RESUMO
OBJECTIVE: Obesity is a risk factor for cardiovascular disease and venous thrombosis. Previous studies have shown that in late pregnancy a compression of the inferior vena cava (VCI) leads to a hypotensive syndrome. The objective of this study was to explore the correlation between obesity and an elevated pressure in the VCI simulating obesity-induced vena cava compression syndrome. METHODS: A left and right heart catheterization was performed in 29 patients. After right atrial pressure measurement, the catheter was pulled back through the VCI, and the pressure gradient between the thoracic and abdominal vena cava was measured. We determined the correlation between the BMI and the pressure gradient. RESULTS: In 29 patients, a high BMI was associated with an increased pressure gradient between the thoracic and abdominal vena cava (r = 0.66). This correlation was particularly close in patients with a BMI >30 kg/m(2) (P = 0.0008). Two patients had complications such as recurrent thrombosis, with one of them having the highest pressure gradient of 16 mm Hg. CONCLUSIONS: Because mechanical obstruction of the VCI leads to an increased risk for venous thrombosis in patients with obesity, this finding needs to be considered in the decision-making for interventional treatments like bariatric surgery.
Assuntos
Pressão Venosa Central , Edema/etiologia , Obesidade/complicações , Trombose/etiologia , Veia Cava Inferior/fisiologia , Veia Cava Inferior/fisiopatologia , Adulto , Função do Átrio Direito , Cateterismo Cardíaco , Feminino , Humanos , Masculino , PressãoAssuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/patologia , Imunossupressores/uso terapêutico , Miocardite/tratamento farmacológico , Miocardite/patologia , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Resultado do TratamentoRESUMO
Resistant hypertension is associated with high morbidity and mortality. Resistant hypertension is defined as blood pressure above targets despite treatment with at least three antihypertensive drugs in adequate dose and combination. Nonadherence is a frequent cause of uncontrolled hypertension and can be improved by providing fixed dose (of two or three agents) single pill combination. Triple combination of the most widely used antihypertensive agents (renin-angiotensin-aldosterone system antagonists, calcium channel blockers and diuretics) is a safe and effective therapy. Fourth line therapy is the use of an aldosterone antagonist. Renal denervation and baroreceptor stimulation can be considered in patients who remained uncontrolled despite optimal medical therapy.
