Cardiotoxicidade por cocaína e disfunção ventricular em paciente jovem / Cocaine cardiotoxicity and ventricular disfunction in a young patient

RESUMO: O uso de substâncias psicoativas pode induzir complicações cardiovasculares. O objetivo deste relato é descrever o caso de um paciente jovem com cardiomiopatia dilatada secundária ao uso de cocaína. Paciente com dispneia há seis meses, com piora progressiva, dispneia paroxística noturna, ortopneia e edema de membros inferiores. Ao exame físico apresentava taquicardia (110 bpm), com demais sinais vitais sem alterações, presença de estertores crepitantes em bases e campos médios, ascite de moderado volume e edema importante de membros inferiores. No eletrocardiogra-ma, apresentava ritmo sinusal com sobrecarga de câmaras esquerdas; na radiografia de tórax, apenas cardiomegalia acentuada. O ecocardiograma evidenciou fração de ejeção (FE) do ventrículo esquerdo (VE) reduzida (7%), aumento de átrio esquerdo e ventrículo direito (VD), com hipertrofia excêntrica e disfunção sistólica acentuada do VE, com disfunção moderada do VD e hipertensão pulmonar (39 mmHg). Na ressonância, apresentou dilatação discreta do átrio direito, VD com dilatação importante, disfunção sistólica biventricular importante, com hipocinesia difusa (FE 8% de VD), além de fibrose miocárdica de padrão não coronariano inferosseptal. O caso relatado evidencia um diagnóstico cujo mecanismo fisiopatológico da cardiomiopatia dilatada não está claro. A associação mais coerente da cardiomiopatia dilatada apre-sentada pelo paciente está relacionada ao uso abusivo de cocaína, devido ao estímulo recorrente e de longa duração que o excesso de catecolaminas provocou no miocárdio. Tendo em vista o espectro de cardiomiopatia, infarto e arritmias que potencialmente podem ocorrer associados ao uso de cocaína, deve-se considerar a hipótese de cardiotoxicidade na avaliação de paciente com história de abuso de cocaína. (AU)

ABSTRACT: The use of psychoactive substances can induce cardiovascular complications. The purpose of this report is to describe the case of a young patient with dilated cardiomyopathy secondary to cocaine use. Patient with dyspnea for six months, with progressive worsening, paroxysmal nocturnal dyspnea, orthopnea, and lower limb edema. Physical examination showed tachycardia (110 bpm), with other vital signs without alterations, presence of crackling rales in the bases and middle fields, moderate volume ascites, and significant lower limb edema. Electrocardiogram showed sinus rhythm with left chamber overload; chest X-ray only marked cardiomegaly. The echocardiogram showed reduced left ventricular (LV) ejection fraction (7%), enlarged left atrium, and right ventricle (RV), with eccentric hypertrophy and severe left ventricular systolic dysfunction, with moderate RV dysfunction and pulmonary hyper-tension (39 mmHg). Resonance presented mild right atrial dilatation, RV with significant dilatation, significant biven-tricular systolic dysfunction, with diffuse hypokinesia, and myocardial fibrosis of non-coronary pattern. The reported case shows a diagnosis whose pathophysiological mechanism of dilated cardiomyopathy is not clear. The most coher-ent association of dilated cardiomyopathy presented by the patient is related to cocaine abuse, due to the long-term recurrent stimulus that excess catecholamines caused in the myocardium. Given the spectrum of cardiomyopathy, infarction, and arrhythmias that may potentially occur associated with cocaine use, the hypothesis of cardiotoxicity should be considered in the evaluation of a patient with a history of cocaine abuse. (AU)

Echocardiografic abnormalities in patients with sickle cell/β thalassemia do not depend on the β-thalassemia phenotype

ABSTRACT Objectives and methods: We evaluated possible relationships between echocardiographic findings and clinical and laboratory parameters, in a cohort of Brazilian patients diagnosed with sickle cell/β-thalassemia, to better understand the cardiac involvement in this disease. Results: Left atrial (LA) and left ventricular (LV) dilation were found in 19.5 and 11% of patients, respectively; systolic left ventricular dysfunction was present in a single patient. There were no differences in masses and volumes of cardiac chambers comparing Sβ0 with Sβ+ patients, and no relationship between these parameters and specific complications of the disease. However, parameters of altered ventricular geometry were significantly correlated with serum creatinine, hepatic transaminases and bilirubin levels. Moreover, 3 patients presented stroke; they were significantly older [53 (41-56) × 37.5 (18-70), p = 0.048], had higher values of LV posterior wall diastolic thickness [10 (10-11) × 8 (6-14), p = 0.03], LV mass [226 (194-260) × 147 (69-537), p = 0.039] and LA/aortic ratio [1.545 (1.48-1.61) × 1.26 (0.9-1.48), p = 0.032]. Conclusions: Cardiac involvement in this disease does not appear to depend on the thalassemia phenotype. The presence of signs of myocardial remodeling in this group of patients was related to multi-organ impairment and rendered a higher propensity for stroke in older patients, suggesting the need for greater vigilance and control of associated factors.

Síndrome de Rosai-Dormfan associada a Lúpus eritematoso sistêmico: relato de caso / Rosai-Dorfman syndrome associated with systemic erythematous lupus: case report

Objetivo: Relatar um caso de associação de Síndrome de Rosai-Dorfman e Lúpus Eritematoso Sistêmico acompanhado no ambulatório de Clínica Médica de nosso Hospital Universitário. Metodologia: O estudo é em formato de relato de caso, realizado a partir de revisão de prontuário e exames complementares. O termo de consentimento livre e esclarecido foi assinado pela paciente. Resultados: Paciente do sexo feminino, 37 anos, com quadro de pneumonia associada a derrame pleural recorrente e linfonodomega-lia generalizada. Na investigação clínica, foi realizado diagnóstico de Lúpus Eritematoso Sistêmico. Os exames anatomopatológico e imuno-histoquímico da biópsia linfonodal foi compatível com Síndrome de Rosai-Dorfman. Conclusões: A Síndrome de Rosai-Dorfman é uma doença benigna que pode mimetizar neoplasias. A progressão da doença é variável e não há tratamento efetivo estabelecido atualmente, sen-do o seguimento regular importante para avaliar compressão de estruturas vitais. Lúpus eritematoso sistêmico é uma doença inflamatória crônica com acometimento multissistêmico. Seu tratamento adequado costuma resultar em sobrevida longa e com qualidade. Importância do problema e comentários: De acordo com nosso levantamento bibliográfico, este é o quarto artigo relatando a ocorrência concomitante de Síndrome de Rosai-Dorfman e Lúpus Eritematoso Sistêmico em um paciente (AU)

Objective: To report a case of association of Rosai-Dorfman syndrome and Systemic Lupus Erythema-tosus followed at the Internal Medicine ambulatory of our University Hospital. Methodology: This stu-dy is in a case report format, carried out from a review of medical records and complementary exams. The consent form was signed by the patient. Results: Female patient, 37 years old, with a history of pneumonia associated with recurrent pleural effusion and generalized lymphadenopathy. In the clini-cal investigation, Systemic Lupus Erythematosus was diagnosed. The anatomopathological and im-munohistochemical exams of lymph node biopsy were compatible with Rosai-Dorfman Syndrome. Conclusions: Rosai-Dorfman Syndrome is a benign disease that can mimic neoplasms. The disease progres-sion is variable and, currently, there is no effective treatment established. Regular follow-up is important to assess vital structures compression. Systemic Lupus Erythematosus is a chronic inflammatory disease with multisystem affection. The appropriate treatment usually results in long-term and high-quality survival. Pro-blem impact and comments: According to our bibliographic survey, this is the fourth article reporting the concomitant occurrence of Rosai-Dorfman Syndrome and Systemic Lupus Erythematosus in a patient (AU)