[ARVD-FORUM] Clinical case of a pregnant's 36-year-old patient Dr. Avila

[ARVD Symposium]

English - Spanish

Dear colleagues,
I deeply apologize for having used the term "gestosis," which is very common
in Obstetrics to identify the pathology of pregnancy known as Preeclampsia
or High Blood Pressure induced by pregnancy. The exact pathophysiology of
preeclampsia and the etiology is still a little obscure, and there are many
controversies about this topic. The patients are characterized by presenting
proteinuria (always present) high blood pressure and edema (the two latter
are signs not always present). The theory most accepted currently, is the
one about "preeclamptic capillaritis" maybe of autoimmune etiology or
genetics (there is some degree of familial association) where there is
endothelial injury mediated by some cytotoxic factor produced by the
placenta that would produce disorders in cell oxidative mechanisms and
lipidic peroxidation (maybe this relates the pathology with ARVD?), which
added to the natural state of hypercoagulability of pregnancy, platelet
activation and loss of the ratio between the levels of Thromboxane and
prostaglandin, produce multiorganic dysfunction with renal, hepatic,
neurological and hematological involvement, besides uterus and placenta
dysfunction. In the cases of severe preeclampsia there is cardiovascular
involvement with symptoms of acute pulmonary edema and heart failure.
I thank you, dear doctor, for your reply, and let me tell you that
regrettably, the relatives of the patient of this case did not agree to
perform an autopsy on the dead fetus. It would have been very important to
determine whether it was a carrier of ARVD just as his mother.
Kind regards, and I'm looking forward to reading your comments,

Dr. Claudia Avila

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Estimados colegas: Mil disculpas por haber utilizado el termino "gestosis"
que es muy comun en Obstetricia para identificar a la patologia del embarazo
conocida como Preeclampsia o Hipertension inducida por embarazo. La
fisiopatologia exacta de la preeclampsia y la etiologia es un poco oscura
aun y hay muchas controversias con respecto al tema. Las pacientes se
caracterizan por presentar proteinuria(siempre presente) Hipertension
arterial y edemas (estos dos ultimos signos no siempre presentes).La teoria
mas aceptada actualmente es la de "Capilaritis preeclapmtica" tal vez de
etiologia autoinmune o genetica (hay algun grado de asociacion
familiar)donde existe una lesion endotelial mediada por algun factor
citotoxico producido por la placenta que produciria trastornos en los
mecanismos oxidativos celulares y peroxidacion lipidica (tal vez esto
relaciona la patologia con la ARVD?), que sumado al estado natural de
hipercoagulabilidad del embarazo, activacion plaquetaria y perdid
 a de la relacion entre los niveles de Tromboxano y prostaglandinas produce
disfuncion multiorganica con compromiso renal hepatico neurologico y
hematologico, ademas de la disfuncion utero-placentaria.En los casos de
preeclampsia severa hay compromiso cardiovascular con cuadros de Edema agudo
de pulmon e Insuficiencia Cardiaca.
Desde ya le agradezco querido doctor su respuesta, le comento que
lamentablemente los familiares de la paciente de este caso no aceptaron
realizar la autopsia al feto muerto, hubiera sido muy importante para
determinar si el mismo era portador de ARVD al igual que la madre.
Un saludo muy cordial, y espero ansiosamente su comentario

Dr. Claudia Avila