Reinaldo B Bestetti, Marcelo José Ferreira Soares, Rosemary Furlan-Daniel, Augusto Cardinalli-Neto, Marcelo A Nakazone
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About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 <math><mo>±</mo></math> 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. 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引用次数: 0
摘要
肺血栓栓塞症(PE)是慢性恰加斯心脏病(CChD)患者潜在的主要并发症。肺血栓栓塞症的来源是右侧心腔,而不是深静脉血栓形成。人们对继发于南美锥虫病的 PE 患者的危险因素、临床表现和临床过程知之甚少。本综述旨在为医生提供此类数据。我们在 PUBMED 上搜索了 1955 年至 2020 年间与 CChD 患者 PE 相关的论文。共检索到 26 篇手稿,其中 12 篇符合入选标准,被纳入本研究。右侧心脏血栓或 PE 经形态学或影像学研究证实。共报告了 431 例 PE 患者。年龄从 30 岁到 85 岁不等。据报告,约 332 名患者患有慢性心力衰竭 (CHF),而 41 名患者(9%)在尸检时出现心脏性猝死 (SCD)。据报告,临床表现为 1 名患者突然出现呼吸困难,2 名患者咯血,2 名患者慢性心力衰竭恶化,1 名患者胸痛。据报告,6 名患者接受了胸部 X 光检查:其中 3 名患者出现与 PE 一致的异常。一项研究报告的平均左心室射血分数为 42.1 ± 18.7%。右侧心脏血栓形成的发生率从 66% 到 85% 不等。17%的患者死于 PE。恰加斯病心肌病(ChCM)患者的 PE 临床诊断非常困难,因为没有一个性能良好的预测评分。然而,如果出现咯血或心力衰竭(HF)恶化、心电图或胸部 X 光片异常,则应提高 PE 诊断率,并及时转诊至详细的多普勒组织超声心动图和计算机断层扫描血管造影,以及时治疗。
Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination.
Pulmonary thromboembolism (PE) is a potential major complication in patients with chronic Chagas heart disease (CChD). The source of PE is the right-sided chambers instead of deep vein thrombosis. Little is known regarding risk factors, clinical picture, and the clinical course of patients with PE secondary to CChD. The aim of this review was to try to provide doctors with such data. We searched for papers related to PE in CChD patients in the PUBMED from 1955 to 2020. Twenty-six manuscripts were retrieved, of which 12 fulfilled entry criteria and were included in the study. Right-sided cardiac thrombosis or PE was confirmed on morphological or imaging studies. A total of 431 patients with PE were reported. Age varied from 30 to 85 years. About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. However, in the presence of haemoptysis or worsening heart failure (HF), abnormal ECG, or chest X-ray, the diagnosis of PE should be raised, and patients promptly referred to detailed Doppler Tissue Echocardiography and computed tomography angiography, and treated in a timely manner.
期刊介绍:
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.