RESUMEN
We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.
Asunto(s)
Análisis de los Gases de la Sangre/métodos , Venas Yugulares , Respiración con Presión Positiva , Venas Pulmonares/anomalías , Diálisis Renal/instrumentación , Malformaciones Vasculares/diagnóstico por imagen , Catéteres , Angiografía por Tomografía Computarizada/métodos , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Venas Pulmonares/diagnóstico por imagen , Diálisis Renal/métodosRESUMEN
INTRODUCTION: The obesity paradox in chronic obstructive pulmonary disease (COPD), whereby patients with higher body mass index (BMI) fare better, is poorly understood. Higher BMIs are associated with lower lung volumes and greater lung elastic recoil, a key determinant of expiratory airflow. The forced expiratory flow (25-75) (FEF25-75)/forced vital capacity (FVC) ratio reflects effort-independent expiratory airflow in the context of lung volume and could be modulated by BMI. METHODS: We analysed data from the COPDGene study, an observational study of 10 192 subjects, with at least a 10 pack-year smoking history. Data were limited to subjects with BMI 20-40 kg/m2 (n=9222). Subjects were stratified according to forced expiratory volume in 1 s (FEV1) (%predicted)-quintiles. In regression analyses and Cox proportional hazard models, we analysed the association between BMI, the FEF25-75/FVC ratio, the imaging phenotype, COPD exacerbations, hospitalisations and death. RESULTS: There was no correlation between BMI and FEV1(%predicted). However, a higher BMI is correlated with a higher FEF25-75/FVC ratio. In CT scans, a higher BMI was associated with less emphysema and less air trapping. In risk-adjusted models, the quintile with the highest FEF25-75/FVC ratio was associated with a 46% lower risk of COPD exacerbations (OR 0.54, p<0.001) and a 40% lower risk of death (HR 0.60, p=0.02), compared with the lowest quintile. BMI was not independently associated with these outcomes. CONCLUSIONS: A higher BMI is associated with lower lung volumes and higher expiratory airflows when normalised for lung volume, as quantified by the FEF25-75/FVC ratio. A higher FEF25-75/FVC ratio is associated with a lower risk of COPD exacerbations and death and might quantify functional aspects of the paradoxical effect of higher BMIs on COPD.
Asunto(s)
Cuerpos Extraños/etiología , Intubación Intratraqueal/efectos adversos , Avulsión de Diente/etiología , Traumatismos de los Dientes/complicaciones , Tráquea , Cuerpos Extraños/diagnóstico , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Radiografía Torácica , Insuficiencia Respiratoria/terapia , Traumatismos de los Dientes/diagnósticoAsunto(s)
Anomalías Múltiples/diagnóstico , Cardiopatías Congénitas/diagnóstico , Defectos del Tabique Interatrial/diagnóstico , Deformidades Congénitas de las Extremidades Inferiores/diagnóstico , Deformidades Congénitas de las Extremidades Superiores/diagnóstico , Anomalías Múltiples/patología , Cardiopatías Congénitas/patología , Defectos del Tabique Interatrial/patología , Humanos , Deformidades Congénitas de las Extremidades Inferiores/patología , Masculino , Articulación Metacarpofalángica/anomalías , Articulación Metacarpofalángica/patología , Persona de Mediana Edad , Deformidades Congénitas de las Extremidades Superiores/patologíaRESUMEN
This case report reviews the ECG manifestations of chronic obstructive pulmonary disease (COPD). Distinct changes of the P-wave axis, QRS axis and morphology are a direct result of the pathophysiological and anatomical changes associated with COPD. These changes are illustrated in a patient with a history of COPD presenting with hypoxaemia and symptoms of shortness of breath.
Asunto(s)
Electrocardiografía , Cardiopatías/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Tabaquismo/complicaciones , Diagnóstico Diferencial , Cardiopatías/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Tabaquismo/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
A 53-year-old man on warfarin for postoperative pulmonary embolism presented with chest pain and was found to be in cardiac tamponade due to an atraumatic haemopericardium. Findings of tamponade and a novel approach to the pathophysiology of pericardial disease to explain these finding are presented.