RESUMEN
A 41-year-old male was admitted to our hospital with congestive heart failure and bronchopneumonia. During hospitalization extreme sinus bradycardia, sinus arrest up to 6.2 seconds and high grade AV block were observed to occur simultaneously with apneic episodes of ECG monitoring. After that, a diagnosis of Pickwickian syndrome was made in this obese patient. In spite of weight reduction, change of sleep position and acetazolamide administration, obstructive sleep apnea and severe bradyarrhythmias were not improve. These severe bradyarrhythmias and ventricular tachyarrhythmias may be one cause of the not infrequent sudden deaths in patients with this Pickwickian syndrome. In addition to the tracheostomy, we propose that implantation of a cardiac permanent pacemaker should be selected for the bradyarrhythmias in association with the Pickwickian syndrome.
Asunto(s)
Estimulación Cardíaca Artificial , Síndrome de Hipoventilación por Obesidad/terapia , Adulto , Análisis de los Gases de la Sangre , Electrocardiografía , Humanos , Masculino , Síndrome de Hipoventilación por Obesidad/diagnóstico , TraqueostomíaAsunto(s)
Envejecimiento , Presión Sanguínea , Hemodinámica , Hipertensión/fisiopatología , Adulto , Anciano , Diástole , Humanos , Persona de Mediana Edad , SístoleAsunto(s)
Ecocardiografía , Hemodinámica , Hipertensión/fisiopatología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A Bjork-Shiley mitral valve prosthesis had to be replaced 4 years after implantation because of disc entrapment by an over-grown fibrous tissue on its sewing cuff. This abnormal fibrous tissue was found out to be an organizing platelet-fibrin deposit, of which luminal surface was only incompletely endothelialized. It is indicated that the heart valve prosthesis generally remains non-endothelialized for a prolonged period of time after implantation in man. Anticoagulation therapy should thus be given throughout the postoperative period for patients with the heart valve prosthesis.
Asunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral/cirugía , Trombosis/etiología , Adulto , Plaquetas/patología , Endotelio/fisiología , Femenino , Fibrina/análisis , Humanos , Válvula Mitral/patología , Complicaciones Posoperatorias , Trombosis/patologíaRESUMEN
35 patients with chronic renal failure were examined during the first 2 h of hemodialysis by invasive and non-invasive methods. The cardiac output was determined by the dye dilution technique in 11 of these patients and by Swan-Ganz catheterization in 5. In the patients without severe myocardial damage, the cardiac output during hemodialysis showed a significant increase (p less than 0.05), accompanied by a significant decrease of both mean blood pressure (p less than 0.05) and total peripheral resistance (p less than 0.05). Mean pulmonary artery pressure and pulmonary artery wedge pressure were reduced in all cases during hemodialysis. The increase in cardiac output during hemodialysis in patients with chronic renal failure may be attributed to the decrease in afterload.