RESUMO
A 52-year-old men with rheumatoid arthritis of 12-year history presented with severe chest pain. The electrocardiogram was consistent with acute inferior myocardial infarction. Transthoracic echocardiography showed increased left ventricular dimensions and hypokinesia in the inferolateral wall. Coronary angiography performed for percutaneous coronary intervention showed aneurysmatic dilatation (15-16 mm) and total occlusion of the right coronary artery by a large thrombus. As there was no stent available for dilated right coronary artery and due to the large thrombus burden, medical therapy was decided and tissue plasminogen activator infusion was started. The patient's chest pain progressively decreased. Coronary angiography performed on the fifth day of admission showed TIMI 3 flow in the right coronary artery. Warfarin was added to standard anti-ischemic treatment with a target INR of 2.5-3.0. Our literature search yielded no reported case of such aneurysmatic dilatation associated with rheumatoid arthritis.
Assuntos
Artrite Reumatoide , Aneurisma Coronário/diagnóstico , Trombose Coronária/diagnóstico , Infarto do Miocárdio/diagnóstico , Angina Pectoris , Angioplastia Coronária com Balão , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/terapia , Angiografia Coronária , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapiaRESUMO
A 25-year-old male patient underwent primary femoral artery repair following a gunshot injury. Postoperative examination showed a thrill and bruit in the right femoral region. Peripheral angiography performed under right femoral Doppler ultrasound guidance revealed an arteriovenous fistula between the right superficial femoral artery and femoral vein. Through selective angiography from the left femoral artery, an endovascular stent was implanted in the right femoral artery. Control contrast injection showed near-total closure of the fistula and Doppler ultrasonography on the following day showed total closure.
Assuntos
Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/métodos , Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Stents , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Veia Femoral/diagnóstico por imagem , Veia Femoral/lesões , Humanos , Masculino , Radiografia , Resultado do TratamentoAssuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Progressão da Doença , Eletrocardiografia , Teste de Esforço , Humanos , Japão , Masculino , Ultrassonografia , Função Ventricular Esquerda/fisiologia , População BrancaRESUMO
OBJECTIVE: Brain natriuretic peptide (BNP) reflects the left ventricular pressure and volume overload. It is known that it increases in systolic dysfunction proportionally with left ventricular pressure increase. The BNP levels are well correlated with NYHA classification and prognosis. Our aim was to evaluate the predictive value of BNP in patients with diastolic dysfunction but normal systolic dysfunction demonstrated by echocardiography. METHODS: Fifty patients (mean age: 48.5+/-6.75 years; 29 males, 21 females) were included in this cross-sectional, case-controlled study. Systolic dysfunction was the exclusion criterion. The following parameters were used to evaluate diastolic function: isovolumetric relaxation time, transmitral early to late filling flow velocities (E/A) ratio, deceleration time E, pulmonary vein Doppler findings and color mitral flow propagation velocity. Diastolic dysfunction was determined in 30 hypertensive patients (Group 1), whereas 20 patients who had normal diastolic flow patterns on echocardiography (Group 2). Blood samples were taken for serum BNP level measurements. RESULTS: The BNP levels were 12.0+/-4.97 pg/ml in individuals with normal filling pattern and 66.17+/-17.56 pg/ml in individuals with abnormal filling patterns (p<0.001). The accuracy of BNP in detection of diastolic dysfunction was assessed with receiver-operating characteristic (ROC) analysis. The area under the ROC curve for BNP test accuracy in detection any abnormal diastolic dysfunction was 0.969 (95% CI, 0.909 to 1.029; p<0.001). A BNP value of 37.0 pg/ml had sensitivity of 80%, specificity of 100%, a positive predictive value of 100%, a negative predictive value of 23% and accuracy of 88% in identifying asymptomatic prolonged relaxation pattern. We found a strong correlation between left ventricular mass index and plasma BNP levels (r=0.62, p<0.05). CONCLUSION: Estimation of BNP values could be accepted as a fast and reliable blood test in the diagnosis of asymptomatic diastolic dysfunction.