A. Leandro Barros , A. Herruzo León , J. Serpa Morán , C. Tejada González , A. Ruiz-Saavedra , A. García Lledó
{"title":"Protocolo de diagnóstico clínico, analítico y de imagen de la insuficiencia cardíaca","authors":"A. Leandro Barros , A. Herruzo León , J. Serpa Morán , C. Tejada González , A. Ruiz-Saavedra , A. García Lledó","doi":"10.1016/j.med.2025.06.017","DOIUrl":"10.1016/j.med.2025.06.017","url":null,"abstract":"<div><div>The diagnosis of heart failure (HF) is supported by additional blood and imaging tests to confirm the diagnosis and guide treatment. A case history and physical examination are essential, observing characteristic signs and symptoms as a consequence of congestion and fluid overload, the cardinal symptom of which is dyspnea. Among the additional tests that must be performed when HF is suspected are an electrocardiogram, blood tests (urea, creatinine, liver function), and natriuretic peptides (BNP and NT-proBNP). In addition, a chest X-ray should be ordered, as it may show pulmonary edema and pleural effusion, while echocardiography is key to evaluating cardiac function and structure, including ejection fraction and possible abnormalities.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2158-2160"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez
{"title":"Protocolo diagnóstico de la cardiopatía en el paciente oncológico","authors":"E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.035","DOIUrl":"10.1016/j.med.2025.06.035","url":null,"abstract":"<div><div>In patients with cancer who are going to undergo oncologic treatment, cardiovascular risk factors and pre-existing heart disease must be identified and considered before starting therapies associated with potential cardiovascular toxicity. Based on this assessment, a prevention and follow-up plan must be established to enable an early diagnosis and manage cardiovascular complications. The risk-benefit ratio of certain oncologic treatments will be evaluated by multidisciplinary teams, determining whether to continue or discontinue therapy in the presence of adverse events. In patients undergoing prolonged treatment with high cardiovascular risk, follow-up must be performed until the end of treatment. Upon completion of oncologic therapy, a reassessment of cardiovascular risk is recommended with a focus on coordinating long-term follow-up to detect potential late complications. In the case of secondary neoplasms, the patient's cardiovascular risk must always be restratified before initiating any treatment.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2281-2285"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Movasat Hajkhan, E. Fernández Fernández, C. Corral Cuadrado, C. Bohórquez Heras, E. Rabadán Rubio
{"title":"Protocolo diagnóstico de la afectación renal en las vasculitis","authors":"A. Movasat Hajkhan, E. Fernández Fernández, C. Corral Cuadrado, C. Bohórquez Heras, E. Rabadán Rubio","doi":"10.1016/j.med.2025.06.007","DOIUrl":"10.1016/j.med.2025.06.007","url":null,"abstract":"<div><div>Systemic vasculitides constitute a heterogeneous group of diseases characterized by inflammation of the blood vessels, which can significantly affect the kidney. This protocol presents an updated diagnosis of renal involvement in vasculitides, focusing on early identification and accurate characterization of kidney damage. Clinical manifestations, laboratory tests, and imaging techniques are systematically reviewed, with special emphasis on the usefulness of renal biopsy. The main conditions that entail renal involvement are analyzed in detail: ANCA-associated vasculitides, IgA vasculitis, anti-GBM vasculitis, cryoglobulinemic vasculitides, and polyarteritis nodosa. The distinctive features, histologic patterns, and prognostic considerations of each condition are described. The importance of an early, accurate diagnosis is emphasized, since renal involvement is a determining prognostic factor in the progression of these diseases. This protocol provides practical guidelines for the diagnostic approach to renal involvement in vasculitides, facilitating clinical decision making and optimization of therapeutic management.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2093-2098"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Serpa Morán , J. Gómez Delgado , A. Leandro Barros , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó
{"title":"Protocolo de manejo de la insuficiencia cardíaca crónica con fracción de eyección ventricular izquierda reducida","authors":"J. Serpa Morán , J. Gómez Delgado , A. Leandro Barros , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó","doi":"10.1016/j.med.2025.06.016","DOIUrl":"10.1016/j.med.2025.06.016","url":null,"abstract":"<div><div>The management of heart failure with reduced ejection fraction (HFrEF) includes lifestyle changes, pharmacological measures, and implantable devices. Pharmacological measures include three drug groups: diuretics aimed at controlling fluid overload and congestive symptoms; drugs with prognostic implications, whose use is practically mandatory and which include four main groups: beta-adrenergic blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid antagonists, sodium-glucose cotransporter-2 inhibitors (SGLT2is); and other supportive drugs with less evidence on their indications, which are useful when the above do not achieve symptoms control.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2154-2157"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Leandro Barros , M.C. Monedero Martín , J. Serpa Morán , C. Tejada González , A. Ruiz-Saavedra , A. García Lledó
{"title":"Insuficiencia cardíaca: epidemiología, mecanismos etiopatogénicos y clasificación","authors":"A. Leandro Barros , M.C. Monedero Martín , J. Serpa Morán , C. Tejada González , A. Ruiz-Saavedra , A. García Lledó","doi":"10.1016/j.med.2025.06.010","DOIUrl":"10.1016/j.med.2025.06.010","url":null,"abstract":"<div><div>Heart failure (HF) is a syndrome characterized by the presence of signs and symptoms of systemic/pulmonary congestion and/or low output. Its prevalence is increasing and it has a high mortality rate. It may be due to multiple cardiac and some extracardiac conditions. The key elements for diagnosis are the medical history, physical examination, natriuretic peptides determination, and echocardiogram. Knowing the left ventricular ejection fraction is essential, since it defines groups with different etiopathogenesis, management, and prognosis. Activation and maintenance of the neurohormonal axis is the main trigger for disease progression in HF. In addition, there is ventricular remodeling as an adaptation to volume or pressure overload, either by heart chamber dilation or by ventricular hypertrophy. Treatment aimed at the cause and neurohormonal axis blockade is key to management and has prognostic implications in patients with HF with reduced ejection fraction.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2105-2113"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Reina Barrera , O. Uclés Cabeza , F. Álvarez Herrero , A. Baturone Blanco , A. Bartolomé Sánchez , A. Martín-Conejero
{"title":"Protocolo diagnóstico y terapéutico de la trombosis venosa","authors":"J. Reina Barrera , O. Uclés Cabeza , F. Álvarez Herrero , A. Baturone Blanco , A. Bartolomé Sánchez , A. Martín-Conejero","doi":"10.1016/j.med.2025.06.026","DOIUrl":"10.1016/j.med.2025.06.026","url":null,"abstract":"<div><div>Superficial vein thrombosis (SVT) is defined as confirmed thrombosis of the superficial veins. It most commonly affects the lower limbs. The diagnosis is based on clinical suspicion and is confirmed by Doppler ultrasound. Treatment includes general measures and anticoagulation with fondaparinux. Deep vein thrombosis (DVT) is the formation of a thrombus in the deep venous system. It is diagnosed by Doppler ultrasound. Probability scales such as the Wells score have been developed and D-dimer is used to rule out DVT. DVT treatment has two phases—acute and chronic—and is based on anticoagulation. Direct oral anticoagulants (DOACs) or low-molecular-weight heparins (LMWH) are used, followed by an oral anticoagulant. In some cases, surgical interventions such as a thrombectomy may be performed.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2216-2220"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez
{"title":"Protocolo diagnóstico de la disnea crónica cardiogénica","authors":"E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.036","DOIUrl":"10.1016/j.med.2025.06.036","url":null,"abstract":"<div><div>Dyspnea is a symptom that affects 25% of patients in outpatient settings and is a well-studied predictor of mortality. Chronic dyspnea (more than three weeks) may originate from various conditions and represents a diagnostic challenge due to the overlap of different clinical presentations and comorbidities. Cardiogenic dyspnea may result from ischemic heart disease, heart failure, valvular heart diseases, hypertension, or arrhythmias. A detailed medical history and comprehensive physical examination, including inspection, palpation, and auscultation of the patient, are essential for its diagnosis. With this, the origin of the dyspnea can be identified in two-thirds of cases. However, performing additional tests will confirm or rule out the potential cardiogenic origin and allow for guiding the individual suspicion for each patient. These tests include chest X-rays, electrocardiogram, blood analysis, echocardiography, cardiopulmonary exercise testing, and cardiac catheterization.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2286-2289"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez
{"title":"Hipertensión pulmonar","authors":"M.A. Sanromán Guerrero, E. Hernández Sánchez, J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.029","DOIUrl":"10.1016/j.med.2025.06.029","url":null,"abstract":"<div><div>Pulmonary hypertension is a rare, underdiagnosed disease characterized by highly nonspecific clinical manifestations and an estimated latency period of at least two years from symptoms onset to diagnostic confirmation. Therefore, a high degree of clinical suspicion is necessary to facilitate early detection, provide the patient with appropriate treatment, and improve prognosis. Its definitive confirmation requires a right heart catheterization. The primary goal of treatment is always to achieve low risk. If this cannot be attained through pharmacological measures, alternative options such as lung transplantation can be considered for eligible patients. New molecular pathways, such as the activin/BMPR axis, have been studied with a novel emerging drug called sotatercept.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2227-2235"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Rico Sánchez-Mateos, C. Bohórquez Heras, A. Movasat Hajkhan, A. Abbasi Pérez, P. Pretel Ruiz
{"title":"Vasculitis. Concepto, clasificación, mecanismos etiopatogénicos y criterios de sospecha clínica","authors":"E. Rico Sánchez-Mateos, C. Bohórquez Heras, A. Movasat Hajkhan, A. Abbasi Pérez, P. Pretel Ruiz","doi":"10.1016/j.med.2025.06.001","DOIUrl":"10.1016/j.med.2025.06.001","url":null,"abstract":"<div><div>Vasculitides are a group of inflammatory diseases that affect blood vessels, generating a wide spectrum of clinical manifestations and outcomes. This update reviews the basic concepts, classification, etiopathogenic mechanisms, and criteria for clinical suspicion. The current classification, based mainly on the size of the affected vessels, provides a useful yet limited framework, given the heterogeneity and overlap among subtypes. Advances in genetics and epigenetics have improved the understanding of predisposing and triggering factors while immunological mechanisms offer clues to understanding the underlying inflammatory process. Early diagnosis is essential to prevent serious complications, but there are challenges due to the nonspecificity of symptoms and the coexistence of diseases that may mimic vasculitis. Pseudovasculitis, for example, has similar clinical and radiological features, which underscores the importance of a careful assessment. The combination of an initial clinical evaluation with modern diagnostic tools opens new perspectives for more effective management adjusted to each patient's specific characteristics.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2037-2046"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Bohórquez Heras, E. Rico Sánchez-Mateos, E. Fernández Fernández, J. Campos Esteban, A. Abbasi Pérez
{"title":"Vasculitis de pequeño vaso","authors":"C. Bohórquez Heras, E. Rico Sánchez-Mateos, E. Fernández Fernández, J. Campos Esteban, A. Abbasi Pérez","doi":"10.1016/j.med.2025.06.004","DOIUrl":"10.1016/j.med.2025.06.004","url":null,"abstract":"<div><div>Small-vessel vasculitides are a group of inflammatory diseases that affect arterioles, capillaries, and venules, classified by Chapel Hill nomenclature (2012). They include immunocomplex-mediated vasculitis (IgA vasculitis, cryoglobulinemic vasculitis, hypocomplementemic urticarial vasculitis) and vasculitides associated with anti-neutrophil cytoplasmic antibodies (ANCA) or anti-glomerular basement membrane antibodies (anti-GBM). These diseases have heterogeneous immunopathological mechanisms with multisystem involvement. IgA vasculitis, prevalent in children, is associated with IgA deposits in small vessels, frequently triggered by respiratory infections. Its manifestations include palpable purpura, arthritis, abdominal pain, and nephritis, the latter being the main determinant of the prognosis. Cryoglobulinemic vasculitis is usually associated with hepatitis C or autoimmune diseases. It manifests as purpura, neuropathy, arthralgias, and glomerulonephritis. Its treatment combines antivirals, glucocorticoids, and immunotherapy such as rituximab. Hypocomplementemic urticaria vasculitis includes persistent urticaria-like lesions, hypocomplementemia, and anti-C1q antibodies, with renal and pulmonary involvement in severe cases. Microscopic polyangiitis (MAP), associated with ANCA, mainly affects the kidneys and lungs, causing necrotizing glomerulonephritis and alveolar hemorrhage. Anti-GBM vasculitis is rare. It is characterized by autoantibodies that target collagen IV. It manifests as a lung-kidney syndrome with alveolar hemorrhage and rapidly progressive glomerulonephritis. Its diagnosis combines symptoms, immunology, and histopathology. Management depends on the severity and organs involved and prolonged follow-up is key.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2064-2081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}