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1.
Artigo em Inglês | MEDLINE | ID: mdl-34205792

RESUMO

Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Síndrome Coronariana Aguda/diagnóstico por imagem , Dor no Peito/etiologia , Angiografia Coronária , Serviço Hospitalar de Emergência , Humanos , Radiologistas
2.
Medicina (Kaunas) ; 57(5)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34067941

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. CASE SUMMARY: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. CONCLUSIONS: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.


Assuntos
Intervenção Coronária Percutânea , Pericardite , Dor no Peito/etiologia , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Pericardite/etiologia
3.
Eur J Emerg Med ; 28(4): 292-298, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34187993

RESUMO

BACKGROUND AND IMPORTANCE: Current guidelines for patients presenting to the emergency department with chest pain without ST-segment elevation myocardial infarction (non-STEMI) on electrocardiogram are based on troponin measurement. The HEART score is reportedly a reliable work-up strategy that combines clinical evaluation with troponin value. A clinical rule that could select very low-risk patients without the need for a blood test (HEAR score, being the HEART score without the troponin item) would be of great interest. OBJECTIVES: To prospectively assess the safety of a HEAR score <2 to rule-out non-STEMI without troponin measurement. Secondary objective was to assess the safety of a sequential strategy that combines HEAR score and HEART (defined as two-step HEART strategy). DESIGN, SETTINGS AND PARTICIPANTS: Prospective observational study in six emergency departments. Patients with nontraumatic chest pain and no alternative diagnosis were included and followed up for 45 day. Patients were considered at low-risk if the HEAR score was <2 or, for the two-step HEART strategy, if the HEART score was <4. OUTCOMES MEASURE AND ANALYSIS: The primary endpoint was the 45-day rate of major adverse cardiac events (MACE) in patients with a HEAR score <2. A HEAR score based strategy was consider safe if the rate of the primary endpoint was below 1%, with an upper margin of the 95% confidence interval (CI) below 3%. RESULTS: Among 1452 patients included, 1402 were analyzed and 97 (7%) had a MACE during the follow-up period. The HEAR score was <2 in 279 (20%) patients and one presented a MACE [0.4% (95% CI: 0.01-1.98)]. The two-step HEART strategy classified low-risk an additional 476 patients (34%) and one of these 476 patients had a MACE [0.3% (95% CI: 0.03-0.95)]. The two-step HEART strategy would have theoretically avoided 360 troponin measurements (19%). CONCLUSIONS: In our prospective multicenter study, a HEAR based work-up strategy was safe, with a very low risk of MACE at 45 day. We also report that a two-step HEART-based strategy may safely allow significant reduction of troponin measurements in patients presenting to the emergency department with chest pain.


Assuntos
Dor no Peito , Troponina , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Estudos Prospectivos , Medição de Risco , Fatores de Risco
4.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167972

RESUMO

A 60-year-old man presented with headache, giddiness, abdominal pain and palpitation. When evaluated outside for the same, the patient was diagnosed to have hypertension and started on antihypertensives for which he did not respond. ECG was suggestive of non-ST elevation myocardial infarction. The patient was subjected to a coronary angiogram, which was normal. Patient had multiple episodes of fluctuating blood pressures. CT of the abdomen showed a 7.1×5.6×8.2 cm mass in the left adrenal gland suggestive of a pheochromocytoma. Serum, urine metanephrines and normetanephrines were elevated. After discussing with the multidisciplinary team, the patient was stabilised with alpha blockers and taken up for laparoscopic left adrenalectomy. Histopathology was reported as pheochromocytoma with a Pheochromocytoma Adrenal Scaled Score of 10/20 suggestive of malignancy. This is one such case of a malignant pheochromocytoma, which was managed successfully despite the perplexities faced in stabilising the crisis followed by laparoscopic resection in a moribund patient.


Assuntos
Neoplasias das Glândulas Suprarrenais , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adrenalectomia , Dor no Peito/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Normetanefrina , Feocromocitoma/diagnóstico , Feocromocitoma/diagnóstico por imagem
5.
BMJ Open ; 11(6): e042406, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172542

RESUMO

OBJECTIVES: To identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men. DESIGN: Cross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS. SETTING: Nine OHS-PC in the Netherlands. PARTICIPANTS: 993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016. PRIMARY OUTCOME MEASURE: Diagnosis of ACS retrieved from the patient's medical record in general practice, including hospital specialists' discharge letters. RESULTS: Among 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%). CONCLUSION: Our results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses. TRIAL REGISTRATION NUMBER: NTR7331.


Assuntos
Síndrome Coronariana Aguda , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores Sexuais , Telefone , Triagem
6.
Medicine (Baltimore) ; 100(26): e26558, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190194

RESUMO

ABSTRACT: A warning system included directly faxing electrocardiography information to the mobile phone immediately after an ST-segment elevation myocardial infarction (STEMI) diagnosis was made at a non-percutaneous coronary intervention (PCI) capable hospital. This study aimed to explore the outcomes after using a warning system in transfer STEMI patients.From October 2013 to December 2016, 667 patients experienced a STEMI event and received primary PCI at our institution. 274 patients who were divided into transfer group were transferred from non-PCI capable hospitals and connected to a first-line cardiovascular doctor by the warning system. Other 393 patients were divided into the non-transfer group.The transfer group still had a longer pain-to-reperfusion time and presented higher troponin-I level when compared with non-transfer group. There was no significant difference in the use of drug-eluting stent and procedural devices between non-transfer and transfer groups. The prevalence of different anti-platelet agents loading did not differ between non-transfer and transfer groups. Non-significant trend about higher prevalence of statin use was noted in transfer group (78.9% vs 86.1%, P = .058). The transfer group presented similar clinical short-term results regarding both cardiovascular and all-cause mortality when comparing with non-transfer group. The transfer group provided non-significant trend about lower one-year cardiovascular mortality (10.7% vs 6.2%, P = .052) and lower all-cause mortality (12.2% vs 6.9%, P = .026) when compared with non-transfer group. There was a significant difference in the Kaplan-Meier curve of 1-year cardiovascular mortality between the transfer group and the non-transfer group (P = .049).After using the warning system, the inter-facility transfer group had comparable outcomes even though a longer pain-to-reperfusion time and a higher peak troponin-I level when comparing with non-transfer group.


Assuntos
Dor no Peito , Sistemas de Informação Hospitalar , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento/normas , Dor no Peito/sangue , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia/métodos , Feminino , Sistemas de Informação Hospitalar/organização & administração , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Transferência de Pacientes/métodos , Transferência de Pacientes/organização & administração , Transferência de Pacientes/normas , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Melhoria de Qualidade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Taiwan/epidemiologia , Troponina I/sangue
7.
Medicine (Baltimore) ; 100(24): e26371, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128896

RESUMO

ABSTRACT: Most patients with coronavirus disease 2019 (COVID-19) have mild to moderate illness not requiring hospitalization. However, no study has detailed the evolution of symptoms in the first month of illness.At our institution, we conducted remote (telephone and video) visits for all adult outpatients diagnosed with COVID-19 within 24 h of a positive nasopharyngeal polymerase chain test for SARS-CoV-2. We repeated regular video visits at 7, 14, and 28 days after the positive test, retrospectively reviewed the prospective data collected in the remote visits, and constructed a week by week profile of clinical illness, through week 4 of illness.We reviewed the courses of 458 symptomatic patients diagnosed between March 12, 2020, and June 22, 2020, and characterized their weekly courses. Common initial symptoms included fever, headache, cough, and chest pain, which frequently persisted through week 3 or longer. Upper respiratory or gastrointestinal symptoms were much shorter lived, present primarily in week 1. Anosmia/ageusia peaked in weeks 2 to 3. Emergency department visits were frequent, with 128 visits in the 423 patients who were not hospitalized and 48 visits among the 35 outpatients (7.6%) who were eventually hospitalized (2 subsequently died). By the fourth week, 28.9% said their illness had completely resolved. After the 4-week follow up, 20 (4.7%) of the 423 nonhospitalized patients had further medical evaluation and management for subacute or chronic COVID-19 symptoms.Mild to moderate outpatient COVID-19 is a prolonged illness, with evolving symptoms commonly lasting into the fourth week of illness.


Assuntos
Assistência Ambulatorial , COVID-19/complicações , COVID-19/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anosmia/etiologia , COVID-19/diagnóstico , Dor no Peito/etiologia , Tosse/etiologia , Dispneia/etiologia , Serviço Hospitalar de Emergência , Fadiga/etiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mialgia/etiologia , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
11.
BMJ Case Rep ; 14(5)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031058

RESUMO

A 62-year-old man was referred to the emergency department with retrosternal chest pain for 4 days. Coronary angiogram and ECG showed no occlusion of coronary vessels. Contrast-enhanced CT of thorax showed b/l pleural effusion, pneumomediastinum, right hydropneumothorax, with the underlying collapse of lungs and intercostal drainage tube in situ. Intercostal tube showed purulent discharge. Repeat oral contrast did not show any leakage through the upper gastrointestinal tract, and the patient is admitted to the intensive care unit following endotracheal intubation. However, an upper gastrointestinal endoscopy, performed at the bedside in the intensive care unit unexpectedly revealed a foreign body (piece of coconut shell) impacted at the lower oesophagus. The foreign body was removed successfully using oesophagoscopy, and the patient made a full recovery following multidisciplinary teamwork between critical care and surgeons.


Assuntos
Corpos Estranhos , Hidropneumotórax , Derrame Pleural , Dor no Peito/etiologia , Esôfago , Humanos , Masculino , Pessoa de Meia-Idade
12.
Emergencias ; 33(3): 181-186, 2021 06.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33978331

RESUMO

BACKGROUND: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS: A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.


Assuntos
Fatores Etários , Serviços Médicos de Emergência , Comportamento de Busca de Ajuda , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Feminino , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/estatística & dados numéricos , Paris/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
14.
Am J Case Rep ; 22: e931758, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33941758

RESUMO

BACKGROUND Certain health conditions have been proven to have an effect on the severity of COVID-19, the disease caused by SAR-COV-2. The list of identified comorbid conditions includes hematological diseases, with sickle cell disease (SCD) falling into this category. CASE REPORT This case series examines the history, presentation, and clinical course of 5 patients with SCD who tested positive for SAR-COV-2 during the spring and summer of 2020. These patients experienced COVID-19 severities ranging from a mild cough and congestion to 8-day hospitalizations requiring blood transfusions. CONCLUSIONS While there is still a great amount of research on the interaction between COVID-19 and SCD needed, from this study we have concluded that patients with SCD do not always present with the classic COVID-19 triad of cough, shortness of breath, and fever. Often, these patients present with symptoms of vaso-occlusive crisis (VOC), including severe leg, flank, and chest pain, as was seen in 4 of 5 of our patients. We, and several other researchers, believe that this association between COVID-19 and VOC could be due to COVID-19 triggering inflammatory cytokines (notably IL-6) leading to system-wide inflammation, which induces sickling of the red blood cells. Based on this report, we recommend that SCD patients presenting with VOC who have had exposure to SAR-COV-2 be promptly tested for SAR-COV-2 to guide treatment and reduce mortality and morbidity in this vulnerable population.


Assuntos
Anemia Falciforme/complicações , Dor no Peito/etiologia , Dor no Flanco/etiologia , SARS-CoV-2 , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , COVID-19/complicações , COVID-19/diagnóstico , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Medicine (Baltimore) ; 100(18): e25692, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950950

RESUMO

INTRODUCTION: The relationship between chronic empyema and malignant tumors, most of which are lymphoma, has been recognized for many decades. Sarcomatoid carcinoma associated with chronic empyema is extremely rare, may metastasize to other organs in the early stage, and rapidly progresses to death. As far as we know, this was the first case report on sarcomatoid carcinoma associated chronic empyema. THE PATIENTS MAIN CONCERNS AND IMPORTANT CLINICAL FINDINGS: A 59-year-old man presented to our hospital with a 9-year history of chronic empyema and a chief complaint of left chest wall pain for 5 months. The diagnostic contrast-enhanced computed tomography (CT) showed a large irregular soft tissue mass located on the left lower hemithorax at the margin of the empyema cavity extending to the adjacent chest wall and lung parenchyma. In addition, CT revealed pleural and pulmonary metastases surrounded by ground glass opacity. THE MAIN DIAGNOSIS, THERAPEUTICS INTERVENTIONS, AND OUTCOMES: The patient underwent CT guided percutaneous core needle biopsy (PCNB). The histopathological evaluation showed carcinomatous proliferation of pleomorphic spindle cells with extensive necrosis. Immunohistochemically, tumor cells were positive for cytokeratin and vimentin. The final histopathological diagnosis was sarcomatoid carcinoma underlying chronic empyema. The tumors showed rapid progression on serial simple radiography. Palliative treatments were performed, but the patient still developed severe dyspnea and died shortly after on day 16. CONCLUSION: Sarcomatoid carcinoma can occur very rarely as a complication of chronic empyema, and is more aggressive than usual. Early detection of developing malignancy during the follow-up of chronic empyema is an important factor for patient prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Dor no Peito/etiologia , Empiema Pleural/diagnóstico , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pleurais/diagnóstico , Biópsia com Agulha de Grande Calibre , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/secundário , Empiema Pleural/etiologia , Evolução Fatal , Humanos , Neoplasias Renais/diagnóstico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Pleura/diagnóstico por imagem , Pleura/patologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/secundário , Tomografia Computadorizada por Raios X
16.
Biomed Res Int ; 2021: 6611051, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33954184

RESUMO

Background: Acute coronary syndrome (ACS) is a critical disease encountered in the emergency department (ED). Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. Method: Data from 11,323 patients who visited the ED with chest pain at university hospitals in Korea were retrospectively analyzed. The cohort was categorized into two age groups: the adult (30-64 years) and elderly (>65 years). Baseline characteristic data (age, sex, vital signs, triage category, etc.) were obtained. We selected patients who revisited the ED within 30 d and investigated whether ACS was diagnosed. Result: The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Conclusion: Elderly patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up.


Assuntos
Síndrome Coronariana Aguda , Dor no Peito , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos
20.
Am J Case Rep ; 22: e930090, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33875632

RESUMO

BACKGROUND The main causes for takotsubo syndrome (TS) in oncological patients are stress related to cancer diagnosis and treatment, pain in the course of the disease, treatment complications, and paraneoplastic syndromes. CASE REPORT An obese 62-year-old female patient, with a 3-day history of chest pain, was admitted to the hospital with a suspected acute coronary event. She had been diagnosed with high-grade bladder cancer 6 months before. After the transurethral electroresection of the tumor 5 months before and subsequent chemotherapy (gemcitabine and cisplatin), the patient was qualified for the next cancer surgery. On admission, the patient remained without chest pain. The ECG record demonstrated inverted T waves in the leads from above the anterior and lateral wall. The coronarography demonstrated minor atherosclerotic changes in the coronary arteries. The left ventriculography presented akinesis of the apex and the apical and mid-segment of the anterior wall, and the ejection fraction (EF) was 38%. Takotsubo syndrome was diagnosed. Laboratory testing revealed elevated concentration of troponin and N-terminal pro-B-type natriuretic peptide. The subsequent ECG records demonstrated deeply inverted T waves and numerous ventricular premature beats and increased QTc (528 ms). A control echocardiography showed improved left ventricular contractive function (EF - 47%). On the 4th day of hospitalization, the patient was discharged and referred for further oncological treatment. CONCLUSIONS The diagnosis of TS in oncology patients is difficult, especially in the presence of atherosclerotic lesions in coronary arteries. Takotsubo syndrome in cancer patients delays the next stages of oncological treatment, which worsens the prognosis of these patients.


Assuntos
Cardiomiopatia de Takotsubo/diagnóstico , Neoplasias da Bexiga Urinária/complicações , Dor no Peito/etiologia , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/terapia , Troponina/sangue , Neoplasias da Bexiga Urinária/terapia
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