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Srpski arhiv za celokupno lekarstvo
2011, vol. 139, br. 5-6, str. 376-379
jezik rada: srpski
vrsta rada: prikaz slučaja
doi:10.2298/SARH1106376S


Značaj ehokardiografije u dijagnostikovanju idiopatske plućne arterijske hipertenzije - prikaz bolesnika
aOpšta bolnica, Leskovac
bUniverzitet u Nišu, Medicinski fakultet, Institut za prevenciju, lečenje i rehabilitaciju reumatičkih i kardioloških bolesti 'Niška Banja' - Niška Banja
cKlinika za kardiovaskularne bolesti, Klinički centar Srbije, Beograd

e-adresa: gabikardio@gmail.com

Sažetak

Uvod. Idiopatska plućna arterijska hipertenzija (IPAH) je retka i teška progresivna bolest s prevalencijom od oko 15 obolelih na milion stanovnika, od koje najčešće obolevaju žene. Prikaz bolesnika. Četrdesetsedmogodišnja žena se javila lekaru zbog simptoma i znakova insuficijencije desne strane srca. Tokom prethodnih sedam godina osećala je gušenje i zamor pri hodanju. U fizičkom nalazu posebno je bio naglašen II ton nad plućnom arterijom. Na elektrokardiogramu uočeni su znaci hipertrofije desne komore. Radiografski snimak, spirometrijski test, perfuzioni sken i spiralni CT nalaz pluća isključili su sekundarnu plućnu arterijsku hipertenziju. Rezultati imunoloških testova na sistemske bolesti vezivnog tkiva i HIV bili su u referentnim granicama. Ehokardiografskim pregledom kolor doplerom ustanovljena je trikuspidna regurgitacija umerenog stepena, s visokim vrednostima maksimalnog i srednjeg sistolnog pritiska u desnoj komori (135/110 mm Hg), te je isključeno prethodno oboljenje srca. Kateterizacija desne strane srca potvrdila je dijagnozu IPAH na osnovu vrednosti pritiska u plućnoj arteriji od 101/47/66 mm Hg i plućnog kapilarnog pritiska od 30/13/10 mm Hg. Započeta je osnovna terapija sildenafilom, a kod bolesnice je i dalje postojalo znatno ograničenje u podnošenju napora. Zaključak. IPAH je teško oboljenje sa nespecifičnim simptomima i znacima. Skrining-test za IPAH je kolor dopler ehokardiografija, koja pokazuje visoku korelaciju sa kateterizacijom srca.

Ključne reči

idiopatska plućna arterijska hipertenzija; etiologija; dijagnoza; lečenje

Reference

Ahearn, G.S., Tapson, V.F., Rebeiz, A., Greenfield, J.C. (2002) Electrocardiography to Define Clinical Status in Primary Pulmonary Hypertension and Pulmonary Arterial Hypertension Secondary to Collagen Vascular Disease. Chest, 122(2): 524-527
Bossone, E., Rubenfire, M., Bach, D.S., Ricciardi, M., Armstrong, W.F. (1999) Range of tricuspid regurgitation velocity at rest and during exercise in normal adult men: implications for the diagnosis of pulmonary hypertension. Journal of the American College of Cardiology, 33(6): 1662-1666
Chemla, D., Herve, P. (2008) Estimation of mean pulmonary artery pressure: simpler than expected. Chest, 133(3): 592-593
Condliffe, R., Kiely, D.G., Peacock, A.J., Corris, P.A., Gibbs, S.R., Vrapi, F., i dr. (2009) Connective tissue disease-associated pulmonary arterial hypertension in the modern treatment era. Am J Respir Crit Care Med, 179, str. 151-7
Eisenberg, P.R., Lucore, C., Kaufman, L. (1999) Fibrinopeptide A levels indicative of pulmonary vascular thrombosis in patients with primary pulmonary hypertension. Circulation, 82, str. 84-7
Eysmann, S.B., Palevsky, H.I., Reichek, N., Hackney, K., Douglas, P.S. (1989) Two-dimensional and Doppler-echocardiographic and cardiac catheterization correlates of survival in primary pulmonary hypertension. Circulation, 80(2): 353-360
Farber, H.W., Simms, R.W., Lafyatis, R. (2010) Analytic Review: Care of Patients With Scleroderma in the Intensive Care Setting. Journal of Intensive Care Medicine, 25(5): 247-258
Friedberg, M.K., Feinstein, J.A., Rosenthal, D.N. (2006) A Novel Echocardiographic Doppler Method for Estimation of Pulmonary Arterial Pressures. Journal of the American Society of Echocardiography, 19(5): 559-562
Galiè, N., Manes, A., Uguccioni, L., Serafini, F., de Rosa, M., Branzi, A., i dr. (1998) Primary pulmonary hypertension: Insights into pathogenesis from epidemiology. Chest, 114(3 Suppl):184S-194S
Galiè, N., Hoeper, M.M., Humbert, M., Torbicki, A., Vachiery, J.L., Barberaet, J.A., i dr. (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: The task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS),. Eur Heart J., 30(20), str. 2493-537
Galiè, N., Ussia, G., Passarelli, P., Parlangeli, R., Branzi, A., Magnani, N. (1995) Role of pharmacologic tests in the treatment of primary pulmonary hypertension. Am J Cardiol, 75: 55A-62A
Galiè, N., Manes, A., Negro, L., Palazzini, M., Bacchi-Reggiani, M.L., Branzi, A. (2009) A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J., 30(4), str. 394-403
Hinderliter, A.L., Willis, I.P.W., Long, W., Clarke, W.R., Ralph, D., Caldwell, E.J., Williams, W., Ettinger, N.A., Hill, N.S., Summer, W.R. (1999) Frequency and prognostic significance of pericardial effusion in primary pulmonary hypertension. American Journal of Cardiology, 84(4): 481-484
MacGregor, A.J., Canavan, R., Knight, C. (2001) Pulmonary hypertension in systemic sclerosis: risk factors for progression and consequences for survival. Rheumatology, 40(4): 453-459
McLaughlin, V.V., Shillington, A. (2002) Survival in Primary Pulmonary Hypertension: The Impact of Epoprostenol Therapy. Circulation, 106(12): 1477-1482
Mcquillan, B.M., Picard, M.H., Leavitt, M., Weyman, A.E. (2001) Clinical Correlates and Reference Intervals for Pulmonary Artery Systolic Pressure Among Echocardiographically Normal Subjects. Circulation, 104(23): 2797-2802
Nauser, T.D., Stites, S.W. (2001) Diagnosis and treatment of pulmonary hypertension. Am Fam Physician, 63(9), str. 1789-98
Rubin, L.J., Badesch, D.B. (2005) Evaluation and management of the patient with pulmonary arterial hypertension. Ann Intern Med, 143, str. 282-92
Rudarakanchana, N., Trembath, R.C., Morrell, N.W. (2001) New insights into the pathogenesis and treatment of primary pulmonary hypertension. Thorax, 56, str. 888-90
Runo, J.R., Loyd, J.E. (2003) Primary pulmonary hypertension. Lancet, 361(9368): 1533-1544
Shapiro, S.M., Oudiz, R.J., Cao, T., Romano, M.A., Beckmann, X.J., Goegiou, D., i dr. (1997) Primary Pulmonary Hypertension: Improved Long-Term Effects and Survival With Continuous Intravenous Epoprostenol Infusion. Journal of the American College of Cardiology, 30(2): 343-349