reductions in waist circumference (low-volume HIIT, Δ = -4%, P < .05; high-volume HIIT, Δ = -2%, P < .001) and improvements in CRF (low-volume HIIT, Δ = 15%, P < .01; high-volume HIIT, Δ = 22%; P < .001) with significant between-group differences (attention control vs HIIT groups). Conclusions: Results suggest that a 16-wk intervention (2 d/wk) of different HIIT volumes with Mediet recommendations could equally improve CRF and waist circumference after MI. Low-volume HIIT may be a potent and time-efficient exercise training strategy to improve functional capacity

PROFILAXIS DE LA NEFROPATÍA INDUCIDA POR CONTRASTE EN PACIENTES DE ALTO RIESGO CON SÍNDROME CORONARIO AGUDO SIN ELEVACIÓN DEL SEGMENTO ST / Prophylaxis of contrast-induced nephropathy in high risk patients with non-ST-segment elevation acute coronary syndrome

ResumenIntroducción y objetivos: La eficacia de la administración conjunta de suero salino isotónico y N-acetilcisteína presenta resultados dispares en la prevención de la nefropatía por contraste yodado. Nuestro objetivo fue valorar la posible eficacia de esta estrategia combinada en pacientes con alto riesgo de desarrollar nefropatía inducida por contraste, ingresados y sometidos a intervencionismo coronario percutáneo por síndrome coronario agudo sin elevación del segmento ST en nuestro centro. Método: Se aplicó esta estrategia en los pacientes referidos, con al menos un factor de alto riesgo para desarrollar la nefropatía inducida por contraste: mayores de 80 años, diabetes mellitus, creatinina basal mayor de 1,5 mg/dl o alto volumen de contraste (mayor de 400 ml). El protocolo se aplicó durante 12 meses (pacientes que recibieron el protocolo de prevención) y se comparó con similares pacientes en los 12 meses previos que no recibieron profilaxis. Resultados: Un total de 30 pacientes (24 %) desarrollaron nefropatía inducida por contraste. El porcentaje fue significativamente mayor en el grupo que no recibió profilaxis: 35,9 % vs. 11,5 % (p = 0.003). Conclusiones: La combinación de N-acetilcisteína por vía oral e hidratación parenteral en pacientes de alto riesgo, con síndrome coronario agudo sin elevación de ST, podría ser beneficiosa para evitar la aparición de la nefropatía inducida por contraste. /Abstract Introduction and Objectives: The effectiveness of the administration of isotonic saline solution and N-acetylcysteine shows different results in the prevention of iodine contrast nephropathy. Our objective was to assess the potential effectiveness of this combined strategy in patients at high risk for contrast-induced nephropathy, who were admitted in our center for percutaneous coronary intervention due to non-ST-segment elevation acute coronary syndrome. Method: This strategy was applied in the patients mentioned, with at least one risk factor for developing contrast-induced nephropathy: over 80 years, diabetes mellitus, baseline creatinine greater than 1.5 mg / dl or high volume of contrast (greater than 400 ml). The protocol was applied for 12 months (patients that received the prevention protocol) and compared with similar patients in the previous 12 months who received no prophylaxis. Results: A total of 30 patients (24 %) developed contrast-induced nephropathy. The percentage was significantly higher in the group that did not receive prophylaxis: 35.9 % vs. 11.5 % (p = 0.003). Conclusions: The combination of N-acetylcysteine orally and parenteral hydration in high-risk patients with acute coronary syndrome without ST elevation could be beneficial to avoid the appearance of contrast-induced nephropathy

Profilaxis de la nefropatía inducida por contraste en pacientes de alto riesgo con síndrome coronario agudo sin elevación del segmento ST

Introduction and objectives: The effectiveness of the administration of isotonic saline solution and N-acetyl-cysteine shows different results in the prevention of iodine contrast nephropathy. Our objective was to assess the potential effectiveness of this combined strategy in patients at high risk for contrast-induced nephropathy, who were admitted in our center for percutaneous coronary intervention due to non-ST-segment elevation acute coronary syndrome. Method: This strategy was applied in the patients mentioned, with at least one risk factor for developing contrast-induced nephropathy: over 80 years, diabetes mellitus, baseline creatinine greater than 1.5 mg/dl or high volume of contrast (greater than 400 ml). The protocol was applied for 12 months (patients that received the prevention protocol) and compared with similar patients in the previous 12 months who received no prophy-laxis. Results: A total of 30 patients (24%) developed contrast-induced nephropathy. The percentage was significantly higher in the group that did not receive pro-phylaxis: 35.9% vs. 11.5% (p=0.003). Conclusions: The combination of N-acetylcysteine orally and parenteral hydration in high-risk patients with acute coronary syndrome without ST elevation could be beneficial to avoid the appearance of contrast-induced nephropathy.Introducción y objetivos: La eficacia de la administración conjunta de suero salino isotónico y N-acetilcis-teína presenta resultados dispares en la prevención de la nefropatía por contraste yodado. Nuestro objetivo fue valorar la posible eficacia de esta estrategia combinada en pacientes con alto riesgo de desarrollar nefropatía inducida por contraste, ingresados y sometidos a intervencionismo coronario percutáneo por síndrome coronario agudo sin elevación del segmento ST en nuestro centro. Método: Se aplicó esta estrategia en los pacientes referidos, con al menos un factor de alto riesgo para desarrollar la nefropatía inducida por contraste: mayores de 80 años, diabetes mellitus, creatinina basal mayor de 1,5 mg/dl o alto volumen de contraste (mayor de 400 ml). El protocolo se aplicó durante 12 meses (pacientes que recibieron el protocolo de prevención) y se comparó con similares pacientes en los 12 meses previos que no recibieron profilaxis. Re-sultados: Un total de 30 pacientes (24 %) desarrollaron nefropatía inducida por contraste. El porcentaje fue significativamente mayor en el grupo que no recibió profilaxis: 35,9 % vs. 11,5 % (p=0.003). Conclusio-nes: La combinación de N-acetilcisteína por vía oral e hidratación parenteral en pacientes de alto riesgo, con síndrome coronario agudo sin elevación de ST, podría ser beneficiosa para evitar la aparición de la nefropatía inducida por contraste