RESUMO
Pericardial effusion (PE) prognosis depends on the underlying etiology. We sought to assess the outcome of patients with chronic (>3 months), large (diastolic echo-free space >2 cm), idiopathic (without apparent etiology), C-reactive protein (CRP) negative PE, a topic where data are lacking. A total of nâ¯=â¯74 patients were enrolled in this study. Patients were treated by pericardiocentesis (nâ¯=â¯39) or surgical pericardial "window" (PW) (nâ¯=â¯13) or conservatively (nâ¯=â¯22). The median follow-up was 24 months (interquartile range: 15 to 38). Among those patients who had PE drained (nâ¯=â¯52), PE re-accumulation occurred in 32 cases (61.5%) and the rate was significantly higher in the pericardiocentesis subgroup (76.9% for pericardiocentesis vs 15.4% for PW group, p <0.001). Patients with re-accumulation had longer disease duration (32.1 ± 25.7 months vs 19.5 ± 23.8 months, pâ¯=â¯0.01), higher maximum PE diameter (32.2 ± 9.4 mm vs 26.1 ± 4.9 mm, pâ¯=â¯0.003) and larger PE volume drained at baseline (1,912 ± 707 mL vs 1,508 ± 387 mL, pâ¯=â¯0.04). Large PE re-accumulation occurred in 41% of patients who underwent pericardiocentesis and in 7.7% of those who underwent PW. In Cox survival analysis the only independent predictor of fluid re-accumulation was the type of intervention, with PW being associated with significantly reduced risk (hazard ratio 0.115, 95% confidence interval 0.015 to 0.875, pâ¯=â¯0.037). Major complications needing treatment were recorded in 12.8% and 15.4% (pâ¯=â¯0.999) of patients who underwent pericardiocentesis and PW, respectively. Moreover, invasive procedures were not helpful in establishing new diagnoses and guide treatment. In conclusion, in asymptomatic patients with chronic, large, hemodynamically insignificant, CRP negative, idiopathic PE, conservative management seems a more reasonable approach in most cases.
Assuntos
Tratamento Conservador , Derrame Pericárdico/terapia , Técnicas de Janela Pericárdica , Pericardiocentese , Idoso , Doenças Assintomáticas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RecidivaAssuntos
Cardiologia/normas , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Grécia/epidemiologia , Humanos , Incidência , Ilhas/epidemiologia , Masculino , Ilhas do Mediterrâneo/epidemiologia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Resultado do TratamentoAssuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Eletrocardiografia , Idoso , Fibrilação Atrial/diagnóstico por imagem , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Fatores de RiscoAssuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Ecocardiografia , Troponina/sangue , Aneurisma/diagnóstico , Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Aorta/diagnóstico por imagem , Aorta/patologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/patologia , Dor no Peito , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Tamponamento Cardíaco/etiologia , Pericárdio/lesões , Transtornos Relacionados ao Uso de Substâncias , Ferimentos Perfurantes/complicações , Adulto , Tamponamento Cardíaco/terapia , Hemostasia/fisiologia , Humanos , Masculino , Derrame Pericárdico/etiologia , Derrame Pericárdico/terapia , Derrame Pleural/etiologia , Derrame Pleural/terapia , Tomografia Computadorizada por Raios XAssuntos
Ecocardiografia Transesofagiana , Neoplasias Cardíacas/patologia , Linfoma de Células B/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Linfoma de Células B/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cardiac involvement in patients with polymyositis is well-documented and includes myocarditis, coronary arteritis, pericarditis, valvular dysfunction and arrhythmias. CASE REPORT: There are only few reports of acute myocarditis in patients with polymyositis and, although it usually follows a chronic, mild course, it may occasionally become life-threatening. We describe the case of a 36-year-old young woman suffering from polymyositis who presented with clinical signs and symptoms mimicking an ST Elevation Acute Coronary Syndrome. The atypical features of the pain, the young age of the woman, the lack of significant cardiovascular risk factors and the medical history of an autoimmune disease, led us to reconsider our initial diagnosis towards the presence of focal myocarditis. CONCLUSION: We describe our diagnostic approach and comment on our speculations and decisions about the treatment of such a life threatening event.
RESUMO
We describe a case where a mild carotid atherosclerotic plaque was assessed by contrast enhanced harmonic ultrasonography and image analysis. Quantitative indices of plaque echogenicity were determined prior and after the injection of microbubbles. Changes in plaque echogenicity were detected possibly due to the flow of microbubbles through vasa vasorum within the plaque and at the plaque base at the adventitial level. Future histological studies remain to be done to link the presence and the extent of plaque and adventitial neovascularization with the visual and quantitative findings derived by contrast enhanced harmonic ultrasound and image analysis.
Assuntos
Estenose das Carótidas/diagnóstico por imagem , Meios de Contraste , Microbolhas , Neovascularização Patológica/diagnóstico por imagem , Idoso , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Estenose das Carótidas/complicações , Humanos , Masculino , Neovascularização Patológica/complicações , UltrassonografiaRESUMO
Coronary arteriovenous fistulas are rare. The right coronary artery (RCA) seems to be the most common site of origin, while the right ventricle, right atrium and the main pulmonary artery are the most common draining chambers. We report on a patient with fistulas in both coronary arteries: one arising from the circumflex artery and draining into the coronary sinus (CS), and a fistulous connection between the proximal aorta and the CS, represented by an enlarged and cirsoid RCA. Despite the factthat the non-invasive diagnosis of coronary fistulas has traditionally been difficult, in this case echocardiography led to the suspicion of the anomaly.
Assuntos
Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Fístula Arteriovenosa/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Fístula Arteriovenosa/diagnóstico por imagem , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Lipomatose Simétrica Múltipla , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Seio Aórtico/diagnóstico por imagem , UltrassonografiaAssuntos
Fibrilação Atrial/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Teste de Esforço , Isquemia Miocárdica/diagnóstico , Adulto , Idoso , Fibrilação Atrial/fisiopatologia , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/fisiologia , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Ecocardiografia sob Estresse , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Cintilografia , Estatística como Assunto , Radioisótopos de TálioRESUMO
INTRODUCTION: latrogenic vascular trauma is more frequent today as a result of the increase in diagnostic and therapeutic femoral catheterizations. Management of related complications is elective or urgent and sometimes needs complex vascular reconstruction. The present study evaluated when and whether conservative, urgent surgical, or elective surgical treatment is appropriate. METHODS: A retrospective analysis was made of 45 consecutive iatrogenic vascular trauma patients, among 10,450 cardiac diagnostic or therapeutic catheterizations. Patients' demographics, type of catheterization, time from catheterization to initial diagnosis, the type of complication (thrombosis, infection, bleeding, pseudoaneurysm, etc.), time from presentation of the complication to definite treatment, diagnostic imaging and decision making, the surgical or conservative management, the length of stay and the clinical outcome were determined and analyzed. RESULTS: We identified and treated 30 early and 15 late (after patient's discharge) arterial complications: 18 pseudoaneurysms, 6 bleedings, 9 hematomas, 5 deep vein thromboses, 3 arteriovenous fistulas, 2 arterial embolisms and 2 arterial thromboses. Eight patients underwent emergency surgical repair, three elective surgical repair and 31 were managed conservatively. Decision making was based only on clinical evaluation in 12 patients, whereas vascular ultrasound was the most frequent diagnostic imaging modality in the remainder. A total of 10 (22.2%) minor secondary complications were identified after the initial management with no limb loss and zero mortality. CONCLUSIONS: Close clinical observation and conservative management of vascular trauma complications resulted in a low incidence of the necessity for surgical repair (25% of cases). Bleeding and acute leg ischemia were the most frequent indication for emergency surgical treatment, whereas the majority of pseudoaneurysms, fistulas and vein thrombosis were successfully treated conservatively. Late vascular complications do occur and add an important morbidity factor to early catheterization complications.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Angiografia Coronária/efeitos adversos , Artéria Femoral/lesões , Ferimentos Penetrantes Produzidos por Agulha/terapia , Doenças Vasculares Periféricas/terapia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/diagnóstico , Ferimentos Penetrantes Produzidos por Agulha/etiologia , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
To investigate the effects of thrombolysis on vectorcardiographic (VCG) descriptors of ventricular repolarization in association with ST-segment resolution, 70 consecutively recruited patients with acute myocardial infarction underwent digital 12-lead electrocardiograms (ECGs) before and at 3 hours after thrombolysis. The alterations in the VCG descriptors spatial T amplitude and spatial QRS-T angle from the pre- to the post-thrombolysis ECG, as well as the ST-segment resolution, were calculated. Angiography revealed patency of the infarct-related coronary artery after thrombolysis in 52 (74%) patients (group A) and occlusion in 18 (26%) (group B). The spatial T amplitude was highly significantly reduced after thrombolysis in group A (P<.0001), but only marginally reduced in group B (P=.016). The spatial QRS-T angle was also significantly, although only marginally, reduced after thrombolysis in group A (P=.019), whereas it was not changed after thrombolysis in group B (P=.868). An ST-segment resolution of 60% and a 25% reduction in the spatial T amplitude after thrombolysis were able to identify patency of the infarct-related coronary artery with sensitivities of 90% and 77% and specificities of 94% and 74%, respectively. Both VCG descriptors were significantly affected by thrombolysis in patients with acute myocardial infarction, but constituted only moderate markers of thrombolysis efficacy, as evidenced by the presence of patency in the infarct-related coronary artery, compared with the ST-segment resolution.
Assuntos
Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/estatística & dados numéricos , Vetorcardiografia/estatística & dados numéricos , Comorbidade , Feminino , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Estatística como Assunto , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/prevenção & controle , Resultado do Tratamento , Vetorcardiografia/métodosRESUMO
We present a case of a 71-year-old homeless diabetic man who was hospitalized due to bilateral cellulitis of the lower limbs. Because of severe calcific aortic stenosis, he had undergone valve replacement by a bioprosthesis 3 years earlier. Except from the two preadmission days, he reported no fever, malaise, or weight loss at any time after surgery. On examination, no specific signs or symptoms suggesting infective endocarditis were noted. After six blood cultures were taken, the patient was put on cloxacillin, clindamycin and gentamicin. All the six blood cultures were finally proven to be negative.
Assuntos
Aneurisma Roto , Valva Mitral/patologia , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Bioprótese , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Valva Mitral/diagnóstico por imagemRESUMO
An increased prevalence of coronary artery ectasia (CAE) and a low frequency of diabetes mellitus have been reported in patients with abdominal aortic aneurysm (AAA). The prevalence of diabetes was studied in 190 patients with CAE in comparison with 341 age- and gender-matched patients with coronary artery disease alone. Diabetes mellitus was found to be independently but inversely associated with CAE (relative risk 0.603, 95% confidence interval 0.375 to 0.960, p = 0.037), thus resembling the relation between diabetes and AAA.