358
￭
Sun-133￭
The rare case of myxomatous heart, hypertensive emergency as cerebral infarction with hypothyroidism
1인제의대 일산백병원 내과, 2인제의대 일산백병원 순환기내과
*
이청환
1, 이성윤
2, 도준형
2, 남궁준
2, 권성욱
2, 곽재진
2, 황지원
2Thyroid hormones and cardiovascular system are closely related. Pericardial effusion in hypothyroidism is one of the well-known complications. However, it is uncommon that pericardial effusion progresses to the cardiac tamponade. In this context, we report a case of hypothyroidism presenting with cardiac tamponade, hypertensive crisis. The 46 years-old woman presented to emergent symptom with dysarthria and left side weakness as starting on 30minutes before. The initial vital sign was blood pressure of 213/124 mmHg, body temperature of 36.3’C, heart rate of 60bpm, and respiratory rate of 20bpm.
Electrocardiogram showed normal sinus rhythm, chest radiograph showed large cardiomegaly as water bottle sign. Neuroimaging modality was immedi- ately carried out, as brain CT revealed intracranial hemorrhage on Rt. basal
ganglia, Rt. thalamus and Rt. periventricular white matter. Transthoracic echo- cardiography revealed preserved left ventricular systolic function, definite LV hypertrophy, and large amount of pericardial effusion, however, E wave respi- ratory variation and collapsed right ventricle was not showed. Laboratory test was remarkable for elevated TSH above 100(0.27-4.20uIU/mL) and decreased level of Free T4<0.08(0.74-1.80ng/dL) and T3<0.20(0.80-2.00ng/mL) and the others are unremarkable. This patient was performed emergent peri- cardiocentesis, and 1040cc of straw-colored fluid was drained. Any malignant cells, any bacteria on culture study, and mycobacterium on acid-fast bacilli stain were not detected on pericardial effusion. Negative result on serology test was checked as included antinuclear antibody, human immunodeficiency virus, antineutrophil cytoplasmic antibodies and anticardiolipin antibodies.
Patient took the medications as synthyroid and anti-hypertensive drug. We confirmed normalization of blood pressure and thyroid function test.
Follow-up study of TTE showed no evidence of pericardial effusion and defi- nite LV hypertrophy. Hypothyroidism and cardiac tamponade as myxomatous heart may cause hypertensive crisis. Therefore, it should be considered that hypertensive crisis with pericardial effusion and cardiac tamponade could be caused by hypothyroidism.
￭
Sun-134￭
Risk factors and clinical impact of Postoperative AF in hip fracture surgery patients
1건국대학교병원 내과, 2건국대학교병원 심장혈관내과
*
배성준
1, 권창희
1,2 Background/Aims: Atrial fibrillation (AF) is the most common developing arrhythmia in postoperative patients. Limited data are available regarding preoperative risk factors and clinical impact of postoperative AF following hip fracture surgery (HFS). This study aimed to investigate the incidence, risk factors, and clinical impact of postoperative AF in patients with HFS. Methods: This study included 244 patients underwent hip fracture surgery between August 2014 and November 2015. Retrospective analysis was performed of study patients for the incidence, risk factors, and clinical impact of postoperative AF.Results: Nine patients (3.7%) developed postoperative AF after HFS. Multivariable logis- tic regression analysis showed that elevated creatinine >1.0 mg/dL (HR, 11.32, 95% con- fidence intervals [CI], 2.15-59.71) and prior history of COPD (HR, 9.21, 95% CI, 1.79-47.35) were significant predictors for postoperative AF. Patients with postoperative AF had significantly more ICU care and heart failure incidence. Conclusions: Elevated creatinine level (>1.0 mg/dlL) and history of COPD were significant predictors for post- operative AF development in patients with HFS. Postoperative AF significantly con- tributed to ICU care and heart failure incidence in these patients.
358
￭
Sun-133￭
The rare case of myxomatous heart, hypertensive emergency as cerebral infarction with hypothyroidism
1인제의대 일산백병원 내과, 2인제의대 일산백병원 순환기내과
*
이청환
1, 이성윤
2, 도준형
2, 남궁준
2, 권성욱
2, 곽재진
2, 황지원
2Thyroid hormones and cardiovascular system are closely related. Pericardial effusion in hypothyroidism is one of the well-known complications. However, it is uncommon that pericardial effusion progresses to the cardiac tamponade. In this context, we report a case of hypothyroidism presenting with cardiac tamponade, hypertensive crisis. The 46 years-old woman presented to emergent symptom with dysarthria and left side weakness as starting on 30minutes before. The initial vital sign was blood pressure of 213/124 mmHg, body temperature of 36.3’C, heart rate of 60bpm, and respiratory rate of 20bpm.
Electrocardiogram showed normal sinus rhythm, chest radiograph showed large cardiomegaly as water bottle sign. Neuroimaging modality was immedi- ately carried out, as brain CT revealed intracranial hemorrhage on Rt. basal
ganglia, Rt. thalamus and Rt. periventricular white matter. Transthoracic echo- cardiography revealed preserved left ventricular systolic function, definite LV hypertrophy, and large amount of pericardial effusion, however, E wave respi- ratory variation and collapsed right ventricle was not showed. Laboratory test was remarkable for elevated TSH above 100(0.27-4.20uIU/mL) and decreased level of Free T4<0.08(0.74-1.80ng/dL) and T3<0.20(0.80-2.00ng/mL) and the others are unremarkable. This patient was performed emergent peri- cardiocentesis, and 1040cc of straw-colored fluid was drained. Any malignant cells, any bacteria on culture study, and mycobacterium on acid-fast bacilli stain were not detected on pericardial effusion. Negative result on serology test was checked as included antinuclear antibody, human immunodeficiency virus, antineutrophil cytoplasmic antibodies and anticardiolipin antibodies.
Patient took the medications as synthyroid and anti-hypertensive drug. We confirmed normalization of blood pressure and thyroid function test.
Follow-up study of TTE showed no evidence of pericardial effusion and defi- nite LV hypertrophy. Hypothyroidism and cardiac tamponade as myxomatous heart may cause hypertensive crisis. Therefore, it should be considered that hypertensive crisis with pericardial effusion and cardiac tamponade could be caused by hypothyroidism.
￭
Sun-134￭
Risk factors and clinical impact of Postoperative AF in hip fracture surgery patients
1건국대학교병원 내과, 2건국대학교병원 심장혈관내과
*
배성준
1, 권창희
1,2 Background/Aims: Atrial fibrillation (AF) is the most common developing arrhythmia in postoperative patients. Limited data are available regarding preoperative risk factors and clinical impact of postoperative AF following hip fracture surgery (HFS). This study aimed to investigate the incidence, risk factors, and clinical impact of postoperative AF in patients with HFS. Methods: This study included 244 patients underwent hip fracture surgery between August 2014 and November 2015. Retrospective analysis was performed of study patients for the incidence, risk factors, and clinical impact of postoperative AF.Results: Nine patients (3.7%) developed postoperative AF after HFS. Multivariable logis- tic regression analysis showed that elevated creatinine >1.0 mg/dL (HR, 11.32, 95% con- fidence intervals [CI], 2.15-59.71) and prior history of COPD (HR, 9.21, 95% CI, 1.79-47.35) were significant predictors for postoperative AF. Patients with postoperative AF had significantly more ICU care and heart failure incidence. Conclusions: Elevated creatinine level (>1.0 mg/dlL) and history of COPD were significant predictors for post- operative AF development in patients with HFS. Postoperative AF significantly con- tributed to ICU care and heart failure incidence in these patients.
