RESUMEN
A 24-year-old Japanese man with type 2 diabetes mellitus and diabetic neuropathy was admitted to our ward to evaluate the cause of orthostatic intolerance. During a head-up tilt test, his heart rate increased from 105 to 155 beats/minute within 3 minutes, and chest discomfort began. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), and orthostatic intolerance disappeared after ß-blocker treatment. Scintigraphy using 123I-metaiodobenzylguanidine showed decreased cardiac uptake. Power spectral analysis of heart rate variability for 24 hours in Holter electrocardiography demonstrated decreases in both sympathetic and parasympathetic nervous system activities, with a greater decrease in parasympathetic activity than sympathetic activity. The relative sympathetic hyperactivity in the present patient with diabetic neuropathy seemed to be related to POTS.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/complicaciones , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Humanos , Masculino , Síndrome de Taquicardia Postural Ortostática/etiología , Adulto JovenAsunto(s)
Electrocardiografía , Lidocaína/análogos & derivados , Taquicardia Paroxística/tratamiento farmacológico , Taquicardia Supraventricular/tratamiento farmacológico , Anciano de 80 o más Años , Antiarrítmicos/uso terapéutico , Femenino , Humanos , Lidocaína/uso terapéutico , Taquicardia Paroxística/fisiopatología , Taquicardia Supraventricular/fisiopatologíaRESUMEN
It is sometimes very difficult to diagnose dissecting aortic aneurysms in the early stage. We report an autopsy case in which an acute myocardial infarction and cerebral infarction simultaneously occurred and the symptoms were transiently ameliorated in a patient with an acute aortic dissection.