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1.
J Adv Res ; 40: 197-206, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-36100327

RESUMEN

INTRODUCTION: Pulmonary hypertension secondary to left heart disease (PH-LHD) is a common and fatal disease. However, no effective therapeutic targets have been identified. OBJECTIVES: Here, we set out to illustrate the functional role and underlying mechanisms of fatty acid-binding protein 5 (FABP5) in PH-LHD development. METHODS: We performed a systematic analysis of datasets GSE84704 and GSE16624 to identify differentially expressed genes and then constructed protein-protein interaction network for significant modules. Potential target genes in the modules were validated by RT-qPCR and western blot in a PH-LHD mouse model. PH-LHD or sham mice were treated with FABP5 antagonist SBFI-26 or DMSO for 28 days. The role of FABP5 on cardiac function was determined by echocardiography, its impact on pulmonary vascular remodelling were evaluated with right heart catheter, histological analysis and western blot. In vitro, primary pulmonary adventitial fibroblasts were used to investigate the pro-fibrotic mechanisms involving in FABP5. RESULTS: FABP5 was the only one dramatically upregulated along with increased protein expression in the established PH-LHD mouse model. Inhibition of FABP5 by SBFI-26 injection abrogated pulmonary artery remodelling in PH-LHD and improved cardiac function. In vitro, SBFI-26 or FABP5 siRNA blunted the TGF-ß1-induced fibrotic response in cultured pulmonary adventitial fibroblasts. Mechanistically, FABP5 knockdown inhibited GSK3ß phosphorylation and increased ß-catenin phosphorylation. The wnt/ß-catenin agonist SKL2001 diminished the antifibrotic effect of FABP5 knockdown on pulmonary adventitial fibroblasts under TGF-ß1 stimulation. CONCLUSION: FABP5 is an important mediator of pulmonary artery remodelling and a potential therapeutic target for PH-LHD.


Asunto(s)
Proteínas de Unión a Ácidos Grasos/metabolismo , Cardiopatías , Hipertensión Pulmonar , Proteínas de Neoplasias/metabolismo , Fibrosis Pulmonar , Enfermedad Cardiopulmonar , Animales , Ciclobutanos , Ácidos Dicarboxílicos , Proteínas de Unión a Ácidos Grasos/genética , Fibrosis , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/genética , Ratones , Arteria Pulmonar , Fibrosis Pulmonar/complicaciones , Enfermedad Cardiopulmonar/complicaciones , Factor de Crecimiento Transformador beta1 , Remodelación Vascular , beta Catenina
2.
Int J Public Health ; 67: 1604599, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35574277

RESUMEN

Objectives: This study aims to investigate the impact of hypertension, diabetes, and high blood cholesterol on increased mortality from cardiovascular diseases such as coronary heart disease, stroke, and pulmonary heart disease in a multi-dimensional way. Methods: The grey relational analysis methodology is adopted to assess the connection between cardiac risk factors and related mortality. The Hurwicz and the Conservative (Min-Max) criterion approach are also utilized to identify the prospective risk factor that contributes the most to increased cardiac mortality. Results: The findings reveal that hypertension has a more grounded relationship with stroke and pulmonary heart disease mortality, whereas high blood cholesterol appears to be the leading contributor to deaths from coronary heart disease. The results based on the Hurwicz and the Min-Max criterion show a robust connection between dyslipidemia, coronary heart disease, and cardiovascular disease mortality. Conclusion: Combating uncontrolled blood cholesterol and blood pressure levels would necessitate a multi-pronged strategy at both the national and local levels. Besides, the suggested methodologies provide a valuable tool and additional practical knowledge for public health policymakers and decision-makers in drawing rational decisions to combat China's rising CVD burden.


Asunto(s)
Enfermedades Cardiovasculares , Enfermedad Coronaria , Hipertensión , Enfermedad Cardiopulmonar , Accidente Cerebrovascular , China/epidemiología , Colesterol , Humanos , Hipertensión/complicaciones , Estudios Prospectivos , Enfermedad Cardiopulmonar/complicaciones , Factores de Riesgo
3.
J Healthc Eng ; 2022: 8495996, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35378941

RESUMEN

Chronic obstructive pulmonary disease is a common respiratory disease. This paper observes the effects of cardiopulmonary rehabilitation promotion mode intervention combined with oxygen therapy on cardiopulmonary function and blood gas analysis indexes in patients with chronic obstructive pulmonary disease (COPD) complicated with cor pulmonale. A total of 136 COPD patients with cor pulmonale admitted to our hospital from July 2018 to October 2020 were selected as the research objects and divided into two groups by a simple random method. 136 patients are given oxygen therapy while the traditional group and cardiopulmonary rehabilitation group are given traditional mode and cardiopulmonary rehabilitation promotion mode intervention. Cardiopulmonary rehabilitation promotion mode intervention combined with oxygen therapy can improve the cardiopulmonary function of COPD patients with cor pulmonale, regulate the expression of related serum factors, improve self-care ability, and reduce the number of hospitalizations.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Enfermedad Cardiopulmonar , Análisis de los Gases de la Sangre , Humanos , Oxígeno , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/terapia
4.
J Clin Ultrasound ; 50(5): 611-617, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35285521

RESUMEN

Acute attack of dyspnea may be combined with acute cor pulmonale (ACP). Rapid and accurate identification of the etiology of ACP is the key to its diagnosis and treatment. Echocardiography is a better imaging tool in the assessment of right ventricular function. Under the guidance of the theory of cardiopulmonary interaction, ultrasonography can detect lung lesions, which causes ACP. We report the case of a 67-year-old man who received mechanical ventilation for acute respiratory failure. Right ventricular dysfunction was detected by echocardiography. Lung ultrasound showed a high risk of pulmonary embolism. However, obstructive atelectasis should not be ruled out after increasing back area ultrasonography. To avoid pitfalls, combined cardiac and lung ultrasound should be used carefully and strictly.


Asunto(s)
Insuficiencia Cardíaca , Hipertensión Pulmonar , Atelectasia Pulmonar , Embolia Pulmonar , Enfermedad Cardiopulmonar , Anciano , Insuficiencia Cardíaca/complicaciones , Humanos , Hipertensión Pulmonar/complicaciones , Masculino , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/diagnóstico por imagen , Ultrasonografía/efectos adversos
6.
Am J Cardiol ; 144: 125-130, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33385352

RESUMEN

This study aimed to quantify survival rates for patients with tricuspid regurgitation (TR) using real-world data. Several clinical conditions are associated with TR, including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser co-morbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared with patients with TR alone. TR severity was also significantly associated (hazard ratio = 1.33; p = 0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD before their TR diagnosis.


Asunto(s)
Insuficiencia Cardíaca/fisiopatología , Mortalidad , Insuficiencia de la Válvula Tricúspide/fisiopatología , Disfunción Ventricular Derecha/fisiopatología , Anciano , Anciano de 80 o más Años , Causas de Muerte , Femenino , Insuficiencia Cardíaca/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Hipertensión Arterial Pulmonar/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Insuficiencia de la Válvula Tricúspide/complicaciones , Disfunción Ventricular Derecha/complicaciones
7.
Rev. esp. anestesiol. reanim ; 68: 0-0, 2021. ilus
Artículo en Español | IBECS | ID: ibc-196869

RESUMEN

INTRODUCCIÓN: Se han introducido recientemente técnicas de anestesia regional, para aportar analgesia en la cirugía de mama. Dichas técnicas son raramente utilizadas como anestesia primaria, debido a la complejidad de la inervación de la mama, con numerosas estructuras que pueden verse potencialmente alteradas durante la cirugía. CASO CLÍNICO: Paciente femenino de unos 70 años con diagnóstico de carcinoma ductal invasivo en la mama izquierda, programada para mastectomía simple. Tras la evaluación anestésica e identificación de complicaciones cardiovasculares perioperatorias de alto riesgo, fue propuesta para cirugía con anestesia regional únicamente. Se realizó una combinación exitosa de bloqueo del nervio pectoral (Pecs II), bloqueo fascial pecto-intercostal (PIFB) y bloqueo ecoguiado del nervio supraclavicular. CONCLUSIÓN: Este es el primer caso que reporta una técnica novedosa en una paciente con enfermedad cardiopulmonar severa, a quien se practicó cirugía de mama en la era de la COVID-19


INTRODUCTION: Regional anesthesia techniques were recently introduced to provide analgesia for breast surgery. These techniques are rarely used as the primary anesthesia due to the complexity of breast innervation, with numerous structures that can potentially be disrupted during breast surgery. CASE REPORT: A female patient in her sixties diagnosed with invasive ductal carcinoma on her left breast was scheduled for a simple mastectomy. After anesthetic evaluation, identification of high risk perioperative cardiovascular complications, it was proposed to perform the surgery only with regional anesthesia. A combination of pectoral nerve block (Pecs II), pecto-intercostal fascial block (PIFB) and supraclavicular nerve block ultrasound-guided were successfully performed. CONCLUSION: This is the first case reporting a novel approach in a patient with severe cardiopulmonary disease who underwent breast surgery in a COVID-19 era


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Bloqueo del Plexo Braquial/métodos , Mastectomía Simple/métodos , Anestésicos Locales/administración & dosificación , Neoplasias de la Mama/cirugía , Pandemias , Infecciones por Coronavirus/epidemiología , Enfermedad Cardiopulmonar/complicaciones , Carcinoma Ductal de Mama/cirugía
10.
Cesk Patol ; 56(4): 227-230, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33736444

RESUMEN

Deep venous thrombosis and pulmonary thrombembolism are referred to as venous thrombembolism. Pulmonary thrombembolism affects the right ventricle. Two morphologically and clinically distinct conditions are distinguished according to change of blood pressure and speed of blood pressure increase in the pulmonary artery - acute and chronic cor pulmonale. Acute cor pulmonale develops during rapid increase (within seconds) of blood pressure in the pulmonary artery. Morphologically, the condition leads to dilatation of the right ventricle and clinically to sudden cardiac death or severe circulatory instability. Chronic cor pulmonale represents myocardial hypertrophy of the right ventricle as a response to the gradually increasing pressure in the pulmonary artery. Herein, we demonstrate a rare case report of right ventricular myocarditis in a 51-year-old woman with pulmonary thromboembolism and morphological signs of chronic pulmonary hypertension. This non-infectious myocarditis is histologically characterized by myocardial damage (myocytolysis) and dominant histiocytic and neutrophil infiltration accompanied by scanty T-lymphocytes. These inflammatory changes differ from those associated with myocardial infarction. The possible pathological mechanisms of right ventricular myocarditis induced by pulmonary thrombembolism are discussed.


Asunto(s)
Miocarditis , Enfermedad Cardiopulmonar , Enfermedad Crónica , Femenino , Ventrículos Cardíacos , Humanos , Persona de Mediana Edad , Miocarditis/complicaciones , Miocardio , Enfermedad Cardiopulmonar/complicaciones
11.
BMJ Open Respir Res ; 6(1): e000381, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31681476

RESUMEN

Introduction: Breathlessness is a cardinal symptom in cardiorespiratory disease. An instrument for measuring different aspects of breathlessness was recently developed, the Multidimensional Dyspnea Profile (MDP). This study aimed to validate the MDP in terms of the underlying factor structure, internal consistency, test-retest reliability and concurrent validity in Swedish outpatients with cardiorespiratory disease. Methods: Outpatients with stable cardiorespiratory disease and breathlessness in daily life were recruited. Factor structure of MDP was analysed using confirmatory factor analysis; internal consistency was analysed using Cronbach's alpha; and test-retest reliability was analysed using intraclass correlation coefficients (ICCs) for patients with unchanged breathlessness between assessments (baseline, after 30-90 min and 2 weeks). Concurrent validity was evaluated using correlations with validated scales of breathlessness, anxiety, depression and health-related quality of life. Results: In total, 182 outpatients with cardiorespiratory disease and breathlessness in daily life were included; 53.3% were women; main diagnoses were chronic obstructive pulmonary disease (24.7%), asthma (21.4%), heart failure (19.2%) and idiopathic pulmonary fibrosis (18.7%). The MDP total, immediate perception and emotional response scores, and individual item scores showed expected factor structure and acceptable measurement properties: internal consistency (Cronbach's alpha, range 0.80-0.93); test-retest reliability at 30-90 min and 2 weeks (ICC, range 0.67-0.91); and concurrent validity. There was no evidence of a learning effect. Findings were similar between diagnoses. Discussion: MDP is a valid instrument for multidimensional measurement of breathlessness in Swedish outpatients across cardiorespiratory diseases.


Asunto(s)
Disnea/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Cardiopulmonar/complicaciones , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Anciano de 80 o más Años , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Reproducibilidad de los Resultados , Suecia , Traducciones
12.
Artículo en Chino | MEDLINE | ID: mdl-31594135

RESUMEN

Objective: To determine the diagnosis value and therapy significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in pneumoconiosis patients with chronic pulmonary heart disease (CPHD) . Methods: A total of 22 pneumoconiosis complicated with CPHD (A group) , 20 pneumoconiosis complicated with coronary heart disease (B group) and 25 pneumoconiosis without heart disease (C group) were selected. The level of blood NT-proBNP was examined and analyzed in the three groups. We observed the difference blood level of NT-proBNP concentration between before and after of therapy in pneumoconiosis patients with CPHD. The optimal cutoff value of blood NT-proBNP was determined according to the principle of maximum Youden's index associated with clinical analysis. Results: Blood NT-proBNP concentrations were 543.19±78.92, 1017.38±731.06, 109.56±57.46 pg/ml in three groups, respectively. Compared with C group, there was a significant increase in the blood levels of NT-proBNP in both A and B groups (P<0.05, P<0.01) , especially for B group. Compared with NT-proBNP 543.19±78.92 pg/ml before therapy, the153.34±58.40 pg/ml was significantly declined after therapy in B group (P<0.05) . The optional threshold for peripheral blood NT-proBNP level as a diagnostic indicator for pneumoconiosis complicated with CPHD was 450 pg/ml. The specificity and sensitivity of NT-proBNP were 95.46% and 54.17%, respectively. Conclusion: Blood NT-proBNP level may be useful as a tool for monitoring the effect of pneumoconiosis patients with CPHD treatment with higher sensitivity in. Blood NT-proBNP cut-off >450 pg/ml should be applied in clinical practice as a valuable diagnostic prediction for pneumoconiosis patients with CPHD.


Asunto(s)
Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neumoconiosis/sangre , Enfermedad Cardiopulmonar/sangre , Biomarcadores , Humanos , Neumoconiosis/complicaciones , Enfermedad Cardiopulmonar/complicaciones
13.
Lung ; 196(5): 583-590, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29951921

RESUMEN

INTRODUCTION: Left ventricular systolic dysfunction (LVSD) and cardiac decompensation often accompany AECOPD. Differentiation between the two is difficult and mainly relies on clinical and echocardiographic diagnostic procedures. The value of biomarkers, such as NT-proBNP, as diagnostic tools is still insufficiently investigated. The main goals of this trial were to investigate the value of NT-proBNP as a diagnostic tool for LVSD in AECOPD patients and determine its cut-off value which could reliably diagnose LVSD during AECOPD. PATIENTS AND METHODS: This trial prospectively enrolled 209 patients with AECOPD. The patients were divided into four groups-AECOPD plus chronic pulmonary heart disease (CPHD) with or without left ventricular compromise (LVSD), and AECOPD patients without CPHD with or without LVSD. NT-proBNP was measured within first 48 h of hospitalization. RESULTS: Majority of patients were male (61%) active smokers (41.6%), average age of 68 years. High quality of echocardiography was obtained in 63.3 and 22.5% of the patients had LVSD. Average value of NT-proBNP in patients with LVSD was 3303.2 vs. 1092.5 pg/mL in patients without LVSD. Significant differences in NT-proBNP value (p = 0.0001) were determined between observed patient groups. At the cut-off value of 1505 pg/mL, sensitivity, specificity, and positive and negative predictive values are 76.6, 83.3, 57.1, and 92.47%, respectively. CONCLUSION: At the cut-off value of 1505 pg/mL NT-proBNP could be used as a diagnostic marker for LVSD in acute exacerbation of COPD.


Asunto(s)
Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Enfermedad Pulmonar Obstructiva Crónica/sangre , Disfunción Ventricular Izquierda/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Enfermedad Crónica , Progresión de la Enfermedad , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Cardiopulmonar/sangre , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/fisiopatología , Sensibilidad y Especificidad , Sístole , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatología
14.
Ann Am Thorac Soc ; 15(Suppl 1): S42-S44, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29461887

RESUMEN

The term cor pulmonale has traditionally been used as a synonym for right heart failure due to chronic respiratory diseases, although this condition is less frequently seen in the modern era because of the use of long-term oxygen therapy along with aggressive measures directed at optimizing ventilation and gas exchange. The mechanisms by which adaptation or maladaptation of right heart structure and function in the broader setting of pulmonary vascular disease, either intrinsic to the pulmonary circulation or due to respiratory diseases, have garnered considerable interest along with the development of medical and surgical treatments for pulmonary hypertension. Thus, the right heart is no longer considered an "innocent bystander" in pulmonary hypertension, but rather a key component in its pathophysiology. Furthermore, the status of right heart function is a major determinant of outcome. Accordingly, the right heart has become a potential, appealing target for novel therapies to treat hypertensive pulmonary vascular disease.


Asunto(s)
Hipertensión Pulmonar/diagnóstico , Enfermedad Cardiopulmonar/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/fisiopatología , Enfermedad Cardiopulmonar/complicaciones , Enfermedad Cardiopulmonar/fisiopatología , Función Ventricular Derecha
15.
Ann Am Thorac Soc ; 15(Suppl 1): S30-S34, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29461894

RESUMEN

Almost 70 years ago, Drs. Baldwin, Cournand, and Richards defined chronic pulmonary insufficiency by the presence of respiratory symptoms, radiologic evidence of pulmonary emphysema on chest radiography, and physiologic gas trapping. A decade later, airflow obstruction on spirometry was added to the definition and insufficiency became a disease. Contemporary studies are reviving the diagnostic approach described by these early luminaries, with researchers finding that symptomatic smokers with preserved spirometry have increased exacerbations and that smokers and non-smokers with normal spirometry but emphysema on chest computed tomography have increased mortality. Hence, the Baldwin-Cournand-Richards concept of disease defined by respiratory symptoms, radiologic findings, and physiology-regardless of spirometric criteria-is being rediscovered. Baldwin, Cournand, and Richards also stated that "functionally, it is obvious that the pulmonary and circulatory apparatus are one unit," and they defined combined cardiopulmonary insufficiency as chronic pulmonary insufficiency with (left or right) cardiac and pulmonary artery enlargement. They appreciated the complexity of these interactions, which include the potential role of gas trapping in heart failure with reduced ejection fraction; the impact of emphysema on blood flow in heart failure with preserved ejection fraction; multiple contributions to cor pulmonale with increased pulmonary artery pressure; and cor pulmonale parvus in emphysema; all of which may be amenable to specific therapeutic interventions. Given the complexity of heart-lung interactions originally identified by Baldwin, Cournand, and Richards and the potentially large therapeutic opportunities, large-scale studies are still warranted to find specific therapies for subphenotypes of combined cardiopulmonary insufficiency.


Asunto(s)
Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfisema Pulmonar/diagnóstico , Enfermedad Cardiopulmonar/diagnóstico , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfisema Pulmonar/complicaciones , Enfermedad Cardiopulmonar/complicaciones , Fumar/efectos adversos , Espirometría , Tomografía Computarizada por Rayos X , Función Ventricular Derecha
16.
Rev. méd. hondur ; 85(1-2): 30-34, ene.-jun. 2017. ilus, tab
Artículo en Español | LILACS | ID: biblio-884091

RESUMEN

Antecedentes. La esclerosis sistémica sin esclerodermia es una variante rara de la esclerosis sistémica limitada en la que los pacientes no presentan manifestaciones cutáneas importantes. Caso clínico. Se presenta caso de paciente femenina en la sexta década de la vida sin antecedentes patológicos de importancia que presentaba Síndrome de Raynaud, fotosensibilidad y pares- tesias en manos; al examen físico estertores finos e induración leve de la piel de los dedos, se sospechaba enfermedad del colágeno y se realizaron exámenes de laboratorio que confirmaron diagnóstico de Esclerosis Sistémica sin esclerodermia, ya que presentaba mayores manifestaciones cardiopulmonares. Inició tratamiento con esteroides sistémicos pero se complicó con Neumonitis Intersticial tratada con Azatriopina e Hipertensión pulmonar manejada con Sildenafil. También se comenzó Rituximab, como terapia de artritis reumatoide diagnosticada posteriormente. Ha presentado leve mejoría en el patrón pulmonar restrictivo por lo que el tratamiento con Rituximab aún persiste. Paciente con buena evolución clínica y exámenes de laboratorio control dentro de los rangos normales, sin embargo función pulmonar continúa alterada, pero sin modificar actividades diarias. Conclusión: La caracterización de la enfermedad es vital, actualmente se cuenta con criterios diagnósticos más certeros para orientar el manejo adecuado dentro de una amplia gama de posibilidades terapéuticas...(AU)


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedades Pulmonares Intersticiales , Enfermedad Cardiopulmonar/complicaciones , Enfermedad de Raynaud , Esclerodermia Sistémica/diagnóstico
17.
BMJ Case Rep ; 20162016 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-27793867

RESUMEN

Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.


Asunto(s)
Hernia Diafragmática/complicaciones , Enfermedad Cardiopulmonar/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Anciano , Insuficiencia Cardíaca/complicaciones , Hernia Diafragmática/diagnóstico por imagen , Humanos , Masculino , Respiración Artificial/métodos , Apnea Obstructiva del Sueño/terapia , Pared Torácica
18.
J Ultrasound Med ; 35(11): 2333-2342, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27629759

RESUMEN

OBJECTIVES: To investigate the value of 2-dimensional (2D) speckle-tracking echocardiography for assessing right ventricular (RV) systolic function in patients with chronic pulmonary heart disease (CPHD) and the correlation of its parameters with the right ventricular ejection fraction (RVEF) on cardiac magnetic resonance imaging (MRI). METHODS: According to pulmonary arterial systolic pressure, 80 patients with CPHD and tricuspid regurgitation were divided into 2 groups: 42 with mild pulmonary hypertension (PH; 30-50 mm Hg) and 38 with moderate or severe PH (≥50 mm Hg); 41 control participants were recruited. All participants underwent 2D speckle-tracking echocardiography and cardiac MRI. The longitudinal peak systolic strain and longitudinal peak systolic strain rate were measured by echocardiography in each segment of the RV free wall and interventricular septum and compared with the RVEF on cardiac MRI. RESULTS: Strain values in all segments of the RV free wall and interventricular septum were lower in the mild PH group than the control group (P < .05). Strain rate values in the apical segment of the RV free wall and basal segment of the interventricular septum were lower in the mild PH group than the control group (P< .05). Strain and strain rate values in all segments of the RV free wall and interventricular septum were lower in the moderate or severe PH group than the control group (P < .05). Strain and strain rate values in all segments of the RV free wall and interventricular septum were lower in the moderate or severe PH group than the mild PH group (P< .05). Strain and strain rate values in all segments of the RV free wall and the interventricular septum correlated with the RVEF (P < .001). CONCLUSIONS: The ability of speckle-tracking echocardiography to directly monitor RV myocardial function may allow early sensitive detection of subclinical myocardial dysfunction in patients with CPHD, with better risk stratification and timely institution of therapy.


Asunto(s)
Ecocardiografía , Enfermedad Cardiopulmonar/complicaciones , Disfunción Ventricular Derecha/complicaciones , Disfunción Ventricular Derecha/diagnóstico por imagen , Adulto , Anciano , Enfermedad Crónica , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Cardiopulmonar/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Disfunción Ventricular Derecha/fisiopatología
19.
Mol Med Rep ; 14(1): 661-70, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27221156

RESUMEN

Coronary heart disease (CHD), idiopathic pulmonary arterial hypertension (IPAH) and pulmonary heart disease (PHD) are circulatory system diseases that may simultaneously emerge in a patient and they are often treated together in clinical practice. However, the molecular mechanisms connecting these three diseases remain unclear. In order to determine the multidimensional characteristic correlations between these three diseases based on genomic networks to aid in medical decision-making, genes from the Online Mendelian Inheritance in Man database were obtained, and applied network construction and modularized analysis were conducted. Functional enrichment analysis was conducted to explore the associations between overlapping genes, modules and pathways. A total of 29 overlapping genes and 3 common modules were identifed for the 3 diseases. Glycosphingolipid biosynthesis and the arachidonic acid metabolism are common pathways, and the biosynthetic process is suggested to be the major function involved in the three diseases. The current study reported, to the best of our knowledge for the first time, the role of glycosphingolipid biosynthesis in IPAH and PHD. The present study provided an improved understanding of the pathological mechanisms underlying CHD, IPAH and PHD. The overlapping genes, modules and pathways suggest novel areas for further research, and drug targets. The observations of the current study additionally suggest that drug indications can be broadened because of the presence of common targets.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Hipertensión Pulmonar Primaria Familiar/genética , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Enfermedad Cardiopulmonar/genética , Biología Computacional/métodos , Enfermedad de la Arteria Coronaria/complicaciones , Bases de Datos Genéticas , Epistasis Genética , Hipertensión Pulmonar Primaria Familiar/complicaciones , Ontología de Genes , Redes Reguladoras de Genes , Humanos , Modelos Biológicos , Enfermedad Cardiopulmonar/complicaciones
20.
Zhonghua Jie He He Hu Xi Za Zhi ; 39(4): 298-303, 2016 Apr 12.
Artículo en Chino | MEDLINE | ID: mdl-27117076

RESUMEN

OBJECTIVE: To study the risk factors for acute pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: From November of 2009 to May of 2014, 522 admitted patients [aged 42-93 years, mean(72±9)] with AECOPD received CT pulmonary angiography(CTPA) in the First Affiliated Hospital of Guangzhou Medical University. The patients were classified as PE positive (positive result on CTPA) or PE negative (negative results on CTPA), and related risk factors for PE were analyzed. RESULTS: The frequency of PE was 10.3% in this series of 522 patients with AECOPD. Single factor analysis showed that the following factors were significantly different (χ(2)=4.32-57.06, mean P<0.05)between PE positive and PE negative groups: age≥70 years, immobilization≥3 days, deep vein thrombosis(DVT) and a history of venous thromboembolism(VTE), cor pulmonale caused by COPD, pneumonia, stroke, artery embolization, atrial fibrillation, lower extremity edema, the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP) and D-dimmer. Multiple regression analysis showed that immobilization ≥3 days(OR=25.36, 95%CI: 7.42-86.69, P<0.001), lower extremity edema(OR=7.34, 95%CI: 3.43-15.71, P<0.001) and D-dimmer≥2 000 µg/L(OR=10.10, 95%CI: 2.25-45.42, P=0.003) were the risk factors. The ratio for purulent sputum was 48.1%(26/54) in the PE positive group, and 42.6% (23/54) of the patients showed concurrent purulent sputum and increase of blood markers of infection. The frequency of purulent sputum between PE positive and PE negative groups was not different. CONCLUSIONS: Patients with AECOPD admitted to hospital should be considered for the presence of PE if they had the risk factors of immobilization≥3 days, lower extremity edema and D-dimmer ≥2 000 µg/L.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Embolia Pulmonar/complicaciones , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Angiografía , Productos de Degradación de Fibrina-Fibrinógeno/química , Humanos , Persona de Mediana Edad , Análisis Multivariante , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Enfermedad Cardiopulmonar/complicaciones , Factores de Riesgo , Tromboembolia Venosa/complicaciones , Trombosis de la Vena/complicaciones
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