<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2182-5173</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Medicina Geral e Familiar]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Med Geral Fam]]></abbrev-journal-title>
<issn>2182-5173</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Medicina Geral e Familiar]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2182-51732021000400352</article-id>
<article-id pub-id-type="doi">10.32385/rpmgf.v37i4.13014</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Síndroma de roubo da subclávia: um caso clínico de aparente hipotensão]]></article-title>
<article-title xml:lang="en"><![CDATA[Subclavian steal syndrome: apparently a hypotension clinical case]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Coelho]]></surname>
<given-names><![CDATA[Diana Patrícia Pereira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Inês José Maia da]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Okai]]></surname>
<given-names><![CDATA[Hiroshi]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ACeS Aveiro Norte USF Vale do Vouga ]]></institution>
<addr-line><![CDATA[São João da Madeira ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>09</month>
<year>2021</year>
</pub-date>
<volume>37</volume>
<numero>4</numero>
<fpage>352</fpage>
<lpage>356</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2182-51732021000400352&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2182-51732021000400352&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2182-51732021000400352&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A estenose da artéria subclávia proximal, condicionando a síndroma de roubo da subclávia, é frequentemente secundária a doença arterial aterosclerótica. Pode ser totalmente assintomática ou cursar com sintomas de isquemia do membro superior ipsilateral ou sintomas de isquemia transitória da circulação cerebral posterior. Apesar de o diagnóstico definitivo ser imagiológico, as alterações ao exame objetivo são fortemente sugestivas, nomeadamente um diferencial de pressão arterial entre os dois membros superiores.  Descrição do caso:  Mulher de 69 anos, com HTA, DM tipo 2, dislipidemia e obesidade, recorreu à consulta por tonturas, cefaleias e descida dos valores tensionais, com dois meses de evolução, tendo decidido suspender a medicação anti-hipertensora. Referia episódio prévio de cefaleia, disartria súbita e sensação de &#8220;língua presa&#8221;, que motivou ida ao serviço de urgência. Neste, quando observada, já não apresentava qualquer alteração objetiva. No exame físico, na consulta do MF, destacava-se uma PA 108/75mmHg, avaliada no membro superior esquerdo. Devido aos vários fatores de risco ateroscleróticos e ao episódio prévio sugestivo de AIT foram pedidos exames complementares de diagnóstico, incluindo ecodoppler dos vasos cervicais, que demonstrou um fluxo retrógrado da artéria vertebral esquerda, sugestivo de estenose da artéria subclávia esquerda proximal. Na sequência, um EO minucioso revelou um diferencial de PA, entre os dois membros superiores (108/79mmHg à esquerda e 170/81 à direita). Foi recomendado retomar a medicação anti-hipertensora, reforçado o controlo dos múltiplos fatores de risco ateroscleróticos e referenciada a cirurgia vascular.  Comentário:  Neste caso, os valores tensionais eram aparentemente diminuídos; contudo, após a avaliação da pressão arterial em ambos os membros superiores, constatou-se que a utente mantinha uma HTA grau 2 não controlada. Os autores pretendem alertar para a importância de, no meio das muitas tarefas do dia-a-dia, ser mantida uma boa prática semiológica na determinação da pressão arterial, em ambos os braços.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  The proximal subclavian stenosis associated with subclavian steal syndrome is frequently secondary to atherosclerotic arterial disease. It can be completely asymptomatic or present symptoms of superior ipsilateral arm ischemia or transitory posterior-circulation cerebral ischemia. The final diagnosis is imagiological. However, the alterations to the physical examination (PhE) are extremely suggestive, namely, arterial pressure discrepancy between the two superior arms.  Case description:  A 69-year-old woman, with hypertension, diabetes mellitus type 2, dyslipidaemia, and obesity, has gone to the medical appointment with dizziness, headache and a decrease in blood pressure which had two months of evolution. She decided to suspend the antihypertensive treatment by herself. She also referred to a previous headache episode, sudden dysarthria, and a &#8216;tied tongue&#8217; sensation, which let her go to emergency care. In urgency care, when she was observed, no objective alterations were found. During the family physician appointment, PhE showed a blood pressure 108/75mmHg, which was evaluated on the superior left arm. Due to the various atherosclerosis risk factors and the previous episode suggestive of AIT, complementary diagnostic exams were made, including carotid and vertebral doppler ultrasonography, which showed a retrograde flow from the left vertebral artery that suggests proximal left subclavian stenosis. Consequently, a detailed PhE revealed a blood pressure discrepancy between the two superior arms (108/79mmHg on the left and 170/81mmHg on the right). The woman was recommended to retake antihypertensive medicines, to control the multiple atherosclerosis risk factors and she was tracked to a vascular surgery appointment.  Comments:  In this clinical case the BP values were, apparently, decreased. However, after an evaluation in both superior arms, it was revealed that the patient presented uncontrolled grade 2 hypertension. The authors really want to alert for the importance of keeping the good semiological practice of BP determination, in both arms, even though the multitasking daily routines.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Hipotensão]]></kwd>
<kwd lng="pt"><![CDATA[Determinação da pressão arterial]]></kwd>
<kwd lng="pt"><![CDATA[Síndroma de roubo da subclávia]]></kwd>
<kwd lng="pt"><![CDATA[Aterosclerose]]></kwd>
<kwd lng="en"><![CDATA[Hypotension]]></kwd>
<kwd lng="en"><![CDATA[Blood pressure determination]]></kwd>
<kwd lng="en"><![CDATA[Subclavian steal syndrome]]></kwd>
<kwd lng="en"><![CDATA[Atherosclerosis]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bayat]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Chuen]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Subclavian steal syndrome]]></article-title>
<source><![CDATA[Medscape]]></source>
<year>2019</year>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tan]]></surname>
<given-names><![CDATA[TY]]></given-names>
</name>
<name>
<surname><![CDATA[Schminke]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Lien]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Tegeler]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Subclavian steal syndrome can the blood pressure difference between arms predict the severity of steal?]]></article-title>
<source><![CDATA[J Neuroimaging]]></source>
<year>2002</year>
<volume>12</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>131-5</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Granito]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Azevedo]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Jardim]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Andrade]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
<name>
<surname><![CDATA[Lélis]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Chaves]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Aterosclerose: a propósito do fenómeno de roubo da subclávia]]></article-title>
<source><![CDATA[Rev Soc Port Med Interna]]></source>
<year>2011</year>
<volume>18</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>35-9</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ehrenfeld]]></surname>
<given-names><![CDATA[WK]]></given-names>
</name>
<name>
<surname><![CDATA[Chapman]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
<name>
<surname><![CDATA[Wylie]]></surname>
<given-names><![CDATA[EJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of occlusive lesions of the branches of the aortic arch]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1969</year>
<volume>118</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>263-43</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nicholls]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
<name>
<surname><![CDATA[Koutlas]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
<name>
<surname><![CDATA[Strandness]]></surname>
<given-names><![CDATA[DE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical significance of retrograde flow in the vertebral artery]]></article-title>
<source><![CDATA[Ann Vasc Surg]]></source>
<year>1991</year>
<volume>5</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>331-6</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<collab>Direção-Geral da Saúde</collab>
<source><![CDATA[Diagnóstico, tratamento e controlo da hipertensão arterial: circular normativa n.º 2/DGCG, de 31/03/2004]]></source>
<year>2004</year>
<publisher-loc><![CDATA[Lisboa ]]></publisher-loc>
<publisher-name><![CDATA[DGS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="book">
<collab>European Society of Cardiology</collab>
<source><![CDATA[Hipertensão: recomendações da ESC/ESH para o tratamento da hipertensão arterial: recomendações de bolso de 2018 da ESC]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Lisboa ]]></publisher-loc>
<publisher-name><![CDATA[Sociedade Portuguesa de Cardiologia]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<collab>European Society of Cardiology</collab>
<article-title xml:lang=""><![CDATA[Tradução Portuguesa das guidelines de 2013 da ESH/ESC para o tratamento da hipertensão arterial]]></article-title>
<source><![CDATA[Rev Port Hipertens Risco Cardiovasc]]></source>
<year>2014</year>
<numero>39^sSuppl</numero>
<issue>39^sSuppl</issue>
<supplement>Suppl</supplement>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="book">
<collab>Direção-Geral da Saúde</collab>
<source><![CDATA[Hipertensão arterial: definição e classificação: norma n.º 20/2011, de 28/09/2011, atualizada em 19/03/2013]]></source>
<year>2013</year>
<publisher-loc><![CDATA[Lisboa ]]></publisher-loc>
<publisher-name><![CDATA[DGS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Cotran]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Robins]]></surname>
<given-names><![CDATA[SL.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Atherosclerosis]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Cotran]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Robins]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
</person-group>
<source><![CDATA[Basic pathology]]></source>
<year>1997</year>
<edition>6</edition>
<page-range>282-9</page-range><publisher-name><![CDATA[Saunders]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
