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- 저자 : ( Anastacio Degayo ) (검색결과 2 건)
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( Anastacio Manuel Jun Jun Degayo ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Previous studies found that treatment of cardiovascular diseases and decreases in urinary protein excretion is associated with reduction in cardiovascular risks.It was also postulated in previous trials that there was an increase in urinary protein excretion preceding ischemic cardiac events, although the pathophysiology is uncertain.To date, there have been no clinical trials directly associating proteinuria with depressed systolic function in patients with Acute Myocardial Infarction (AMI). Methods: Consecutive adult patients (=19years) admitted at the UP-PGH with the diagnosis of AMI from January, 2012 to June,2012 and with written consent were included. Patients with renal failure,urinary tract infection and diabetes mellitus were excluded.Using the standardized data collection form, clinical profi le, levels of troponin I,electrocardiogram (ECG), ejection fraction (EF) based on transthoracic echocardiogram and presence of proteinuria were obtained. Chi-square, Students T-test and Fischer`s Exact test were utilized to determine statistical differences between groups. Odds Ratio was used to test for strength of association between proteinuria and depressed systolic function. Results: A total of 88 patients were included,with the mean age of 60 years. Twenty- nine patients(33%) have normal EF and 59(67%) of them have depressed systolic function. Proteinuria is present in 55% of patients.Chest pain(81%) and dyspnea(22%) were most common presenting symptom with dyslipidemia(86%) and hypertension(64%) as the most common co-morbidities. Comparing patients with normal systolic function(EF=55%) and those with depressed systolic function(EF<55%), the baseline characteristics were essentially the same except for higher incidence of ST elevation among patients with depressed systolic function(63%vs.28%, p-value=0.004). The computed odds ratio of having proteinuria for depressed systolic function is 2.75 times the estimated odds of having proteinuria for normal systolic function(95%- CI=1.10-6.89). Conclusions: There is a strong association between proteinuria and depressed systolic function, with more than twice the likelihood of having depressed systolic function in the presence of proteinuria on urinalysis.
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( Manalo Jaime Aherrera ),( Lauro Abrahan ),( Anastacio Degayo ),( Michael Agbayani ),( Michael Reyes ),( Wilfred Dee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Synopsis: The Wolff Parkinson White syndrome and mitral stenosis (MS) is a unfortunate combination, with less than 15 patients reported in literature. They are individually associated with supraventricular arrhythmias and their combination may have profound hemodynamic consequences. Our case is a young male presenting with neurologic deficits who was newly diagnosed with the WPW syndrome and mitral stenosis. Case: A 25 year old male sought consult syncope, palpitations, and dizziness. On the day of admission, he experienced persistent palpitations then subsequently lost consciousness. He had a diastolic rumble, right sided hemiparesis, and dysarthria. A cranial CT scan revealed a left basal ganglia infarction. Electrocardiogram showed sinus rhythm and left atrial enlargement, a short PR interval, wide QRS complexes, and delta waves. Holter monitoring showed episodes of atrial fl utter with rapid ventricular rates. QRS complexes were narrow during other episodes of tachycardia. Echocardiogram revealed moderate mitral stenosis and a dilated LA with no thrombus. Diagnosis was WPW syndrome and rheumatic MS manifesting as a stroke in the young. Percutaneous transvenous mitral commissurotomy (PTMC) was done. He is now on regular follow up on chronic anticoagulation and medical therapy for the WPW syndrome. Conclusion: To our knowledge, this is the fi rst case of a WPW syndrome with rheumatic MS presenting as a stroke in the young who was successfully managed with PTMC for MS and anti-arhrythmics for the WPW syndrome. This unfortunate combination may have potentiated the risk for cardioembolic events which emphasizes that detection of these entities is of paramount importance. Though either of the two entities may have caused the stroke, treatment is warranted for both entities as to avoid future episodes of cardioembolic phenomena.
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