Cocaine-induced myocarditis

de Ayala Fernández, José Ángel; Fraile Gutiérrez, Virginia; Fernández-Pérez, Gabriel

doi:10.1016/j.medcle.2020.03.018

array:24 ["pii" => "S2387020621002400" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.03.018" "estado" => "S300" "fechaPublicacion" => "2021-06-25" "aid" => "5247" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:631-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775320303651" "issn" => "00257753" "doi" => "10.1016/j.medcli.2020.03.016" "estado" => "S300" "fechaPublicacion" => "2021-06-25" "aid" => "5247" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:631-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Miocarditis por cocaína" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "631" "paginaFinal" => "632" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cocaine-induced myocarditis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 750 "Tamanyo" => 57618 ] ] "descripcion" => array:1 [ "es" => "RM. Muestra zonas de realce tardío miocárdicas, parcheadas, sin distribución vascular. Afectan a regiones medias y subepicárdicas del ventrículo izquierdo (a diferencia de las lesiones isquémicas, que afectan característicamente al subendocardio). RM: resonancia magnética; TC: tomografía computarizada." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Ángel de Ayala Fernández, Virginia Fraile Gutiérrez, Gabriel Fernández-Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José Ángel" "apellidos" => "de Ayala Fernández" ] 1 => array:2 [ "nombre" => "Virginia" "apellidos" => "Fraile Gutiérrez" ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Fernández-Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020621002400" "doi" => "10.1016/j.medcle.2020.03.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002400?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320303651?idApp=UINPBA00004N" "url" => "/00257753/0000015600000012/v1_202106110528/S0025775320303651/v1_202106110528/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020621002394" "issn" => "23870206" "doi" => "10.1016/j.medcle.2021.05.002" "estado" => "S300" "fechaPublicacion" => "2021-06-25" "aid" => "5191" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:632-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Neonatal debut of ornithine transcarbamylase deficiency with severe hyperammoniemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "632" "paginaFinal" => "633" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Debut neonatal de déficit de ornitina transcarbamilasa con hiperamoniemia grave" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esperanza Lepe Balsalobre, Rocío Cabra Rodríguez, José María Maesa Márquez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Esperanza" "apellidos" => "Lepe Balsalobre" ] 1 => array:2 [ "nombre" => "Rocío" "apellidos" => "Cabra Rodríguez" ] 2 => array:2 [ "nombre" => "José María" "apellidos" => "Maesa Márquez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320302694" "doi" => "10.1016/j.medcli.2020.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320302694?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002394?idApp=UINPBA00004N" "url" => "/23870206/0000015600000012/v1_202106160926/S2387020621002394/v1_202106160926/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020621002527" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.03.020" "estado" => "S300" "fechaPublicacion" => "2021-06-25" "aid" => "5250" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:630-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "High adenosine deaminase level in the pleural effusion of a case with leukemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "630" "paginaFinal" => "631" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nivel alto de adenosina desaminasa en el derrame pleural de un caso con leucemia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Füsun Fakılı, Mahşuk Taylan, Sibel Cangi" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Füsun" "apellidos" => "Fakılı" ] 1 => array:2 [ "nombre" => "Mahşuk" "apellidos" => "Taylan" ] 2 => array:2 [ "nombre" => "Sibel" "apellidos" => "Cangi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775320303687" "doi" => "10.1016/j.medcli.2020.03.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320303687?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002527?idApp=UINPBA00004N" "url" => "/23870206/0000015600000012/v1_202106160926/S2387020621002527/v1_202106160926/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Cocaine-induced myocarditis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "631" "paginaFinal" => "632" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Ángel de Ayala Fernández, Virginia Fraile Gutiérrez, Gabriel Fernández-Pérez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "José Ángel" "apellidos" => "de Ayala Fernández" "email" => array:1 [ 0 => "jangeldayala@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Virginia" "apellidos" => "Fraile Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gabriel" "apellidos" => "Fernández-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Coronaria, Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miocarditis por cocaína" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 750 "Tamanyo" => 57618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "MRI. Shows patchy, myocardial delayed enhancement areas, without vascular distribution. They affect the middle and subepicardial regions of the left ventricle (unlike ischemic lesions, with a characteristic subendocardial involvement). MRI: magnetic resonance imaging; CT: computed tomography." ] ] ] "textoCompleto" => "Cocaine use has increased in recent years. The ease of administration and low cost means that more and more patients with cardiovascular complications such as unstable angina, acute myocardial infarction, aortic dissection or acute myocarditis, with the latter probably being underdiagnosed, are being seen in intensive care units.We report the case of 25-year-old male with a 3-h history of oppressive central chest pain. The electrocardiogram (ECG) showed generalized early repolarization with elevated high-sensitivity troponins I up to 9000 ng/l.After admission to the Coronary ICU, an echocardiogram was performed showing mild LV dysfunction (53% biplane) without anomalies in segmental contractility. On further interviews with the patient, he reported regular cocaine use. Given the suspicion of cocaine-induced myocardial involvement, without persistent ST elevation, a coronary computed tomography (CT) scan was performed showing normal coronary arteries and impaired myocardial perfusion, with patchy areas and without a vascular territory distribution. Given the suspicion of cocaine-induced myocarditis, a magnetic resonance imaging (MRI) was performed that showed a patchy subepicardial delayed enhancement in the LV wall indicative of an inflammatory lesion, unlike ischemic lesions, where the involvement is subendocardial or transmural (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Before these results, he was diagnosed with acute cocaine-induced myocarditis.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The reason for reporting this case is to highlight the cardiac effects of cocaine; they do not always correspond to an ischaemic mechanism and the initial ECG can point to the most appropriate imaging tests for the patient.The pathogenesis of cocaine-induced toxicity is probably multifactorial and not completely known. Several mechanisms are involved,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> including stimulation of the sympathetic nervous system, inhibition of catecholamine reuptake and increased sensitivity to norepinephrine, stimulation of endothelin-1 production, a potent vasoconstrictor, and inhibition of nitric acid production, which acts as a potent vasodilator. Likewise, it produces coronary thrombosis due to platelet activation, stimulating their aggregation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>In addition, it increases the activity of plasminogen activator inhibitors and increases fibrinogen and von Willebrand factor concentrations which, together with a decrease in protein C and antithrombin III, confer a procoagulant effect.Similarly, the pathophysiology of cocaine-induced acute myocarditis is not well understood.References to cocaine-induced myocardial involvement of non-ischaemic origin were already reported in 1986. Diffuse inflammatory cell infiltration, predominantly mononuclear including macrophages and eosinophils, has been demonstrated by endomyocardial biopsy.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> There are different patterns of myocardial damage, such as multifocal necrosis and focal myocarditis.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Today, imaging tests can help us make the differential diagnosis of myocardial damage due to coronary insufficiency or inflammation. Thus, perfusion CT (PCT) and MRI may be helpful in these types of patients. PCT allows the quantification of myocardial blood flow and volume. Cardiac MRI is capable of detecting subepicardial and subendocardial lesions. This difference is especially important since subendocardial lesions with a vascular territory distribution are highly characteristic of ischemic lesions, whereas subepicardial or midventricular lesions represent an inflammatory process (myocarditis), especially when randomly distributed. In our case, a delayed enhancement study showed patchy myocardial uptake areas without vascular distribution, affecting the middle and subepicardial regions. Furthermore, the use of CT in these cases further enhances its usefulness as an emergency test capable of showing normal coronary arteries and, in the same study, myocardial uptake of random characteristics similar to those that can be obtained by MRI.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The clinical and histological features are not specific for cocaine-induced myocardial damage. Other clinical entities must be ruled out for diagnosis. Similarly, it should be borne in mind that not all cocaine-induced cardiac involvement is due to coronary insufficiency and that it could correspond to the clinical features of myocarditis, with the changes in treatment that this entails. Therefore, our patient was treated with non-steroidal anti-inflammatory drugs with a good progression. Current imaging tests must be relied upon and are especially important for differential diagnosis.FundingThe study has not been funded.Conflict of interestsThere is no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: de Ayala Fernández JÁ, Fraile Gutiérrez V, Fernández-Pérez G. Miocarditis por cocaína. Med Clin (Barc). 2021;156:631–632." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 550 "Ancho" => 750 "Tamanyo" => 57618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "MRI. Shows patchy, myocardial delayed enhancement areas, without vascular distribution. They affect the middle and subepicardial regions of the left ventricle (unlike ischemic lesions, with a characteristic subendocardial involvement). MRI: magnetic resonance imaging; CT: computed tomography." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular complications of cocaine use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. Lange" 1 => "L.D. Hillis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200108023450507" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "345" "paginaInicial" => "351" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11484693" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cociane increases the endotelial release of immunoreactive endothelin and its concetration in human plasma and urine: reversal by coincubation with sigma-receptor antagonists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "U. Wilbert-Lampen" 1 => "C. Seliger" 2 => "T. Zilker" 3 => "R.M. Arendt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.98.5.385" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1998" "volumen" => "98" "paginaInicial" => "385" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9714087" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute cardiac events temporally related to cocaine abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Isner" 1 => "N.A. Estes 3rd" 2 => "P.D. Thompson" 3 => "M.R. Costanzo-Nordin" 4 => "R. Subramanian" 5 => "G. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198612043152302" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1986" "volumen" => "315" "paginaInicial" => "1438" "paginaFinal" => "1443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3785295" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct cocaine cardiotoxicity desmonstrated by endomyocardial biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.K. Peng" 1 => "W.J. French" 2 => "P.C. Pelikan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Pathol Lab Med" "fecha" => "1989" "volumen" => "113" "paginaInicial" => "842" "paginaFinal" => "845" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2757483" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic value of ECG-gated multidetector computed tomography in the early phase of suspected acute myocarditis. A preliminary comparative study with cardiac MRI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Dambrin" 1 => "J.P. Laissy" 2 => "J.M. Serfaty" 3 => "C. Caussin" 4 => "B. Lancelin" 5 => "J.F. Paul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00330-006-0391-2" "Revista" => array:6 [ "tituloSerie" => "Eur Radiol" "fecha" => "2007" "volumen" => "17" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16953372" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000012/v1_202106160926/S2387020621002400/v1_202106160926/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000012/v1_202106160926/S2387020621002400/v1_202106160926/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002400?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 156. Issue 12.

Pages 631-632 (June 2021)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Medicina Clínica (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Medicina Clínica (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Medicina Clínica

Tools

Free access articles

Associations of physical activity, sedentary time,...

Med Clin. 2024;163:327-35

Burden of COVID-19 variant omicron in immunocompromised...

Med Clin. 2024;163:347-59

Raynaud phenomenon in a baseball...

Med Clin. 2024;163:e79

Medicina Clínica (English Edition) follows the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter