RESUMEN
Α 33-year-old woman was admitted to our clinic with electrocardiographic (ECG) manifestations of anterior ST-elevation myocardial infarction, dizziness, weakness, and feeling of oncoming collapse. She underwent coronary angiography that showed normal coronary arteries and an echocardiography study that showed reduced left ventricular contractility with diffuse hypokinesis and an estimated ejection fraction of (EF) 35-40 %. The biochemical testing showed enzymatic activity typical of myocardial necrosis. The patient had hypertensive peaks on a 24-h recording of blood pressure, while immunological and virological test results were negative. Magnetic resonance imaging showed partial epicardial enhancement. A tumor in the right adrenal medulla was detected with computed tomography, and biochemical testing showed increased levels of urinary vanillylmandelic acid as well as serum metanephrines. The diagnosis of pheochromocytoma was made and confirmed by histological findings after surgical resection of the tumor. The left ventricular systolic dysfunction gradually reversed, the EF returned to normal, and the ECG findings were normalized, indicating cardiomyopathy due to pheochromocytoma.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Feocromocitoma/complicaciones , Feocromocitoma/diagnóstico , Neoplasias de las Glándulas Suprarrenales/terapia , Adulto , Cardiomiopatías/terapia , Diagnóstico Diferencial , Electrocardiografía/métodos , Femenino , Humanos , Feocromocitoma/terapia , Resultado del TratamientoRESUMEN
Renal sympathetic innervation plays an important role in blood pressure regulation. Gradual activation of renal sympathetic efferent nerves enhances renin release, promotes sodium and water re-absorption, and reduces renal blood flow and glomerular filtration rate. On the other hand, activation of renal afferent sympathetic nerves induced by renal injury results in central sympathetic activation. This reciprocal relationship between the kidneys and the brain is involved in the pathogenesis of hypertension and other disease conditions characterized by sympathetic overactivity. Renal sympathetic nerve ablation has been recently introduced for the treatment of resistant hypertension. This review aims to provide the pathophysiological basis of renal nerve ablation for the attenuation of sympathetic overactivity.
Asunto(s)
Ablación por Catéter/métodos , Hipertensión/cirugía , Riñón/inervación , Simpatectomía/métodos , Sistema Nervioso Simpático/fisiopatología , Vías Aferentes/fisiopatología , Animales , Presión Sanguínea/fisiología , Vías Eferentes/fisiopatología , Hemodinámica/fisiología , Humanos , Hipertensión/fisiopatología , Riñón/fisiopatologíaRESUMEN
Reported is a technique that was used to treat a distal left anterior descending (LAD) perforation in a patient undergoing percutaneous coronary intervention (PCI) for distal LAD total occlusion. The perforation was successfully treated by re-occluding the LAD with implantation of a polytetrafluoroethylene (PTFE)-covered stent in a diagonal branch extending to the LAD (side branch graft stenting technique) delivered using the dual catheter technique. This approach is proposed as an alternative bail-out technique that can be used in cases where other treatment options for coronary perforation are either unavailable or potentially not successful, especially during PCI for total occlusions, where the disadvantage of main vessel occlusion is already present.