Noncomplicated course of hypertension, paroxysmal atrial fibrillation and essential thrombocytaemia
Authors:
J. Pella 1; P. Kalist 1; J. Lazúr 2
Authors‘ workplace:
III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta prof. MUDr. Jozef Pella, Ph. D.
1; Hematologické oddelenie FN L. Pasteura, Košice, Slovenská republika, prednosta prim. MUDr. Ján Lazúr
2
Published in:
Vnitř Lék 2005; 51(9): 1007-1010
Category:
Case Report
Overview
In the case report we describe more than 17-year long monitoring and treatment of 79-year-old woman patient. In spite of progressive increase of number of diseases (altogether 6), each being associated with increased risk of thromboembolic (alternatively haemorrhagic) events, the history was without complications up to now. Hypertension, diagnosed in the year of 1987, was the first disease we monitored and treated with calcium channel blocker (CCB – verapamil). Patient experienced the first paroxysm of atrial fibrillation (PAF) in the year of 1997. This paroxysm was managed by application of propaphenone in combination with acetylsalicylic acid in daily oral dose of 300 mg. We detected essential thrombocytaemia (ET) in the year of 1999. Maximum thrombocyte count (Tr) did not exceed the value 1 000 × 109/l. In respect to the age and associated diseases we started to administer also cytoreductive treatment with hydroxyurea (Litalir) in addition to the treatment with acetylsalicylic acid mentioned above. The last 4 years we diagnosed diffuse osteoporosis with positive LATEX titre (1 : 40). Mild primary hypothyroidism was substituted by levothyroxine (Euthyrox). Because of dyspeptic complaint verified gastroscopically in the year of 2002 (small aphthous lesions in gastric antrum) we replaced acetylsalicylic acid with ticlopidine, which is less aggressive to gastric mucosa and which was subjectively better tolerated by the patient. In the year of 2004 repeated gastroscopy confirmed complete cure of aphthous changes (virtually normal finding). Seven years after the first attack (that was also the last one) of PAF the patient is still without atrial fibrillation (AF). At present she is subjectively without complaint, objective findings – blood pressure (BP), blood cell count, liver function tests are normal. In the literature we have not found the case of the above mentioned combination of 6 diseases without embolic and haemorrhagic complications.
Key words:
hypertension – atrial fibrillation – essential thrombocytaemia
Sources
1. Bialy D, Lehman MH, Schumacher DN et al. Hospitalisation for arrhythmias in USA: Importance of atrial fibrilation. J Amer Coll Cardiol 1992; 19: 414A.
2. Brugada R, Tapscott T, Czernussewicz G et al. Identification of the first locus for familiar atrial fibrillation utilizing a rapid novel pooled DNA strategy. J Amer Coll Cardiol 1999; 29: 407-411.
3. Donahue PT, Beth-Conti J. Atrial fibrillation: rate control versus maintenance of sinus rhytm. Curr Opin Cardiol 2001; 16: 46-53.
4. Gugliotta R, Marchioli M, Fiacchini M et al. Epidemiological, diagnostic therapeutic and prognostic aspects of essential thrombocythemia in retrospective study of the GIMMC group in two thousand patients. Abstracts of the American Society of HEMATOLOGY, 39th Annual Meeting, December 5-9, 1997, San Diego.
5. Kalist P, Pella J. Fibrilácia predsiení - Základné fakty. Košice: ORIENS 2002.
6. Kannel WB, Abbot RD, Savage DD et al. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med 1982; 306: 1018.
7. Kerr C, Boone J. Follow up of atrial fibrillation: The initial experience of clinical trials. Eur H J 1996; 17: 48-51.
8. Kumagai K, Fukunami M, Ohmori M. Increased intracardiovascular clotting in patients with chronic atrial fibrillation. J Amer Coll Cardiol 1990; 16: 377-380.
9. Lip GY, Beevers DG, Cooper JR. ABC of atrial fibrilation. Atrial fibrillation in general and hospital practice. Br Med J 1995; 312: 175-178.
10. Lip GY, Golding DJ, Nazir M et al. A survey of atrial fibrillation in general practice. The West Birmingham atrial fibrillation project. Br J Gen Pract 1997; 47: 285-289.
11. Murphy S, Peterson P, Iland H et al. Experience of the Polycythaemia Vera Study Group with essential thrombocythaemia. Semin Hematol 1997; 34: 29-38.
12. Narayan SM, Cain ME, Smith JM. Atrial fibrillation. Lancet 1997; 350: 943-950.
13. Pella D, Rybár R, Trejbal D. Ateroskleróza a artériová hypertenzia. Interná medicína 2001; 1: 86-90.
14. Stanley GR, Gregory WA. Porovnanie smerníc: antikoagulačná liečba na optimalizáciu prevencie iktov u pacientov s fibriláciou predsiení. J Amer Coll Cardiol 2004; 6: 145-151.
15. Stárek Z, Novák M, Dvořák I et al. Význam snímaní jícnového EKG a jícnové stimulace síní v diagnostice a terapii supraventrikulárních arytmií. Kardiol Rev 2003; 2: 51-55.
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Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
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