7/7 A normal pulse ox does not mean nothing is wrong. It means the problem sits past the point the finger clip can see. Follow @Covid_institute. #LongCOVID #Microclots #EndothelialDysfunction #PostCOVID #LongCovidDoctor

7/7 The distinction matters. Treating the symptoms without naming the mechanism produces the outcome you already know: normal tests, real symptoms, no path forward. Follow @Covid_institute. #LongCOVID #EndothelialDysfunction #NitricOxide

7/7 Same presentation from the outside. Two mechanisms, two different workups. Treating one for the other is why breathlessness with normal labs goes unresolved for months. Follow @Covid_institute. #LongCOVID #Microclots #EndothelialDysfunction

8/8 The vascular layer COVID injured is among the more responsive injuries the illness produces. The damage is real. The recovery is also real. The labs already exist to measure both. books.covidinstitute.org/han… #LongCOVID #EndothelialDysfunction #VascularHealth #LongCovidRecovery

8/8 Ask your provider about the pairing before your next supplement refill. The dose is fine. The cofactor matters. books.covidinstitute.org/han… #LongCOVID #EndothelialDysfunction #VitaminD #VitaminK2

🧠⚠️ 𝗣𝗥𝗘𝗦: “𝗿𝗲𝘃𝗲𝗿𝘀𝗶𝗯𝗹𝗲” 𝗻𝗼 𝘀𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮 𝘀𝗶𝗲𝗺𝗽𝗿𝗲 𝗯𝗲𝗻𝗶𝗴𝗻𝗼 🚨 @SpringerNature 👇🏼👇🏼👇🏼👇🏼 📑🔗🔑🔓 t.me/ClubCrit ⬇️⬇️⬇️⬇️ 🧵👇 El 𝙨𝙞́𝙣𝙙𝙧𝙤𝙢𝙚 𝙙𝙚 𝙚𝙣𝙘𝙚𝙛𝙖𝙡𝙤𝙥𝙖𝙩𝙞́𝙖 𝙥𝙤𝙨𝙩𝙚𝙧𝙞𝙤𝙧 𝙧𝙚𝙫𝙚𝙧𝙨𝙞𝙗𝙡𝙚 (𝙋𝙍𝙀𝙎) es un cuadro neurológico agudo asociado sobre todo con: 📈 HTA severa 🫘 disfunción renal 🦠 sepsis 🧬 autoinmunidad 💊 inmunosupresores/citotóxicos Y aunque muchas veces revierte: ☠️ la mortalidad reportada va de 𝟭𝟬–𝟭𝟵% 🧠 y hasta 𝟰𝟬–𝟰𝟰% pueden quedar con secuelas clínicas o radiológicas. 🧠💥 𝙇𝙖 𝙥𝙧𝙚𝙨𝙚𝙣𝙩𝙖𝙘𝙞𝙤́𝙣 𝙘𝙡𝙞́𝙣𝙞𝙘𝙖 𝙚𝙨 𝙢𝙪𝙮 𝙫𝙖𝙧𝙞𝙖𝙗𝙡𝙚, 𝙥𝙚𝙧𝙤 𝙝𝙖𝙮 𝙪𝙣 𝙥𝙖𝙩𝙧𝙤́𝙣 𝙦𝙪𝙚 𝙙𝙚𝙗𝙚𝙨 𝙧𝙚𝙘𝙤𝙣𝙤𝙘𝙚𝙧 𝙩𝙚𝙢𝙥𝙧𝙖𝙣𝙤 Los síntomas más frecuentes son: ⚡ 𝙘𝙤𝙣𝙫𝙪𝙡𝙨𝙞𝙤𝙣𝙚𝙨 🤕 𝙘𝙚𝙛𝙖𝙡𝙚𝙖 👁️ 𝙖𝙡𝙩𝙚𝙧𝙖𝙘𝙞𝙤𝙣𝙚𝙨 𝙫𝙞𝙨𝙪𝙖𝙡𝙚𝙨 😵‍💫 𝙘𝙤𝙣𝙛𝙪𝙨𝙞𝙤́𝙣 / 𝙚𝙣𝙘𝙚𝙛𝙖𝙡𝙤𝙥𝙖𝙩𝙞́𝙖 😴 𝙙𝙞𝙨𝙢𝙞𝙣𝙪𝙘𝙞𝙤́𝙣 𝙙𝙚𝙡 𝙚𝙨𝙩𝙖𝙙𝙤 𝙙𝙚 𝙘𝙤𝙣𝙘𝙞𝙚𝙣𝙘𝙞𝙖 📌 Las convulsiones ocurren en 𝟲𝟬–𝟵𝟬% de los casos. 🩻 𝙈𝙍𝙄 𝙚𝙨 𝙡𝙖 𝙘𝙡𝙖𝙫𝙚: 𝙡𝙖 𝙏𝘼𝘾 𝙖𝙮𝙪𝙙𝙖, 𝙥𝙚𝙧𝙤 𝙥𝙪𝙚𝙙𝙚 𝙦𝙪𝙚𝙙𝙖𝙧𝙨𝙚 𝙘𝙤𝙧𝙩𝙖 El estudio diagnóstico de elección es la 𝙍𝙈 𝙘𝙚𝙧𝙚𝙗𝙧𝙖𝙡 🧲 Lo típico: 📍 edema vasogénico 📍 predominio 𝙥𝙖𝙧𝙞𝙚𝙩𝙤-𝙤𝙘𝙘𝙞𝙥𝙞𝙩𝙖𝙡 📍 hiperintensidad en 𝙏𝟮/𝙁𝙇𝘼𝙄𝙍 Pero ojo 👀 🚫 no siempre es “posterior puro” Puede haber compromiso de: 🧠 lóbulos frontales 🌰 ganglios basales 🌉 tronco encefálico 🎯 cerebelo 👉 La 𝙏𝘼𝘾 puede mostrar hipodensidades, pero puede 𝙨𝙪𝙗𝙚𝙨𝙩𝙞𝙢𝙖𝙧 la extensión y no distingue bien edema vasogénico de citotóxico. 🧬 𝙇𝙖 𝙛𝙞𝙨𝙞𝙤𝙥𝙖𝙩𝙤𝙡𝙤𝙜𝙞́𝙖 𝙜𝙞𝙧𝙖 𝙖𝙡𝙧𝙚𝙙𝙚𝙙𝙤𝙧 𝙙𝙚 𝟮 𝙜𝙧𝙖𝙣𝙙𝙚𝙨 𝙚𝙟𝙚𝙨 1️⃣ 𝙛𝙖𝙡𝙡𝙤 𝙙𝙚 𝙖𝙪𝙩𝙤𝙧𝙧𝙚𝙜𝙪𝙡𝙖𝙘𝙞𝙤́𝙣 𝙥𝙤𝙧 𝙃𝙏𝘼 𝙖𝙜𝙪𝙙𝙖 ➜ hiperperfusión ➜ ruptura de la barrera hematoencefálica 2️⃣ 𝙙𝙞𝙨𝙛𝙪𝙣𝙘𝙞𝙤́𝙣 𝙚𝙣𝙙𝙤𝙩𝙚𝙡𝙞𝙖𝙡 ➜ aumento de permeabilidad ➜ edema vasogénico Eso explica por qué PRES aparece en contextos como: 🤰 preeclampsia/eclampsia 🫘 ERC/ESRD 💊 tacrolimus/ciclosporina 🦠 sepsis 🧫 autoinmunidad 👉 En otras palabras: HTA endotelio vulnerable = terreno perfecto para PRES. 🚑 𝙀𝙡 𝙩𝙧𝙖𝙩𝙖𝙢𝙞𝙚𝙣𝙩𝙤 𝙨𝙞𝙜𝙪𝙚 𝙨𝙞𝙚𝙣𝙙𝙤 𝙥𝙧𝙞𝙣𝙘𝙞𝙥𝙖𝙡𝙢𝙚𝙣𝙩𝙚 𝙙𝙚 𝙨𝙤𝙥𝙤𝙧𝙩𝙚… 𝙥𝙚𝙧𝙤 𝙧𝙖́𝙥𝙞𝙙𝙤 𝙮 𝙙𝙞𝙧𝙞𝙜𝙞𝙙𝙤 Las prioridades son muy claras: ✅ controlar 𝙋𝘼 ✅ retirar o ajustar el 𝙙𝙚𝙨𝙚𝙣𝙘𝙖𝙙𝙚𝙣𝙖𝙣𝙩𝙚 ✅ tratar 𝙘𝙤𝙣𝙫𝙪𝙡𝙨𝙞𝙤𝙣𝙚𝙨 ✅ corregir trastornos metabólicos ✅ dar 𝙏𝙍𝙍 si la falla renal lo exige ✅ resolver la causa obstétrica si aplica El artículo sugiere en HTA aguda una reducción gradual, apuntando a 𝙋𝘼𝙈 𝟭𝟬𝟱–𝟭𝟮𝟱 𝙢𝙢𝙃𝙜, evitando caídas bruscas que puedan provocar isquemia. Opciones antiHTA IV frecuentes: 💉 𝙡𝙖𝙗𝙚𝙩𝙖𝙡𝙤𝙡 💉 𝙣𝙞𝙘𝙖𝙧𝙙𝙞𝙥𝙞𝙣𝙤 💉 𝙣𝙞𝙢𝙤𝙙𝙞𝙥𝙞𝙣𝙤 y como antiepilépticos: ⚡ levetiracetam, fenitoína, valproato. 🤰🧒🫀 𝙉𝙤 𝙩𝙤𝙙𝙤𝙨 𝙡𝙤𝙨 𝙋𝙍𝙀𝙎 𝙨𝙚 𝙘𝙤𝙢𝙥𝙤𝙧𝙩𝙖𝙣 𝙞𝙜𝙪𝙖𝙡: 𝙝𝙖𝙮 𝙥𝙤𝙗𝙡𝙖𝙘𝙞𝙤𝙣𝙚𝙨 𝙚𝙨𝙥𝙚𝙘𝙞𝙖𝙡𝙚𝙨 Destacan 3 grupos donde hay que pensar distinto: 🧒 𝙥𝙚𝙙𝙞𝙖́𝙩𝙧𝙞𝙘𝙤𝙨: más convulsiones, más patrones atípicos en imagen 🤰 𝙤𝙗𝙨𝙩𝙚́𝙩𝙧𝙞𝙘𝙤𝙨: fuertemente ligados a preeclampsia/eclampsia; aquí el 𝙈𝙜𝙎𝙊₄ sigue siendo central 🫀🫘 𝙩𝙧𝙖𝙨𝙥𝙡𝙖𝙣𝙩𝙚/𝙞𝙣𝙢𝙪𝙣𝙤𝙨𝙪𝙥𝙧𝙚𝙨𝙞𝙤́𝙣: muy asociados a 𝙞𝙣𝙝𝙞𝙗𝙞𝙙𝙤𝙧𝙚𝙨 𝙙𝙚 𝙡𝙖 𝙘𝙖𝙡𝙘𝙞𝙣𝙚𝙪𝙧𝙞𝙣𝙖 como tacrolimus/ciclosporina 📌 Hasta 𝟳𝟬% de los pacientes pueden requerir UCI y 𝟯𝟱–𝟰𝟬% soporte ventilatorio transitorio. 🎯 “𝙍𝙚𝙫𝙚𝙧𝙨𝙞𝙗𝙡𝙚” 𝙨𝙞́… 𝙥𝙚𝙧𝙤 𝙘𝙤𝙣 𝙫𝙞𝙜𝙞𝙡𝙖𝙣𝙘𝙞𝙖 𝙚𝙨𝙩𝙧𝙚𝙘𝙝𝙖 𝙮 𝙨𝙞𝙣 𝙧𝙚𝙩𝙧𝙖𝙨𝙤𝙨 El pronóstico suele ser bueno si se reconoce temprano, pero no siempre 😬 Factores de mal pronóstico: 🧠 encefalopatía severa 🩸 hemorragia 📉 restricción en difusión / infarto 🫘 ESRD 🦠 malignidad / sepsis ❤️ FA 📌 La recurrencia ocurre en aproximadamente 4% y suele relacionarse con persistencia del desencadenante: HTA no controlada, inmunosupresión, enfermedad renal, inflamación sistémica. 🔥 Take-home: 𝙋𝙍𝙀𝙎 𝙙𝙚𝙗𝙚 𝙥𝙚𝙣𝙨𝙖𝙧𝙨𝙚 𝙩𝙚𝙢𝙥𝙧𝙖𝙣𝙤 en cualquier paciente con convulsiones/encefalopatía HTA, renal, sepsis, embarazo o inmunosupresores. El error más peligroso no es no saber tratarlo; es 𝙣𝙤 𝙨𝙤𝙨𝙥𝙚𝙘𝙝𝙖𝙧𝙡𝙤 𝙖 𝙩𝙞𝙚𝙢𝙥𝙤. ‼️Si te sirve: ❤️ Me gusta | 🔁 Repost | ➕ Follow para más👇🏼👇🏼👇🏼👇🏼 📚📖#ClubCrit👨🏻‍⚕️👨🏻‍🏫🧠🫶 📚📖 Más en el blog 👉 [buff.ly/61OGR7B] #PRES #NeurocriticalCare #FOAMed #FOAMcc #ClubCrit #PRES #NeurocriticalCare #Seizures #HypertensiveEmergency #Neurology #MRI #Neuroimaging #Pathophysiology #EndothelialDysfunction #HTN #BloodPressureControl #StatusEpilepticus #ObstetricCriticalCare #Pediatrics #Transplant #CriticalCare #CriticalCare #CuidadoCrítico #MedTwitter #CritCare #icu #intensivecare #diagnosis #management #UCI #MedicinaBasadaEnEvidencia #MedEd #MedX #IntensiveCare #MedIntensiva #MedXCommunity #MedED #ICUmanagement #MustRead #LecturaRecomendada

7/7 Volume 6 covers endothelial dysfunction, microclots, and vascular recovery in detail. books.covidinstitute.org/han… #LongCOVID #EndothelialDysfunction #Microclots #LongCovidRecovery

7/7 The question is not whether your cholesterol is controlled. The question is whether your blood vessels are functioning. Follow @Covid_institute #LongCOVID #EndothelialDysfunction #Microclots #Statins

6/6 Recovery is not faith. It is measurable biology on a timeline you can track. Follow @Covid_institute for endothelial and microclot workup. #LongCOVID #EndothelialDysfunction #Microclots

📢 #CallForPapers The call -"Cell Biology of Vascular Aging'- is focusing on the role of molecular mechanisms of #aging in the pathogenesis of cardiovascular diseases, #COVID19, #hypertension, #obesity and ##vascularhomeostasis. Read more in the comments and submit📧 at the link⬇: springer.com/journal/11357/u… #CellBiology #vascularaging #cardiovasculardiseases #endothelialdysfunction #atherogenesis #pericyte #tumor #vascularhomeostasis

7/7 Your cardiologist is not wrong. Your heart is fine. The problem is downstream, in vessels a thousand times smaller than the stress test evaluates. Follow @Covid_institute #LongCOVID #EndothelialDysfunction #Microvasculature #BrainFog #LongCovidRecovery

6/6 Not treatment failure. Incomplete treatment. Understanding the clot composition changes the treatment conversation entirely. Follow @Covid_institute for mechanism-based Long COVID education. #LongCOVID #Microclots #EndothelialDysfunction #Anticoagulation #LongCovidRecovery

I hope this website can help make a difference. 🫀 * operational but still in progress — like most of us. 🥰 #INOCA #ANOCA #MINOCA #CMD #CAS #MVA #VSA #CoronaryArterySpasm #MicrovascularSpasm #MicrovascularDysfunction #EndothelialDysfunction #NOCAD inocabelgium.my.canva.site

#mdpijcm #HighlyCitedPaper🔥 Citations 39 #EndothelialDysfunction in #HeartFailure: What Is Its Role? 👉mdpi.com/2766124 👥Andrea Drera 🏫@unibs_official @MediPharma_MDPI

📢 #CallForPapers The call -"Cell Biology of Vascular Aging'- is focusing on the role of molecular mechanisms of #aging in the pathogenesis of cardiovascular diseases, #COVID19, #hypertension, #obesity and ##vascularhomeostasis. Read more in the comments and submit📧 at the link⬇: springer.com/journal/11357/u… #CellBiology #vascularaging #cardiovasculardiseases #endothelialdysfunction #atherogenesis #pericyte #tumor #vascularhomeostasis

#ANOCA #INOCA #MINOCA #NOCAD 🫀 #Endotypes #CAS #VSA #CMD #MVA ❤️‍🩹 #EndothelialDysfunction #MyocardialBridging #MixedEndotypes 2/2

#ANOCA #INOCA #MINOCA #NOCAD 🫀 #Diagnosis #Endotypes #Treatment #CAS #VSA #CMD #MVA ❤️‍🩹 #EndothelialDysfunction #MyocardialBridging #MixedEndotypes #CoronaryFUNCTIONtesting #Adenosine #Acetylcholine 1/2

The Central Role of Endothelial Dysfunction in Cardiovascular Disease Progression - Ney Carter Borges hemostasistoday.com/voices/n… #Hematology #Hemostasis #HemostasisNews #HemostasisToday #Medicine #Health #MedX #MedNews #MedEd #EndothelialDysfunction

#PAH silently destroys pulmonary blood vessels long before the heart fails— #PULSAR aims to spot this drift early via advanced AI/multi-omics for truly preventive care. sidrastart.com/project/2c8f8… #EthicalAI #SidraChain #VascularHealth #EndothelialDysfunction #metabolichealth

Macro- and microvascular endothelial function reduced in patients with #MECFS. #EndothelialDysfunction #FMD journals.plos.org/plosone/ar… (Photo from tv2.no): Dr. Fluge and Dr. Mella, Haukeland University Hospital, Bergen, Norway).