RESUMO
The aortic dissection may be associated with unusual complications such as fistula formation and vascular compression. We describe a case of a 71-year-old patient admitted to our Hospital because of acute chest pain; transthoracic and transesophageal echocardiography revealed the presence of a type A aortic dissection associated with a mass infiltrating the right ventricular outflow and proximal tract of the pulmonary artery. The ultrasonographic morphology and the surgical findings showed the presence of a hematoma which was consequent to acute aortic dissection and which mimicked a tumor infiltrating the right ventricular outflow.
Assuntos
Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Hematoma/diagnóstico , Hematoma/etiologia , Células Neoplásicas Circulantes , Obstrução do Fluxo Ventricular Externo/diagnóstico , Obstrução do Fluxo Ventricular Externo/etiologia , Doença Aguda , Idoso , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Chylothorax is a rare but serious complication of coronary artery bypass grafting. We describe a case of double myocardial revascularization with the internal mammary artery developing the complication ten weeks after cardiac surgery. The reasons for late symptomatology of lymphatic injury are analyzed. Conservative treatment with low-fat diet, total parenteral nutrition and pleural drainage was attempted unsuccessfully; chyle leakage of around 500 ml/day and onset of nutritional deficiency made it advisable to seal the thoracic duct surgically.
Assuntos
Quilotórax/etiologia , Revascularização Miocárdica , Complicações Pós-Operatórias/etiologia , Idoso , Quilotórax/diagnóstico , Quilotórax/reabilitação , Terapia Combinada , Eletrocardiografia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/reabilitação , Radiografia Torácica , Toracotomia , Fatores de TempoRESUMO
A 17-year-old patient sustained blunt trauma to the chest, during a motor vehicle accident, resulting in a pericardial laceration and cleft of anterior leaflet of mitral valve; both lesions were treated conservatively at a later date. The reasons of late symptomatology of valvular injury and absent initial identification are analyzed. Echocardiography's role for diagnosis, indication and choice of surgical treatment is emphasized.
Assuntos
Valva Mitral/lesões , Pericárdio/lesões , Acidentes de Trânsito , Adolescente , Humanos , Masculino , Valva Mitral/cirurgia , Motocicletas , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Pericárdio/cirurgia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
To evaluate whether the combination of nifedipine with chlorthalidone exerts an additive antihypertensive effect when compared to single-drug treatment, 66 uncomplicated essential hypertensives, whose diastolic blood pressure was greater than 100 and less than 115 mm Hg at the end of a 1-month washout placebo period, received, according to a randomized, double-blind, crossover design, nifedipine (20 mg b.i.d.), chlorthalidone (25 mg o.d.), the two drugs combined at the same doses, and the corresponding placebo. When compared to the randomized placebo the three active treatments significantly (p less than 0.001) reduced blood pressure without changing heart rate and body weight. However, blood pressure values were similarly reduced under nifedipine and the combination and were significantly lower (p less than 0.05) than those under chlorthalidone. Moreover, the percentage of responders and normalized patients under nifedipine and the two drugs combined were similar and significantly (normalized, p less than 0.0001; responders, p less than 0.02) greater than those under chlorthalidone. Under chlorthalidone and its combination with nifedipine, plasma potassium tended to decrease and blood glucose and serum uric acid were significantly (p less than 0.05) increased. These data show that the combination of nifedipine with chlorthalidone does not exert any additive antihypertensive effect when compared to nifedipine alone and that this combination increases both blood glucose and serum uric acid. Taken together these findings indicate that the combination of a dihydropyridine calcium antagonist with a thiazide diuretic is devoid of any clinical significance in the treatment of uncomplicated essential hypertensives.
Assuntos
Clortalidona/administração & dosagem , Hipertensão/tratamento farmacológico , Nifedipino/administração & dosagem , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
To determine whether the combination of nifedipine + chlorthalidone exerts an additive antihypertensive effect when compared with single-drug treatment, we studied 66 uncomplicated essential hypertensives, with diastolic blood pressure of greater than 100 and less than 115 mmHg. At the end of a 1-month washout placebo period, using a double-blind crossover design, the patients were randomly allocated to nifedipine (20 mg twice a day), chlorthalidone (25 mg once a day), the two drugs combined at the same doses and the corresponding placebo. Compared with the randomly allocated placebo, the three active treatments significantly reduced blood pressure without changing the heart rate or body weight. Both the absolute and percentage decreases in mean blood pressure induced by nifedipine and the combination compared with placebo were similar and significantly greater than those induced by chlorthalidone. Taken together, these data show that the combination of nifedipine + chlorthalidone does not exert any additive antihypertensive effect compared with nifedipine alone. This finding indicates that the combination of a dihydropyridine calcium antagonist + a thiazide diuretic is probably devoid of any particular clinical significance in the treatment of uncomplicated essential hypertensives.
Assuntos
Clortalidona/uso terapêutico , Hipertensão/tratamento farmacológico , Nifedipino/uso terapêutico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Sinergismo Farmacológico , Quimioterapia Combinada , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como AssuntoAssuntos
Catecolaminas/sangue , AMP Cíclico/sangue , GMP Cíclico/sangue , Infarto do Miocárdio/sangue , Nucleotídeos Cíclicos/sangue , Idoso , Arritmias Cardíacas/etiologia , Dopamina/sangue , Epinefrina/sangue , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Norepinefrina/sangueAssuntos
Circulação Coronária , Miocárdio , Probabilidade , Processos Estocásticos , Radioisótopos de Xenônio , Animais , Cães , PerfusãoRESUMO
UNLABELLED: In 11 anaesthetised, Open chest dogs the time course and degree of the coronary vasodilating response to intracoronary adenosine infusion was assessed. Continuous adenosine infusion, at a rate of 2.5 to 13.5 mumol . min-1, produced rapid (15 to 30s) vasodilation of the same degree as that evoked by a 30 s period of ischaemia (reactive peak hyperaemia), a finding reported previously by others. However, continuing the infusion led to further coronary vasodilation, reaching a maximum 20 to 45 min from the beginning of the infusion and remaining constant for up to 2 h, independently of further increases in the dose. This late response produced, on average, vasodilatation twice as great as that observed during reactive hyperaemia and was not associated with any haemodynamic change or with the opening of arterio-venous shunts. THE RESULTS: 1) suggest the existence of a double, time-dependent response of coronary receptor(s) to adenosine; 2) demonstrate, in the presence of a prolonged vasodilating stimulus, a possible increase in coronary blood flow to a degree far beyond that of post-ischaemic reactive peak flow, which is generally considered to be the maximal value of coronary blood flow that can be achieved.
Assuntos
Adenosina/farmacologia , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Animais , Doença das Coronárias/fisiopatologia , Cães , Fatores de TempoAssuntos
Circulação Coronária , Adenosina , Animais , Pressão Sanguínea , Cães , Modelos Cardiovasculares , Resistência Vascular , Função VentricularRESUMO
To investigate the pathogenesis of myocardial infarction we undertook a systematic study of patients with angina at rest, a syndrome known to evolve frequently into infarction. Among 187 consecutive patients, 37 had infarction, all in the area that showed electrocardiographic changes during angina. In all 76 patients who underwent hemodynamic monitoring, 201thallium myocardial scintigraphy or angiography during angina, a vasospastic origin of the attacks was documented. In six patients with infarction shortly after these studies and in two in whom the infarction developed during hemodynamic monitoring or during angiography the onset of infarction was indistinguishable from the onset of anginal attacks. One patient in whom spasm was observed at the onset of infarction died six hours later; at post-mortem examination, a fresh laminar thrombus was found at the site of the spasm. After infarction, complete thrombotic occlusion of the branch shown to undergo vasospasm was documented in two patients by angiography.
Assuntos
Angina Pectoris/complicações , Vasos Coronários/fisiopatologia , Infarto do Miocárdio/etiologia , Adulto , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/fisiopatologia , Angiografia Coronária , Circulação Coronária , Vasos Coronários/patologia , Eletrocardiografia , Feminino , Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Radioisótopos , Cintilografia , Descanso , Tálio , Trombose/patologiaAssuntos
Angina Pectoris Variante/diagnóstico , Angina Pectoris/diagnóstico , Sistema de Condução Cardíaco/fisiopatologia , Adulto , Angina Pectoris Variante/epidemiologia , Angina Pectoris Variante/etiologia , Angiocardiografia , Arritmias Cardíacas/epidemiologia , Angiografia Coronária , Unidades de Cuidados Coronarianos , Circulação Coronária , Doença das Coronárias/etiologia , Morte Súbita/etiologia , Eletrocardiografia , Teste de Esforço , Feminino , Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Mortalidade , Infarto do Miocárdio/epidemiologia , Cintilografia , Risco , Espasmo/complicaçõesRESUMO
Coronary angiography was performed during 34 angina attacks in thirty patients admitted because of recurrent angina at rest. Nineteen (seventeen with S-T segment elevation and two S-T depression) had angiograms during a spontaneous attack, eleven (nine with S-T elevation and two with S-T depression) during an attack induced by intravenous ergonovine maleate. Control coronary angiograms showed a wide range of atherosclerotic obstruction, from normal vessels to severe triple-vessel disease. During the anginal attack, all patients with S-T segment elevation had vasospasm localised to one of the major branches, often resulting in complete occlusion. Attacks with S-T segment depression were seen only in patients with double or triple vessel disease, and here the vasospasm generally affected coronary branches without causing complete occlusion. When appropriately searched for, vasospastic angina seems to be common.