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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).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">RM: resonancia magnética; TC: tomografía computarizada.</p>" ] ] ] "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." 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"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" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "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" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "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" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Virginia" "apellidos" => "Fraile Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gabriel" "apellidos" => "Fernández-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI: magnetic resonance imaging; CT: computed tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The pathogenesis of cocaine-induced toxicity is probably multifactorial and not completely known. Several mechanisms are involved,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></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"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Similarly, the pathophysiology of cocaine-induced acute myocarditis is not well understood.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3</span></a> There are different patterns of myocardial damage, such as multifocal necrosis and focal myocarditis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study has not been funded.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">There is no conflict of interest.</p></span></span>" "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" => "<p class="elsevierStyleNotepara" id="npar0005">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.</p>" ] ] "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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI: magnetic resonance imaging; CT: computed tomography.</p>" ] ] ] "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" ]
