RESUMEN
The cardiac effects of dermatomyositis and polymyositis are found frequently at autopsy, even though the clinical manifestations are rare. We report the observation of a patient with dermatomyositis, in whom ventricular tachycardia, and dilated hypokinetic cardiomyopathy were in the foreground of the cardiac anomalies. This rhythm disturbance responds to treatment, as opposed to the associated dilated cardiomyopathy. Electrocardiographic anomalies are frequent, notably conduction disturbances. Ventricular rhythm disturbances are of poorly defined frequency. Cardiac insufficiency is often stabilised with treatment. The other effects are much rare.
Asunto(s)
Cardiomiopatías/etiología , Dermatomiositis/complicaciones , Taquicardia Ventricular/etiología , Anciano , Cardiomiopatías/patología , Ecocardiografía , Humanos , Masculino , Taquicardia Ventricular/tratamiento farmacológico , Taquicardia Ventricular/patologíaAsunto(s)
Embolia Pulmonar/etiología , Anciano , Femenino , Humanos , Embolia Pulmonar/diagnóstico , TrombosisRESUMEN
The development of acute myocardial ischaemia in a territory with baseline repolarization abnormalities can be reflected by transient pseudo-normalisation of the T wave and/or ST segment. These repolarization abnormalities can occur spontaneously, during a stress test or during of an isoproterenol test. Clinicians should be familiar with these unusual electrocardiographic changes of acute ischaemia, which require appropriate surveillance and treatment.
Asunto(s)
Errores Diagnósticos/prevención & control , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatología , Enfermedad Aguda , Sesgo , Cardiotónicos/efectos adversos , Electrocardiografía/métodos , Electrocardiografía/normas , Prueba de Esfuerzo/efectos adversos , Humanos , Isoproterenol/efectos adversos , Isquemia Miocárdica/terapia , Pronóstico , Reproducibilidad de los ResultadosRESUMEN
The authors report a case of primary biliary cirrhosis, associated with moderate pericardial effusion, in a patient with antiphospholipid antibodies. The pericardial effusion resolved, and did not recur, in response to treatment with Colchicine and ursodesoxycholic acid.
Asunto(s)
Colagogos y Coleréticos/uso terapéutico , Cirrosis Hepática Biliar/complicaciones , Derrame Pericárdico/etiología , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Compuestos Orgánicos , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/tratamiento farmacológico , Recurrencia , Resultado del Tratamiento , Ácido Ursodesoxicólico/uso terapéuticoRESUMEN
Left ventricular pseudo-aneurysm is a neo-cavity characterised by the presence of a narrow neck and a wall consisting of fibrous tissue and thrombotic debris without any muscular cells. The diagnosis must be made as soon as possible by non-invasive methods (echocardiography, CT scan, MRI ...) or by angiography before early surgical treatment, in view of the high risk of secondary rupture. The authors report this original case of a post-infarction left ventricular pseudoaneurysm which recurred five years after initial surgical cure.
Asunto(s)
Aneurisma Falso/patología , Aneurisma Cardíaco/patología , Infarto del Miocardio/complicaciones , Adulto , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Angiografía , Ecocardiografía , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/cirugía , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Balloon coronary angioplasty is a revascularization procedure which increases the luminal diameter at a site of arterial stenosis, leading to mechanical disruption of the atherosclerotic plaque and to stretching of the vascular wall (1). This procedure can be complicated by thrombosis or restenosis, which occur in 5% and 30% of the cases respectively (2). These complications probably result from exposure of blood to components of atherosclerotic plaque, subendothelium and components of vascular wall, leading to activation of coagulation (thrombin generation) and platelets (3,4). Recent data point to simultaneous increase of leukocyte adhesive receptors, indicating an additional process of leukocyte activation, which could play a key role in the vascular healing process after angioplasty (5). These elements could also play a role in the thrombotic and stenotic complications.
Asunto(s)
Angina de Pecho/sangre , Angina Inestable/sangre , Angioplastia Coronaria con Balón , Monocitos/metabolismo , Tromboplastina/metabolismo , Anciano , Células Cultivadas , Enfermedad Coronaria/terapia , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Monocitos/química , Monocitos/citología , Fragmentos de Péptidos/metabolismo , Precursores de Proteínas/metabolismo , Protrombina/metabolismo , Tromboplastina/inmunología , Factores de TiempoRESUMEN
Horton's disease is a giant cell arteritis well known for its presentation as temporal arteritis. It is, in fact, a systemic disease which affects over 1% of the general populations after 50 years of age. With the exception of the risk of blindness by occlusion of the ophthalmic artery, the cardiovascular manifestations of Horton's disease are not well known and probably underestimated by clinicians. The main complications are involvement of the large arteries, especially the thoracic aorta and subclavian and axillary arteries, the femoro-popliteal axis and supra-aortic arterial vessels. During the initial phase of the disease, extension of arteritis to the carotid and vertebral arteries is of particular concern because of the risk of cerebral infarction. The coronary arteries, myocardium, pericardium of pulmonary arteries may also be affected by the inflammatory process. In the long-term, Horton's disease may be complicated by aneurysms, dissection of parietal rupture of the thoracic aorta. Treatment is based on steroid therapy, sometimes associated with antiplatelet agents or anticoagulants during the initial phase of treatment. Long-term follow-up is justified because of the risk of late aortic complications.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Arteritis de Células Gigantes/complicaciones , Anciano , Antiinflamatorios/uso terapéutico , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Arteritis/etiología , Arteritis/fisiopatología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Diagnóstico Diferencial , Arteritis de Células Gigantes/diagnóstico , Arteritis de Células Gigantes/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Isquemia Miocárdica/fisiopatología , Pronóstico , EsteroidesRESUMEN
The association of pulmonary hypertension and polyendocrinopathies or connective tissue diseases has been reported by several authors. The causes of this form of pulmonary hypertension are not clear but an autoimmune process has often been proposed. The authors report a case of non-autoimmune hyperthyroidism and reversible pulmonary hypertension after total thyroidectomy and normalisation of thyroid function. This case supports the hypothesis of a non-autoimmune aetiology of some causes of pulmonary hypertension in diseases of the thyroid.
Asunto(s)
Hipertensión Pulmonar/etiología , Hipertiroidismo/complicaciones , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/fisiopatología , Hipertiroidismo/diagnóstico , Hipertiroidismo/cirugía , Persona de Mediana Edad , Tiroidectomía , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/fisiopatologíaRESUMEN
The aim of this study was to assess, by a discriminant analysis, the different parameters of exercise stress testing associated with multivessel disease after uncomplicated myocardial infarction and to determine whether their combination improved the diagnostic value of ST depression alone, the usual diagnostic criterion. One hundred and seventeen out of 240 consecutive pts admitted for acute myocardial infarction between october 1992 and may 1994 underwent early exercise stress testing and coronary angiography 8.5 +/- 3 days and 13 +/- 8 days respectively after infarction. The population was divided into two groups: a "study" group (pts recruited between october 1992 and october 1993) for whom a diagnostic equation had been established based on a discriminant analysis, and "a control" group (pts recruited between november 1993 and may 1994) allowing validation of the diagnostic equation. Of the 9 clinical and 14 exercise stress test variables, only 3 remained statistically significant after discriminant analysis in this study group: the number of METS achieved (p < 0.0005), maximal ST depression in V5 (p < 0.005) and maximal heart rate (p < 0.01). Using these three parameters, a discriminating equation was established in the study group and then validated in the control group. Using this equation, the percentage of pts correctly identified as having multivessel disease was 75% in the study group and 79% in the control group, whereas ST depression, the most commonly used criterion, only classified 68% of the study group and 60% of the control group correctly. This study confirmed the good tolerance of early maximal exercise stress testing after uncomplicated myo-cardial infarction. The combination of three easily discernable parameters improved the diagnostic performance of the stress test in identifying multivessel disease after myocardial infarction.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Prueba de Esfuerzo , Infarto del Miocardio/complicaciones , Adulto , Anciano , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/patología , Análisis Discriminante , Electrocardiografía , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Platelet activation plays a pivotal role in the pathogenesis of acute coronary disease. Monocytes are involved in the progression of atherosclerosis and are potent activators of blood coagulation through their ability to synthesize tissue factor (TF). The aim of this study was to compare markers of monocyte and coagulation activation in the systemic blood of patients with unstable angina, acute myocardial infarction, or stable angina. METHODS AND RESULTS: We studied 26 patients with unstable angina (10 +/- 5 hours after the onset of the last episode of pain), 18 patients with acute myocardial infarction (5 +/- 4 hours after the onset of pain), and 34 patients with stable angina. We measured levels of TF expression in peripheral blood mononuclear cells (isolated by gradient centrifugation and incubated for 16 hours, with or without endotoxin stimulation), levels of plasma prothrombin fragment 1 + 2 (F1 + 2), and levels of fibrinogen in peripheral blood. In patients with unstable angina, both stimulated and unstimulated cells exhibited higher levels of TF expression than in patients with stable angina (P = .0001). In patients with acute myocardial infarction, monocyte TF activity did not differ from that in patients with stable angina. Mean levels of F1 + 2 and of fibrinogen did not differ significantly between groups. Only in the unstable angina group, a modest correlation was found between fibrinogen (r = .72, P = .005) and F1 + 2 levels (r = .54, P = .001) levels and the degree of monocyte TF expression. In patients with unstable angina, monocyte TF expression (both stimulated and unstimulated, assessed by biological activity and by antigen techniques) and fibrinogen levels were correlated with the time elapsed from the beginning of the most recent episode of pain (.61 < r < .72, .02 < P < .0001). By contrast, there was no correlation between these variables and the time from onset of pain in patients with acute myocardial infarction. CONCLUSIONS: A time-dependent activation of systemic monocytes and a time-dependent increase in fibrinogen levels occurs in unstable angina but not in myocardial infarction. These findings provide further evidence that a specific inflammatory process occurs in unstable angina. Further studies are required to determine whether monocyte activation is a cause or a consequence of plaque instability in patients with unstable angina and to clarify the interrelations between platelet and monocyte activation in these circumstances.
Asunto(s)
Angina de Pecho/sangre , Angina Inestable/sangre , Monocitos/fisiología , Infarto del Miocardio/sangre , Adulto , Anciano , Anciano de 80 o más Años , Coagulación Sanguínea , Femenino , Fibrinógeno/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/metabolismo , Estudios Prospectivos , Protrombina/metabolismo , Tromboplastina/metabolismo , Factores de TiempoRESUMEN
Rheumatoid valvular heart disease and aortic valve replacement for a rheumatoid lesion have been previously reported in the literature. The authors report the first case of emergency surgery for acute aortic regurgitation due to necrosis and rupture of a rheumatoid granuloma: the anatomopathological lesions observed were patholognomic.