RESUMO
The following case report and literature review will emphasize the individualized therapeutic management of a complex prothrombotic pathology. The onset of acute portal vein thrombosis in a patient with atrial fibrillation and good compliance to anticoagulation with a direct oral anticoagulant, who associates significant thrombocytosis, after excluding predisposing inflammations, infections or solid neoplasia, raises the diagnostic suspicion of myeloproliferative disorder, and imposes a complex interdisciplinary approach.
Assuntos
Erros de Diagnóstico , Transtornos Puerperais/diagnóstico , Atelectasia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Cesárea/efeitos adversos , Dispneia/etiologia , Feminino , Humanos , Gravidez , Transtornos Puerperais/sangue , Transtornos Puerperais/etiologia , Atelectasia Pulmonar/sangue , Atelectasia Pulmonar/etiologia , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Doenças Raras , Insuficiência Respiratória/sangue , Insuficiência Respiratória/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The cardiopulmonary test has demonstrated its role in predicting long term prognostic of patients with heart failure, but only few data are available regarding its utility on short term period. METHODS: During 2011-2013, the study enrolled 55 patients over 18 years, with different cardiovascular, metabolic and/or pulmonary pathologies, and 10 control patients matched for age, sex and surgical intervention type, without an associated pathological history who underwent elective abdominal surgery with general anesthesia. RESULTS: The most important predictors of the heart failure worsening after abdominal surgery were peak VO2 as percent of predicted VO2 lower than 59.42±12.52, ventilator equivalent for CO2 at anaerobic threshold over 39.53±5.27 and VD/VT ratio at anaerobic threshold over 0.33±0.06. Lean VO2 lower than 9.58±2.47 also correlated with the above mentioned complication. The ventilator equivalent for CO2, above 39.53±5.27 at anaerobic threshold, respectively 40.67±6.73 at peak exercise, correlates with short term worsening of heart failure after general anesthesia for abdominal surgery. CONCLUSION: The CPX test has a certain value in predicting short term worsening of heart failure after general anesthesia for elective abdominal surgery in patients known with cardiovascular, pulmonary and/or metabolic disorders.