RESUMO
HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardial cardiac tamponade. The subcapsular hematoma and cardiac tamponade were managed conservatively.
Assuntos
Tamponamento Cardíaco/etiologia , Síndrome HELLP , Hematoma/complicações , Hepatopatias/complicações , Adulto , Ecocardiografia , Feminino , Humanos , Gravidez , Tomografia Computadorizada por Raios XRESUMO
Heart disease represents the leading cause of death in Barbados and the Organization of Eastern Caribbean States (OECS). The North Shore University Hospital, N.Y., through its Lifeline Programme offered the only regular outlet for approximately 450 patients who had cardiac surgery there between 1982 and 1992. A changing US health care policy, however, predicted an end to this programme and in 1989 a decision was made to develop a cardiac catheterisation and an open heart surgical programme at the Queen Elizabeth Hospital (QEH) in Barbados, to serve Barbados and the OECS. This programme was implemented in December 1993 and between then and September 1995, 231 patients, aged two weeks to 75 years, underwent cardiac catheterisation. Of these patients, 186 were suspected of having coronary artery disease (CAD), 21 of having congenital heart disease (CHD) and 24 of having valvular disease. Fifteen patients were from countries other than Barbados, 70 have had open heart surgery (with a surgical mortality of 2.8 percent) and 12 have had closed heart procedures. One hundred and twenty-four (124) trans-oesophageal echocardiograms were done. A successful cardiac surgical programme has been set up at the QEH in Barbados with the cooperation of the Government and the private sector. The results are excellent and the spinoffs to the hospital have been many. In particular, a significant improvement in "critical care". What is more important, however, the programme has been set up at a "low" cost and is cost-effective, saving the country significant foreign exchange. Plans are in place to introduce Interventional Cardiology in the near future (AU)