We describe the case of a 30-year-old female patient with chronic thromboembolic pulmonary hypertension that has an excellent functional capacity under treatment with sildenafil. She did an exercise stress echocardiography that revealed marked right ventricular dilatation during exercise. This information was used for clinical decision and the authors discuss the potential utility of this echocardiographyc sign.
In a patient suspected of acute coronary syndrome that after exercise echocardiography revealed right ventricular dilatation and conducted to the correct diagnosis of acute pulmonary thromboembolism.Another patient with chronic thromboembolic pulmonary disease and severe pulmonary arterial hypertension with good response to treatment with bosentan experienced the same phenomenon2. We now describe a third case that, in our opinion highlights the utility of exercise echocardiography in this clinical setting.
We report the case of a 30-year-old female patient, with a previous history of chronic pulmonary thromboembolism(PTE) and pulmonary arterial hypertension. She had C and S Protein deficit diagnosed at the first episode of PTE two years ago. She was referred to our Unit for studyand treatment.
- Ramanath VS, Lacomis JM, Katz WE: Diagnosis of pulmonaryembolism by acute right heart morphologic and hemodinamicchanges observed during exercise stress echocardiography.J Am Soc Echocardiogra 2004, 17:1005-8.
- Cotrim C, Loureiro MJ, Miranda R, Lohmann C, Sim─é┬Áes O, CordeiroP, Fernandes R, Almeida S, Lopes L, Carrageta : Right ventricledilatation during exercise. A new sign? Rev Port Cardiol 2007,26(9):939-940.
- Cotrim C, Sim─é┬Áes O, Loureiro MJ, Cordeiro P, Lopes L, Almeida S,Ial─é╦ç M, iranda , marrageta M: Stress echocardiography in theevaluation of exercise physiology in patients with severearterial pulmonary hypertension. New methodology. Rev PortCardiol 2005, 4(12):1451-1460.
- Doyle RL, McCrory D, Channick RN, Simonneau G, Conte J: Surgicaltreatments/interventions for pulmonary arterial hypertension.ACCP Evidence-based clinical practice guidelines.Chest 2004, 126:63S-71S.
- Klepetko W, Mayer E, Sandoval J, trulock EP, Vachiery JL, DartevelleP, Pepke-Zaba J, Jamieson SW, Lang I, Corris P: interventional andSurgical Modalities of Treatment for Pulmonary ArterialHypertension. J Am Coll Cardiol 2004, 43:73S-80S.
- Ghofrani H, Schermuly R, Rose F, Wiedemann R, ohstall MG,Kreckel A, Olschewski H, Weissmann N, Enke B, Ghofrani S, SeegerW, Grimminger F: Sildenafil for long-term treatment of nonoperablechronic thromboembolic ulmonary hypertension.Am J Respir Care Med 2003, 167:1139-41.