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Medicamentos para la Insuficiencia Cardíaca y el Síndrome Coronario Crónico

Medicamentos para la Insuficiencia Cardíaca y el Síndrome Coronario Crónico

La insuficiencia cardíaca ( IC IC Inhaled Anesthetics) es un síndrome progresivo debido a disfunción sistólica o diastólica, que provoca un gasto cardíaco insuficiente. El tratamiento incluye modificaciones del estilo de vida, además de un inhibidor del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de angiotensina-neprilisina ( ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) o un inhibidor de la enzima convertidora de angiotensina (IECA o antagonista del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de angiotensina II si no se tolera), betabloqueantes con base científica, antagonistas del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de mineralocorticoides e inhibidores del cotransportador de sodio-glucosa tipo 2 (SGLT2). El síndrome coronario crónico (SCC), antes denominado angina estable, se origina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una estenosis coronaria fija y contribuye a la progresión de la insuficiencia cardíaca. El tratamiento incluye terapia antianginosa, antiagregantes plaquetarios, estatinas y control de la comorbilidad.

Last updated: Aug 26, 2025

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Insuficiencia Cardíaca

La insuficiencia cardíaca ( IC IC Inhaled Anesthetics) es un síndrome progresivo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el que el corazón no bombea la sangre adecuadamente para satisfacer las demandas metabólicas.

Fisiopatología Clave:

  • ↓ Gasto cardíaco → Activación de mecanismos compensatorios
  • Activación del SNS → ↑ FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions, contractilidad y vasoconstricción
  • Activación del SRAA → Retención de Na+/líquidos y remodelado ventricular
  • Cascada neurohormonal → Deterioro progresivo

Clasificaciones:

  • Por fracción de eyección: Insuficiencia cardíaca con fracción de eyección reducida (ICFEr) ≤40% vs. insuficiencia cardíaca con fracción de eyección preservada (ICFEp) ≥50% vs. insuficiencia cardíaca con fracción de eyección intermedia (ICFEi) entre 41 y 49%
  • Clasificación de la New York Heart Association (NYHA):
    • Clase I: sin limitaciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la actividad física, asintomático
    • Clase II: cómodo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum reposo, pero con ligera limitación durante la actividad física moderada/prolongada
    • Clase III: cómodo solo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum reposo. Las actividades cotidianas, como vestirse, resultan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum limitaciones marcadas de la actividad física.
    • Clase IV: sintomático incluso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum reposo

Presentación Clínica:

  • IC IC Inhaled Anesthetics de lado izquierdo:
    • Disnea
    • Ortopnea
    • Disnea paroxística nocturna
    • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar
  • IC IC Inhaled Anesthetics de lado derecho:
    • Distensión venosa yugular
    • Edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema periférico
    • Hepatomegalia
    • Ascitis

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Tratamiento Farmacológico de la IC: Los 4 grandes + 1

1. Inhibidores de la ECA / ARA-II / ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors

  • Mecanismo: Bloqueo del SRAA →
    • ↓ ​​precarga/poscarga
    • Previene la remodelación
  • Efectos secundarios:
    • Hiperpotasemia
    • ↑ creatinina
    • Hipotensión
    • Angioedema Angioedema Angioedema is a localized, self-limited (but potentially life-threatening), nonpitting, asymmetrical edema occurring in the deep layers of the skin and mucosal tissue. The common underlying pathophysiology involves inflammatory mediators triggering significant vasodilation and increased capillary permeability. Angioedema (ECA)
    • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome (ECA)
  • Contraindicaciones:
    • Estenosis bilateral de la arteria renal
    • Embarazo
    • Hiperpotasemia grave
Clase de Fármaco Ejemplos Puntos Clave
Inhibidores de la enzima convertidora de angiotensina (ECA)
  • Lisinopril Lisinopril One of the angiotensin-converting enzyme inhibitors (ACE inhibitors), orally active, that has been used in the treatment of hypertension and congestive heart failure. Renin-Angiotensin-Aldosterone System Inhibitors
  • Enalapril Enalapril An angiotensin-converting enzyme inhibitor that is used to treat hypertension and heart failure. Hypertension Drugs
    		•
  • Primera línea para la ICFEr
  • Reduce el riesgo de mortalidad
    		•
    Antagonistas de los LOS Neisseria receptores de angiotensina II (ARA-II)
  • Valsartán
  • Losartán
    		•  Usar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de intolerancia a inhibidores de la ECA ( tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome)
    Inhibidor del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de angiotensina-neprilisina ( ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors) Sacubitril/valsartán
  • Superior a los LOS Neisseria inhibidores de la ECA en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ICFEr
  • Bloquea la neprilisina
    		•

    2. Betabloqueantes

    • Mecanismo: Bloqueo del SNS →
      • ↓ FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions
      • ↓ demanda de oxígeno
      • Previene arritmias
    • Betabloqueantes específicos para la IC IC Inhaled Anesthetics:
      • Succinato de metoprolol Metoprolol A selective adrenergic beta-1 blocking agent that is commonly used to treat angina pectoris; hypertension; and cardiac arrhythmias. Antiadrenergic Drugs (solo la fórmula XL)
      • Carvedilol Carvedilol A carbazole and propanol derivative that acts as a non-cardioselective beta blocker and vasodilator. It has blocking activity for alpha 1 adrenergic receptors and, at higher doses, may function as a blocker of calcium channels; it also has antioxidant properties. Carvedilol is used in the treatment of hypertension; angina pectoris; and heart failure. It can also reduce the risk of death following myocardial infarction. Class 2 Antiarrhythmic Drugs (Beta Blockers) (bloqueo de α + β)
      • Bisoprolol Bisoprolol A cardioselective beta-1 adrenergic blocker. It is effective in the management of hypertension and angina pectoris. Class 2 Antiarrhythmic Drugs (Beta Blockers)
    • Puntos clave:
      • El aumento gradual de la dosis, comenzando con una dosis baja y aumentando lentamente con el tiempo, reduce el riesgo de efectos secundarios
      • Reduce la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ICFEr
    • Efectos secundarios:
      • Bradicardia
      • Hipotensión
      • Fatiga
      • Broncoespasmo
    • Contraindicaciones:

    3. Antagonistas de los LOS Neisseria Receptores de Mineralocorticoides ( ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy)

    • Mecanismo: Bloqueo de la aldosterona →
      • ↓ pérdida de K+
      • ↓ fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans
      • ↓ remodelación
    • Efectos secundarios:
      • Hipercalemia (¡monitorear!)
      • Ginecomastia (espironolactona)
    • Monitorización:
      • K+ (valor inicial, 1 semana, mensual inicialmente)
      • Creatinina (valor inicial, 1 semana, mensual inicialmente)
    Medicamento Indicación Características principales
    Espironolactona
  • ICFEr
  • Hipertensión resistente
    		•
  • No selectivo
  • Ginecomastia
    		•
    Eplerenona
  • ICFEr
  • Post-IM
    		•
  • Selectivo
  • Menos ginecomastia
    		•

    4. Inhibidores del SGLT2

    • Mecanismo: Bloqueo de la reabsorción de glucosa/Na+ →
      • Diuresis
      • ↓ precarga
      • Cardioprotector
    • Primera clase en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mostrar un beneficio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ICFEp (principalmente ↓ hospitalización, reducción moderada de la mortalidad)
    • Inhibidores del SGLT2 aprobados para la IC IC Inhaled Anesthetics:
      • Dapagliflozina: ICFEr e ICFEp
      • Empagliflozina: ICFEr e ICFEp
    • Efectos secundarios:
      • Infecciones urinarias
      • Infecciones genitales
      • Cetoacidosis diabética (rara)
      • Gangrena de Fournier (rara)

    +1. Diuréticos de asa ASA Anterior Cord Syndrome

    • Mecanismo: Bloqueo del cotransportador Na-K-2Cl → diuresis
    • Solo alivia los LOS Neisseria síntomas; no reduce la mortalidad
    • Efectos secundarios:
      • Hipopotasemia
      • Hiponatremia
      • Ototoxicidad
      • Lesión renal
    Medicamento Potencia Duración
    Furosemida 1x 6 horas
    Bumetanida 40x 6 horas
    Torsemida 10x 12 horas

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    Terapias Adicionales para la IC

    Opciones Complementarias

    Terapia Indicación Mecanismo Notas
    Hidralazina + Isosorbida Pacientes de raza negra con ICFEr Vasodilatación Alternativa a IECA/ARA-II
    Ivabradina ICFEr + RS + FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions ≥70 en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum BB máximo Bloquea la corriente del nódulo sinoatrial Reducción pura de la FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions
    Digoxina ICFEr + fibrilación auricular o síntomas Inhibición de la Na-K ATPasa Solo mejora los LOS Neisseria síntomas
    Vericiguat Síntomas persistentes de ICFEr Guanilato ciclasa soluble Evidencia emergente (no de primera línea)

    Terapias Emergentes

    Terapia Indicación Mecanismo
    Omecamtiv mecarbil ICFEr avanzada Activador de la miosina cardíaca
    AR AR Aortic regurgitation (AR) is a cardiac condition characterized by the backflow of blood from the aorta to the left ventricle during diastole. Aortic regurgitation is associated with an abnormal aortic valve and/or aortic root stemming from multiple causes, commonly rheumatic heart disease as well as congenital and degenerative valvular disorders. Aortic Regurgitation GLP-1 GLP-1 A peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. Glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. These glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake. Insulinomas (Semaglutida) ICFEp + obesidad Pérdida de peso + cardioprotección
    Finerenona ICFEi/ICFEp + DM DM Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus/enfermedad renal crónica ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy selectiva

    Fármacos que se Deben Evitar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la IC IC Inhaled Anesthetics

    • Bloqueadores de los LOS Neisseria canales de calcio (no dihidropiridínicos): verapamilo, diltiazem Diltiazem A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of calcium ion on membrane functions. Class 4 Antiarrhythmic Drugs (Calcium Channel Blockers)
    • Antiarrítmicos: Clase I (excepto amiodarona), dronedarona
    • AINE: empeoran la función renal y la retención de líquidos
    • Tiazolidinedionas: causan retención de líquidos

    Terapia con Dispositivos

    • Desfibrilador Cardioversor Implantable:
      • Indicación: FE ≤35% + tratamiento médico óptimo ≥3 meses + esperanza de vida >1 año
      • Prevención primaria de la muerte súbita cardíaca
    • Terapia de Resincronización Cardíaca:
      • Indicación: FE ≤35% + BRI + QRS ≥150 ms MS Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition. Multiple Sclerosis + NYHA II-IV
      • La estimulación BiV mejora la sincronía
    • CardioMEMS:
      • Indicación: NYHA III + hospitalización reciente
      • Nuevas evidencias para la monitorización hemodinámica

    Síndrome Coronario Crónico (SCC)

    El síndrome coronario crónico (SCC), anteriormente conocido como “angina estable”, es una cardiopatía isquémica crónica con patrones de angina predecibles.

    • Fisiopatología: Estenosis coronaria fija → desajuste oferta-demanda

    Terapia Antianginosa

    • Primera línea:
      • Betabloqueantes: ↓ FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions, ↓ demanda de oxígeno
      • Bloqueadores de los LOS Neisseria canales de calcio: vasodilatación coronaria
        • Dihidropiridinas: amlodipino (vasodilatación periférica)
        • No dihidropiridinas: diltiazem Diltiazem A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of calcium ion on membrane functions. Class 4 Antiarrhythmic Drugs (Calcium Channel Blockers), verapamilo (↓ FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions + vasodilatación)
    • Segunda línea:
      • Nitratos de acción prolongada: venodilatación, ↓ precarga
      • Ranolazina: bloqueador tardío de los LOS Neisseria canales de Na+

    Protección Cardiovascular

    • Terapia obligatoria:
      • Aspirina: antiagregante plaquetario (75-100 mg al AL Amyloidosis día)
        • No se recomienda el uso rutinario de aspirina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con enfermedad coronaria estable sin antecedentes de eventos ateroscleróticos.
      • Estatinas de alta intensidad: estabilización de la placa
      • Inhibidor de la ECA: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de hipertensión, diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus mellitus o disfunción ventricular izquierda
    • Opciones adicionales:
      • Clopidogrel Clopidogrel A ticlopidine analog and platelet purinergic p2y receptor antagonist that inhibits adenosine diphosphate-mediated platelet aggregation. It is used to prevent thromboembolism in patients with arterial occlusive diseases; myocardial infarction; stroke; or atrial fibrillation. Antiplatelet Drugs: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de intolerancia a la aspirina
      • Betabloqueantes: tras un infarto de miocardio o con insuficiencia cardiaca

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    Tratamiento combinado de la IC + SCC

    Medicamentos de Doble Beneficio

    1. Inhibidores de la ECA / ARA-II / ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors

    • Beneficio para la IC IC Inhaled Anesthetics:
      • ↓ precarga/poscarga
      • Previene la remodelación
      • Reduce la mortalidad
    • Beneficio del SCC: beneficio demostrado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mortalidad tras un infarto de miocardio, especialmente con disfunción ventricular izquierda
    • Opción: Se prefiere el ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors (sacubitril/valsartán) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de ICFEr

    2. Betabloqueantes

    • Beneficio para la IC IC Inhaled Anesthetics:
      • ↓ activación del SNS
      • Previene arritmias
      • Reduce la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la ICFEr
    • Beneficio del SCC:
      • ↓ FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions y demanda de oxígeno
      • Terapia antianginosa de primera línea
    • Opción: Carvedilol Carvedilol A carbazole and propanol derivative that acts as a non-cardioselective beta blocker and vasodilator. It has blocking activity for alpha 1 adrenergic receptors and, at higher doses, may function as a blocker of calcium channels; it also has antioxidant properties. Carvedilol is used in the treatment of hypertension; angina pectoris; and heart failure. It can also reduce the risk of death following myocardial infarction. Class 2 Antiarrhythmic Drugs (Beta Blockers) o succinato de metoprolol Metoprolol A selective adrenergic beta-1 blocking agent that is commonly used to treat angina pectoris; hypertension; and cardiac arrhythmias. Antiadrenergic Drugs (formulaciones probadas para la IC IC Inhaled Anesthetics)

    3. Inhibidores del SGLT2

    • Beneficio para la IC IC Inhaled Anesthetics: reduce la mortalidad tanto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ICFEr como en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ICFEp
    • Beneficio para el SCC: protección cardiovascular, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes diabéticos
    • Opción: Dapagliflozina o empagliflozina

    Opciones Emergentes de Doble Beneficio:

    • AR AR Aortic regurgitation (AR) is a cardiac condition characterized by the backflow of blood from the aorta to the left ventricle during diastole. Aortic regurgitation is associated with an abnormal aortic valve and/or aortic root stemming from multiple causes, commonly rheumatic heart disease as well as congenital and degenerative valvular disorders. Aortic Regurgitation GLP-1 GLP-1 A peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. Glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. These glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake. Insulinomas: evidencia emergente para ICFEp + obesidad (semaglutida, tirzepatida)

    Plan de Tratamiento Completo

    • Terapia triple esencial (ambas afecciones):
      • ECA/ ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors: iniciar dosis baja, aumentar hasta la máxima dosis tolerada
      • Betabloqueante: objetivo de FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions 60-70 lpm
      • Inhibidor de SGLT2: dosis estándar
    • Aditivos específicos para la IC IC Inhaled Anesthetics:
      • ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy: reduce la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ICFEr
      • Diurético de asa ASA Anterior Cord Syndrome: para el control del volumen (solo mejora los LOS Neisseria síntomas)
    • Aditivos específicos para el SCC:
      • Aspirina: 81 mg al AL Amyloidosis día (obligatorio)
      • Estatina de alta intensidad: objetivo de LDL <70 mg/dl
      • Antianginosos adicionales si es necesario:
        • Amlodipino
        • Nitratos de acción prolongada
        • Ranolazina

    Qué EVITAR en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la Enfermedad Combinada

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    Interacciones Farmacológicas Clave y Contraindicaciones

    Interacciones Principales

    • ECA + ARA-II + ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy → Hipercalemia grave
    • Nitratos + inhibidores de la PDE5 → Hipotensión grave
    • Betabloqueantes + verapamilo/ diltiazem Diltiazem A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of calcium ion on membrane functions. Class 4 Antiarrhythmic Drugs (Calcium Channel Blockers) → Bloqueo cardíaco
    • Niveles de digoxina ↑ con verapamilo, amiodarona y quinidina

    Parámetros de Monitorización

    • ECA/ARA-II/ ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy: K+, creatinina (1-2 semanas después del inicio)
    • Digoxina: Nivel 0,5-2,0 ng/mL, función renal
    • Diuréticos de asa ASA Anterior Cord Syndrome: Electrolitos, función renal
    • SGLT2i: A1c en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, síntomas genitales/urinarios (monitorizar la tasa de filtración glomerular)

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    Perlas de Alto Rendimiento para el USMLE

    Perlas Farmacológicas

    • ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors > Inhibidor de la ECA para beneficio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mortalidad por ICFEr
    • Solo los LOS Neisseria inhibidores de SGLT2 ayudan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mortalidad por ICFEp
    • La espironolactona causa ginecomastia; la eplerenona no.
    • El carvedilol Carvedilol A carbazole and propanol derivative that acts as a non-cardioselective beta blocker and vasodilator. It has blocking activity for alpha 1 adrenergic receptors and, at higher doses, may function as a blocker of calcium channels; it also has antioxidant properties. Carvedilol is used in the treatment of hypertension; angina pectoris; and heart failure. It can also reduce the risk of death following myocardial infarction. Class 2 Antiarrhythmic Drugs (Beta Blockers) tiene actividad α-bloqueante adicional.
    • Los LOS Neisseria diuréticos de asa ASA Anterior Cord Syndrome no mejoran la mortalidad, solo los LOS Neisseria síntomas.

    Perlas Clínicas

    • Betabloqueantes contraindicados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la IC IC Inhaled Anesthetics descompensada (usar tras la estabilización).
    • Iniciar un IECA antes que un betabloqueante en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la IC IC Inhaled Anesthetics.
    • No combinar IECA + ARA-II (no hay beneficio, más efectos secundarios)
    • La ivabradina solo funciona si la FEVI es ≤35%, NYHA II-III, FC Fc Crystallizable fragments composed of the carboxy-terminal halves of both immunoglobulin heavy chains linked to each other by disulfide bonds. Fc fragments contain the carboxy-terminal parts of the heavy chain constant regions that are responsible for the effector functions of an immunoglobulin (complement fixation, binding to the cell membrane via fc receptors, and placental transport). This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme papain. Immunoglobulins: Types and Functions ≥70 lpm a pesar del betabloqueante máximo y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ritmo sinusal.
    • La hidralazina/nitratos son especialmente beneficiosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes de raza negra.

    Perlas de Efectos Secundarios

    • Tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome por IECA → Cambiar a ARA-II
    • El riesgo de hiperpotasemia es mayor con la combinación de IECA + ARA II + ARM Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy
    • Ototoxicidad por diuréticos de asa ASA Anterior Cord Syndrome: dependiente de la dosis, generalmente reversible
    • Los LOS Neisseria inhibidores del SGLT2 pueden causar cetoacidosis diabética euglucémica

    Perlas de Enfermedades Combinadas

    • 3 de los LOS Neisseria 4 fármacos fundamentales para la IC IC Inhaled Anesthetics también benefician la enfermedad coronaria.
    • El enfoque de doble beneficio reduce la cantidad de comprimidos necesarios y mejora la adherencia.
    • El amlodipino es el único bloqueador de los LOS Neisseria canales de calcio seguro en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con IC IC Inhaled Anesthetics.
    • Los LOS Neisseria betabloqueantes son de primera línea para ambas afecciones.

    Tips para la Memoria

    Consejo de estudio:

    • Concéntrese en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria mecanismos, los LOS Neisseria principales efectos secundarios y las contraindicaciones para el examen Step 1.
    • Enfatice la toma de decisiones clínicas y la selección de fármacos para el examen Step 2.
    • Para pacientes con IC y SCC, recuerde el enfoque de “triple amenaza” utilizando primero medicamentos de doble beneficio.

    Manejo de la IC – Enfoque “SAGE” (por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)

    • SGLT2 inhibitor (inhibidor de SGLT2)
    • ACE inhibitor/ ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors (inhibidor de la ECA/ ARNI ARNi Renin-Angiotensin-Aldosterone System Inhibitors)
    • Get a beta-blocker going (iniciar tratamiento con betabloqueantes)
    • Eplerenone/ spironolactone Spironolactone A potassium sparing diuretic that acts by antagonism of aldosterone in the distal renal tubules. It is used mainly in the treatment of refractory edema in patients with congestive heart failure, nephrotic syndrome, or hepatic cirrhosis. Its effects on the endocrine system are utilized in the treatments of hirsutism and acne but they can lead to adverse effects. Potassium-sparing Diuretics (eplerenona/espironolactona)

    Derivación por IC avanzada – “I NEED HELP” (por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)

    • Inotrope dependence (dependencia de inotrópicos)
    • NYHA Class IV symptoms (síntomas de clase III-IV de la NYHA)
    • EF <20% (fracción de eyección <20%)
    • Escalating diuretic needs (aumento de la necesidad de diuréticos)
    • Defibrillator shocks (descargas del desfibrilador)
    • Hospitalizations frequent (hospitalizaciones frecuentes)
    • End-organ dysfunction (disfunción orgánica)
    • Low blood pressure <90 (presión arterial <90 mmHg)
    • Prognostic medication intolerance (intolerancia a medicamentos pronósticos)

    IC + SCC combinados – “Triple amenaza”

    Triple amenaza: 3 medicamentos que ofrecen beneficios dobles para pacientes con IC IC Inhaled Anesthetics y enfermedad coronaria, creando un enfoque terapéutico sinérgico.

    Referencias

    1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. https://doi.org/10.1161/CIR.0000000000001063
    2. Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. https://doi.org/10.1161/CIR.0000000000001168
    3. McDonagh TA, Metra M, Bauersachs J. The 2023 ESC Guidelines for the management of heart failure. Eur Heart J. 2023;44(32):3028-3114. https://doi.org/10.1093/eurheartj/ehad195
    4. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2021;77(6):772-810. https://doi.org/10.1016/j.jacc.2020.11.022
    5. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol. 2023;81(18):1835-1878. https://doi.org/10.1016/j.jacc.2023.03.393
    6. Usman MS, Siddiqi TJ, Anker SD, Bakris GL, Bhatt DL, Filippatos G, Fonarow GC, Greene SJ, Januzzi JL, Khan MS, Kosiborod MN, McGuire DK, Pina IL, Rosenstock J, Vaduganathan M, Verma S, Zieroth S, Butler J. SGLT2 inhibition in heart failure: New mechanistic insights and expanded clinical indications. J Am Coll Cardiol. 2024;83(12):1432-1445. https://www.jacc.org/doi/10.1016/j.jacc.2023.04.034
    7. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. https://www.nejm.org/doi/full/10.1056/NEJMoa1911303
    8. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. https://doi.org/10.1093/eurheartj/ehz425
    9. Colucci WS, Borlaug BA. (2025). Heart failure: Clinical manifestations and diagnosis in adults. UpToDate. 2024. Retrieved August 2025, from https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults
    10. Colucci WS. (2024). Overview of the management of heart failure with reduced ejection fraction in adults. UpToDate. Retrieved August 2025, from https://www.uptodate.com/contents/overview-of-the-management-of-heart-failure-with-reduced-ejection-fraction-in-adults
    11. Borlaug BA, Colucci WS. (2025). Treatment and prognosis of heart failure with preserved ejection fraction. UpToDate. Retrieved August 2025, from https://www.uptodate.com/contents/treatment-and-prognosis-of-heart-failure-with-preserved-ejection-fraction
    12. Mahler SA. (2025). Approach to the patient with suspected angina pectoris. UpToDate. Retrieved August 2025, from https://www.uptodate.com/contents/approach-to-the-patient-with-suspected-angina-pectoris
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