Acute heart failure/Falla cardíaca aguda/Falha cardiaca aguda

• Published in: Iatreia (Medellín, Colombia) Colombia), 2015-01, p.78
• Main Authors: Sanchez, Sr., Juan Manuel, Ricardo, Jairo Alfonso Gandara
• Format: Article
• Language: Spanish
• ISSN: 0121-0793

We describe the clinical case of a 26 year-old woman who came to Hospital Universitario San Vicente Fundacion (Medellin, Colombia) with symptoms and signs of acute heart failure. She had been previously diagnosed with chronic heart failure with reduced ejection fraction without clear origin, pulmonary thromboembolism and ischemic strobe, without optimal neurohormonal modulation. She was admitted with clinical findings of fluid overload and low tissue perfusion, with inotropic support requirement and parenteral diuretics; clinical stability was achieved with the progressive introduction of medical therapy for heart failure. For the study of the latter, heart MRI was done that showed a delayed enhancement area in the left anterior descending artery. Coronary angiography was carried out in which no significant lesions were found in the epicardial arteries. Finally, compensation of the acute heart failure was achieved, and chronic anticoagulation was started for probable thrombophilic disease, due to the recurring arterial and venous thrombotic events. KEYWORDS Congestive Heart Failure: Infarction: Ischemic Cardiopathy Se presenta el caso clinico de una mujer de 26 anos de edad, que acudio al Hospital Universitario San Vicente Fundacion (Medellin) con sintomas y signos de falla cardiaca aguda y diagnostico previo de falla cardiaca cronica con fraccion de expulsion disminuida, de origen no claro, tromboembolismo pulmonar y ataque cerebrovascular isquemico, sin modulacion neurohormonal optima. Ingreso a la institucion con hallazgos clinicos de sobrecarga hidrica y baja perfusion tisular, con requerimiento de soporte inotropico y diureticos parenterales; se logro estabilizarla e introducir progresivamente la terapia medica para la falla cardiaca. Para el estudio del origen de esta enfermedad, se hizo resonancia magnetica de corazon, que demostro un area de realce tardio en el territorio de la arteria descendente anterior, sugestiva de necrosis, por lo que se le efectuo coronariografia, en la que no se hallaron lesiones en las arterias coronarias epicardicas. Finalmente se logro la compensacion de la falla cardiaca aguda y se decidio hacer anticoagulacion cronica por la probable trombofilia de la paciente, en concordancia con los fenomenos tromboticos arteriales y venosos recurrentes. PALABRAS CLAVE Cardiopatia Isquemica; Insuficiencia Cardiaca Congestiva; Infarto Se apresenta o caso clinico de uma mulher de 26 anos de idade, que foi ao Hospital Universitario San