背景:我们报道了一例93岁左心室功能正常且二尖瓣环严重钙化的患者,轻度二尖瓣狭窄功能不全。
方法:她开发了爬行药物引起的肾毒性,这种毒性通常被完全忽略,主要由于他汀类药物,质子泵抑制剂,还有阿司匹林.钠和液体滞留,伴随着随之而来的高血压,虽然不严重,由于二尖瓣关闭不全恶化而导致急性心力衰竭(肺下水肿)。这是由于收缩期钙化二尖瓣环收缩效率较低,二尖瓣跨瓣梯度增加,因为经瓣二尖瓣梯度与血流呈指数关系。在暂停肾毒性药物并开始静脉注射呋塞米后,她迅速改善。随访6个月时,她很稳定,在NYHA1-2功能类中,尽管肾功能仅部分恢复。
结论:进行性肾衰竭可使二尖瓣病变功能恶化,甚至轻微。在病因不明的肾衰竭的情况下,始终可以怀疑药物引起的肾毒性。即使在非自闭症患者中,暂停使用罪魁祸首药物也可以改善肾功能并显着改善临床症状。
BACKGROUND: We report the
case of a 93-year-old patient with normal left ventricular function and severe mitral annulus calcification, with mild mitral steno-insufficiency.
METHODS: She had developed creeping drugs-induced renal toxicity that is generally totally overlooked, due mainly to statins, a proton pump inhibitor, and aspirin. The Na and fluid retention, along with hypertension that ensued, although not severe, caused acute heart failure (sub-pulmonary edema) by worsening the mitral insufficiency. This occurred due to a less efficient calcific mitral annulus contraction during systole and an increasing mitral transvalvular gradient, as the transvalvular mitral gradient has an exponential relation to flow. After the suspension of the nephrotoxic drugs and starting intravenous furosemide, she rapidly improved. At 6 months follow-up, she is stable, in an NYHA 1-2 functional class, despite the only partial recovery of the renal function.
CONCLUSIONS: Progressive renal failure can functionally worsen even minimal mitral valvulopathy. Drug-induced nephrotoxicity can always be suspected in
case of renal failure of unknown etiology. The suspension of the culprit drugs can improve renal function and dramatically improve the clinical symptoms even in a nonagenarian.