Exercise Training Improved Pulmonary Gas Exchange Abnormalities in Pulmonary Hypertension due to Heart Failure: A Case Report

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.

Cardiodefibrilador automático implantable: incidencia, causas y predictors de mortalidad. Valor de los registros prospectivos / Implantable automatic cardiodefibrillator: incidence causes and predictors of mortality. Value of the prospective records

The implantable automatic cardiodefibrilator (IACD) has proved to be an effective tool in the prevention of both primary and secondary sudden death. Even so, the mortality of patients receiving an IACD still remains elevated. Recent data, obtained from the secondary analysis of different studies, suggest that the discharges of the deice, between other clinical variables, both electrocardiiographic and ultrasonographic could be associated to a higher mortality, maybe due to a contribution to the progression of the cardiac insufficiency. The aims of this report were to evaluate the incidence of mortality, causes of death and the time since the implantation till the death, to analyze appropriate an inappropriate shocks and other variaables as potential predictors of mortality in patients with IACD. The results obtained in this study are detailed in the article

The changes in cardiac dimensions and function in patients with end stage renal disease undergoing hemodialysis

BACKGROUND: It is absolutely necessary to evaluate cardiac function on starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. METHODS: Twenty patients with end stage renal disease, who had been in a hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital, were enrolled. They were examined with echocardiography and gated blood pool scintigraphy on starting hemodialysis and after follow-up. The data were analyzed by paired t-test. RESULTS: The patients were 46.2 +/- 16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus (n=10), hypertension1), glomerulonephritis2) and others1). The duration of symptoms associated with end stage renal disease and underlying diseases was 3.4 2.6 years and the duration of hemodialysis was 13.8 7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p 0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p < 0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p < 0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p 0.05) and in four cases associated with cardiac diseases without diabetes there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p < 0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p < 0.05) as a whole while it increased (5.90%, p < 0.05) in the cases associated with diabetes and cardiac diseases. CONCLUSION: During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore, we can expect that adequate hemodialysis - with dry weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cardiomyopathy.

Ventricular functions in children with human immunodeficiency virus infection after ACE-inhibitors.

Nine pediatric symptomatic patients infected with human immunodeficiency virus with elevated pulmonary arterial pressure (MPA pressure) and ejection fraction (EF); and with fractional shortening, (FS) mean velocity of circumferential fiber shortening (MVCfc) and left ventricular peak systolic wall stress (PS) were prospectively evaluated using 2-dimensional and M-mode serial echocardiography and Doppler cardiography after administration of an ACE inhibitor (Inhibace 0.025 mg/kg/D orally) for 12 weeks. The MPA pressure was not decreased, however the MVCfc and PS improved significantly (p < 0.05). Further, long term evaluation is required to determine its effect in preventing dilated cardiomyopathy and elevated mean pulmonary pressure.

Cardiomiopatia dilatada por doxorrubicina em pre-escolar / Cardiomyopathy dilated by doxorubicin in child, preschool

Os autores relatam um caso de cardiomiopatia dilatada em pre-escolar de 3 anos, causada pela doxorrubicina, um dos mais efetivos agentes antitumorais em pacientes com tumores solidos e leucemias. Comentam sobre os principais efeitos adversos do seu uso, fatores de risco envolvidos, fisiopatologia, metodos propedeuticos de deteccao precoce da agressao cardiaca, e metodos preventivos para protecao contra esta agressao .

Cinnarizine therapy: a new concept in prevention of experimental dilating cardiomyopathy

This work was undertaken to investigate the role of cinnarizine, a potent vasodilator with a property of calcium entry blocker in ameliorating the cardiomyopathic lesion induced by cobalt and adriamycin toxicity. Cobalt 20mg. Kg[-1]or adriamycin 50mg. Kg[-1] have been injected intra-peritonealy twice weekly in rats treated with cinnarizine 2mg.Kg[-1] intra-peritonealy. The results showed that cobalt or adriamycin induced cardiomegaly. The associated alteration in haemoglobin level and red blood corpuscles count as well as the histopathology of heart were modified when cinnarizine injected simultaneously with cobalt or adriamycin