1 / 21

Inima tricamerala

Inima tricamerala. Aurelian Cosmin Diaconu Clinica de Medicina Interna si Cardiologie Spitalul Clinic Coltea. Motivele internarii. Pacienta P.I., in varsta de 30 ani, se prezinta pentru: Tuse cu expectoratie muco-purulenta, febra, frison si dispnee inspiratorie. Istoric.

keon
Download Presentation

Inima tricamerala

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Inima tricamerala Aurelian Cosmin Diaconu Clinica de Medicina Interna si Cardiologie Spitalul Clinic Coltea

  2. Motivele internarii Pacienta P.I., in varsta de 30 ani, se prezinta pentru: • Tuse cu expectoratie muco-purulenta, febra, frison si dispnee inspiratorie

  3. Istoric • Diagnosticata de la nastere cu canal atriventricular comun tip incomplet si situs inversus abdominal. • Familia a refuzat interventia chirurgicala. • In urma cu 3 luni, a fost diagnosticata cu chisturi de ovar, pentru care a urmat tratament cu contraceptive orale.

  4. Examen clinic la internare • Hipotrofie staturo-ponderala • Cianoza de tip central • Hipocratism digital • Jugulare turgescente • Pulmonar: raluri subcrepitante bazal dreapta; SaO2=86% fara oxigenoterapie. • Suflu sistolic localizat precordial • T.A.= 110/60mmHg • A.V.=86b/min regulat

  5. Diagnostic de etapa • Canal atrioventricul comun tip incomplet • Insuficienta mitrala • Insuficienta tricuspidiana • Infectie pulmonara acuta • Situs inversus abdominal • Chisturi de ovar

  6. Biologic la internare • Hemoleucograma evidentiaza: - trombocitopenie 109*10l³/uL - poliglobulie cu o hemoglobina de 19.8g/dl. • CRP 6.6mg/dl

  7. Electrocardiograma la internare

  8. Radiografia cord-pulmon

  9. Ecografia cardiaca transtoracica • SIV 13mm, VS 39mm, PP 10mm,VD 46mm, perete liber 12mm, AP 38mm, • Atriu unic: diametru transvers de 75mm • Insuficienta mitrala excentrica moderata prin cleft de valva mitrala anterioara • Insuficienta tricuspidiana excentrica severa: gradient VD-AD=106mmHg • Posibil solutie de continuitate la nivelul septului interventricular membranos, cu sunt bidirectional • SIV aplatizat sistolo-diastolic catre VS, FE 55%. • VCI 25mm cu minim colaps inspirator.

  10. Ecografia abdominala • Ficat: lob drept de 6cm, lob stang de 14cm • Splina in spatiul Traube, cu un ax lung de 9cm • La nivelul ovarului drept formatiuni chistice, dintre care cea mai mare de 4-5cm.

  11. Diagnostic diferential • Trombembolismpulmonarsuprainfectat -pro: poliglobulie, tratament cu contraceptive orale, absentatratamentului anticoagulant in istoric -contra (?): D-dimeriinegativi • Infectiepulmonaraacuta -pro: hipertensiunepulmonarasevera, imunodepresia , simptomatologia -contra (?): lipsaelementelorradiografice

  12. Diagnostic final • Insuficienta cardiaca clasa III NYHA • Canal atrioventricular comun tip incomplet • Insuficienta mitrala excentrica moderata prin cleft de valva mitrala anterioara. • Hipertensiune arteriala pulmonara severa • Insuficienta tricuspidiana severa • Posibil DSV membranos • Poliglobulie secundara • Trombofilie – Sindrom antifosfolipidic • Situs inversus abdominal • Infectie pulmonara acuta • Formatiuni chistice ovar drept

  13. Tratament • Regim igieno-dietetic hiposodat. • Vaccinare periodica (vaccinarea antigripala si antipneumococica) • Profilaxia endocarditei • Tratamentul medical: • tratamentul insuficientei cardiace • anticoagulant oral + protector gastric (IPP) • vasodilatatoare pulmonare (prostacicline sintetice, antagonisti ai receptorilor de endotelina 1, inhibitori ai fosfodiesterazei-5) • Tratamentul poliglobuliei secundare: flebotomii repetate cu inlocuire izovolumica • Chirurgical: depasit

  14. Particularitatea cazului • Pacienta cu boalacardiacacongenitalacianogenacomplexaneoperataajunge la varsta de 30 ani. • Asociereacelor 3 factori de risctrombogeni (poliglobuliasecundara, consumul de contraceptive oralesiprezentaanticoagulantuluilupic) aduce un prognostic grav in plus pacienteinoastre.

  15. Date generale (1) • Reprezinta 3% din totalul malformatiilor cardiace, aparand la 2 nasteri din 10000) • Afecteaza in mod egal ambele sexe. • Asocierea frecventa cu Sindrom Down (20%)

  16. Date generale (2) • Tipuri de canal atrio-ventricular comun: • Partial (incomplet): DSA OP + cleft VMA, ± DSV ± cleftVT • Complet: un singur inel atrioventricular cu 4-6 cuspe sau 2 hemivalvemitro-tricuspidiene

More Related