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Inicio Hipertensión y Riesgo Vascular Resistant hypertension and Morgagni hernia: The importance of nocturnal hypoxaem...
Journal Information
Vol. 39. Issue 1.
Pages 42-45 (January - March 2022)
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Vol. 39. Issue 1.
Pages 42-45 (January - March 2022)
Clinical case
Resistant hypertension and Morgagni hernia: The importance of nocturnal hypoxaemia
Hipertensión resistente y hernia de Morgagni: la importancia de la hipoxemia nocturna
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L. Castilla-Guerraa,
Corresponding author
castillafernandez@hotmail.com

Corresponding author.
, P. Luque Lineroa, C. Romero Muñozb
a Unidad de Hipertensión, Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Virgen Macarena, Sevilla, Spain
b Servicio de Neumología, Hospital Virgen Macarena, Sevilla, Spain
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Abstract

A 51-year-old woman consulted for resistant arterial hypertension despite adequate antihypertensive treatment. Physical examination and analytical study showed no relevant abnormalities, with pulse oximeter saturation of 95%. The study highlighted nocturnal respiratory polygraphy with data of mild intensity sleep apnoea syndrome, and severe nocturnal hypoxaemia (apnoea hypopnoea index per hours of sleep [AHI] 7.8; desaturation index per hour [ODI]: 12.6. Oxygen-medium saturation: 89%, minimum saturation: 72%. CT90: 34.2%).

The chest X-ray showed elevation of the right hemidiaphragm, and the chest computed tomography (CT) revealed a Morgagni hernia with a maximum diameter of 20cm. After adjusting the antihypertensive treatment, the patient was referred to General Surgery for intervention. The onset of resistant hypertension secondary to severe nocturnal hypoxemia from a large Morgagni hernia has not been previously described in the literature.

Keywords:
Hypertension
Resistant hypertension
Morgagni's hernia
Nocturnal hypoxemia
Sleep apnoea–hypopnoea syndrome
Resumen

Mujer de 51 años de edad que consultó por hipertensión arterial resistente, pese a tratamiento antihipertensivo adecuado. Presentaba una exploración y estudio analítico sin alteraciones relevantes, con saturación del 95% por pulsioximetría. En el estudio destacaba una poligrafía respiratoria nocturna con datos de síndrome de apnea del sueño de intensidad leve, e hipoxemia nocturna grave (índice de apneas hipopnea por horas de sueño [IAHH] 7,8; índice de desaturaciones por hora [IDH]: 12,6. Oxígeno-saturación media: 89%, saturación mínima: 72%. CT90: 34,2%).

La radiografía de tórax mostró una elevación de hemidiafragma derecho, comprobándose en la tomografía computarizada (TC) torácica una hernia de Morgagni de 20 cm de diámetro máximo. Tras ajustar el tratamiento antihipertensivo, la paciente se derivó a cirugía general para su intervención. La aparición de hipertensión resistente secundaria a hipoxemia nocturna grave por una gran hernia de Morgagni no ha sido descrita previamente en la literatura.

Palabras clave:
Hipertensión
Hipertensión resistente
Hernia de Morgagni
Hipoxemia nocturna
Síndrome de apnea hipopnea nocturna

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