Assuntos
Endocardite/diagnóstico , Neoplasias Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Leiomiossarcoma/diagnóstico , Procedimentos Cirúrgicos Cardiovasculares , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Eletrocardiografia , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgiaRESUMO
Radiotherapy, an established treatment for local and regional control in neoplastic disease, may have several acute, subacute and chronic side effects. One of the main concerns about mediastinal radiotherapy is the occurrence of long-term cardiovascular complications after oncological treatment. This is an important issue--especially for thoracic neoplasms with long-term survival, such as breast cancer or Hodgkin's lymphoma--because of the increased cardiovascular morbidity and mortality. We present the case of a 50-year-old woman who developed several cardiovascular complications of radiotherapy more than 10 years after the successful treatment of Hodgkin's lymphoma, underlining the particular problems related to optimal therapeutic options in this population.
Assuntos
Doença da Artéria Coronariana/etiologia , Coração/efeitos da radiação , Doença de Hodgkin/radioterapia , Neoplasias do Mediastino/radioterapia , Lesões por Radiação , Angioplastia Coronária com Balão , Ponte de Artéria Coronária , Doença da Artéria Coronariana/terapia , Feminino , Humanos , Pessoa de Meia-Idade , RecidivaRESUMO
Myasthenia gravis is an autoimmune neuromuscular disorder characterized by skeletal muscle involvement, causing muscle weakness and fatigue. The prevalence of the disease is approximately 1:7500 with a maximal prevalence during the second and third decade in women and the fifth and sixth decade in men, although it may appear at any age. The disease has a slight female preponderance, with a sex ratio of 3:2. Cardiac involvement in myasthenia gravis may take several forms, ranging from asymptomatic ECG changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure and sudden death. We hereby report two cases of patients with myasthenia gravis who developed signs and symptoms of cardiovascular involvement, requiring admission in a cardiology ward for further investigation and treatment. The particular characteristics of the first case may be summarized by the symptomatic conduction disturbances with frequent episodes of syncope in a patient with myasthenia gravis who necessitated permanent pacing and the difficulties we encountered in the establishment of conduction disturbancies etiology (due to the disease or due to the treatment with acetylcolinesterase inhibitors). The second case shows a different kind of cardiac involvement in myasthenia gravis--the ECG changes (giant diffuse T waves in a patient with cardiovascular risk factors) which needed further investigation and long term surveillance.