RESUMO
CONTEXT: Dilated cardiomyopathy is a significant health problem in Africa. Diagnosis and treatment can be challenging as it frequently affects young patients and those without risk factors for cardiac disease. ISSUE: A previously well HIV negative 17 year old boy presented to Mseleni hospital in December 2011 with a short history of worsening shortness of breath on exertion. The history had been preceded by a brief upper respiratory tract infection with general malaise and headache, from which he had recovered fully. On examination, he was clammy, peripherally shut down and clearly in respiratory distress. He had a raised jugular venous pressure (JVP) and palpable displaced apex beat. He had a loud P2, third heart sound and pansystolic murmur over the apex. He had scattered inspiratory crepitations bibasally. Routine blood tests on admission, including malaria and viral serology, were unremarkable. A chest x-ray showed a grossly dilated cardiac shadow and enlarged pulmonary trunk. A cardiac ultrasound ruled out pericardial effusion but did show a dilated and hypokinetic left ventricle. He was diagnosed with dilated cardiomyopathy secondary to a viral infection and managed accordingly. LESSONS LEARNED: Dilated cardiomyopathy, although rare worldwide, is a significant problem throughout Africa. It has been shown to account for up to 48% of admissions with heart failure. Its aetiology is multifactorial and includes exposure to toxins and infectious agents. Presenting symptoms can be vague but improved prognosis and outcomes require prompt diagnosis and appropriate management.
Assuntos
Cardiomiopatia Dilatada/terapia , Adolescente , África , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/diagnóstico por imagem , Pressão Venosa Central/fisiologia , Testes Diagnósticos de Rotina , Hospitais Rurais/normas , Humanos , Veias Jugulares/fisiopatologia , Masculino , Anamnese , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Admissão do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Síndrome do Desconforto Respiratório/complicações , Fatores de Risco , Ultrassonografia , Recursos HumanosRESUMO
Gastro intestinal Stromal Tumours (GISTs) are a rare neoplasm of the gastrointestinal tract. They often grow silently and present late when surgical cure is not possible. Chemo and radiotherapy have a very poor success rate. We present a case of successful surgical removal of a gastrointestinal stromal tumour in a patient who presented with GI bleeding and a recurrent microcytic anaemia.
