Asunto(s)
Cateterismo Cardíaco/instrumentación , Migración de Cuerpo Extraño/etiología , Defectos del Tabique Interventricular/terapia , Dispositivo Oclusor Septal , Anciano , Cateterismo Cardíaco/efectos adversos , Procedimientos Quirúrgicos Cardíacos , Remoción de Dispositivos , Ecocardiografía Doppler en Color , Electrocardiografía , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Humanos , Diseño de Prótesis , Factores de Tiempo , Resultado del TratamientoRESUMEN
This is the case of a young man suffering from schizophrenia and treated with clozapine. He developed acute heart failure associated with pericardial effusion and midventricular dyskinesia with severe systolic dysfunction and left ventricular dilatation at echocardiogram, readily resolved after the suspension of clozapine therapy. The segmental wall motion abnormalities observed at echocardiogram in this case are peculiar and have never been described before. The possible cardiotoxic effects of clozapine have been reported previously in the literature. Because of its serious potential side effects this drug is not considered the first choice for treatment of schizophrenia. Before beginning treatment, patients should undergo a cardiac evaluation, and they should also be periodically followed up with echocardiograms.
Asunto(s)
Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Miocarditis/inducido químicamente , Esquizofrenia/tratamiento farmacológico , Disfunción Ventricular/inducido químicamente , Enfermedad Aguda , Insuficiencia Cardíaca/inducido químicamente , Humanos , Masculino , Contracción Miocárdica/efectos de los fármacos , Miocarditis/diagnóstico por imagen , Miocarditis/fisiopatología , Derrame Pericárdico/inducido químicamente , Ultrasonografía , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Función Ventricular Izquierda/efectos de los fármacos , Función Ventricular Derecha/efectos de los fármacos , Adulto JovenRESUMEN
BACKGROUND: The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. The objective of this study was to determine the utility of measuring plasma NT-proBNP levels in patients with acute coronary syndromes. METHODS AND RESULTS: We studied 66 patients admitted in our division for acute coronary syndromes. Patients underwent a venous blood sample within 24 h from the admission to determine NT-proBNP levels. Increasing plasma levels of NT-proBNP (in tertiles) was associated with a greater history of hypertension and current smoking, whereas biochemical parameters were associated with higher level of creatine kinase-MB mass, cardiac troponin I, and renal insufficiency. We detected correlations between the values of NT-proBNP and several variables; positive correlations were found between the values of NT-proBNP and creatinine (r=+0354; P=0.0024), cardiac troponin I levels (r=0320; P=0.0111), and creatine kinase-MB mass values (r=0261; P=0.035). An interesting result of our study was a significantly longer hospitalization in those patients belonging to the third tertile compared with those belonging to the first one (P=0.02). Finally, we showed a higher N-terminal brain natriuretic peptide level in patients with poor outcome during the hospitalization (left-ventricular systolic dysfunction, recurrent ischemic events, or death) compared with those who did not (3204+/-1841 vs. 836+/-1136, P=0.003). CONCLUSION: Measurement of B-type natriuretic peptide provides predictive information during the hospitalization in patients with acute coronary syndromes.