Evaluation of Right Ventricular Systolic and Diastolic Function in Patients with Newly Diagnosed Obstructive Sleep Apnea Syndrome without Hypertension

WOS: 000263747400006PubMed ID: 19151552Objectives: We investigated right ventricular (RV) structural and functional cardiac alterations in obstructive sleep apnea (OSA) independent of systemic hypertension and their correlation to the severity of OSA. Methods: Forty-one moderate-to-severe OSA but otherwise healthy patients and 30 body mass index-matched control subjects were included. All subjects underwent 24-hour ambulatory blood pressure monitoring, standard and tissue Doppler imaging of the RV. Results: The OSA group had increased RV wall thickness, impaired right ventricular outflow tract fractional shortening (RVOT fs), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and RV myocardial acceleration during isovolumic contraction (IVA) (p < 0.001). Apnea hypopnea index (AHI) and mean pulmonary artery (PA) pressure were correlated with all these indices (p < 0.01 for all). RV free wall thickness (p < 0.001) and IVA (p = 0.006) remained significant predictors of AHI after adjusting for age, body mass index, mean PA pressure, RVOT fs, TAPSE and MPI in a multiple stepwise linear regression model. Conclusions: OSA is associated with impaired RV function despite normal systemic blood pressures. The level of RV dysfunction has a direct relationship with the severity of OSA. RV free wall thickness and IVA are independent predictors of AHI in uncomplicated OSA patients. Copyright (C) 2009 S. Karger AG, Base

A Case of Dengue Fever Complicated with Trombophlebitis in a Child

Dengue fever is a disease characterized by flu like symptoms which is endemic in tropic and subtropic regions. Dengue virus is from Filavivirus family. Dengue fever is rarely seen in our country. Hemorrhagic and thrombotic complications can be observed during the course of the disease. Herein we present a child case of Dengue fever diagnosed in our country who was complicated with thrombophlebitis. A previously healthy 16-year old boy was presented with headache, malaise and fever lasting for six days. He had returned from Philippines a week ago where he had stayed for a month. On physical examination, he was dehydrated with fever of 39.3 degrees C. His heart rate was 109/min, respiratory rate was 28/min, blood pressure was 132/78 mmHg, oxygen saturation was %96 (room air) and capillary refill time was 5 seconds. His oral mucosa was dry and turgor was decreased. He had generalized erythematous rash, muscle pain and 2 cm splenomegaly. Laboratory examination revealed polycythemia and thrombocytopenia. He was hospitalized and intravenous hydration was initiated because of severe dehydratation and hemoconcentration. His history revealed that his roommate in Philippines was diagnosed as Dengue fever, recently. Pain and limitation of movement on left antecubital region developped on follow-up. Peripheral pulses could be palpated on both distal extremities and there was no difference of heat. Superficial doppler ultrasonography revealed echogenic thrombus extending from cephalic vein to wrist, and basilic vein to axillary region without recanalization. He was started on enoxaparin treatment. Serum Dengue fever IgM and IgG were reported as positive and he was discharged with recovery one week after hospitalization. Dengue fever should be considered as differential diagnosis of patients with flulike symptoms who had travel history to endemic countries. Hemorrhagic complications and hemorrhagic shock syndrome which are frequently seen in patients with Dengue fever can cause mortality. In addition, superficial and deep vein thrombosis can be observed in severely dehydrated patients with Dengue fever. These patients should be carefully observed for possible thromboembolic complications