Publikacje

Marcin Koć, Piotr Bienias

Mimo coraz lepszych możliwości diagnostycznych i terapeutycznych ostra zatorowość płucna (APE) pozostaje istotnym problemem klinicznym. Do oceny ciężkości choroby wykorzystuje się liczne badania, w tym obrazowe i laboratoryjne. Niestety, często pomijana jest technika dostępna w większości punktów medycznych, w przypadku której na wynik trzeba czekać nie dłużej niż kilka minut — badanie elektrokardiograficzne (EKG). W przedstawionym przypadku autorzy przypomnieli typowe elektrokardiograficzne cechy APE, przybliżyli możliwość pośredniej stratyfikacji ryzyka na podstawie zapisów EKG u chorych z APE, a także, nieco obok kwestii związanych z EKG, zwrócili uwagę na zmiany w leczeniu chorych na APE wprowadzone w najnowszych wytycznych dotyczących diagnostyki i leczenia tej choroby.

Piotr Bienias, Piotr Pruszczyk

Badanie elektrokardiograficzne (EKG) cechuje niedostateczna czułość i swoistość, by mogło stanowić pojedyncze narzędzie w wykrywaniu przerostu lub powiększenia prawej komory serca. Brak typowych odchyleń w EKG nie wyklucza również nadciśnienia płucnego. Objawy kliniczne i obciążający wywiad powinny ukierunkowywać na poszerzenie diagnostyki prawej komory o badanie echokardiograficzne. W pracy przedstawiono 2 przypadki chorych z potwierdzonym przerostem prawej komory i nadciśnieniem płucnym bez typowych dla tych stanów zmian w EKG.

Mateusz Jermakow, Agnieszka Palus, Michał Ciurzyński, Bronisława Pietrzak, Katarzyna Kurnicka, Piotr Pruszczyk, Piotr Bienias

Objective: Amniotic fluid embolism (AFE) is a diagnostically challenging type of pulmonary embolism that occurs when amniotic fluid enters maternal circulation during delivery or postpartum. This obstetric complication is very rare but characterized by high mortality rate. The main symptoms are dyspnea, cardiovascular collapse, disseminated intravascular coagulation (DIC) and even sudden cardiac death. The aim of the article is to draw attention to AFE as a rare but possible and catastrophic complication of perinatal period. The authors present a 28-year-old woman who was admitted to obstetric ward during the first stage of labour. The patient developed sudden deterioration of her medical state with acute respiratory distress symptoms. An emergency cesarean section was performed, complicated by excessive bleeding. After a detailed assessment of the patient's condition and evaluation of the results of additional tests, we diagnosed AFE as the cause of the patient's deterioration.Conclusion: Conclusions: The case study shows how unpredictable, unpreventable and dangerous is AFE. It is still one of the main causes of maternal deaths in developed countries. Four diagnostic criteria proposed by the Society for Maternal-Fetal Medicine (SMFM) may accelerate diagnosis. AFE as a medical emergency, requires immediate multidisciplinary response and aggressive treatment. The initial medical care may be facilitated by the application of the general guidelines recommended by SMFM. The case report also emphasizes the need for further research on this disease, in particular on early detection and prevention.Keywords: amniotic fluid embolism; disseminated intravascular coagulation; pregnancy complications; respiratory insufficiency.

Krzysztof Jankowski, Ewa Ożdżeńska‑Milke, Barbara Lichodziejewska, Michał Ciurzyński, Piotr Pruszczyk

The study presents the case of a 78-year-old woman with recurrent pulmonary embolism, treated with 2 courses of thrombolysis. In this patient, due to heparin-induced thrombocytopenia, fondaparinux therapy was used.

Michał Ciurzyński, Krzysztof Jankowski, Bronisława Pietrzak, Natalia Mazanowska, Ewa Rzewuska, Robert Kowalik, Piotr Pruszczyk

Background: A serious complication of heparin treatment, heparin-induced thrombocytopenia (HIT) is rarely observed in pregnant women. Drug therapy during pregnancy should always be chosen to minimize fetal risk. The management of HIT in pregnancy represents a medical challenge. Unlike heparins, the anticoagulants used in patients with HIT do cross the placenta, with unknown fetal effects.Case report: We present a case of a 24-year-old female presenting for care at 34 weeks of gestation with acute pulmonary embolism treated initially with unfractionated heparin (UFH) and low molecular weight heparin (LMWH), who developed HIT. She was then successfully treated with fondaparinux.Conclusions: To the best of our knowledge, this is one of the first case reports describing a successful use of fondaparinux in the treatment of HIT in a third-trimester pregnant woman, providing a novel approach for this subset of patients.

Marek Roik, Dominik Wretowski, Andrzej Łabyk, Maciej Kostrubiec, Olgierd Rowiński, Piotr Pruszczyk

Justyna Domienik-Karłowicz, Michał Ciurzyński, Piotr Pruszczyk

Marek Roik, Dominik Wretowski, Katarzyna Irzyk, Andrzej Łabyk, Olga Dzikowska-Diduch, Piotr Pruszczyk

Magdalena Pływaczewska, Dorota Piotrowska-Kownacka, Olga Zdończyk, Marek Roik, Krzysztof Jankowski, Magdalena Koczaj-Bremer, Marek Gołębiowski, Piotr Pruszczyk

Andrzej Łabyk, Dominik Wretowski, Sabina Zybińska-Oksiutowicz, Aleksandra Furdyna, Katarzyna Ciesielska, Dorota Piotrowska-Kownacka, Olga Dzikowska-Diduch, Barbara Lichodziejewska, Andrzej Biederman, Piotr Pruszczyk, Marek Roik

Background: Approximately a quarter of patients with advanced sarcoidosis develop pulmonary hypertension (PH), which affects their prognosis. We report unusual case of confirmed chronic thromboembolic pulmonary hypertension (CTEPH) in a patient with stage IV sarcoidosis successfully treated with balloon pulmonary angioplasty (BPA).Case presentation: A 65 years old male with a history of colitis ulcerosa, and pulmonary sarcoidosis diagnosed in 10 years before, on long term oral steroids, with a history of deep vein thrombosis and acute pulmonary embolism chronically anticoagulated was referred to our center due to severe dyspnea. On admission he presented WHO functional class IV, mean pulmonary artery pressure (mPAP) in right heart catheterization (RHC) was elevated to 54 mmHg. Diagnosis of CTEPH was definitely confirmed with typical V/Q scan, and with selective pulmonary angiography (PAG) completes by intravascular imagining (intravascular ultrasound, optical coherent tomography). The patient was deemed inoperable by CTEPH team and two sessions of BPA with multimodal approach resulted in significant clinical and haemodynamical improvement to WHO class II and mPAP decrease to 27 mmHg.Conclusions: Balloon pulmonary angioplasty, rapidly developing method of treatment of inoperable CTEPH patients, is also extremely useful therapeutic tool in complex PH patients.Keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Sarcoidosis.