肺动脉高压房间隔造口术后伴先兆偏头痛。

Migraine with aura following atrial septostomy for pulmonary arterial hypertension.

作者信息

Rogan Mark P, Walsh Kevin P, Gaine Sean P

机构信息

Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.

出版信息

Nat Clin Pract Cardiovasc Med. 2007 Jan;4(1):55-8. doi: 10.1038/ncpcardio0746.

DOI:10.1038/ncpcardio0746

PMID:17180151

Abstract

BACKGROUND

A 34-year-old woman with known familial pulmonary arterial hypertension presented with syncope. Despite medical therapy with an endothelin-receptor antagonist and a phosphodiesterase inhibitor, the patient had NYHA class III symptoms, with exertional dyspnea. Right heart catheterization revealed severe pulmonary hypertension (right atrial pressure 15 mmHg, right ventricular pressure 80/15 mmHg, pulmonary artery pressure 80/35 mmHg, mean pulmonary artery pressure 52 mmHg). The patient underwent balloon atrial septostomy, creating a right-to-left shunt. Although she had no history of headaches or migraine attacks, the patient developed a migraine headache with aura on the third day after the procedure. Migraine attacks recurred for the next 2 days, but symptoms were relieved with simple analgesia.

INVESTIGATIONS

Physical examination, electrocardiography, laboratory testing, 6-min-walk test, right heart catheterization, chest radiography, transesophageal echocardiography, transthoracic echocardiography.

DIAGNOSIS

Migraine with aura following atrial septostomy.

MANAGEMENT

Bosentan, sildenafil, furosemide, spironolactone and warfarin therapy, atrial septostomy, and paracetamol therapy for migraine.

摘要

背景

一名34岁已知患有家族性肺动脉高压的女性出现晕厥。尽管使用内皮素受体拮抗剂和磷酸二酯酶抑制剂进行了药物治疗，但该患者仍有纽约心脏协会（NYHA）III级症状，伴有劳力性呼吸困难。右心导管检查显示严重肺动脉高压（右心房压力15 mmHg，右心室压力80/15 mmHg，肺动脉压力80/35 mmHg，平均肺动脉压力52 mmHg）。该患者接受了球囊房间隔造口术，形成了右向左分流。尽管该患者既往无头痛或偏头痛发作史，但在术后第三天出现了伴有先兆的偏头痛。偏头痛发作在接下来的2天内复发，但通过简单的镇痛症状得到缓解。