Pulmonale Thromboembolien bei Antiphospholipid-Syndrom

Abstract

A 37-year-old woman in acute right heart failure had experienced systemic venous thromboses for 17 years, five miscarriages and repeated pulmonary emboli. For the last 7 years she had been treated symptomatically for pulmonary hypertension. The platelet count was 62,000/microliters, thromboplastin time under phenprocoumon was 22%, partial thromboplastin time was 72 s. Despite anticoagulation with phenprocoumon and heparin (7,500 IU two times daily subcutaneously) new pulmonary emboli occurred and platelet count fell to 12,000/microliters. An increased titre for anticardiolipin antibodies (IgG > 320 GPL U/l, IgM 8 MPL U/l), antinuclear (1:640) and anti-ds-DNA antibodies (> 200 IU/ml) with simultaneous complement consumption suggested secondary antiphospholipid syndrome associated with lupus erythematodes. Treatment with prednisolone (150 mg/d), immunoglobulins (20 mg/d intravenously for 5 days) and heparin (25,000 IU/24 h intravenously) achieved an increase in platelet count to 200,000/microliters within 10 days, but fell again when the prednisolone dose was reduced, recovering under azathioprine, 150 mg/d. Four weeks later the patient died of renewed acute right heart failure.

Convergent cardiorespiratory neurons represent a significant portion of cardiac and respiratory neurons in the vagal ganglia

“…This autonomic remodeling results in progression of heart failure and arrhythmias (1)(2)(3). On the other hand, injury to the central nervous system, such as subarachnoid hemorrhage, can affect vagal neuronal density, leading to cardiac electrophysiological abnormalities However, while axonal branching is known to be ubiquitous in the brain (4), and specific cardiopulmonary preganglionic parasympathetic neurons that coordinate cardiopulmonary function have been identified in the nucleus ambiguous of the brainstem (5), little attention has been given to potential cardiac and respiratory interactions that may exist via a shared peripheral autonomic network. Using retrograde fluorescent labeling techniques, Tomney and colleagues reported evidence of branching post-ganglionic sympathetic efferent cardiopulmonary neurons in the canine sympathetic ganglia (6).…”