RESUMO
OBJECTIVES: Hypermetabolic state in Graves' disease (GD) has a great impact on heart homeostasis, acting directly on the heart muscle and modulating the autonomic nervous system. To characterize cardiac autonomic neuropathy (CAN) as a possible complication in patients with GD. METHODS: We evaluated euthyroid GD patients and a control group of healthy euthyroid people. CAN was assessed using autonomic tests of cardiovascular reflex and heart rate variability: respiratory, Valsalva, orthostatic and orthostatic hypotension tests, high frequency, low frequency, and very low-frequency bands. Transthoracic echocardiography was performed in GD patients. RESULTS: Sixty GD patients and 50 people in control group were assessed. CAN was diagnosed in 20% of GD and 14% in the control group. Among GD, 13.3% presented incipient, and 6.7% established CAN, while in the control group, it was verified incipient in 8% and established in 6% (P = .7479). All GD patients with CAN presented an alteration in the deep breathing test. Age and smoking were evidenced as factors associated with the presence of CAN, while higher TRAb values at diagnosis decreased the chance of CAN. CONCLUSIONS: The prevalence of CAN in euthyroid GD patients was 20%. Changes in the cardiac autonomic nervous system were identified, pointing to the importance of evaluating this complication in these patients. Smoking was a predictive factor for CAN, increasing its relationship with conditions that aggravate GD.
Assuntos
Doenças do Sistema Nervoso Autônomo , Doença de Graves , Fumar , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Doença de Graves/complicações , Doença de Graves/epidemiologia , Doença de Graves/fisiopatologia , Doenças do Sistema Nervoso Autônomo/epidemiologia , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores Etários , Frequência Cardíaca/fisiologia , Estudos de Casos e Controles , Idoso , Cardiopatias/etiologia , Cardiopatias/epidemiologiaRESUMO
Angioedema is a rare reaction to streptokinase, acute and potentially fatal, which should be quickly diagnosed and treated to guarantee the best prognosis for the patient. We describe here the case of a 65-year-old man, who displayed an anaphylactic reaction after the beginning of thrombolysis with streptokinase, which was quickly treated, and remained hospitalized for one week in the Intensive Care Unit.
Assuntos
Angioedema/induzido quimicamente , Fibrinolíticos/efeitos adversos , Estreptoquinase/efeitos adversos , Idoso , Angioedema/diagnóstico , Angioedema/terapia , Eletrocardiografia , Humanos , MasculinoRESUMO
O angioedema é uma reacão rara, aguda e potencialmente fatal, à estreptoquinase, devendo ser diagnosticada prontamente e tratada para garantir melhor prognóstico ao paciente. Descrevemos aqui o caso de um homem de 65 anos, que apresentou reacão anafilática após o início de trombólise com estreptoquinase, sendo rapidamente tratado, permaneceu uma semana internado em Unidade de Terapia Intensiva.