ABSTRACT
We report the case of a young man first seen by is in 1989 at the age of 20 years. The diagnoses of hypertrophic cardiomyopathy, Wolf-parkinson-White syndrome, congestive heart failure and pulmonary hypertension were made. One month later the patient had jaundice and hepatomegaly and a diagnosis of acute viral hepatitis A was established by laboratory findings. The ALT and AST levels were persistently elevated, seven times the normal mean, during six years. Two liver biopsies in 1991 and 1993 showed liver injury secondary to congestive heart failure (CHF) as the only abnormality. This case illustrates the importance of liver injury secondary to CHF as a cause of a marked and persistent increase of ALT and AST that resembles that of other liver diseases.
Subject(s)
Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Heart Failure/enzymology , Hepatitis A/complications , Hepatitis, Chronic/diagnosis , Adult , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/enzymology , Cholestasis, Intrahepatic/etiology , Diagnosis, Differential , Fatal Outcome , Heart Failure/diagnosis , Heart Failure/etiology , Hepatitis A Antibodies , Hepatitis Antibodies/blood , Humans , Hypertension, Pulmonary/complications , Liver/pathology , Male , Time Factors , Wolff-Parkinson-White Syndrome/complicationsABSTRACT
OBJECTIVES: To analyse the hemodynamic and ventricular function effects of oral captopril in severe aortic stenosis. PATIENT POPULATION: inclusion criteria: patients older than 18 years with critical aortic stenosis. EXCLUSION CRITERIA: angiotensin-converting enzyme inhibitor used previously contraindication to right catheterisation aortic insufficiency, valvular prosthesis in aortic position, or other valvulopathy. As well as the need for immediate valvular aortic replacement arrhythmia, A-V conduction alterations, or ventilatory support. PROTOCOL: prospective, no randomized. Swan-Ganz catheter was used. Basal hemodynamic measurements were made on 1, 2, 4, 6 and 8 hours during 48 hours. Captopril was administered 12.5 mg first and then 8 mg tid (6 doses). STATISTICAL ANALYSIS: Neuman-Keuls test was used for multivariate comparisons. Statistical significance was determined with P < 0.05. RESULTS: 22 patients were analyzed. Systemic vascular resistance fell from 1750 Dyn/seg/cm-5 to 1200 (P-0.001), cardiac output increased from 4.1l/min to 5.8 (P-0.001), cardiac index increased from 2.4 l/min/m2 to 2.9 (P-0.009), stroke volume from 47 ml to 64 (P-0.04) and stroke volume index from 27 ml/m2 to 36 (P-0.002). In patients with heart failure (n = 7) the systemic vascular resistance fell from 2050 Dyn/seg/cm-5 to 1463 (P-0.04), cardiac output increased from 2.8l/min to 4.1 (P-0.04), cardiac index from 2.07 l/min/m2 to 2.75 (P-0.04), stroke volume from 46 ml to 64 (P-0.03), pulmonary capillary wedge pressure fell from 19 mmHg to 16 (0.04) and the systolic pulmonary arterial pressure fell from 63 mmHg to 42 (P-0.009). CONCLUSIONS: captopril improves the hemodynamic parameters in patients with critical aortic stenosis, principally in those with heart failure.
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/pharmacology , Aortic Valve Stenosis/drug therapy , Captopril/pharmacology , Hemodynamics/drug effects , Ventricular Dysfunction, Left/drug therapy , Ventricular Function, Left/drug effects , Administration, Oral , Adult , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/physiopathology , Captopril/administration & dosage , Cross-Over Studies , Female , Heart Failure/drug therapy , Heart Failure/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Cocaine use has been associated with ischemic syndromes, especially angor pectoris, myocardial infarction, cardiac arrhythmias and sudden death. A significant number of persons suffering from myocardial infarction associated with cocaine abuse do not have significant coronary atherosclerosis, and the mechanism for infarction in these patients have remained obscure. This report describes a young man with angiographically normal coronary arteries in whom cocaine abuse probably produced coronary artery spasm leading to coronary thrombosis and infarction.
Subject(s)
Cocaine , Myocardial Infarction/chemically induced , Opioid-Related Disorders/complications , Adult , Humans , MaleABSTRACT
Twenty five consecutive patients with fever of unknown origin (FUO) who underwent diagnostic laparatomy (DL) are reviewed. There were 14 females and 11 males, with a mean age of 34 years. The main symptoms and signs besides fever were malaise, weight loss, varied abdominal complaints, peripheral lymph nodes enlargement, hepatomegaly and splenomegaly. The main laboratory abnormalities were: anemia, leukocytosis, and mild alterations in liver function tests. CT scan was performed in 14 patients: hepatomegaly, splenomegaly and or retroperitoneal nodes were found in 10 of them. During laparotomy, an extensive exploration of intra-abdominal organs was performed, taking multiple biopsies for histopathologic and microbiologic analysis. Splenectomy was performed in 17 patients, prophylactic appendectomy in four, and cholecistectomy in one. Laparotomy was useful to establish a diagnosis in 64 percent of cases. The most frequently diagnosed pathologies were lymphoma and tuberculosis. Postoperative morbidity was 12% and mortality was 4%. Mean follow-up was 29 months. When preoperative data were analyzed, no predictive factors were found for a laparotomy with diagnostic success. It is concluded that DL is a useful last-step procedure in the diagnostic work-up for patients with FUO.
