Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined as an acute myocardial infarction without angiographically obstructive coronary artery disease or stenosis ≤ 50%. It is a complex and challenging entity since for adequate management it is not enough just arrive at the diagnosis, but one must also try to identify the underlying etiology. This article aims to review the different current diagnostic modalities and discuss the existing evidence for the specific treatment of some of the most prevalent etiologies.
Key words: MINOCA, cardiac magnetic resonance
Introduction and Objective: The treatment of transthyretin (TTR) cardiac amyloidosis is based on two fundamental strategies: supportive therapy and disease-modifying therapy. Supportive therapy aims to prevent and control disease complications, providing support to affected organs and improving patient quality of life. In contrast, disease-modifying therapy focuses on interrupting or slowing the production and accumulation of amyloid fibrils responsible for tissue damage. This therapy employs drugs that act at different stages of amyloidogenesis: silencing the TTR gene to reduce protein production, stabilizing circulating TTR to prevent its dissociation and monomer formation, and destroying and reabsorbing already formed amyloid deposits. The benefits, efficacy, and safety of these therapies as treatments for cardiac amyloidosis will be rigorously evaluated.
Methods: An literature review of studies published between 2013 and 2024 was conducted in electronic databases such as PubMed, Google Scholar, ELSEVIER, UpToDate, and ClinicalKey, with the primary objective of evaluating the efficacy and clinical relevance of fafamidis in cardiac amyloidosis.
Results: Clinical trials have shown that tafamidis meglumine is a safe and effective medication for the treatment of ATTRv30M and ATTR-CM. The drug has been associated with a reduction in the rate of cardiovascular-related hospitalizations, improved cardiac function, and better quality of life in patients.
Conclusions: Tafamidis has proven to be an effective and safe therapy for transthyretin cardiac amyloidosis, significantly improving patient survival and quality of life. Although it faces accessibility challenges due to its cost, it stands as a cornerstone in the treatment of this disease. Continuous research is crucial to optimize its use and develop complementary therapies.
Key words: Cardiac amyloidosis, Tafamidis, Tetramer, Monomers, Transthyretin stabilizer, V30M mutation.
Purpose: To determine the weekly effect of exercise-based cardiac rehabilitation (CR) on perceived stress and mood states in patients with coronary artery disease (CAD).
Methods: Twenty-one patients were measured every week for eight weeks on perceived stress and mood states (fatigue, vigor, tension, and friendship), using the scale of perceived stress (EEP-10) and the profile of mood states (POMS). Functional exercise capacity was obtained based on the 6-minute walk test (6MWT) at pre- and post-CR. Repeated measures ANOVA was used to determine outcomes differences. Effect sizes were also calculated, and probability was set at level p < 0.05.
Results: Patients reduced stress, F(8-160) = 7.72, p < 0.01, η2 =.279, 11.5±4.3 to 5.7±4.3 score 50% post CR. Stress reduced from week 1, 11.5±4.3 to 8.0±4.6, p = 0.049 and was maintained subsequently. Fatigue decreased, F(8-160) = 4.3, p = 0.016, η2 =.178, 6.3±5.2 to 2.6±2.3, score, 58% after CR. The change in fatigue was observed until week 7, 6.3±5.2 to 3.1±3.8, p =.010. Vigor increased, F(8-160) =7.1, p = 0.0019, η2 =.263, 12.2±4.6 to 16.0±3.6, score, 31% more post CR. The improvement in vigor was observed until week 5, 12.2±4.6 to 3.6±16.1, p = 0.009 and it was maintained afterward. Tension decreased, F(8-160) =7.8, p = 0.005, η2 =.281, 6.0±4.5 to 2.4±2.8 score, 60% less post CR. The decrease in tension was observed at week 3, 6.0±4.5 to 3.2±3.1, p = 0.037 and remained at week 5, 6 and 8, p = 0.004, p = 0.005, p = 0.005, respectively. Friendship only improved 12.5% at week 5, 15.2±3.1 to 17.1±2.7, p = 0.015. The 6MWT distance improved 26%, 444±86 to 559±88 m, ES = 1.2, p < 0.01.
Conclusion: Our eight-week exercise-based CR was effective on reducing the levels of perceived stress and improving the mood states of vigor, fatigue, and tension.
Key words: Cardiac Rehabilitation, Perceived Stress, Mood States.
