Lege Artis Medicinae

[A case of restrictive cardiomyopathy due to anthracycline treatment]

HELTAI Krisztina, SZABÓKI Ferenc

MARCH 20, 2002

Lege Artis Medicinae - 2002;12(03)

[INTRODUCTION - A case of restrictive cardiomyopathy with consecutive arrhythmia is presented which developed 20 years after adriablastin treatment CASE REPORT - A 30 years old women has already been treated for 3 years at an outpatient clinic for paroxysmal supraventricular tachycarcia (PSVT) and shortness of breath. All therapeutic interventions were ineffectual, since the patient refused to take the prescribed medicines because of feeling worse after taking them. This lack of compliance was first explained by vegetative neurosis, but later she was examined with the suspicion of dilatative cardiomyopathy and coronary heart disease. The patient was admitted to the Cardiology Intensive Care Unit with cardiogenic shock which developed after injection of propafenon that had been given due to PSVT. On admission sinus rhythm was seen, but later PSVT and non-sustained VT were recorded. Echocardiography showed diffuse hypokinesis, normal diameter of left ventricle and increased right ventricle pressure. Considering the low EF and the recurring high frequency arrhythmia, amiodarone treatment was introduced successfully. From the medical history of the patient it emerged, that in 1977, she underwent surgery due to neuroblastoma with consecutive combined chemotherapy containing adriablastin. CONCLUSION - It is presumed that the recurring arrhythmia was a consequence of restrictive cardiomyopathy resulting from anthracycline treatment. To prove the diagnosis of restrictive cardiomyopathy echocardiography, Swan-Ganz catheter insertion, coronarography and myocardium biopsy were performed to exclude other possible causes of restrictive cardiomyopathy and to verify the toxic effect of anthracycline.]

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[Cough syncope is an infrequently diagnosed form of situational syncope. Most of the reported cases occurs among middle-aged or elderly overweight males, suffering from chronic obstructive lung disease. In our report of four cases we demonstrate the underlying mechanism of cough syncope. Hemodynamic recordings at the time of simulated cough attacks demonstrated the equalisation of the arterial and central venous pressures with consequent cerebral hypoperfusion. The first case illustrates the difficulties of the diagnostic work-up and the confounding effects of the co-existing arrhythmia. The second and fourth cases draw attention to the relationship between cough syncope and accidents. All four patients suffered from chronic obstructive pulmonary disease resulting from heavy smoking which seems to be the most important underlying factor of this syndrome.]

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[The aim of this brief literary review was to draw attention to psychiatric disorders accompanying childbearing and to point out their importance. Authors begin with a historical perspective, the definition of concepts and the presentation of epidemiological data. It is followed by the mapping of multiple entwining etiological factors, then focus on the risc factors. Finally the principles are outlined to be followed in screening, prevention and treatment. Although these conditions develop quite frequently and have serious consequences regarding the individual (“unity of mother and child”) as well as the family and the society, their recognition still present difficulties. Following the establishment of the diagnosis, it is also important to start adequate therapy in time. The solution of the future would be to focus on prevention. This would be realized through the teamwork of would-be parents, health care specialists and researchers.]

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