RESUMEN
A case of loculated pericardial effusion diagnosed by chest roentgenogram and subsequent echocardiogram is presented. This effusion was unusual in its late appearance after thoracotomy and its discrete location which resulted in hemodynamic embarrassment. Subsequent cultures demonstrated an infected pericardial space and septicemia.
Asunto(s)
Taponamiento Cardíaco/etiología , Enfermedades de las Válvulas Cardíacas/cirugía , Derrame Pericárdico/etiología , Complicaciones Posoperatorias , Adulto , Taponamiento Cardíaco/diagnóstico por imagen , Ecocardiografía , Endocarditis Bacteriana/complicaciones , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Radiografía , Sepsis/complicaciones , Infecciones Estafilocócicas/complicaciones , Staphylococcus epidermidis , Factores de TiempoRESUMEN
A diminution in the anticoagulant effect of IV heparin with concomitant use of IV nitroglycerin has been reported. However, recent reports have disputed the existence of this interaction. The objective of this study was to assess the potential interaction of these agents in a clinical setting. Forty-five patients hospitalized with angina or acute myocardial infarction received low-dose nitroglycerin (5-20 micrograms/minute), and 13 received high-dose nitroglycerin (80-240 micrograms/minute). The two groups were similar with respect to sex, age, weight, and angina class; however, the high-dose group had a greater degree of congestive heart failure. The heparin dose required to achieve therapeutic anticoagulation did not differ between the groups. Results suggest no inhibition of heparin anticoagulation by IV nitroglycerin at clinically relevant doses.
Asunto(s)
Angina Inestable/tratamiento farmacológico , Heparina/administración & dosificación , Infarto del Miocardio/tratamiento farmacológico , Nitroglicerina/administración & dosificación , Adulto , Anciano , Interacciones Farmacológicas , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Disección Aórtica/terapia , Aneurisma Coronario/terapia , Stents , Adulto , Disección Aórtica/diagnóstico , Disección Aórtica/diagnóstico por imagen , Cateterismo Cardíaco , Aneurisma Coronario/diagnóstico , Aneurisma Coronario/diagnóstico por imagen , Electrocardiografía , Tratamiento de Urgencia , Femenino , Fibrinolíticos/uso terapéutico , Fluoroscopía , Humanos , Factores de TiempoRESUMEN
We prospectively evaluated 62 adults referred for coronary arteriography, using a systematic physical examination protocol to identify musculoskeletal sources of chest pain. In seven patients (11%) the chest pain was reproduced on physical examination; six of them ultimately had a diagnosis of nonanginal chest pain made by their cardiologist, based on history and data from noninvasive and coronary arteriographic studies. Five had normal coronary arteriograms. These patients described their pain in terms often associated with true angina. Musculoskeletal tenderness that did not reproduce the pain was common and was unrelated to coronary artery disease. Demonstration of musculoskeletal tenderness that reproduces chest pain, when combined with noninvasive findings suggesting low probability of coronary artery disease, may be useful in decreasing the incidence of unnecessary invasive cardiac evaluation, and appropriately directing initial therapy.