RESUMO
A 56 year old man presented with an atypical chest infection. Remote inferoposterior myocardial infarction was noted on electrocardiography and transthoracic echocardiography. Hepatic failure developed with sudden gross elevation of liver aminotransferases and coagulopathy. No primary hepatic cause could be identified. Subsequent right heart failure led to transoesophageal echocardiography that revealed a large inoperable ventricular septal defect. Histopathological data showed ischaemic hepatitis and reinfarction of the inferoposterior myocardial wall. Acute cardiac events may be silent and precipitate misleading severe hepatic dysfunction.
Assuntos
Ruptura Cardíaca Pós-Infarto/complicações , Falência Hepática Aguda/complicações , Transtornos da Coagulação Sanguínea/etiologia , Ecocardiografia Transesofagiana , Eletrocardiografia , Evolução Fatal , Insuficiência Cardíaca/etiologia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To examine the serial use of magnetic resonance imaging (MRI) to evaluate regional myocardial perfusion changes following percutaneous coronary angioplasty and stent implantation (PTCA). MATERIALS AND METHODS: Six patients with single vessel coronary artery disease (CAD) underwent contrast-enhanced first pass MRI immediately prior to (visit A) and within 7 days after (visit B) PTCA. Three sequential short axis slices were obtained after gadodiamide (Gd) bolus (0.025 mmol/kg(-1)) at rest and during adenosine. Each short axis was divided radially into eight regions of interest (ROIs). ROIs were anatomically assigned to a coronary artery territory (CAT). Stress and rest qualitative and quantitative (unidirectional extraction fraction constant (K(i)); index of myocardial perfusion reserve (MPRI) = stressK(i) / restK(i)) perfusion parameters were determined for ROI supplied by remote and stenosed/stented vessels for each visit. RESULTS: In stented ROIs the number of ROIs demonstrating normal perfusion, as opposed to reversible perfusion deficits, increased. Qualitative perfusion assessment in remote CATs was unchanged. MPRI in stenotic CATs was lower than in remote CATs at visit A (P < 0.001). Following PTCA, MPRI increased in stented CATs (P < 0.001) but was unchanged in remote CATs. CONCLUSION: Restoration of myocardial perfusion following PTCA can be delineated with qualitative and quantitative perfusion MRI. Although at present the investigation is technically complex and not perfectly sensitive or specific, MRI has the potential to be a valuable tool for patient follow-up and evaluation of revascularization strategy efficacy.
Assuntos
Angioplastia Coronária com Balão , Circulação Coronária , Doença das Coronárias/terapia , Imageamento por Ressonância Magnética/métodos , Stents , Adulto , Idoso , Meios de Contraste , Doença das Coronárias/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do TratamentoRESUMO
The authors developed and tested a dual stress magnetic resonance (MR) imaging protocol to evaluate myocardial perfusion, function, and hibernation. The technique was well tolerated, and high-quality images were achieved. The comprehensive information obtained can be used to guide clinical management decisions regarding coronary artery revascularization procedures. This protocol offers a one-stop assessment of patients with coronary artery disease with use of a clinical MR imager.
Assuntos
Circulação Coronária/fisiologia , Doença das Coronárias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Contração Miocárdica/fisiologia , Miocárdio Atordoado/diagnóstico , Adenosina , Agonistas Adrenérgicos beta , Meios de Contraste/administração & dosagem , Angiografia Coronária , Doença das Coronárias/fisiopatologia , Doença das Coronárias/terapia , Apresentação de Dados , Tomada de Decisões , Dobutamina , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Aumento da Imagem/métodos , Injeções Intravenosas , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Revascularização Miocárdica , Variações Dependentes do Observador , Planejamento de Assistência ao Paciente , Vasodilatadores , Função Ventricular Esquerda/fisiologiaRESUMO
A case of dothiepin poisoning complicated by cardiogenic shock is described. Hypotension was resistant to conventional inotropes but responded rapidly to high-dose intravenous glucagon. Glucagon should be considered as a useful therapeutic positive inotrope and a potentially antiarrhythmic agent in severe tricyclic antidepressant overdose.
