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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
objavljeno: 16/08/2011
doi: 10.2298/SARH1106376S
Značaj ehokardiografije u dijagnostikovanju idiopatske plućne arterijske hipertenzije - prikaz bolesnika
Stojković Gabrijelaa, Mladenov Sunčicaa, Jovanović Dimitrijea, Stanković Aleksandara, Deljanin-Ilić Marinab ORCID, Ristić Arsenc ORCID
aOpšta bolnica, Leskovac
bUniverzitet u Nišu, Medicinski fakultet, Institut za prevenciju, lečenje i rehabilitaciju reumatičkih i kardioloških bolesti 'Niška Banja' - Niška Banja
cKlinički centar Srbije, Klinika za vaskularnu hirurgiju, 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

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