RESUMO
ABSTRACT Objective: Right-heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. This study aimed to evaluate if different types of pulmonary hypertension (PH) would cause the same effect on right-heart functions and serum ADMA levels in female patients. Methods: This study included patients with PAH as group I, patients with PVH due to mitral stenosis (mitral valve area ≤ 1.5 cm2, without any additional valve or left-heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II, and healthy control subjects as group III. Transthorasic echocardiographic evaluations for right-heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected, and the serum ADMA concentrations were obtained with the ELISA kit (DRG® International Inc., Springfield, NJ, USA). Results: Patients in groups I and II had higher ADMA levels than healthy control subjects. Right-atrium area and dimensions, right-ventricular (RV) volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure, RV wall thickness, and RV outflow tract diameters were significantly higher in group I patients than in group II patients. Right-ventricular myocardial performance index was lower, and RV fractional area change and tricuspid valve systolic tissue Doppler velocity were higher in group II patients than in group I patients. Conclusion: This study demonstrated that both PAH and PVH caused increase in right-heart dimensions and impairment in right-heart functions.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Arginina/análogos & derivados , Óxido Nítrico Sintase , Hipertensão Pulmonar/fisiopatologia , Ecocardiografia , Disfunção Ventricular DireitaRESUMO
This is a report of a patient who had documented coronary artery disease and was admitted with chest pain, nausea, vomiting and headache. She was immediately taken to coronary angiography and underwent percutaneous coronary intervention with stent implantation. After the operation, she was coincidentally diagnosed to have Carbon Monoxide (CO) poisoning. We discuss if percutaneous intervention (PCI) was an overtreatment and briefly review the mechanisms of the cardiovascular effects of CO toxicity which is an insidious pathology and diagnosed only if it is suspected.
Este es un reporte de una paciente con enfermedad de la arteria coronaria documentada, quien fuera ingresado con dolor de pecho, náuseas, vómitos y dolor de cabeza. A la paciente se le hizo inmediatamente una angiografía coronaria y se le realizó una intervención coronaria percutánea con implantación de stent. Después de la operación, se le diagnosticó por coincidencia envenenamiento por monóxido de carbono (CO). Analizamos si la intervención percutánea (IPC) fue un sobretratamiento y examinamos brevemente los mecanismos de los efectos cardiovasculares de la toxicidad por CO que puede ser insidiosa y diangosticada sólo si se tiene sospecha.