RESUMEN
La alternancia eléctrica es un amplio concepto que describe las variaciones, latido a latido, en la dirección, amplitud y/o duración de cualquier componente del electrocardiograma. Se asocia a taponamiento cardiaco, arritmias malignas y muerte súbita. Presentamos el caso de una paciente de 77 años con alternancia eléctrica a partir de la cual se llegó al diagnóstico de taponamiento cardiaco (AU)
Electrical alternans is a broad term that describes alternate-beat variation in the direction, amplitude and duration of any component of the ECG wave-form. It is associated with cardiac tamponade, serious ventricular arrhythmias, and sudden death. We present the clinical case of a 77-year-old female with electrical alternans, from which a diagnosis of cardiac tamponade was established (AU)
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades Cardiovasculares , Electrocardiografía/métodos , Electrocardiografía/tendencias , Electrocardiografía , Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/fisiopatología , Taponamiento Cardíaco , Taponamiento Cardíaco/prevención & control , Alternancia de Síntomas , Arritmia Sinusal/prevención & control , Arritmia Sinusal , Taquicardia Sinusal/prevención & control , Taquicardia SinusalRESUMEN
BACKGROUND: To investigate endothelin-1 (ET-1)-dependent hepatic and mesenteric vasoconstriction, and oxygen and lactate fluxes in an acute, fixed low cardiac output (CO) state. METHODS: Sixteen anesthetized, mechanically ventilated pigs were studied. Cardiac tamponade was established to reduce portal venous blood flow (Q(PV)) to 2/3 of the baseline value. CO, hepatic artery blood flow (Q(HA)), Q(PV), hepatic laser-Doppler flow (LDF), hepatic venous and portal pressure, and hepatic and mesenteric oxygen and lactate fluxes were measured. Hepatic arterial (R(HA)), portal (R(HP)) and mesenteric (R(mes)) vascular resistances were calculated. The combined ET(A)-ET(B) receptor antagonist tezosentan (RO 61-0612) or normal saline vehicle was infused in the low CO state. Measurements were made at baseline, after 30, 60, 90 min of tamponade, and 30, 60, 90 min following the infusion of tesozentan at 1 mg/kg/h. RESULTS: Tamponade decreased CO, Q(PV), Q(HA), LDF, hepatic and mesenteric oxygen delivery, while hepatic and mesenteric oxygen extraction and lactate release increased. R(HA), R(HP) and R(mes) all increased. Ninety minutes after tesozentan, Q(PV), LDF and hepatic and mesenteric oxygen delivery and extraction increased approaching baseline values, but no effect was seen on CO or Q(HA). Hepatic and mesenteric handling of lactate converted to extraction. R(HA), R(HP) and R(mes) returned to baseline values. No changes were observed in these variables among control animals not receiving tesozentan. CONCLUSION: In a porcine model of acute splanchnic hypoperfusion, unselective ET-1 blockade restored hepatomesenteric perfusion and reversed lactate metabolism. These observations might be relevant when considering liver protection in low CO states.
Asunto(s)
Gasto Cardíaco Bajo/tratamiento farmacológico , Taponamiento Cardíaco/tratamiento farmacológico , Antagonistas de los Receptores de Endotelina , Endotelina-1/fisiología , Piridinas/uso terapéutico , Circulación Esplácnica/efectos de los fármacos , Tetrazoles/uso terapéutico , Animales , Dióxido de Carbono/sangre , Gasto Cardíaco Bajo/sangre , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/fisiopatología , Taponamiento Cardíaco/sangre , Taponamiento Cardíaco/complicaciones , Taponamiento Cardíaco/fisiopatología , Evaluación Preclínica de Medicamentos , Femenino , Lactatos/sangre , Circulación Hepática/efectos de los fármacos , Masculino , Modelos Animales , Oxígeno/sangre , Consumo de Oxígeno/efectos de los fármacos , Piridinas/farmacología , Sus scrofa , Tetrazoles/farmacología , Resistencia Vascular/efectos de los fármacos , Vasoconstricción/efectos de los fármacosRESUMEN
An 86-year-old man with severe chest pain and shock was transferred to our hospital. Computed tomography revealed type A aortic dissection with cardiac tamponade. He needed intubation and closed chest massage preoperatively. At operation, intrapericardial space was filled with clotted blood and rupture of the ascending aorta was confirmed. He underwent a successful emergency graft replacement of the ascending aorta. Postoperative course was uneventful except for mild hemianopsia due to cerebral infarction. He had recovered to be able to walk and is doing well.