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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
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0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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CLEAR FILTERS
A very rare cause of a very severe disease
Session:
Sessão de Casos Clínicos I
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2018
Topic:
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Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Cátia Santos Ferreira; Tatiana Pereira; Ana Lai; Rui Baptista; Filipe Vilão; Lina Carvalho; Mariano Pêgo
Abstract
<p><strong>Background:</strong> The differential diagnosis of pulmonary hypertension (PH) is a challenge and less frequent causes may stand out.</p> <p><strong>Clinical case:</strong> A 43-year-old male presented to the Emergency Room with exertional dyspnoea, hemoptoic cough and a 3-kg weight loss, progressively worsening over the last 3 months. He was an active smoker (40 pack-years). On physical examination, he had signs of elevated jugular vein pressure and bibasal pulmonary crackles. Laboratory tests presented elevated D-dimers (8.04 mg.mL<sup>-1</sup>) and severe hypoxemia (pAO<sub>2</sub> 38 mmHg). As there was a strong suspicion of pulmonary embolism, the patient underwent a CT pulmonary angiogram that excluded it. However, a right pleural and a pericardial effusion were present, as well as interlobular septal thickening with areas of ground-glass opacity and mediastinal lymphadenopathy. The echocardiogram revealed a dilated right ventricle (RV) with conserved systolic function and a mild tricuspid regurgitation with a peak velocity of -3.9 m.s<sup>-1</sup>, yielding an estimated pulmonary artery systolic pressure of 68 mmHg. Taking into consideration the high probability of PH and the chest CT findings, pulmonary veno-occlusive disease (PVOD) was suspected and further work-up was undertaken. Serum immunology tests were all negative. Right heart catheterization revealed precapillary PH (table 1), supporting the presumptive diagnosis of PVOD. A thoracentesis was also performed. On the 11<sup>th</sup> day of admission, he suffered a syncope associated with hypotension, tachycardia and hyperlactacidemia. The echocardiogram revealed a severe pericardial effusion with signs of tamponade and the patient underwent an emergent pericardiocentesis, complicated by a RV perforation. Immediately, a surgical suture was successfully performed and a lung biopsy was taken. However, the patient remained in cardiogenic shock and died on the next day.</p> <p>The final diagnosis was made based on the combined results of the pleural and pericardial effusion cytopathology, that revealed signet-ring cells, and the lung biopsy, that showed massive neoplastic lymphatic embolization in bronchial arterioles and arteries and inter-lobular venules: PH due to pulmonary tumor thrombotic microangiopathy (PTTM) secondary to a gastric cancer.</p> <p><strong>Conclusion:</strong> PTTM should be considered in the differential diagnosis of PH of patients without a known cancer as well as in patients with well-known carcinoma who develop acute or subacute <em>cor pulmonale</em>. The prognosis is very poor.</p>
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