RESUMO
Background: Pulmonary tumour embolism is a rare entity that can arise from a wide variety of neoplasms. It can initially manifest as a pulmonary embolism with right heart failure and be refractory to thrombolytic therapy. Cholangiocarcinoma is a rare malignancy that arises from the epithelium of the biliary tree, representing 3% of all the gastrointestinal malignancies, being the intrahepatic cholangiocarcinoma the second most common liver tumour after hepatocellular carcinoma. Case summary: This case regards a patient that presented to our centre with acute pulmonary embolism, deep vein thrombosis, and unrevealing previous medical history. Imaging studies revealed pulmonary embolism, an ovarian mass, and multiple hepatic hypodensities. Throughout the hospitalization, the patient's haemodynamic state and right heart failure worsened, eventually leading to multi-organ failure and death. Post-mortem evaluation revealed cholangiocarcinoma cells on the pulmonary arteries. Discussion: Pulmonary tumour embolism is a rare pathology that can present with acute right heart failure. The diagnosis of occult cancer can be challenging, and the appropriate treatment for this entity remains an unexplored subject.
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This study explored the effect of pterostilbene (PTS) complexed with hydroxypropyl-ß-cyclodextrin (HPßCD) on right heart function, glutathione and glutaredoxin systems, and the expression of redox-sensitive proteins involved with regulation calcium levels in the experimental model of pulmonary arterial hypertension (PAH) induced by monocrotaline (MCT). After 7 days of PAH induction, rats received daily doses of the PTS:HPßCD complex (corresponding to 25, 50, or 100 mg·kg-1 of PTS) or vehicle (control group, CTR0) (an aqueous solution containing HPßCD; CTR0 and MCT0 (MCT group that did not receive PTS treatment)) via oral administration for 2 weeks. The results showed that the PTS:HPßCD complex increased the content of reduced glutathione and the activity of glutathione-S-transferase and glutaredoxin in the right ventricle (RV) of MCT-treated rats in a dose-dependent manner. Additionally, at higher doses, it also prevented the reduction of stroke volume and cardiac output, prevented myocardial performance index (MPI) increase, reduced lipoperoxidation, reduced total phospholamban, and increased the expression of sarcoplasmic reticulum calcium ATPase in the RV of MCT-treated rats. These results demonstrate that the PTS:HPßCD complex has a dose-dependent antioxidant mechanism that results in improved cardiac function in experimental right heart failure. Our results open a field of possibilities to PTS administration as new therapeutic approach to conventional therapy for right ventricular dysfunction. Novelty Pterostilbene complexed with hydroxypropyl-ß-cyclodextrin could be a new therapeutic approach. Pterostilbene complexed with hydroxypropyl-ß-cyclodextrin reestablishes redox homeostasis through glutathione metabolism modulation, leading to an improved MPI in pulmonary arterial hypertension-provoked right heart failure.
Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Estresse Oxidativo , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/metabolismo , Estilbenos/uso terapêutico , 2-Hidroxipropil-beta-Ciclodextrina/uso terapêutico , Animais , Antioxidantes/farmacologia , Cálcio/metabolismo , Ecocardiografia , Glutationa/metabolismo , Ventrículos do Coração/efeitos dos fármacos , Hipertensão Pulmonar/induzido quimicamente , Peroxidação de Lipídeos , Masculino , Monocrotalina , Ratos , Ratos Wistar , Volume SistólicoRESUMO
BACKGROUND: Heart Failure (HF) patients developed changes in body composition as overhydration, muscle-skeletal wear and cardiac cachexia (CC). The possible factors involved in the development of CC in Right Heart Failure (RHF) patients are venous congestion, nutrient malabsorption. However, in HF, the overhydration obscure the loss of fat-free mass and difficult the body composition assessment. Bioelectrical impedance vectorial analysis (BIVA) is a method validated and used for hydration status and body composition assessment in HF. The aim of this study was to investigate the body compositions changes assessment by BIVA in the subjects with and without RHF and evaluate the risk factors for devolvement CC in HF subjects. MATERIAL AND METHODS: Prospective cohort study. Subjects with confirmed diagnoses of HF, >18 years old without CC according to BIVA criteria were included. Subjects with congenital heart disease, cancer, HIV, and end-stage renal disease were excluded. Body composition was an assessment by BIVA. 288 HF patients were evaluated. RHF subjects had an impedance vector reduction (9.26 dR/H and -1.92 dXc/H, T2=14.9, Dâ¯=â¯0.45, p<0.001), while subjects without RHF no-showed statistically significant changes (7.57 dR/H and 0.72 dXc/H, T2=3, Dâ¯=â¯0.17, pâ¯=â¯0.200). The risks factors to development CC were age, RHF, phase angle < 5°, total body water were risks factors while handgrip strength was a protector factor. CONCLUSIONS: RHF has greater disturbances in body composition and is a risk factor to development CC.
Assuntos
Composição Corporal , Caquexia/etiologia , Impedância Elétrica , Insuficiência Cardíaca/complicações , Adulto , Idoso , Estudos de Coortes , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desequilíbrio HidroeletrolíticoRESUMO
Resumen El ventrículo derecho, históricamente, ha sido en gran medida olvidado e y la gran mayoría de las técnicas diagnósticas,los abordajes terapéuticos y las investigaciones clínicas están dirigidas al ventrículo izquierdo. Con una anatomía y fisiologíamuy diferente a su contraparte izquierda, el ventrículo derecho dispone de limitadas opciones terapéuticas cuando éste falla, lo cual empeora enormemente el pronóstico del paciente. La presente revisión pretende hacer un análisis de la anatomía, fisiología, fisiopatología, estudios de imagen y tratamiento de la falla ventricular derecha con el fin de retomar su importancia en la cardiología actual.
Abstract The right ventricle has been, historically, largely forgotten and the vast majority of diagnostic techniques, therapeutic approaches and clinical research are directed to the left ventricle. With a very different anatomy and physiology from its left counterpart, the right ventricle has limited therapeutic options when it fails, which greatly worsens the patient's prognosis. The present review intends to analyze the anatomy, physiology, physiopathology, imaging studies and treatment of right ventricular failure in order to resume its importance in current cardiology.
Assuntos
Humanos , Disfunção Ventricular Direita , Costa Rica , Insuficiência Cardíaca , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/patologiaRESUMO
BACKGROUND: The prognosis in patients with Chronic Obstructive Pulmonary Disease (COPD) depends, in large part, on the frequency of exacerbations. Cardiovascular diseases, including heart failure (HF), are the risk factors for exacerbations. However, the importance of HF type over the exacerbations in COPD patients is unknown. OBJECTIVE: To determine whether right heart failure (RHF) is an independent risk factor for severe exacerbations in patients with COPD. METHODS: A prospective cohort study of 133 patients diagnosed with COPD with a follow-up period from 2010 to 2016. Patients with bronchial hyperreactivity, asthma, or pulmonary embolism were excluded. RESULTS: The mean age was 74.7 ± 8.2 years and 43.6% were men, 69.9% had severe exacerbations during follow-up. Subjects with RHF had lower FEV1 (50.2 ± 19.9 vs 57.4 ± 16.9, P = .006) and greater incidence of stroke (15.4% vs 1.8%, P = .009) compared to those without RHF. Subjects with RHF were at higher risk of severe exacerbations (HR, 2.46; CI 95%, 1.32-4.58, P = .005) compared to those without RHF after adjusting for confounding variables. CONCLUSION: In patients with COPD, RHF is an independent risk factor for suffering severe exacerbations.
Assuntos
Insuficiência Cardíaca/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Masculino , México/epidemiologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Volume Sistólico , Função Ventricular Direita/fisiologiaRESUMO
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition characterized by complex lesions of the lungs and other organs as well as a progressive obstruction of the airway. In COPD patients, heart failure (HF) is associated with worse conditions such as inflammation, arterial stiffness, and increased risk mortality. However, the association of HF, COPD, and stroke are unclear; the examination of the role of HF, especially right HF, about increased risk of stroke in COPD patients has not been studied. We aimed to determine if right HF is a risk factor for stroke in patients with COPD. MATERIALS AND METHODS: A case-control study of patients with COPD was carried out. The cases were defined as COPD patients with ischemic stroke and control COPD patients without stroke. RESULTS: A total of 162 patients with COPD were analyzed: COPD with stroke (n = 35) and COPD alone (n = 127). COPD patients with right HF were at a greater risk of stroke compared with patients without right HF (odds ratio 3.03, 95% confidence interval 1.13-10.12, p = .044) adjusted for confounding factors. CONCLUSIONS: Right HF is an independent risk factor for stroke, probably because of cerebrovascular stasis secondary to congestion of the superior vena cava.
Assuntos
Insuficiência Cardíaca/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Logísticos , Pulmão/fisiopatologia , Masculino , México/epidemiologia , Análise Multivariada , Razão de Chances , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Volume Sistólico , Função Ventricular DireitaRESUMO
La pericarditis constrictiva (PC) crónica es una entidad infrecuente, pero incapacitante y potencialmente fatal, cuyo diagnóstico supone un desafío para los facultativos. Su diagnóstico se basa en la existencia de una afectación hemodinámica, una fisiopatología de constricción y, en la mayoría de los casos, de un pericardio engrosado, y a menudo, también calcificado. La ecocardiografía es la técnica de elección y la más utilizada en la evaluación inicial de pacientes con sospecha de patología pericárdica, dado que, principalmente, permite determinar numerosos parámetros que demuestran la fisiopatología constrictiva. La pericardiectomía es el tratamiento de elección de la PC crónica con clínica persistente, siendo el pronóstico muy bueno si se realiza de forma precoz. Se reporta el caso de un varón de 72 años en el que, como ocurre con frecuencia, el diagnóstico y tratamiento de la PC sintomática se realizó tras numerosas visitas y exploraciones y en una fase avanzada de la enfermedad.
The chronic constrictive pericarditis (CP) is an uncommon, disabling and potentially fatal disease but whose diagnosis is a challenge for physicians. Diagnosis is based on the existence of hemodynamic compromise, pathophysiology constriction and, in most cases, a thickened pericardium and often also calcified. Echocardiography is the technique of choice and the most used in the initial evaluation of patients with suspected pericardial disease, because, mainly, to determine many parameters those demonstrate the constrictive pathophysiology. Pericardiectomy is the treatment of choice for chronic CP with persistent clinical, with very good prognosis if performed early. We report the case of a man of 72 years in which, as often happens, the diagnosis and treatment of CP was reached after numerous visits and examinations and in an advanced stage of the disease.
A pericardite constritiva (PC) crônica é uma doença rara, incapacitante e potencialmente fatal, mas cujo diagnóstico é um desafio para os médicos. O diagnóstico baseia-se na existência de um compromisso hemodinâmico, com uma fisiopatologia de constrição e ,na maioria dos casos, um pericárdio espessado e frequentemente também calcificado. O ecocardiograma é a técnica de escolha e os mais utilizados na avaliação inicial de pacientes com suspeita de doenças do pericárdio, pois principalmente, ajuda a determinar vários parâmetros que demonstram a fisiopatologia constritiva. A pericardiectomia é o tratamento de escolha para a PC crônica com clínica persistente, e o prognóstico é muito bom se for feito precocemente. Relatamos o caso de um homem de 72 anos em que, como muitas vezes acontece, o diagnóstico e tratamento da PC foi alcançado após inúmeras visitas e exames e em um estágio avançado da doença.
RESUMO
La pericarditis constrictiva (PC) crónica es una entidad infrecuente, pero incapacitante y potencialmente fatal, cuyo diagnóstico supone un desafío para los facultativos. Su diagnóstico se basa en la existencia de una afectación hemodinámica, una fisiopatología de constricción y, en la mayoría de los casos, de un pericardio engrosado, y a menudo, también calcificado. La ecocardiografía es la técnica de elección y la más utilizada en la evaluación inicial de pacientes con sospecha de patología pericárdica, dado que, principalmente, permite determinar numerosos parámetros que demuestran la fisiopatología constrictiva. La pericardiectomía es el tratamiento de elección de la PC crónica con clínica persistente, siendo el pronóstico muy bueno si se realiza de forma precoz. Se reporta el caso de un varón de 72 años en el que, como ocurre con frecuencia, el diagnóstico y tratamiento de la PC sintomática se realizó tras numerosas visitas y exploraciones y en una fase avanzada de la enfermedad.(AU)
The chronic constrictive pericarditis (CP) is an uncommon, disabling and potentially fatal disease but whose diagnosis is a challenge for physicians. Diagnosis is based on the existence of hemodynamic compromise, pathophysiology constriction and, in most cases, a thickened pericardium and often also calcified. Echocardiography is the technique of choice and the most used in the initial evaluation of patients with suspected pericardial disease, because, mainly, to determine many parameters those demonstrate the constrictive pathophysiology. Pericardiectomy is the treatment of choice for chronic CP with persistent clinical, with very good prognosis if performed early. We report the case of a man of 72 years in which, as often happens, the diagnosis and treatment of CP was reached after numerous visits and examinations and in an advanced stage of the disease.(AU)
A pericardite constritiva (PC) cr¶nica é uma doenþa rara, incapacitante e potencialmente fatal, mas cujo diagnóstico é um desafio para os médicos. O diagnóstico baseia-se na existÛncia de um compromisso hemodinÔmico, com uma fisiopatologia de constriþÒo e ,na maioria dos casos, um pericárdio espessado e frequentemente também calcificado. O ecocardiograma é a técnica de escolha e os mais utilizados na avaliaþÒo inicial de pacientes com suspeita de doenþas do pericárdio, pois principalmente, ajuda a determinar vários parÔmetros que demonstram a fisiopatologia constritiva. A pericardiectomia é o tratamento de escolha para a PC cr¶nica com clínica persistente, e o prognóstico é muito bom se for feito precocemente. Relatamos o caso de um homem de 72 anos em que, como muitas vezes acontece, o diagnóstico e tratamento da PC foi alcanþado após inúmeras visitas e exames e em um estágio avanþado da doenþa.(AU)
RESUMO
JUSTIFICATIVA E OBJETIVOS: O hipertireoidismo é considerado uma causa rara de hipertensão arterial pulmonar isolada. Evidências recentes, entretanto, sugerem ser esta associação frequente, porém subdiagnosticada. O objetivo deste estudo foi apresentar um caso de hipertensão arterial pulmonar (HP) isolada, com falência ventricular direita, secundária ao hipertireoidismo, reversível após o restabelecimento do estado eutireoideo. RELATO DO CASO: Paciente do sexo feminino, 60 anos, previamente hígida, apresentando dispneia aos esforços, emagrecimento, palpitações, ascite e congestão periférica de início há um ano. As avaliações clínicas e os exames complementares evidenciaram HP (pressão arterial sistólica pulmonar = 60-65 mmHg), falência ventricular direita com hipertensão porta supra-hepática e fibrilação atrial. Foram afastadas inicialmente as principais causas secundárias de HP, incluindo cardiopatias esquerdas, pneumopatias, eventos tromboembólicos, colagenoses, drogas, toxinas e doenças infecciosas. Hipertireoidismo foi diagnosticado e iniciado tratamento com propiltiouracil. Após restabelecimento do eutireoidismo, houve importante melhora clínica, com redução gradual e significativa da pressão arterial pulmonar e resolução da congestão periférica. Após um ano de acompanhamento, foi realizado um novo ecocardiograma com a paciente em eutireoidismo que demonstrou recuperação da função cardíaca direita e pressão arterial pulmonar = 37 mmHg, tendo ocorrido reversão do quadro de HP. CONCLUSÃO: A descrição deste caso e a revisão da literatura visam salientar que a associação entre HP e hipertireoidismo é frequente e potencialmente reversível. Dessa forma, a avaliação da função tireoidiana deveria ser incluída rotineiramente na investigação inicial dos casos de hipertensão pulmonar.
BACKGROUND AND OBJECTIVES: Hyperthyroidism is considered a rare cause of isolated pulmonary arterial hypertension. However, recent data suggests that it may be a frequent finding in thyrotoxicosis, normally under diagnosed. The aim of this study was to describe a case of pulmonary hypertension and right heart failure secondary to hyperthyroidism, reversible after euthyroidism achievement. CASE REPORT: A 60 years-old female patient presented with exertion dyspnea, weight lost, palpitations, ascites and peripheral edema for one year. Clinical evaluation demonstrated atrial fibrillation and pulmonary hypertension (pulmonary arterial pressure of 60-65 mmHg), with right heart failure and supra-hepatic portal hypertension. Initial work up for the common secondary causes of pulmonary hypertension was negative, including causes of left heart disease, pulmonary disorders, tromboembolic events, collagen vascular disease, drugs, toxins and infectious diseases. Hyperthyroidism was diagnosed and propylthiouracil was initiated. After euthyroid state was achieved, there was a significant progressive reduction of pulmonary arterial pressure and clinical resolution peripheral edema. After one year of follow-up, an echocardiography was performed with the patient in euthyroidism and demonstrated resolution of right heart failure and pulmonary arterial pressure of 37 mmHg, with resolution of pulmonary hypertension. CONCLUSION: This case report and literature review gave further evidence that the association of pulmonary hypertension and hyperthyroidism is frequent and potentially reversible. Thus, thyroid function should be routinely evaluated in the initial investigation of all pulmonary hypertension cases.