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Pericardita constrictiva

Pericardita constrictiva. Dr. Ioana Comanescu Spitalul Clinic de Urgenta Bucuresti. Pacientul I.A. 31 ani Motivele internarii: dispnee la eforturi mici edeme gambiere bilateral Factori de risc cardiovasculari: Supraponderal Fumator(10PA) DZ nou descoperit. Istoricul bolii.

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Pericardita constrictiva

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  1. Pericardita constrictiva Dr. Ioana Comanescu Spitalul Clinic de Urgenta Bucuresti

  2. Pacientul I.A. • 31 ani • Motivele internarii: • dispnee la eforturi mici • edeme gambiere bilateral • Factori de risc cardiovasculari: • Supraponderal • Fumator(10PA) • DZ nou descoperit

  3. Istoricul bolii • dispnee la eforturi mici • tahicardie cu frecventa cardiaca 90-100bpm • edeme declive bilaterale • Neaga angina pectorala, palpitatii • ECG efectuat in urma cu 24 ore: ritm sinusal De 2 saptamani

  4. Examen clinic • Obezitate tip android(IMC=29,2kg/mp) • Tegumente normal colorate ; vergeturi abdominale fara adenopatii periferice • Edeme gambiere bilateral • Ap cardiovascular: TA= 130/85mmHg; AV 140/min, zgomote cardiace aritmice, fara sufluri cardiace, jugulare turgide; puls periferic prezent bilateral • Ap respirator: sonoritate la percutie, fara dispnee de repaus, MV prezent bilateral fara raluri pulmonare • Hepatomegalie, fara splenomegalie

  5. ECG

  6. Biologic • HLG in limite normale • AST= 31U/L; ALT 59U/L • Glicemie a jeun 134mg/dl; HbA1c 11,3% • Uree 26mg/dl; creatinina 0,83 mg/dl ; Na=141mmol/L; K= 4,1mmol/L • Trigliceride= 118 mg/dl ; colesterol 154 mg/dl • Sideremie 12,81umol/l • TSH= 1,79uU/L • Sumar de urina : fara proteinurie, glucozurie, hematurie

  7. Diagnostic de internare • Insuficienta cardiaca clasa III NYHA predominant dreapta • Fibrilatie atriala cu AV rapida cu debut recent(sub 24 ore) • Diabet zaharat nou descoperit • Obezitate

  8. Evolutie • Sub tratament cu • Anticoagulant cu Heparina nefractionata • Amiodarona • Diuretic de ansa, diuretic antialdosteronic • Ulterior beta blocant neselectiv (Carvedilol) • In 24 ore s-a obtinut conversia la ritm sinusal • Evolutia a fost favorabila cu remiterea edemelor gambiere, pacientul fiind complet asimptomatic in repaus. • A fost transferat pe sectie dupa 24 ore

  9. Ecocardiografia-2D, PLAX, PSAX-

  10. Ecocardiografia-apical 4 camere-

  11. Ecocardiografie PW mitral PW mitral Doppler tisular Mod M color

  12. Ecocardiografie Mod M VCI PW in venele plm

  13. Concluzia Ecocardiografiei • Disfunctie sistolica severa ventriculara stanga cu tulburari difuze de cinetica cu FE 30% • Disfunctie diastolica restrictiva Pericardita constrictiva Cardiomiopatie restrictiva

  14. Diagnostic diferential

  15. Radiografie cord-pulmon-interpretare- • Fara leziuni pleuro-pulmonare • Cardiomegalie • Calcificari pericardice circumferential

  16. RMN

  17. Cateterism cardiac

  18. Cateterism cardiac -curbe de presiune- • Egalizarea presiunii telediastolice intre camerele inimii cu o diferenta de <5mmHg • Aspect al curbei ventriculare diastolice de “radical”

  19. Coronarografie

  20. Diagnostic diferential cardiomiopatie • Restrictiva ? ecocardiografia, RMN • Ischemica ? coronarografia • Miocarditica ? - cu atingere pericardica RMN • Tahiaritmica ?

  21. Diagnostic pozitiv 1. Pericardita constrictiva de etiologie neclara 2. Cardiomiopatie probabil tahiaritmica cu disfunctie sistolica severa reversibila 3. Fibrilatie atriala persistenta convertita chimic la RS 4. Diabet zaharat tip II controlat prin regim 5. Obezitate

  22. Reevaluare la cca 5 luni Clinic: insuficienta cardiaca NYHA I ECG:

  23. Ecocardiografie -parasternal ax lung- 2D Mod M

  24. Ecocardiografie -apical 4 camere, 2D-

  25. Tratament actual • Carvedilol 12,5mg x 2/zi • Amiodarona 200mg 1cp/zi • Spironolactona 25mg 1cp/zi • Furosemid 40mg 1/2cp/zi • Sintrom fucntie de INR • Ramipril 5mg 1cp/zi • Atorvastatina 10mg 1cp/zi • Metformin 1cp/zi • Programat pentru pericardectomie in Germania

  26. PERICARDITA CONSTRICTIVADE RETINUT…. • CLINIC: >IC dreapta, fibrilatie atriala • Cele mai imp. INVESTIGATII : ecocardiografia si RMN +- cateterism Alte: ECG, RxCP, CT, endobiopsie miocardica intraoperatorie TRATAMENT: obligatoriu pericardectomie

  27. PARTICULARITATEA CAZULUI • Asociere intre -pericardita constrictiva de etiologie necunoscuta -disfunctie sistolica reversibila

  28. Va multumesc!

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