ABSTRACT
A 61-year-old man presented to our institution complaining of back pain. Breathing was comfortable. An arterial blood gas showed extreme hypoxia causing chronic respiratory alkalosis. Further investigations revealed aneurysmal dilatation of the ascending aorta and the Crawford Type II thoracoabdominal aneurysm, with compression of both the left main bronchus and the right pulmonary artery. The patient was managed with a two-stage hybrid surgical approach comprising total arch replacement using the frozen elephant trunk technique followed by endovascular repair.
ABSTRACT
We report the case of a 57-year-old woman with anorexia nervosa showing evidence of "tako-tsubo" cardiomyopathy complicated by several syncopes due to recurrent episodes of torsades de pointes. Prolongation of QT interval and QT dispersion have been reported both in the "tako-tsubo" cardiomyopathy and in anorexia nervosa. The QT prolongation and the QT dispersion has been linked as risk indicators for sudden cardiac death. The combination of "tako-tsubo" cardiomyopathy with a condition associated with the prolongation of QT and/or with an increase of QT dispersion, such as anorexia nervosa, makes the acute and subacute prognosis of this disease much more severe than usual.
Subject(s)
Anorexia Nervosa/diagnosis , Takotsubo Cardiomyopathy/diagnosis , Torsades de Pointes/diagnosis , Anorexia Nervosa/complications , Anorexia Nervosa/physiopathology , Female , Humans , Middle Aged , Recurrence , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/physiopathology , Torsades de Pointes/complications , Torsades de Pointes/physiopathologyABSTRACT
Introducción y objetivos. Los resultados obtenidos con los stents liberadores de fármacos (SLF) en el grupo de pacientes de alto riesgo formado por los pacientes diabéticos con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratados con angioplastia primaria no se han estudiado con anterioridad. Nuestro objetivo fue evaluar la eficacia y la seguridad de los SLF en pacientes diabéticos con IAMCEST. Métodos. Llevamos a cabo un análisis combinado de los datos de pacientes individuales de siete ensayos aleatorizados en los que se comparó el empleo de stents liberadores de sirolimus o de paclitaxel (SLF) con el de stents convencionales (SC) en el contexto de un IAMCEST. Se incluyó en este análisis a 389 pacientes con diabetes mellitus de un grupo total de 2.476. Los objetivos del estudio fueron la revascularización de la lesión diana, la trombosis del stent, la muerte y la variable combinada de muerte o infarto de miocardio recurrente durante un periodo de seguimiento de 12-24 meses. Resultados. Hubo 206 pacientes diabéticos tratados con SLF y 183 tratados con SC. El riesgo de que se practicara una revascularización de la lesión diana fue significativamente inferior en los pacientes tratados con SLF en comparación con los pacientes tratados con SC (razón de riesgos [HR] = 0,44; intervalo de confianza [IC] del 95%, 0,23-0,88; p = 0,02). El riesgo de trombosis del stent no presentó diferencias significativas entre los pacientes tratados con SLF y los tratados con SC (HR = 0,33; IC del 95%, 0,09-1,13; p = 0,08). De forma análoga, el riesgo de la variable de valoración combinada formada por la muerte y el infarto de miocardio no presentó diferencias significativas entre los pacientes tratados con SLF y los tratados con SC (HR = 0,64; IC del 95%, 0,36-1,13; p = 0,12). Conclusiones. En comparación con los SC, los SLF mejoran los resultados clínicos en los pacientes diabéticos a los que se practica una angioplastia primaria por un IAMCEST, al reducir la necesidad de reintervención sin incrementar la tasa de mortalidad o infarto de miocardio (AU)
Introduction and objectives. The performance of drug-eluting stents (DES) in high-risk patients with diabetes and acute ST-elevation myocardial infarction (STEMI) who have undergone primary angioplasty has not been previously studied. The objestive was to evaluate the efficacy and safety of DESs in diabetic patients with STEMI. Methods. We performed a pooled analysis of individual patient data from 7 randomized trials that compared DES (ie, sirolimus- or paclitaxel-eluting stents) with bare-metal stent (BMS) in patients with STEMI. The analysis involved 389 patients with diabetes mellitus from a total of 2476 patients. The outcomes of interest were target-lesion revascularization, stent thrombosis, death, and the composite endpoint of death or recurrent myocardial infarction during a follow-up of 12-24 months. Results. Overall, 206 diabetic patients received a DES and 183, a BMS. The risk of target-lesion revascularization was significantly lower in patients treated with a DES compared to those treated with a BMS (hazard ratio [HR] = 0.44; 95% CI, 0.23-0.88; P=.02). There was no significant difference in the risk of stent thrombosis between those treated with a DES or a BMS (HR=0.33; 95% CI, 0.09-1.13; P=.08). Similarly, the risk of the combined endpoint of death or myocardial infarction was not significantly different between patients treated with a DES or a BMS (HR=0.64; 95% CI, 0.36-1.13; P=.12). Conclusions. Compared with BMSs, DES use improved clinical outcomes in diabetic patients undergoing primary angioplasty for STEMI: the need for reintervention was reduced, with no increase in mortality or myocardial infarction. was significantly lower in patients treated with a DES compared to those treated with a BMS (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.23-0.88; P=.02). There was no significant difference in the risk of stent thrombosis between those treated with a DES or a BMS (HR 0.33, 95% CI 0.09-1.13; P=.08). Similarly, the risk of the combined endpoint of death or myocardial infarction was not significantly different between patients treated with a DES or a BMS (HR 0.64, 95% CI 0.36-1.13; P=.12). Conclusions. Compared with BMSs, DES use improved clinical outcomes in diabetic patients undergoing primary angioplasty for STEMI: the need for reintervention was reduced, with no increase in mortality or myocardial infarction (AU)
