ABSTRACT
A pericardite é um processo inflamatório do pericárdio de múltiplas causas, sendo a infecção viral a mais comum. O infarto agudo do miocárdio é um dos principais diagnósticos diferenciais. O objetivo deste artigo foi relatar um caso de pericardite aguda com supradesnivelamento de segmento ST. Os dados foram coletados em um hospital de ensino do Estado de Minas Gerais. O paciente era do sexo masculino, tinha 24 anos e era negro. Foi encaminhado ao serviço médico terciário devido à hipótese de síndrome coronariana aguda com supradesnivelamento do segmento ST. Nos exames do serviço médico de origem, apresentava supradesnivelamento do segmento ST de caráter difuso simultaneamente em paredes inferior e anterior, e alteração da isoenzima MB da creatina quinase de 100ng/mL e troponina I de 21ng/mL. No momento da admissão, encontrava-se em bom estado geral, afebril, estável hemodinamicamente e sem queixa de dor. Referiu que 4 dias antes da admissão, apresentou febre, mal-estar geral, odinofagia e tratamento de amigdalite. Os exames da admissão demonstravam ritmo sinusal, frequência cardíaca de 75bpm, supradesnivelamento de ST em D2, D3, aVF, V1 a V6, isoenzima MB da creatina quinase de 152ng/mL, troponina I de 1,28ng/mL, hemograma normal; ecocardiograma mostrou pericárdio de aspecto anatômico normal e fração de ejeção de 64%. O diagnóstico foi de pericardite aguda de provável etiologia infecciosa. O tratamento foi realizado com ibuprofeno por 7 dias e colchicina por 3 meses. Paciente evoluiu com alta hospitalar após 5 dias. O diagnóstico correto proporcionou a condução adequada do caso, permitindo a redução dos custos hospitalares e eliminando riscos de procedimentos desnecessários. (AU)
Pericarditis is an inflammatory process of the pericardium of multiple causes, being the most common viral infection. Acute myocardial infarction is one of the main differential diagnoses. The objective of this article was to report a case of acute pericarditis with ST-segment elevation. Data were collected at a teaching hospital in the state of Minas Gerais. The patient was a man of 24 years, black. He was referred to the tertiary medical service due to the hypothesis of Acute Coronary Syndrome with ST-segment elevation. In the tests from the medical service of origin, there was diffuse ST-segment elevation, simultaneously on lower and anterior walls, and a change in the Creatinine Kinase MB Isoenzyme of 100ng/ml, and troponin I of 21ng/ml. At the time of admission, he was in good general condition, afebrile, hemodynamically stable, with no complaint of pain. He said that 4 days before admission he had fever, malaise, odynophagia, and treatment for tonsillitis. The admission tests showed sinus rhythm, heart rate of 75bpm, ST-elevation in D2, D3, aVF, V1 to V6, MB isoenzyme of creatine kinase of 152ng/ml, troponin I of 1.28ng/ml, normal complete blood count; echocardiogram showed pericardium of normal anatomical aspect and ejection fraction of 64%. The diagnosis was acute pericarditis of probable infectious etiology. Treatment was performed with ibuprofen for seven days, and colchicine for three months. The patient was discharged from hospital after 5 days. The correct diagnosis provided adequate case management, allowing for reduced hospital costs, and eliminating risks of unnecessary procedures. (AU)
Subject(s)
Humans , Male , Adult , Pericarditis/diagnosis , ST Elevation Myocardial Infarction/diagnosis , Penicillin G Benzathine/therapeutic use , Pericarditis/drug therapy , Pericarditis/diagnostic imaging , Troponin/blood , Chest Pain , Echocardiography , Deglutition Disorders , Tonsillitis/diagnosis , Tonsillitis/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colchicine/therapeutic use , Ibuprofen/therapeutic use , Diagnosis, Differential , Electrocardiography , Creatine Kinase, MB Form/blood , Acute Coronary Syndrome/diagnosis , Fever , Hospitalization , Anti-Bacterial Agents/therapeutic useABSTRACT
Abstract INTRODUCTION: Chronic chagasic cardiopathy (CCC) is essentially a dilated cardiomyopathy in which a subacute, but constant chronic inflammatory process causes progressive destruction of the heart tissue. The action of proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), and anti-inflammatory cytokines, like interleukin IL-10 and IL-17, plays a fundamental role in the immunopathogenesis and evolution of disease. Early anti-congestive therapy, aimed at changing the morbidity and mortality rate, has been shown to reduce disease progression and to alter patients' immune response pattern. METHODS: This cross-sectional study aimed to evaluate the profile of Th1 and Th17 cytokines and IL-17, TNF-α, and IFN-γ expressions in different stages of CCC. Forty patients affected by chronic Chagas disease were divided into different groups according to the stage of the pathology. In agreement with the Brazilian consensus on Chagas disease, patients were classified as presenting an undetermined form, a cardiac form and a digestive form. Serum IFN-γ, TNF-α, IL-10, and IL-17 were evaluated. RESULTS: Lower serum IFN-γ concentrations were detected in patients receiving angiotensin-converting enzyme inhibitors (p = 0.0182), but not in those using angiotensin receptor blockers (p = 0.0783). Patients using amiodarone and aldosterone antagonist presented higher serum TNF-α concentrations (p = 0.0106 and 0.0187, respectively). IL-10 and IL-17 levels did not differ between the study groups (p = 0.7273 and p = 0.6697, respectively). CONCLUSIONS: These results suggest that the cytokine profile and disease progression are altered by anti-congestive medications commonly prescribed for CCC.