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Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.
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<p><b>OBJECTIVE</b>To observe the association between ambulatory blood pressure levels and blood pressure variability (BPV) with myocardial performance index (MPI) in untreated hypertensive patients.</p><p><b>METHODS</b>From January to September 2013, a total of 81 untreated hypertensive patients were included in this study. All patients received ambulatory blood pressure monitoring and echocardiography measurements. MPI was determined in all patients by the following formula: MPI = (isovolumic contraction time + isovolumic relaxation time)/ejection time. The patients were divided into two groups according to left ventricular MPI: patients with MPI < 0.47 (n = 39) and patients with MPI ≤ 0.47 (n = 42). The mean levels and standard deviation (SD) of 24 h, daytime and nighttime blood pressures were compared between the two groups. SD was used to express BPV. Determinants of MPI were identified by multivariate regression analysis.</p><p><b>RESULTS</b>24 h and daytime systolic blood pressure, 24 h, daytime and nighttime diastolic blood pressure, as well as SD of 24 h and daytime systolic blood pressure ((130.1±8.7), (134.0±8.2), (89.1±6.3), (90.9±6.4), (83.1±9.9), (13.7±3.3) and (14.2±3.5) mmHg (1 mmHg = 0.133 kPa), respectively) were significantly higher in patients with MPI > 0.47 than those ((124.8±8.7), (126.7±8.8), (84.5±7.1), (86.2±7.4), (76.4±7.5), (11.8±2.1) and (10.4±1.9) mmHg, respectively) in patients with MPI ≤ 0.47 (all P < 0.05). Multivariate regression analysis showed that 24 h diastolic blood pressure (β = 0.239, P = 0.007) and SD of 24 h systolic blood pressure (β = 0.333, P < 0.001), left ventricular mass index and early diastolic mitral annular velocity were independently associated with MPI.</p><p><b>CONCLUSION</b>The increase of diastolic blood pressure and systolic BPV are associated with the deterioration of left ventricular function.</p>
Assuntos
Humanos , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Diástole , Ecocardiografia , Ventrículos do Coração , Hipertensão , Valva Mitral , Função Ventricular EsquerdaRESUMO
Objective To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Methods Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n =40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated.Results Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E:(0. 88 ±0. 18)cm/s vs (0. 76 ±0. 19) cm/s;E/A ratio:0. 86 ±0. 28 vs 1.02 ±0. 38;Em: (9. 4 ±2. 8)cm/s vs (11. 9 ±3. 8)cm/s;E/Em ratio;7. 9 ± 2. 7 vs 6. 0 ± 1. 8: with all P value ＜0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em; (7.7 ±2. 6) cm/s vs (9. 9 ± 2. 8) cm/s, E/Em: 9. 6 ± 3. 6 vs 7. 4 ± 2. 4, P ＜ 0. 05]. No significant difference was found in A and E/A between these two subgroups [(0. 90 ± 0. 22) cm/s vs (0. 87 ± 0. 17) cm/s; 0. 80 ± 0. 34 vs 0.88 ±0.28, P ＞ 0.05]. Conclusions cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em、E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.
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Objective:To analyze the clinical and echocardiographic features of constrictive pericarditis. Methods: Thirty-six patients diagnosed as having constrictive pericarditis from Oct. 1989 to Jun. 2007 were enrolled in this retrospective study. Clinical manifestations and echocardiographic features were analyzed. Results: The main clinical manifestations were fatigue, effort dyspnea(100%), and sign of pressure elevation of vena cava(97%). Echocardiographic features included thickening of pericardium(67%), abnormal motion of septal and posterior wall of left ventricle in diastole(83%,75% respectively), left and right atrial enlargement(92%,39% respectively), early filling changes of mitral flow with respiration(93%), inferior vena cava dilation and without respiration variation(100%), mitral annulus paradoxical enhanced motion in early diastole. Conclusion: Clinical manifestations of pressure elevation of vena cava were indicators for diagnosis of constrictive pericarditis. Echocardiography could be a valuable method for confirming the diagnosis.
