ABSTRACT
Abstract Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO 2 ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO 2 response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO 2 at ventilatory anaerobic threshold (23.3%) and change in PETCO 2 kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO 2 response during exercise in a patient with PH-HF.
Subject(s)
Humans , Male , Female , Middle Aged , Cardiomyopathy, Dilated/rehabilitation , Endurance Training , Hypertension, Pulmonary/rehabilitation , High-Frequency Ventilation , Cardiomyopathy, Dilated/prevention & control , Pulmonary Gas Exchange , Exercise Test , Cardiac Rehabilitation/methods , Hypertension, Pulmonary/prevention & controlABSTRACT
Este artigo tem por finalidade orientar a conduta nos casos de pacientes com taquicardia ventricular sustentada e disfunção grave, encaminhados para implante de desfibrilador, situação cada vez mais frequente. Discute-se a possibilidade de utilizar alternativas cirúrgicas para solucionar situações em que os limiares de desfibrilação permanecem altos durante os testes realizados no momento do implante
Subject(s)
Humans , Male , Middle Aged , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/physiopathology , Ventricular Fibrillation/rehabilitation , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/rehabilitation , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/rehabilitation , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/trendsABSTRACT
A cardiomioplastia e o procedimento cirurgico em que um musculo e implantado sobre o coracao e estimulado de modo sincronico para auxiliar a funcao contratil cardiaca. Em um paciente de 52 anos com miocardiopatia dilatada e hipertensao pulmonar (que contra-indicava transplante cardiaco) a cirurgia foi realizada pela dissecacao e mobilizacao do musculo grande dorsal, implante de eletrodos musculares, envolvimento do coracao com o musculo, implante de eletrodo cardiaco e conexao de eletrodos a um mioestimulador apropriado (Biotronik Mios). Atraves de estimulos sincronicos de intensidade progressiva, iniciados 2 semanas apos a cirurgia, foi possivel treinar o musculo grande dorsal e obter melhora clinica do paciente. Um processo infeccioso severo determinou remocao do sistema ao final do quarto mes de pos-operatorio (precedida de toracotomia para tratamento de mediastinite). Com a cura da infeccao, no sexto mes, o sistema de estimulacao foi reimplantado (eletrodos musculares, cardiaco e mioestimulador) e novo periodo de treinamento muscular iniciado. Presentemente, no terceiro mes apos o reimplante, foi obtida evidencia ecocardiografica de melhora da funcao ventricular esquerda e o paciente refere importante reducao dos sintomas de insuficiencia cardiaca