Background. Thrombolysis is often the only way in treating people with life-threatening conditions, like acute myocardial infarction (AMI), pulmonary embolism (PE) and acute ischemic stroke (AIS). Complications of thrombolytic therapy are not rare and have clear influence in the quality of life, hospital stay, outcomes and mortality. Most common complications are intracranial hemorrhage, severe injection site, nose, vaginal bleeding and peripheral hematomas.Methods and materials. A retrospective study took place in the Department of Intensive Care, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Medical data of 83 patients, who underwent treatment with thrombolytic drugs in the period of 2007-2011, were analyzed. All patients were treated with intravenous infusion of Alteplase.Inclusion criteria were as follows:• AMI, AIS or PE treatable with thrombolytic therapy. Results. 72.3% (n = 60) of patients experienced massive PE, 13.3% (n = 11) AMI and 14.4% (n = 12) AIS. There were 8.43% (n = 7) of patients who had bleeding complications -2.4% (n = 2) experienced nose bleed during or shortly after thrombolytic therapy, 3.6% (n = 3) had injection site bleeding and 1.2% (n = 1) experienced multiple skin hemorrhages. 11.7% (n = 7) of patients in the group of massive PE were thrombolised during CPR and only one of them experienced bleeding to the pleural cavity. There were no internal or external bleeding observed neither in AMI nor in AIS groups. In-hospital mortality after thrombolytic therapy was 20.5% (n = 17).Conclusions. Thrombolytic therapy very often is the only way in treating acute, life-threatening diseases, like acute myocardial infarction, pulmonary embolism or acute ischemic stroke.Intracranial hemorrhage, injection site, nose, vaginal bleeding and peripheral hematomas are the most common complications of thrombolysis.Risk factors should be evaluated before starting the thrombolytic therapy.Data of our hospital experience do not dramatically differ from worldwide data.
IntroductionPheochromocytoma is a rare and usually benign catecholamine-secreting tumor with a broad variety of signs and symptoms, the most common being palpitations, headaches, and sweating. Rarely, pheochromocytoma can cause severe cardiac complications such as myocardial infarction, pulmonary edema or cardiogenic shock.Case reportWe report a case of a 42-year-old male who presented with acute chest pain, dyspnea, and general weakness. He had a history of episodical high blood pressure and panic attacks, which were unsuccessfully treated with antidepressants. The patient developed a severe left ventricular function impairment with pulmonary edema and cardiogenic shock. Coronary angiography showed a spasm of the right coronary artery. We suspected pheochromocytoma and performed computed tomography ofthe abdomen, which showed a large tumor in the right adrenal gland. It was confirmed to be a pheochromocytoma. The patient was treated with α-blockers, and a successful laparoscopic surgical removal of the pheochromocytoma was carried outeighteen days later. The patient recovered well, and symptoms of pheochromocytoma disappeared.ConclusionPheochromocytoma can cause severe cardiac complications in different mechanisms, such as coronary spasm and direct catecholamine toxic effect on cardiomyocites. Diagnosing and treating pheochromocytoma with cardiac complications remainsa challenge for a physician.Key words: pheochromocytoma, hypertension, acute myocardial infarction, catecholamine-induced cardiomyopathyFeochromocitoma: širdies ir kraujagyslių sistemos komplikacijos ĮvadasFeochromocitoma yra retas dažniausiai nepiktybinis katecholaminus sekretuojantis navikas, kuriam būdinga didelė simptomų įvairovė. Širdies plakimo jausmas, galvos skausmas bei gausus prakaitavimas – būdingiausi pacientų skundai. Retaisatvejais feochromocitoma komplikuojasi gyvybei grėsmingomis širdies ir kraujagyslių sistemos ligomis – miokardo infarktu, plaučių edema bei kardiogeniniu šoku.Klinikinis atvejisĮ priėmimo skyrių atvykęs 42 metų amžiaus vyras skundėsi intensyviu krūtinės skausmu, dusuliu ir bendru silpnumu. Pastaruoju metu pacientas buvo nesėkmingai gydomas antidepresantais dėl besikartojančių panikos atakų, kurių metu padidėdavoarterinis kraujospūdis. Priėmimo skyriuje paciento būklė sparčiai blogėjo, progresavo ūminis kairiojo skilvelio nepakankamumas, išsivystė plaučių edema bei kardiogeninis šokas. Atlikus vainikinių arterijų angiografiją, pastebėtas dešiniosios vainikinės arterijos distalinės dalies spazmas. Įtarus feochromocitomą, buvo atlikta pilvo kompiuterinė tomografija – rastas didelis navikas kairiajame antinkstyje. Laboratoriniais tyrimais patvirtinta feochromocitomos diagnozė. Aštuoniolika dienų pacientas buvo gydytas α-blokatoriais, vėliau sėkmingai atlikta naviko šalinimo operacija. Pooperaciniu laikotarpiu komplikacijų nebuvo, feochromocitomos simptomai išnyko.IšvadosFeochromocitoma gali sukelti sunkių širdies ir kraujagyslių sistemos komplikacijų dėl įvairių katecholaminų pertekliaus poveikio mechanizmų. Aprašytu atveju tai buvo vainikinių arterijų spazmas bei tiesioginis toksinis katecholaminų poveikis kardiomiocitams. Labai didelė nespecifinių simptomų įvairovė bei galimos sunkios komplikacijos lemia tai, kad feochromocitomos diagnostika bei gydymas tebėra nelengvas iššūkis gydytojui.Reikšminiai žodžiai: feochromocitoma, hipertenzija, ūmus miokardo infarktas, katecholaminų sukelta kardiomiopatija.
IntroductionPheochromocytoma is a rare and usually benign catecholamine-secreting tumor with a broad variety of signs and symptoms, the most common being palpitations, headaches, and sweating. Rarely, pheochromocytoma can cause severe cardiac complications such as myocardial infarction, pulmonary edema or cardiogenic shock.Case reportWe report a case of a 42-year-old male who presented with acute chest pain, dyspnea, and general weakness. He had a history of episodical high blood pressure and panic attacks, which were unsuccessfully treated with antidepressants. The patient developed a severe left ventricular function impairment with pulmonary edema and cardiogenic shock. Coronary angiography showed a spasm of the right coronary artery. We suspected pheochromocytoma and performed computed tomography ofthe abdomen, which showed a large tumor in the right adrenal gland. It was confirmed to be a pheochromocytoma. The patient was treated with α-blockers, and a successful laparoscopic surgical removal of the pheochromocytoma was carried outeighteen days later. The patient recovered well, and symptoms of pheochromocytoma disappeared.ConclusionPheochromocytoma can cause severe cardiac complications in different mechanisms, such as coronary spasm and direct catecholamine toxic effect on cardiomyocites. Diagnosing and treating pheochromocytoma with cardiac complications remainsa challenge for a physician.Key words: pheochromocytoma, hypertension, acute myocardial infarction, catecholamine-induced cardiomyopathyFeochromocitoma: širdies ir kraujagyslių sistemos komplikacijos ĮvadasFeochromocitoma yra retas dažniausiai nepiktybinis katecholaminus sekretuojantis navikas, kuriam būdinga didelė simptomų įvairovė. Širdies plakimo jausmas, galvos skausmas bei gausus prakaitavimas – būdingiausi pacientų skundai. Retaisatvejais feochromocitoma komplikuojasi gyvybei grėsmingomis širdies ir kraujagyslių sistemos ligomis – miokardo infarktu, plaučių edema bei kardiogeniniu šoku.Klinikinis atvejisĮ priėmimo skyrių atvykęs 42 metų amžiaus vyras skundėsi intensyviu krūtinės skausmu, dusuliu ir bendru silpnumu. Pastaruoju metu pacientas buvo nesėkmingai gydomas antidepresantais dėl besikartojančių panikos atakų, kurių metu padidėdavoarterinis kraujospūdis. Priėmimo skyriuje paciento būklė sparčiai blogėjo, progresavo ūminis kairiojo skilvelio nepakankamumas, išsivystė plaučių edema bei kardiogeninis šokas. Atlikus vainikinių arterijų angiografiją, pastebėtas dešiniosios vainikinės arterijos distalinės dalies spazmas. Įtarus feochromocitomą, buvo atlikta pilvo kompiuterinė tomografija – rastas didelis navikas kairiajame antinkstyje. Laboratoriniais tyrimais patvirtinta feochromocitomos diagnozė. Aštuoniolika dienų pacientas buvo gydytas α-blokatoriais, vėliau sėkmingai atlikta naviko šalinimo operacija. Pooperaciniu laikotarpiu komplikacijų nebuvo, feochromocitomos simptomai išnyko.IšvadosFeochromocitoma gali sukelti sunkių širdies ir kraujagyslių sistemos komplikacijų dėl įvairių katecholaminų pertekliaus poveikio mechanizmų. Aprašytu atveju tai buvo vainikinių arterijų spazmas bei tiesioginis toksinis katecholaminų poveikis kardiomiocitams. Labai didelė nespecifinių simptomų įvairovė bei galimos sunkios komplikacijos lemia tai, kad feochromocitomos diagnostika bei gydymas tebėra nelengvas iššūkis gydytojui.Reikšminiai žodžiai: feochromocitoma, hipertenzija, ūmus miokardo infarktas, katecholaminų sukelta kardiomiopatija.
Coronary endothelial dysfunction is known to be related with adverse cardiovascular outcome. We obtained a long-term follow-up of patients without significant coronary atherosclerosis, complaining of chest pain, in whom intra-coronary acetylene testing was performed in order to assess endothelial function. The study included 41 patient (35 with endothelial dysfunction, 6 with preserved endothelial function). Events considered as adverse outcome were cardiovascular death, acute myocardium-dial infarction, unstable angina pectoris, percutaneous coronary intervention, coronary-aortic by-pass grafting, ischemic stroke and peripheral artery re-vascularization. A high cardiovascular event rate was observed in patients with and without endothelial dysfunction, 34,3% and 50% respectively. Adverse outcome was related not only to endothelial dysfunction but also to traditional cardiovascular risk factors. Thus, evaluation of endothelial function or its determinants seems to be helpful in identifying a subgroup of patients at high risk.
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