RESUMEN
This case report describes the devastating consequences of spontaneous coronary dissection in a 36-year-old female patient. Surgical revascularization was attempted, but diffuse myocardial infarction developed. The patient was bridged to heart transplantation but died secondary to multiple organ failure. To our knowledge, this is the only reported case of spontaneous dissection of the three main coronary arteries due to severe cystic medial necrosis.
Asunto(s)
Enfermedades del Tejido Conjuntivo/complicaciones , Vasos Coronarios/patología , Infarto del Miocardio/etiología , Adulto , Enfermedades del Tejido Conjuntivo/patología , Angiografía Coronaria , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/patología , Necrosis , Rotura EspontáneaRESUMEN
This paper reports on a fatal intoxication by oral ingestion of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). At admission, the victim was unconscious. His condition deteroriated rapidly with blood loss from his mouth and nose. Since the cause of this condition was not known, gastroscopy was performed and haemorrhagic mucosa was observed in the mouth, oesophagus and stomach. Gastric contents (removed by lavage), urine and blood were submitted for toxicological analysis. Unfortunately, within 3 h of admission (about 5 h following ingestion of the toxin) profound cardiogenic shock developed and the patient died. The identity of the toxic xenobiotic was revealed by gas chromatography-mass spectrometry. Analytical quantification of the herbicide was performed by acid extraction prior to gas chromatographic examination using electron capture detection. His blood level of 2,4-D was 192 mg l-1.
