inima tricamerala n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Inima tricamerala PowerPoint Presentation
Download Presentation
Inima tricamerala

Loading in 2 Seconds...

play fullscreen
1 / 21

Inima tricamerala - PowerPoint PPT Presentation


  • 129 Views
  • Uploaded on

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.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Inima tricamerala' - keon


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
inima tricamerala

Inima tricamerala

Aurelian Cosmin Diaconu

Clinica de Medicina Interna si Cardiologie

Spitalul Clinic Coltea

motivele internarii
Motivele internarii

Pacienta P.I., in varsta de 30 ani, se prezinta pentru:

  • Tuse cu expectoratie muco-purulenta, febra, frison si dispnee inspiratorie
istoric
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.
examen clinic la internare
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
diagnostic de etapa
Diagnostic de etapa
  • Canal atrioventricul comun tip incomplet
  • Insuficienta mitrala
  • Insuficienta tricuspidiana
  • Infectie pulmonara acuta
  • Situs inversus abdominal
  • Chisturi de ovar
biologic la internare
Biologic la internare
  • Hemoleucograma evidentiaza:

- trombocitopenie 109*10l³/uL

- poliglobulie cu o hemoglobina de 19.8g/dl.

  • CRP 6.6mg/dl
ecografia cardiaca transtoracica
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.
ecografia abdominala
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.
diagnostic diferential
Diagnostic diferential
  • Trombembolismpulmonarsuprainfectat

-pro: poliglobulie, tratament cu contraceptive orale, absentatratamentului anticoagulant in istoric

-contra (?): D-dimeriinegativi

  • Infectiepulmonaraacuta

-pro: hipertensiunepulmonarasevera, imunodepresia , simptomatologia

-contra (?): lipsaelementelorradiografice

diagnostic final
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
tratament
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
particularitatea cazului
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.
date generale 1
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%)
date generale 2
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