ABSTRACT
We report a case of pheochromocytoma-induced segmental myocardial dysfunction and electrocardiographic abnormalities mimicking an acute anterior myocardial infarction, probably due to coronary spasm. Coronary angiography showed normal coronaries, and the electrocardiographic and echocardiographic changes resolved completely after therapy with an alpha-adrenergic blocker and tumor removal. Our case illustrates the importance of maintaining a high index of suspicion in patients presenting with an unexpected myocardial event and a hypertensive crisis.
Subject(s)
Adrenal Gland Neoplasms/complications , Pheochromocytoma/complications , Ventricular Dysfunction/etiology , Adrenal Gland Neoplasms/therapy , Adrenergic alpha-Antagonists/therapeutic use , Diagnosis, Differential , Female , Humans , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Pheochromocytoma/therapy , Ventricular Dysfunction/diagnosis , Ventricular Dysfunction/drug therapyABSTRACT
Relatamos o caso de um paciente com alterações eletrocardiográficas e disfunção miocárdica segmentar induzidas por feocromocitoma, simulando infarto agudo do miocárdio. A angiografia coronariana foi normal e houve normalização completa do eletrocardiograma e ecocardiograma, após terapia com um bloqueador alfa-adrenérgico e ressecção do tumor. Espasmo coronariano foi o provável mecanismo envolvido na produção dessas alterações, ilustrando a importância de manter um alto grau de suspeição clínica em pacientes com evento miocárdico inesperado em meio a uma crise hipertensiva.
Subject(s)
Humans , Female , Middle Aged , Adrenal Gland Neoplasms/diagnosis , Myocardial Infarction/diagnosis , Pheochromocytoma/diagnosis , Ventricular Dysfunction/diagnosis , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/therapy , Adrenergic alpha-Antagonists/therapeutic use , Diagnosis, Differential , Myocardial Infarction/etiology , Pheochromocytoma/complications , Pheochromocytoma/therapy , Ventricular Dysfunction/drug therapy , Ventricular Dysfunction/etiologyABSTRACT
OBJECTIVE: To assess the feasibility and safety of coronary interventions performed through the radial artery. METHODS: We studied 103 patients with ages from 38 to 86 years (57 + or -8.7), 90 (87 percent) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the Allen's test. RESULTS: The vascular approach was obtained in 97 (94 percent) patients, 88 (91 percent) treated electively and 9 (9 percent) during acute myocardial infarction, for primary angioplasty; 56 (64 percent) unstable angina; 22 (25 percent) stable angina; 10 (11 percent) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. We approached 107 arteries: anterior descending artery, 49 (46 percent); right coronary artery, 27 (25 percent); circumflex artery, 25 (23 percent); diagonal artery, 6 (6 percent); and 2 saphenous vein bypass grafts. We treated 129 lesions: 80 (62 percent) B2 type; 23 (18 percent) B1 type; 17 (13 percent) C type; and 9 (7 percent). A type. There were 70 stents , and 59 balloon angioplasties performed. Thirty-two (33 percent) patients used GP IIb/IIIa inhibitors. The mean duration of the elective procedure was 42.3Ý12.8 min. Success, correct stent deployment and residual lesion <20 percent, was reached in 100 percent of the lesions treated with stent implantation; arterial dilation with residual lesion <50 percent was obtained in 96 percent of the lesions treated with transluminal coronary angioplasty (TCA). Complications, were: 1 (1.0 percent) non-Q-wave acute myocardial infarction; 2 (2 percent) hematomas in the forearm; and 2 losses of radial pulse. CONCLUSION: Radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications
