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1.
J Coll Physicians Surg Pak ; 32(11): 1492-1494, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36377023

RESUMO

Hyperthyroidism is associated with a number of heart diseases, and it may aggravate previous cardiac problems or cause new ones, such as hyperthyroid cardiopathy. Cases of hyperthyroidism presenting with coronary vasospasm are rarely reported. Herein, we present a case of a 54-year male patient with recurrent left chest pain for 2 months. Coronary angiography showed no obvious coronary artery stenosis, and coronary vasospasm was suspected. After admission, the patient's thyroid function and TSH-receptor antibody (TRAb) were abnormal. However, there was no obvious palpitation, hyperhidrosis, or weight loss, and the diagnosis of Graves' disease was rendered, which seemed to be the cause of coronary vasospasm. The patient did not experience chest pain after treatment with methimazole. Patients with coronary vasospasm should be investigated for the possibility of hyperthyroidism. Key Words: Hyperthyroidism, Chest pain, Coronary angiography, Coronary vasospasm.


Assuntos
Vasoespasmo Coronário , Doença de Graves , Hipertireoidismo , Humanos , Masculino , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/complicações , Hipertireoidismo/complicações , Hipertireoidismo/diagnóstico , Hipertireoidismo/tratamento farmacológico , Metimazol , Doença de Graves/complicações , Doença de Graves/diagnóstico , Doença de Graves/tratamento farmacológico , Antitireóideos/uso terapêutico , Dor no Peito/etiologia
2.
JACC Cardiovasc Imaging ; 15(11): 1916-1925, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36357133

RESUMO

BACKGROUND: In patients with stable chest pain, computed tomography (CT) plaque burden is an independent predictor of future coronary events. OBJECTIVES: The purpose of this study was to determine whether plaque burden and characteristics can predict subsequent death or myocardial infarction in patients with acute chest pain. METHODS: In a post hoc analysis of a multicenter trial of early coronary CT angiography, the authors performed quantitative plaque analysis to assess the association between primary endpoint of 1-year all-cause death or nonfatal myocardial infarction and the GRACE (Global Registry of Acute Coronary Events) score, presence of obstructive coronary artery disease, and plaque burden in 404 patients with suspected acute coronary syndrome. RESULTS: Following the index event, 25 patients had a primary event that was associated with a higher GRACE score (134 ± 44 vs 113 ± 35; P = 0.012), larger burdens of total (46% [IQR: 43%-50%] vs 36% [IQR: 21%-46%]; P < 0.001), noncalcified (41% [IQR: 37%-%47] vs 33% [IQR: 20%-41%]; P < 0.001), and low-attenuation plaque (4.22% [IQR: 3.3%-5.68%] vs 2.14% [IQR: 0.5%-4.88%]; P < 0.001), but not obstructive coronary artery disease (P = 0.065). Total, noncalcified, and low-attenuation plaque burden were the strongest predictors of future events independent of GRACE score and obstructive coronary artery disease (P ≤ 0.002 for all). Patients with a low-attenuation burden above the median had nearly an 8-fold increased risk of the primary endpoint (HR: 7.80 [95% CI: 2.33-26.0]; P < 0.001), outperforming either a GRACE score of >140 (HR: 3.80 [95% CI :1.45-6.98]; P = 0.004) or obstructive coronary artery disease (HR: 2.07 [95% CI: 0.94-4.53]; P = 0.07). CONCLUSIONS: In patients with suspected acute coronary syndrome, low-attenuation plaque burden is a major predictor of 1-year death or recurrent myocardial infarction. (Rapid Assessment of Potential Ischaemic Heart Disease With CTCA [RAPID-CTCA]; NCT02284191).


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infarto do Miocárdio , Placa Aterosclerótica , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/complicações , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/terapia , Angiografia Coronária/métodos , Valor Preditivo dos Testes , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada/efeitos adversos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/terapia , Infarto do Miocárdio/complicações , Fatores de Risco
3.
Chest ; 162(5): e259-e264, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36344135

RESUMO

CASE PRESENTATION: A 52-year-old man came to the cardiac surgery clinic for pulmonary thromboendarterectomy (PTE) evaluation. He had initially appeared at an outside hospital 1 year earlier, with chest pain and shortness of breath. He had no known chronic conditions. A CT pulmonary angiogram (CTPA) at that time showed a filling defect at the bifurcation of the main pulmonary artery. A transthoracic echocardiogram revealed mild mitral valve regurgitation, but otherwise the results were normal. As he was hemodynamically stable and not hypoxemic, he was treated solely by anticoagulation. Despite adhering to prescribed apixaban, he developed progressive dyspnea and reduced exercise tolerance over the subsequent year. A repeat CTPA performed 12 months after the initial presentation showed a persistent filling defect at the level of the pulmonary artery bifurcation, with a new extension now completely occluding the right main pulmonary artery. A pulmonary angiogram confirmed this complete occlusion, and right heart catheterization revealed precapillary pulmonary hypertension, with a mean pulmonary artery pressure of 50 mm Hg. His anticoagulation was transitioned to enoxaparin for presumed apixaban treatment failure, and an investigation for hypercoagulable conditions was initiated. His lupus anticoagulant test result was positive, but he did not meet the criteria for antiphospholipid syndrome because he was negative for anticardiolipin and ß2-glycoprotein antibodies. Assays for antithrombin III, protein C, prothrombin gene, and factor V Leiden mutations produced normal results.


Assuntos
Dispneia , Endarterectomia , Masculino , Humanos , Pessoa de Meia-Idade , Dispneia/diagnóstico , Dispneia/etiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Anticoagulantes/uso terapêutico
4.
Am J Case Rep ; 23: e937196, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36367847

RESUMO

BACKGROUND The purpose of this case report was to present a rare course of pericarditis starting with transverse sinus inflammation in a patient with recurrent chest pain. Typically, the effusion accumulates along the diaphragmatic surface of the back heart, and other localizations, such as the transverse sinus, are uncommon. The main risk factor for pericarditis in Europe is viral infection. In this uncommon case, we strongly suspected underlying Takayasu syndrome. The positive response to treatment with steroids in pericarditis and Takayasu arteritis may be misleading. CASE REPORT A 61-year-old woman was admitted to the Cardiology Clinic because of recurrent chest pain in the form of a retrosternal burning pain with radiation to both arms. With the results of laboratory tests, electrocardiogram, and computer tomography (CT), we excluded acute coronary syndrome, pulmonary embolism, and aortic dissection. In chest CT and transthoracic echocardiography (TTE), we found an effusion around the ascending aorta with uncertain inflammation and in the transverse sinus of the pericardium. After typical pericarditis treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and afterward with steroids, which is similar to Takayasu syndrome treatment, we observed a significant improvement of the patient's clinical condition and no recurrence of chest pain. CONCLUSIONS Despite clinical symptoms, laboratory results, and aorta thickening with surrounding inflammation, Takayasu syndrome was excluded by rheumatologists because of the patient's age. Transverse sinus inflammation is a very rare presentation of pericarditis, but should be considered, especially based on TTE and CT imaging, when other possible causes of retrosternal pain are excluded.


Assuntos
Pericardite , Arterite de Takayasu , Feminino , Humanos , Pessoa de Meia-Idade , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Pericárdio/diagnóstico por imagem , Pericardite/diagnóstico , Dor no Peito/etiologia , Inflamação
5.
Am J Case Rep ; 23: e938041, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36395074

RESUMO

BACKGROUND Chronic thromboembolic pulmonary disease (CTEPD) is the persistent occlusion of pulmonary arteries resulting from 1 or more thrombo-emboli. Its presentation is often non-specific, with exertional dyspnea and fatigue, yet if left undiagnosed risks of chronic thromboembolic pulmonary hypertension and right-sided cardiac failure can ensue. Computed tomography pulmonary angiography (CTPA) and ventilation/perfusion (V/Q) imaging are most commonly utilized for investigating CTEPD. This report is of a 60-year-old woman with a 6-week history of breathlessness and intermittent chest pain due to CTEPD, undetected by CTPA and diagnosed by V/Q imaging. CASE REPORT A 60-year-old woman presented with a 6-week history of breathlessness, intermittent chest pain, and reduced mobility. Her past medical history included chronic obstructive pulmonary disease, pulmonary sarcoidosis, and obesity. Screening tests for infective and ischemic cardiac etiologies were unremarkable. A calculated Wells score was 6, making CTEPD the main differential diagnosis, and she was commenced on therapeutic dose anticoagulation. A CTPA performed on day 2 of admission showed no evidence of acute thromboembolic pulmonary disease or CTEPD. Instead, V/Q scintigraphy on day 6 revealed a perfusion mismatch in the right lung apex, consistent with CTEPD. The patient improved clinically and was discharged on long-term apixaban. CONCLUSIONS A negative CTPA does not necessarily exclude CTEPD. The sensitivity of CTPA for CTEPD is lower than that of V/Q imaging, and can hence lead to false-negative results, as this case highlights. When there is a high clinical suspicion for CTEPD but a negative CTPA study, V/Q imaging should always be undertaken.


Assuntos
Embolia Pulmonar , Tromboembolia , Feminino , Humanos , Pessoa de Meia-Idade , Angiografia/métodos , Dor no Peito/etiologia , Dispneia/etiologia , Pulmão , Perfusão , Imagem de Perfusão , Embolia Pulmonar/diagnóstico por imagem , Cintilografia , Tomografia Computadorizada por Raios X , Relação Ventilação-Perfusão
7.
Emerg Med Clin North Am ; 40(4): 663-678, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36396214

RESUMO

The electrocardiogram (EKG) is a useful diagnostic tool that allows clinicians to rapidly evaluate patients for acute coronary syndrome. With the high prevalence of heart disease in society, the EKG is crucial in the evaluation of chest pain and diagnosis of ischemia. Various guidelines provide criteria to aid in recognizing ischemia and help dictate patient management. Not all ischemic patterns requiring emergent management present within the classic definition of an STEMI. It is critical for clinicians to be able to accurately recognize these ischemic patterns to allow timely and appropriate cardiovascular care.


Assuntos
Síndrome Coronariana Aguda , Eletrocardiografia , Humanos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Síndrome Coronariana Aguda/diagnóstico , Isquemia
8.
Am J Case Rep ; 23: e936985, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36372987

RESUMO

BACKGROUND A normal coronary angiogram in ST-elevation myocardial infarction (STEMI) can be considered a myocardial infarction with non-obstructive coronary arteries (MINOCA) until an alternative diagnosis is obtained. However, the COVID-19 pandemic might delay urgent coronary angiography in a resource-limited setting. Perimyocarditis often causes symptoms, such as chest pain, as well as ST-elevation and high cardiac troponin levels. This STEMI mimicker can also cause cardiogenic shock and death when not treated properly. CASE REPORT A 40-year-old man reported having acute onset of substernal chest pain, which was suspected to be STEMI. The patient was an active smoker without any risk factors or a history of cardiovascular disease. The examination showed elevated cardiac troponin I, ST-elevation in high lateral leads, and regional wall motion abnormality (RWMA) by echocardiogram. Furthermore, thrombolytic therapy had failed, and rescue percutaneous coronary intervention was not performed due to the catheterization laboratory limitation during the COVID-19 pandemic. Before coronary angiography, the patient was scheduled for 2 consecutive days of COVID-19 polymerase chain reaction (PCR) swabs. On the second day of hospitalization, the patient experienced a cardiogenic shock. The COVID-19 PCR results were negative, while coronary angiography revealed normal coronary arteries. The patient was eventually diagnosed with probable acute perimyocarditis. CONCLUSIONS Myocarditis is implicated in young patients without typical cardiovascular risk factors or in those with recent infection and cardiovascular symptoms mimicking acute coronary syndrome. It might also be present in situations where ST-elevation distribution on the electrocardiogram is discordant with the RWMA observed on the echocardiogram.


Assuntos
COVID-19 , Infarto do Miocárdio com Supradesnível do Segmento ST , Masculino , Humanos , Adulto , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , COVID-19/diagnóstico , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Pandemias , Dor no Peito/etiologia
9.
J Med Case Rep ; 16(1): 426, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333745

RESUMO

BACKGROUND: Body stuffing and body packing are two methods of concealing illicit drugs. Body stuffing is defined as the oral ingestion of illicit drugs, typically to avoid law enforcement detection or other consequences of possession, and may present a serious medical emergency in patients. Most commonly, body stuffers ingest possibly large or unknown quantities of illicit substances to avoid detection of the drugs during apprehension. This ingestion is typically hasty or impulsive, and therefore the substances ingested are rarely packaged in a way that would be considered safe for ingestion. CASE PRESENTATION: This case highlights a series of rare complications of impacted esophageal foreign body including esophageal edema, pericarditis, and hydro-pneumothorax for a 16-year-old Hispanic male who was booked into a county juvenile detention and rehabilitation facility. He complained of persistent intractable epigastric pain, along with pleuritic chest pain with multiple episodes of vomiting over the previous 4 days. He denied swallowing any foreign body. He underwent esophagogastroduodenoscopy, and a plastic bag with content suspicious for marijuana was discovered in the distal esophagus and removed. CONCLUSIONS: Failure to consider body stuffing and foreign body impaction in individuals during medical evaluation in detention centers with complaints of chest pain, abdominal pain, dysphagia, and/or certain toxidromes can delay diagnosis and lead to a variety of medical complications.


Assuntos
Transporte Intracorporal de Contrabando , Corpos Estranhos , Drogas Ilícitas , Humanos , Masculino , Adolescente , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Drogas Ilícitas/efeitos adversos , Dor no Peito/etiologia
10.
CMAJ Open ; 10(4): E1000-E1007, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36379587

RESUMO

BACKGROUND: Outpatients presenting with chest pain often face long wait times for cardiology consultation and subsequent investigation for obstructive coronary artery disease (CAD), during which adverse cardiovascular events may occur. Our objective was to describe the design of Cardiac Link, a coronary computed tomography angiogram (CCTA)-guided rapid-access program, and evaluate its effect on cardiology consultation wait times in patients who present to primary care physicians with stable chest pain. METHODS: We conducted a retrospective cohort study at Women's College Hospital, Toronto, Ontario, Canada, between 2017 and 2020 involving eligible patients from the Family Practice Health Centre who underwent CCTA after presenting with stable chest pain or equivalent symptoms. Referring primary care physicians decided on a patient-by-patient basis to opt into the Cardiac Link program when requesting CCTA. Our primary outcome was measure of time from CCTA to cardiology consultation, and our secondary outcomes were measures of time to diagnosis from primary care consultation and CCTA booking time. RESULTS: Our analysis included 148 patients (Cardiac Link n = 98, non-Cardiac Link n = 50). Mean age of the patients was 58.4 (SD 11.2) years and 72% (107/148) were women. We found that the Cardiac Link group had a shorter time from CCTA to cardiology consultation (median 7 [interquartile range {IQR} 6-20] d v. median 100 [IQR 40-138] d; p = 0.01), shorter time to diagnosis (median 33 [IQR 22-55] d v. median 86 [IQR 40-112] d; p < 0.001) and shorter CCTA booking time (median 18 [IQR 11-31] d v. median 65 [IQR 24-92] d; p < 0.001) compared with the non-Cardiac Link group. INTERPRETATION: We determined that the Cardiac Link program reduced cardiology consultation wait times for symptomatic patients who were suspected of having CAD. Our study shows the viability of CCTA-guided rapid-access programs to expedite specialist consultation and reduce unnecessary referral for patients presenting to primary care physicians with stable chest pain.


Assuntos
Cardiologia , Doença da Artéria Coronariana , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Procedimentos Clínicos , Estudos Retrospectivos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Encaminhamento e Consulta , Ontário/epidemiologia
12.
Pediatrics ; 150(5)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36305212

RESUMO

An 11-year-old, previously healthy boy presented to the emergency center (EC) for acute respiratory distress in the setting of 5 months of recurrent and worsening rash with progressive fatigue, shortness of breath, chest pain, and cough. At the onset of his rash, he and his younger brothers were diagnosed with roseola. Although his brothers' symptoms resolved, the patient's rash recurred, prompting his primary care provider to prescribe amoxicillin. The rash subsequently worsened, so amoxicillin was stopped; a prednisone course was prescribed which alleviated the rash. Upon completion of the prednisone course, the rash returned more diffusely with associated symptoms of shortness of breath, chest pain, and cough. Because of these symptoms, his mother brought him to the EC, where his vitals were notable for tachypnea and tachycardia. His initial EC imaging workup was remarkable for an echocardiogram with a mild to moderate circumferential pericardial effusion, chest x-ray (CXR) with a large right pleural effusion, and chest computerized tomography significant for prominent and diffuse mediastinal and hilar lymphadenopathy with numerous enlarged axillary lymph nodes. Laboratory results were notable for elevated liver enzymes, inflammatory markers, d-dimer, and brain natriuretic peptide. Differential diagnosis remained broad, including infectious, oncologic, and rheumatologic etiologies. Our panel of experts reviews the evaluation, hospital course, and treatment of this patient presenting with an unusual rash and serositis.


Assuntos
Exantema , Derrame Pleural , Humanos , Masculino , Criança , Tosse , Prednisona , Exantema/etiologia , Dor no Peito/etiologia , Dispneia , Amoxicilina
13.
Ned Tijdschr Geneeskd ; 1662022 10 20.
Artigo em Holandês | MEDLINE | ID: mdl-36300472

RESUMO

While clinical guidelines are essential for decision-making based on the latest evidence, they are not all-encompassing for any given patient or context. As such, deviating from guideline recommendations is common practice and can be attributed to contextual, ethical, clinical, or scientific factors. In the setting of diagnostic testing deviating from recommended diagnostic work-up may result in both over- and under-testing. In this Clinical Lesson we discuss two scenarios in primary care, one involving high-sensitivity troponin testing in a patient with episodes of chest discomfort, and the other involving CRP testing in a pediatric patient with acute-onset abdominal pain.


Assuntos
Medicina Geral , Troponina , Humanos , Criança , Dor no Peito/diagnóstico , Dor no Peito/etiologia
14.
Can J Cardiol ; 38(10): 1600-1610, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36202592

RESUMO

BACKGROUND: Many women with cardiac chest pain and ischemia or myocardial infarction have no obstructive coronary artery disease (INOCA or MINOCA). Studies suggest that these patients have a decreased quality of life and are at increased risk of cardiovascular events. Our study reports 1-year quality of life, frequency of angina, and outcomes following entry into a multidisciplinary Women's Heart Centre (WHC). METHODS: Patients with INOCA and MINOCA completed questionnaires on baseline demographics and clinical presentation. At 1-year, frequency of chest pain, quality of life, depression and anxiety symptoms, and cardiovascular outcomes were reported and compared with baseline. RESULTS: A total of 154 women with nonobstructive coronary artery disease were included in this study (112 patients with INOCA and 42 with MINOCA). Median age was 59 years, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have specific diagnoses. Following investigations in the WHC, 71.4% of patients with INOCA established a new or a changed diagnosis (most common was coronary microvascular dysfunction at 68%), whereas 60% of patients with MINOCA established new or changed diagnoses (the most common of which was coronary vasospasm at 60%). At 1-year, participants had significantly decreased chest pain, improved quality of life, and improved mental health. CONCLUSIONS: A multidisciplinary WHC significantly increases the yield of a specific diagnosis in patients with INOCA and MINOCA. Further, attending a WHC could significantly improve the clinical and psychological outcomes of women with INOCA and MINOCA.


Assuntos
Doença da Artéria Coronariana , Canadá/epidemiologia , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Angiografia Coronária , Feminino , Seguimentos , Humanos , MINOCA , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
17.
BMJ ; 379: e071133, 2022 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-36261169

RESUMO

OBJECTIVE: To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease. DESIGN: Prospective, multicentre, randomised pragmatic trial. SETTING: Hospitals at 26 sites in 16 European countries. PARTICIPANTS: 2002 (56.2%) women and 1559 (43.8%) men (total of 3561 patients) with suspected coronary artery disease referred for invasive coronary angiography on the basis of stable chest pain and a pre-test probability of obstructive coronary artery disease of 10-60%. INTERVENTION: Both women and men were randomised 1:1 (with stratification by gender and centre) to a strategy of either computed tomography or invasive coronary angiography as the initial diagnostic test (1019 and 983 women, and 789 and 770 men, respectively), and an intention-to-treat analysis was performed. Randomised allocation could not be blinded, but outcomes were assessed by investigators blinded to randomisation group. MAIN OUTCOME MEASURES: The primary endpoint was major adverse cardiovascular events (MACE; cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Key secondary endpoints were an expanded MACE composite (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, transient ischaemic attack, or major procedure related complication) and major procedure related complications. RESULTS: Follow-up at a median of 3.5 years was available in 98.9% (1979/2002) of women and in 99.0% (1544/1559) of men. No statistically significant gender interaction was found for MACE (P=0.29), the expanded MACE composite (P=0.45), or major procedure related complications (P=0.11). In both genders, the rate of MACE did not differ between the computed tomography and invasive coronary angiography groups. In men, the expanded MACE composite endpoint occurred less frequently in the computed tomography group than in the invasive coronary angiography group (22 (2.8%) v 41 (5.3%); hazard ratio 0.52, 95% confidence interval 0.31 to 0.87). In women, the risk of having a major procedure related complication was lower in the computed tomography group than in the invasive coronary angiography group (3 (0.3%) v 21 (2.1%); hazard ratio 0.14, 0.04 to 0.46). CONCLUSION: This study found no evidence for a difference between women and men in the benefit of using computed tomography rather than invasive coronary angiography as the initial diagnostic test for the management of stable chest pain in patients with an intermediate pre-test probability of coronary artery disease. An initial computed tomography scan was associated with fewer major procedure related complications in women and a lower frequency of the expanded MACE composite in men. TRIAL REGISTRATION: NCT02400229ClinicalTrials.gov NCT02400229.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Acidente Vascular Cerebral , Feminino , Humanos , Masculino , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Prospectivos , Dor no Peito/diagnóstico por imagem , Dor no Peito/etiologia , Tomografia Computadorizada por Raios X , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Angiografia por Tomografia Computadorizada , Valor Preditivo dos Testes
18.
J Investig Med High Impact Case Rep ; 10: 23247096221127118, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36255056

RESUMO

Aortic dissection is an infrequent diagnosis that usually presents with acute onset of sharp and severe tearing pain. It rarely presents with atypical symptoms, accompanied by a higher mortality risk that arises the delay in diagnosis. In this report, we discuss a type A aortic dissection case with a presentation of heaviness-like chest pain with no evidence of aortic dissection in his first echocardiography. The patient was treated for acute coronary syndrome (ACS), but on the follow-up, echocardiography aortic dissection was diagnosed accidentally. Differentiation between ACS and aortic dissection is critical in patient management. Each one has an entirely different treatment approach, and misdiagnosis can lead to catastrophic outcomes.


Assuntos
Síndrome Coronariana Aguda , Aneurisma Dissecante , Síndrome Coronariana Aguda/diagnóstico , Aneurisma Dissecante/diagnóstico por imagem , Angina Instável/complicações , Angina Instável/etiologia , Dor no Peito/etiologia , Diagnóstico Tardio , Diagnóstico Diferencial , Humanos
19.
Aust J Gen Pract ; 51(11): 849-854, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36309997

RESUMO

BACKGROUND: Noncardiac chest pain (NCCP) is a diagnosis usually made after cardiac investigations have failed to demonstrate a specific diagnosis to explain either a single episode or recurrent episodes of chest pain. OBJECTIVE: The aim of this article is to describe the major causes and management of NCCP, with a focus on gastrointestinal conditions. DISCUSSION: Despite its generally benign prognosis, NCCP is a cause of significant morbidity and can be responsible for a high personal cost and healthcare burden. NCCP is commonly associated with gastrointestinal conditions, including gastro-oesophageal reflux disease and oesophageal spasm. However, the differential diagnosis extends to musculoskeletal, neurological and psychiatric conditions, and the broad range of causes of the syndrome, which are not mutually exclusive, means that clinicians need to remain vigilant for changes in clinical pattern.


Assuntos
Refluxo Gastroesofágico , Transtornos Mentais , Humanos , Dor no Peito/etiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Diagnóstico Diferencial , Transtornos Mentais/complicações
20.
Acta Biomed ; 93(5): e2022216, 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36300242

RESUMO

Membranous nephropathy (MN) is the commonest cause of nephrotic syndrome (NS) in adult male patients worldwide. Most of the cases (80%) are idiopathic (primary MN, PMN), whereas about 20% are associated with autoimmune diseases, malignancies or exposures (secondary MN). PMN is a kidney-specific autoimmune glomerular disease mediated by antibodies to the M-type phospholipase A2 receptor (anti-PLA2R) (85%), thrombospondin type 1 domain containing 7A (THSD7A) (3-5%), or by other still unidentified mechanisms (10%). Most of the patients with PMN present with NS (80%). Clinical course of PMN is characterised by spontaneous remissions (40%) and relapses (15-30%). One third develop end-stage renal disease (ESRD) within 5 to 15 years from the onset. Anti-PLA2R/THSD7A antibodies levels correlate with proteinuria, clinical course, and outcomes. The treatment still remains matter of debate. Hypertension, proteinuria, and hyperlipidaemia must be treated in all patients. Immunosuppressive therapy is indicated in patients with elevated anti-PLA2R/THSD7A levels and proteinuria >3.5 g/d at diagnosis. With proper management, only 10% or less will develop ESRD over the subsequent 10 years. Here we report a case of a 34-year-old male patient with a ten-year history of asymptomatic PMN, treated with ACE-inhibitors, who presented to our emergency room for acute chest pain and exertional dyspnoea due to ESRD that required urgent dialysis. (www.actabiomedica.it).


Assuntos
Glomerulonefrite Membranosa , Falência Renal Crônica , Adulto , Humanos , Masculino , Receptores da Fosfolipase A2 , Glomerulonefrite Membranosa/complicações , Glomerulonefrite Membranosa/diagnóstico , Trombospondinas , Autoanticorpos , Recidiva Local de Neoplasia , Proteinúria , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Dor no Peito/etiologia , Dispneia/etiologia
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