Ruben Sanchez

libro :voxel en cardiologia/
imagen cardiovascular.
cardiologo

[JAHA @JAHA_AHA]

Tirzepatide was associated with lower 1-year cardiovascular risk vs GLP-1 RAs in T2D with ASCVD in a real-world cohort. https://t.co/7HkVdzhnfT

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫀Congestion is the disease. Diuresis is only the treatment.

For decades, the success of acute heart failure therapy has been measured by urine output, weight loss, or symptom relief. However, these surrogate endpoints do not necessarily indicate that congestion has resolved. Residual congestion at discharge remains one of the strongest predictors of rehospitalization and mortality.

This review proposes a more standardized and physiology-based strategy for decongestion. The objective is not simply to increase urine output, but to achieve effective natriuresis, restore euvolemia, and eliminate congestion before discharge.

The first message is urgency. Intravenous loop diuretics should be administered within 60 minutes of hospital arrival whenever acute heart failure with congestion is diagnosed. Delays may reduce the effectiveness of treatment and worsen outcomes.

The second message is even more important. Early treatment response should be measured objectively. Rather than waiting for body weight to change over several days, clinicians should evaluate:

• Spot urinary sodium after 2 hours, targeting ≥50to70 mmol/L

• Urine output after 6 hours, targeting ≥100to150 mL/hour

Failure to achieve these targets should prompt early intensification of therapy instead of continuing an ineffective regimen.

The review also supports the growing concept of early sequential nephron blockade. Randomized trials such as ADVOR and CLOROTIC demonstrated that adding acetazolamide or thiazide therapy to loop diuretics can improve decongestion in selected patients, particularly when diuretic resistance develops. Acetazolamide appears especially useful in patients with elevated serum bicarbonate, a marker of increased proximal sodium reabsorption and neurohormonal activation.

Another clinically relevant finding is that continuous loop diuretic infusion offers no clear advantage over intermittent bolus administration, consistent with the DOSE trial. Success depends more on achieving an adequate natriuretic response than on the method of administration.

Perhaps the most important lesson is that patients should not leave the hospital while still congested. Successful decongestion must be followed by rapid optimization of guideline directed medical therapy and early outpatient follow up, as demonstrated by the STRONG HF strategy.

Modern heart failure management is evolving from simply prescribing diuretics toward measuring the physiological response to therapy and adapting treatment early. Congestion should no longer be treated empirically. It should be monitored, quantified, and resolved before discharge.

Reference 📚

Bilgeri, V., Spitaler, P., Puelacher, C., et al. (2024). Decongestion in Acute Heart Failure: Time to Rethink and Standardize Current Clinical Practice? Journal of Clinical Medicine, 13(2), 311. https://t.co/fic1FPNt7x

[Julio @JulioFdez79]

El SUCRALFATO es uno de los medicamentos más interesantes para la enfermedad ulcerosa péptica. No es un antiácido ni un inhibidor de bomba de protones: es un análogo sintético de la mucina gástrica que actúa formando una barrera protectora.

[Mauricio Ambriz @AmbrizMau]

Efectos de reducción de los triglicéridos y mecanismos de acción de los agentes terapéuticos novedosos y emergentes:

Journal of Clinical Endocrinology & Metabolism 2026; DOI: https://t.co/y0ASp5enzB

[Stroke AHA/ASA @StrokeAHA_ASA]

#STROKE: Using GBD 2021 dataset, it has been shown that burden of AF-related stroke has declined since 1990, but diabetes-related stroke continues to rise and is projected to increase substantially through 2050. https://t.co/89JzB5IGyY

[NEJM @NEJM]

Many disorders that cause optic disk edema can produce retinal fluid and even macular exudates in a stellate pattern. The development of pronounced radial macular exudates, known as a macular star, suggests neuroretinitis. 👉 https://t.co/3JNnsHzE4l

The macular star is composed of lipids deposited from exudative leakage that tracks along obliquely oriented, radially arranged Henle fibers in the outer plexiform layer (seen in figure). Neuroretinitis can be idiopathic, or it can be caused by immune-mediated or inflammatory diseases, but infection is the most common cause. Approximately two thirds of cases of neuroretinitis are caused by bartonella infection, but syphilis and tuberculosis remain possible diagnoses in this patient’s case.

Learn more in “A 28-Year-Old Man with Headache and Vision Loss in the Right Eye,” a Case Record of the Massachusetts General Hospital, by A.L. Gilbert et al.: https://t.co/3JNnsHzE4l

[Ahmed Bennis MD 🫀 @drbennisahmed]

The current state of artificial intelligence-based invasive coronary angiography image analysis: a systematic review

AI-based ICA analysis has progressed from technical feasibility studies towards clinically oriented applications.

https://t.co/mQPS4wqcYE

[CardioTeca @cardioteca]

🔭 El cardiólogo del futuro: qué cambia, qué permanece y qué debes aprender hoy

Lee el análisis completo en CardioTeca: https://t.co/m1fSyOD1Kt

🤖 Los algoritmos de IA ya superan al cardiólogo en la lectura del ECG: detectan disfunción ventricular izquierda silente y fibrilación auricular paroxística en ritmo sinusal con una precisión que ningún experto humano puede igualar
📊 Un ensayo clínico aleatorizado demostró que el ECG enriquecido con IA reduce la mortalidad por cualquier causa un 30% en pacientes cardíacos de alto riesgo atendidos en urgencias
🧠 Las cinco competencias del cardiólogo de 2035: alfabetización en IA, razonamiento fisiopatológico profundo, comunicación empática, habilidades manuales en intervencionismo y electrofisiología, y ética digital
⚡ «La IA probablemente reemplazará a los médicos que no utilicen esta tecnología» Lüscher TF, Eur Heart J 2026

[Pon｜食と健康 @PonNutr]

血液や免疫細胞を作る造血幹細胞にSIRT3という酵素を届けると、脳や筋肉など全身の炎症を抑制して老化が止まるかもしれないという #NatAging の論文

今は実現が難しいけれど、骨髄にSIRT3をデリバリーする仕組みができれば老化の根本治療になる超絶重要な発見です

[Valy 🎩🎭 @liderfiscal]

#ULTIMAHORA Fuertes declaraciones de China a EEUU:

Si Estados Unidos aún tuviera confianza en su propia competitividad, no necesitaría convertir cada proyecto civil chino en una emergencia de seguridad nacional.

Un puerto se convierte en una amenaza.
Un ferrocarril se convierte en una amenaza.
Una red de telecomunicaciones se convierte en una amenaza.
Incluso un cable submarino se convierte en un arma.

China construye infraestructura.
Washington construye pánico a su alrededor.

América ya no pregunta si un proyecto chino funciona.
Pregunta qué tan rápido puede ser destruido antes de que el mundo note que funciona mejor.

Cuando un imperio ya no puede liderar, intenta incapacitar a aquellos que sí pueden.

¿Cómo puede contestar la Casa Blanca? Seguramente con una guerra

#UrgenteCOMPARTAN #RTMasivo 👇🏼👇🏼👇🏼👇🏼👇🏼👇🏼👇🏼

[Stroke AHA/ASA @StrokeAHA_ASA]

Emerging Therapy Critique by Jha: Glibenclamide may be a compelling therapeutic approach to cerebroprotection in patients with acute ischemic #stroke due to large vessel occlusion. https://t.co/UBa0qKEwx2

[Rhenals acuña @RhenalsMedint]

Este paper es probablemente la mejor síntesis hasta ahora en obesidad. No es una nueva guía. Compara las más recientes EASO (2024), (2025), ACC (2025) y AACE (2025) en un paper.

Obesidad deja de ser definida por IMC y se define ahora por exceso de adiposidad que genera daño.

[Cristina Tejera @cristinatejerap]

El IMC solo identifica a la mitad de las personas con exceso de adiposidad.
Nueva revisión en @NatureRevEndo
que compara los marcos que han cambiado el diagnóstico de obesidad en 2 años: EASO 2024, Comisión Lancet 2025, ACC y AACE 2025.

Dónde convergen y dónde no 👇

https://t.co/HdVdvVOhA0

[Marcos Gamboa @mrcsgmb84]

📄 Documento de consenso sobre como adaptar las guías de insuficiencia cardíaca y trasladar la Terapia Médica Dirigida por Guías (GDMT) a la realidad de los países de ingresos bajos y medios (LMICs). 🧵👇
@IcyfaSemi @IC_LaFe @ICardiacaSEC @SACcardiometab1 @almucastro01 @cardiologiaec
@FaustoHerediaDr @SABOURETCardio @drbennisahmed

[JAMA @JAMA_current]

💬 Perspective: #ArtificialIntelligence may increase efficiency and diagnostic support in medicine, but its value will depend on whether time saved is redirected to face-to-face patient care rather than more screen-based work.

https://t.co/YYV22F34uc

[JAMA @JAMA_current]

RCT: Thrombectomy did not improve 3-month functional outcomes vs medical therapy alone for acute #Stroke from #MDVO, but hemorrhagic complications were more frequent.

https://t.co/s5pTiFSJGs

[Bilim Dünyası @dunyasalbilim]

Diz protezi ameliyatı işte böyle gerçekleşir.

[JAMA Cardiology @JAMACardio]

🔖 Bookmark now, reference later: Most #ThyroidCancer cases are well differentiated and asymptomatic, and surgery with or without #RadioactiveIodine is curative in most tumors >1 cm.

Cite this #JAMAReview: https://t.co/C9aLxEK6jC

[JAMA @JAMA_current]

For recurrent locoregional disease, #surgical resection is the preferred approach. In metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy, while antiangiogenic multikinase inhibitors and targeted therapies may be used for thyroid cancer that does not respond to radioactive iodine or for tumors with specific #genetic alterations.

This treatment framework supports more personalized care, with #therapies directed at alterations including BRAF, RET, NTRK, and MEK in patients with advanced thyroid carcinoma.

🔗 https://t.co/aSFQfwJdvO

[JAMA @JAMA_current]

🔖 Bookmark now, reference later: Management of #ThyroidCancer increasingly reflects #tumor size, #disease extent, and #molecular profile.

This #JAMAReview indicates that observation without surgical resection can be considered for microcarcinomas ≤1 cm, while surgery with or without #RadioactiveIodine is curative in most cases for tumors >1 cm with or without lymph node metastases.

➡️ Save this Review to your citation manager and reference it in future research: https://t.co/aSFQfwJdvO