RESUMO
This case report describes the devastating consequences of spontaneous coronary dissection in a 36-year-old female patient. Surgical revascularization was attempted, but diffuse myocardial infarction developed. The patient was bridged to heart transplantation but died secondary to multiple organ failure. To our knowledge, this is the only reported case of spontaneous dissection of the three main coronary arteries due to severe cystic medial necrosis.
Assuntos
Doenças do Tecido Conjuntivo/complicações , Vasos Coronários/patologia , Infarto do Miocárdio/etiologia , Adulto , Doenças do Tecido Conjuntivo/patologia , Angiografia Coronária , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Necrose , Ruptura EspontâneaRESUMO
This paper reports on a fatal intoxication by oral ingestion of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). At admission, the victim was unconscious. His condition deteroriated rapidly with blood loss from his mouth and nose. Since the cause of this condition was not known, gastroscopy was performed and haemorrhagic mucosa was observed in the mouth, oesophagus and stomach. Gastric contents (removed by lavage), urine and blood were submitted for toxicological analysis. Unfortunately, within 3 h of admission (about 5 h following ingestion of the toxin) profound cardiogenic shock developed and the patient died. The identity of the toxic xenobiotic was revealed by gas chromatography-mass spectrometry. Analytical quantification of the herbicide was performed by acid extraction prior to gas chromatographic examination using electron capture detection. His blood level of 2,4-D was 192 mg l-1.
