RESUMO
Marijuana consumption is growing up becoming very common especially between young people. 9-THC, the main psychoactive compound in cannabis, acts on the endocannabinoid system having different cardiovascular effects, including arrhythmias, acute coronary syndrome, and sudden cardiac death. We present the case of a young man from Gambia with no cardiovascular risk factors, marijuana consumer, presenting to the emergency department with ST-elevation myocardial infarction. At coronary angiography, thrombotic left anterior descending coronary artery subocclusion was documented. We also describe the association between acute coronary syndrome and cannabis abuse.
Assuntos
Síndrome Coronariana Aguda , Cannabis , Trombose Coronária , Abuso de Maconha , Infarto do Miocárdio com Supradesnível do Segmento ST , Masculino , Humanos , Adolescente , Abuso de Maconha/complicações , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Síndrome Coronariana Aguda/complicações , Cannabis/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Angiografia Coronária , Vasos CoronáriosRESUMO
Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification. It appears as a round echodense mass containing central areas of echolucencies resembling liquefaction and with no flow in the central zone on color Doppler. In most cases it involves the posterior mitral annulus region, particularly in female subjects. The pathogenesis remains unclear: hypercholesterolemia and the dissolution of lipid-rich macrophages may be implicated in liquefaction necrosis. Transthoracic and transesophageal echocardiography represents the most reliable technique for diagnosis, whereas cardiac magnetic resonance imaging is the choice in doubtful cases. We report the case of an 82-year-old female patient describing different aspects of this particular clinical condition.
Assuntos
Calcinose , Doenças das Valvas Cardíacas , Feminino , Humanos , Idoso de 80 Anos ou mais , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Calcinose/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Ecocardiografia Transesofagiana , LipídeosRESUMO
AIM: Dyslipidemia is recognized as one of the major risk factors for cardiovascular diseases. This retrospective observational study was aimed to assess the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in dyslipidemic patients with a lipid profile not well controlled by maximally tolerated statin therapy or intolerant to these lipid-lowering drugs. We enrolled 151 patients, of whom, 119 were taking evolocumab and 32 alirocumab. RESULTS: Total cholesterol significantly decreased progressively until the fourth year; after 4âyears there was a significant reduction (-125.5âmg/dl, -51.5%, Pâ<â0.0001 vs baseline, and Pâ<â0.05 vs 1âyear and Pâ<â0.05 vs 2âyears) and -2.8âmg/dl (-2.3%) compared with the third year. Low-density lipoprotein-cholesterol (LDL-C) also decreased significantly until the fourth year. After 3âyears, there was a significant reduction (-117.8âmg/dl, -71.5%, Pâ<â0.0001 vs baseline, and Pâ<â0.05 vs 1âyear) and -13.9âmg/dl (-22.8%) compared with the second year; after 4âyears there was a significant reduction (-121.4âmg/dl, -73.7%, Pâ<â0.0001 vs baseline, and Pâ<â0.05 vs 1âyear and Pâ<â0.05 vs 2âyears) and -3.6âmg/dl (-7.7%) compared with the third year. High-density lipoprotein-cholesterol increased significantly only during the fourth year of detection. After 3âyears, there was a nonsignificant increase (4.9âmg/dl, 10.0%, Pâ=â0.061 vs baseline) and 1.6âmg/dl (3.1%) compared with the second year; after 4âyears, there was a significant increase (5.2âmg/dl, 10.6%, Pâ<â0.05 vs baseline) and 0.3âmg/dl (0.6%) compared with the third year. The value of Tg was significantly reduced progressively until the second year and then stabilized in the third and fourth years. After 3âyears, the value of Tg stabilized (-48.6âmg/dl, -32.4%, Pâ<â0.01 vs baseline, and Pâ<â0.05 vs 1âyear) and -4.8âmg/dl (-4.5%) compared with the second year; after 4âyears (-46.4âmg/dl, -31.0%, Pâ<â0.01 vs baseline, and Pâ<â0.05 vs 1âyear) there was a slight and nonsignificant increase of 2.2âmg/dl (2.2%) compared with the third year. Regarding adverse events, both drugs were well tolerated. CONCLUSIONS: We showed that PCSK9 inhibitors are well tolerated and provide long-term significant LDL-C lowering in individuals with hyperlipidemia.
Assuntos
Dislipidemias/tratamento farmacológico , Inibidores de PCSK9/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We report a COVID-19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.
Assuntos
COVID-19 , Cardiomiopatias , Insuficiência Cardíaca , Hipertensão , Miocardite , COVID-19/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/complicações , Masculino , Miocardite/diagnóstico por imagem , Miocardite/etiologiaRESUMO
Valve-in-Valve transcatheter aortic valve implantation (ViV TAVI) is emerging as an effective therapeutic option for bioprosthetic valve failure. Recently, concern has been raised for early valve deterioration of Mitroflow (Sorin) aortic bioprosthesis, with the development of prevalent stenosis. We report cases of pure severe aortic regurgitation (AR) due to early and mid-term prosthesis degeneration. From June 2018 to October 2019, three patients were treated in our division for the new appearance of severe intraprosthetic regurgitation. Patient 1 (man, 85-year-old) and patient 3 (woman, 83-year-old) had a Mitroflow n. 25 and n. 21 implanted, respectively, in 2012 and 2013 for severe aortic stenosis. Patient 2, a 67-year-old woman with Marfan syndrome underwent a Mitroflow n. 25 implant in 2008 for severe AR and presented chronic type-B aortic dissection. Patient 1 was diagnosed with severe AR in the ambulatory setting, while the other patients presented acute heart failure, requiring inotrope support and high doses intravenous diuretics, and in case 3, temporary extracorporeal ultrafiltration. All patients appeared at high surgical risk and were successfully treated with ViV TAVI, through the right axillary artery in patient 2, and through the femoral artery in patients 1 and 3. Results were good at short- and mid-term follow-up. In conclusion, early and midterm bioprosthesis degeneration with the development of severe AR is a possible complication of the Mitroflow aortic valve. ViV TAVI has been confirmed as a safe and effective therapeutic option in our cases.
RESUMO
Primary cardiac tumors are uncommon and primary liposarcoma of the pericardium is extremely rare. We describe the case of a 55-year-old Caucasian woman without significant medical history, who presented with 3weeks complain of dyspnea, peripheral edema, and gain weight. Echocardiography revealed a huge pericardial mass confirmed by computed tomography and by magnetic resonance. The lesion was primitive of the pericardium but the surgery was not able to cut it off because of the absence of cleavage planes. Histopathologic analysis detected a dedifferentiated liposarcoma. Mediastinum compression syndrome brought the patient to the exitus in a few days.
Assuntos
Neoplasias Cardíacas/patologia , Lipossarcoma/patologia , Pericárdio/patologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Intramyocardial bridge is defined as the segment of a major epicardial coronary artery that runs within the cardiac muscle wall (coronary tunneling). Usually, this kind of anatomic variant is asymptomatic but sometimes it may lead to acute coronary syndrome and/or arrhythmias, and more rarely to sudden cardiac death. Treatment for symptomatic patients is pharmacological, using beta-blockers.
Assuntos
Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/fisiopatologia , Miocárdio/patologia , Síndrome Coronariana Aguda/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Arritmias Cardíacas/etiologia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/etiologia , HumanosRESUMO
The Kounis syndrome was first described in 1991 as'the allergic angina syndrome'which could progress to acute myocardial infarction which was named'allergic myocardial infarction. There are several causes underlying this syndrome including drugs, various conditions and a variety of environmental exposure factors such as animal stings. Hymenoptera stings can induce Kounis syndrome because hymenoptera venom contains allergenic proteins and peptides. The following case report describes a patient who experienced an anaphylactic shock associated with coronary artery ischaemia (inferior ST-segment elevation myocardial infarction) after a bumblebee sting.
Assuntos
Alérgenos , Anafilaxia , Angioplastia Coronária com Balão/métodos , Venenos de Abelha/imunologia , Abelhas , Clorfeniramina/administração & dosagem , Hidrocortisona/administração & dosagem , Mordeduras e Picadas de Insetos , Anafilaxia/tratamento farmacológico , Anafilaxia/etiologia , Anafilaxia/imunologia , Animais , Antialérgicos , Angiografia Coronária , Vasos Coronários/efeitos dos fármacos , Eletrocardiografia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/etiologia , Infarto Miocárdico de Parede Inferior/imunologia , Infarto Miocárdico de Parede Inferior/terapia , Mordeduras e Picadas de Insetos/complicações , Mordeduras e Picadas de Insetos/imunologia , Masculino , Pessoa de Meia-Idade , Stents , Síndrome , Resultado do TratamentoRESUMO
Breast carcinoma is becoming a spread disease that needs a specif teraphy. Tamoxifen is the first line treatment in patients with positivity of expression of estrogen receptors. The risk of thromboembolism is high in patients treated with tamoxifene indipendent from the neoplastic disease. This work focuses the attention on tamoxifen mechanism of thrombosis.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Embolia Pulmonar/induzido quimicamente , Tamoxifeno/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Embolia Pulmonar/diagnósticoRESUMO
We describe the case of a young female affected by a thymus teratoma coexisting with carcinoid tumor.
RESUMO
Boerhaave's syndrome is a very rare disease characterised by a spontaneous rupture of the oesophagus. It is often misdiagnosed and there is no consensus as to the best treatment. We describe a case of a 61 year-old man without significant previous medical history presenting in the emergency room with acute chest and back pain. Despite objective and laboratory tests negative for chest pain screening, computed tomography showed the presence of mediastinal air and pneumothorax consistent with oesophagus rupture. Urgent surgical intervention saved the patient.
Assuntos
Dor no Peito/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Doença Aguda , Dor no Peito/etiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/cirurgia , Radiografia , Resultado do Tratamento , Vômito/etiologiaRESUMO
We describe the case of a 78-year-old woman admitted to our department for suspected silent myocardial ischaemia with the evidence of T wave inversion in anterior lead. All the instrumental exams excluded inducible myocardial ischaemia. A gastroscopy showed a moderate hiatal hernia. We postulate that electrocardiogram modification could be attributed to hiatal hernia.