ABSTRACT
Stress-induced cardiomyopathy is characterized by transient systolic dysfunction ofthe apical or mid segments ofthe left ventricle that mimics myocardial infarction in the absence of obstructive coronary artery disease. Symptoms recur after a phy-sical or emotional stress. We report a 77 years oíd femóle that in 2004, suffered an episode of stress cardiomyopathy after an intense physical effort. In February 2010, immediately after the earthquake that occurred in Chile, the patient consulted for chestpain, STsegment elevation and enzyme elevation. An echocardiography showed a left ventricular anteroseptal akinesia with an ejection fraction of 35 percent. Coronary arteriography did not show significant alterations.
Subject(s)
Aged , Female , Humans , Earthquakes , Takotsubo Cardiomyopathy , Chile , Diagnosis, Differential , Myocardial Infarction/diagnosis , RecurrenceABSTRACT
We analyzed 31 patients with a diagnosis of primary biliary cirrhosis, 29 of them males, aged 23 to 72 years. Liver biopsy was diagnostic in all showing initial findings of the disease in 5. Echotomography and cholangiography demonstrated a patent biliary, tract. Antimithocondrial antibodies were present in 94% of patients. Alkaline phosphatase and biliary acid levels were useful for diagnosis. Pruritus was present with varying intensity in all patients, with premenstural exacerbations in 5 females who had cholestasis of pregnancy or hepatitis caused by progestin drugs before developing cirrhosis. Recurrent urinary tract infection was present in 8 patients, osteosporis in 24, Sjogren's syndrome in 24 and Crest syndrome in 4. Survival ranged from 1 to 12 years, death being caused by rupted esophageal varices in 12 patients and by liver failure in 7. Persistance of pruritus and altered liver function tests after cholestasis of pregnancy or hepatitis caused by progestins should lead to investigation of biliary cirrhosis