ABSTRACT
Relatamos o caso de um paciente com alterações eletrocardiográficas e disfunção miocárdica segmentar induzidas por feocromocitoma, simulando infarto agudo do miocárdio. A angiografia coronariana foi normal e houve normalização completa do eletrocardiograma e ecocardiograma, após terapia com um bloqueador alfa-adrenérgico e ressecção do tumor. Espasmo coronariano foi o provável mecanismo envolvido na produção dessas alterações, ilustrando a importância de manter um alto grau de suspeição clínica em pacientes com evento miocárdico inesperado em meio a uma crise hipertensiva.
Subject(s)
Humans , Female , Middle Aged , Adrenal Gland Neoplasms/diagnosis , Myocardial Infarction/diagnosis , Pheochromocytoma/diagnosis , Ventricular Dysfunction/diagnosis , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/therapy , Adrenergic alpha-Antagonists/therapeutic use , Diagnosis, Differential , Myocardial Infarction/etiology , Pheochromocytoma/complications , Pheochromocytoma/therapy , Ventricular Dysfunction/drug therapy , Ventricular Dysfunction/etiologyABSTRACT
OBJECTIVE: To assess the feasibility and safety of coronary interventions performed through the radial artery. METHODS: We studied 103 patients with ages from 38 to 86 years (57 + or -8.7), 90 (87 percent) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the Allen's test. RESULTS: The vascular approach was obtained in 97 (94 percent) patients, 88 (91 percent) treated electively and 9 (9 percent) during acute myocardial infarction, for primary angioplasty; 56 (64 percent) unstable angina; 22 (25 percent) stable angina; 10 (11 percent) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. We approached 107 arteries: anterior descending artery, 49 (46 percent); right coronary artery, 27 (25 percent); circumflex artery, 25 (23 percent); diagonal artery, 6 (6 percent); and 2 saphenous vein bypass grafts. We treated 129 lesions: 80 (62 percent) B2 type; 23 (18 percent) B1 type; 17 (13 percent) C type; and 9 (7 percent). A type. There were 70 stents , and 59 balloon angioplasties performed. Thirty-two (33 percent) patients used GP IIb/IIIa inhibitors. The mean duration of the elective procedure was 42.3Ý12.8 min. Success, correct stent deployment and residual lesion <20 percent, was reached in 100 percent of the lesions treated with stent implantation; arterial dilation with residual lesion <50 percent was obtained in 96 percent of the lesions treated with transluminal coronary angioplasty (TCA). Complications, were: 1 (1.0 percent) non-Q-wave acute myocardial infarction; 2 (2 percent) hematomas in the forearm; and 2 losses of radial pulse. CONCLUSION: Radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications