RESUMEN
Systemic embolization is the most common extracardiac complication of active infective endocarditis (IE). The assessment of individual patient risk for embolic events in active IE is very difficult. Staphylococcal or fungal endocarditis, infections caused by HACEK and Abiotrophia spp. microorganisms, anterior mitral leaflet vegetations and vegetations with size >10 mm in TTE are associated with higher rate of arterial embolization. In this report we present a 66-year-old patient with active enterococcal aortic native valve endocarditis, with a history of gastric ulcers and with acute abdominal pain due to splenic infarction. We conclude that abdominal pain, particularly in the left-upper-quadrant, may be a sign of splenic infarction. Confirmation of this complication by ultrasonography provides important information about increased risk of future systemic embolic events.
Asunto(s)
Absceso Abdominal/prevención & control , Endocarditis Bacteriana/sangre , Endocarditis Bacteriana/diagnóstico por imagen , Infarto del Bazo/diagnóstico por imagen , Infecciones Estafilocócicas/sangre , Infecciones Estafilocócicas/diagnóstico por imagen , Absceso Abdominal/complicaciones , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/tratamiento farmacológico , Dolor Abdominal/diagnóstico , Enfermedad Aguda , Anciano , Antibacterianos/administración & dosificación , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Diagnóstico Diferencial , Ecocardiografía Transesofágica/métodos , Endocarditis Bacteriana/tratamiento farmacológico , Enterococcus faecalis , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Factores de Riesgo , Infarto del Bazo/complicaciones , Infarto del Bazo/tratamiento farmacológico , Infarto del Bazo/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCD). Most frequently SCD occurs in patients with NYHA class II and III. AIM: To evaluate the influence of prolonged carvedilol therapy on SCD risk in CHF patients. METHODS: The study included 86 patients (81 men and 5 women) aged 56.8+/-9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCD were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) <30%, volume of the left ventricle (LVEDV) >140 ml; in ECG at rest - sinus heart rate (HRs) >75/min, sustained atrial fibrillation, increased QTc; in 24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN <100 ms) and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late ventricular potentials and prolonged fQRS >114 ms. The analysis of SCD risk factors in basic examination in patients who suddenly died was also performed. RESULTS: During one-year carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12 months the following risk factors for SCD were significantly changed: HRs >75/min (50 vs. 16 patients, p=0.006), LVEF <30% (37 vs. 14 patients, p=0.01), SDNN <100 ms (19 vs. 9 patients, p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly reduced (p=0.001). In patients who suddenly died we found a greater amount of SCD risk factors in basic examination (7 vs. 5) as compared to alive patients. CONCLUSIONS: Prolonged beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF increase, reduction of HR at rest and improvement of HRV.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Carbazoles/uso terapéutico , Muerte Súbita Cardíaca/etiología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Propanolaminas/uso terapéutico , Adulto , Anciano , Carvedilol , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Resultado del TratamientoRESUMEN
We present a case of a 56-year-old male who was admitted to our hospital due to cardiac tamponade. A 600 ml of purulent fluid was evacuated from the pericardium. The patient received antibiotics, however, due to recurrent pericardial effusion a pericardial drainage was required. Esophagoscopy and computerised tomography revealed oesophageal carcinoma with oesophago-pericardial fistula.
Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Taponamiento Cardíaco/etiología , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/terapia , Taponamiento Cardíaco/terapia , Diagnóstico Diferencial , Ecocardiografía , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/cirugía , Técnicas de Ventana PericárdicaRESUMEN
Cardiac arrest (CA) refers to abrupt cessation of cardiac pump function. Most sudden deaths in young people are of cardiac origin, at the same time most patients have unrecognised prior heart disease. We report a case of a 17-year-old boy with cardiac arrest induced by ventricular fibrillation. Sinus rhythm was restored after one hour's resuscitation. Based upon elevated necrotic markers, ECG changes and echocardiographic examinations the diagnosis of anterolateral myocardial infarction was established. Coronary angiography revealed only a small myocardial bridge. The patient in a poor general and unconscious state was transferred to the Coronary Care Unit of the Department of Coronary Disease. The patient improved after treatment and without neurological deficit or circulatory insufficiency continued cardiac rehabilitation in a spa hospital. The paper reviews differential diagnosis of cardiac arrest, treatment modalities and describes the course of hospitalisation.
Asunto(s)
Paro Cardíaco/etiología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Fibrilación Ventricular/complicaciones , Adolescente , Diagnóstico Diferencial , Electrocardiografía , Humanos , Masculino , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Resucitación , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: Electrocardiographic lead aVR is usually ignored in patients with chest pain. ST segment elevation in aVR may have diagnostic value in patients with acute coronary syndrome (ACS) and significant stenosis or obstruction of the left main coronary artery (LMCAS), especially when accompanied by ST segment elevation in lead V(1). AIM: To asses the value of lead aVR and V1 for the detection of LMCAS in patients with ACS. METHODS: The study group consisted of 150 patients (mean age 60.6+/-9.5 years, range 33-78 years) with ACS, including 46 with LMCAS and 104 without LMCAS. ECG recordings obtained on admission were compared between these two groups. RESULTS: In patients with LMCAS, ST segment elevation in lead aVR was two times more frequent than in remaining patients (69.6% vs 34.6% p=0.0001) whereas there were no differences in lead V(1). Sensitivity of ST elevation in aVR in detection of LMCAS was 69.6%, specificity - 65.4%, positive predictive value - 47.1%, and negative predictive value - 82.9%. In patients with LMCAS, ST segment depression was significantly more often present in ECG leads other than aVR (45.6% vs 23.1% p<0.01). Patients with LMCAS more often had hypertension (95.6% vs 77.9% p<0.05) and three-vessel disease (78.3% vs 31.8%, p<0.0001). CONCLUSIONS: The assessment of lead aVR in patients with ACS may indicate LMCAS. Additional analysis of lead V(1) does not improve diagnostic accuracy.
Asunto(s)
Estenosis Coronaria/diagnóstico , Vasos Coronarios/patología , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Enfermedad Aguda , Adulto , Anciano , Estudios de Casos y Controles , Estenosis Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
We report a case of Prinzmetal angina initially manifested with short losses of consciousness in a 55-year-old man hospitalized in the Department of Coronary Artery Disease, Institute of Cardiology, Jagiellonian University Medical College in Cracow. Clinical symptomatology of the presented case, causes and mechanism of loss of consciousness in variant angina as well as treatment methods are discussed.
Asunto(s)
Síndrome de Adams-Stokes/complicaciones , Síndrome de Adams-Stokes/diagnóstico , Angina Pectoris Variable/complicaciones , Angina Pectoris Variable/diagnóstico , Síndrome de Adams-Stokes/terapia , Angina Pectoris Variable/terapia , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Inconsciencia/etiologíaRESUMEN
Acute coronary syndrome or perimyocarditis? A case report. A case of a 25-year-old male with a severe chest pain associated with ST segment changes, elevated serum C-reactive protein, myocardial necrosis markers and normal epicardial coronary arteries is presented. The patient recently recovered from upper respiratory infection. Differential diagnosis between acute coronary syndrome and perimyocarditis is discussed.