ABSTRACT
SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.
RESUMO A hipertensão pode cursar com disfunção diastólica de ventrículo esquerdo (VE) e a consequência disso pode ser sintomas e sinais de insuficiência cárdica (IC). O refluxo hepatojugular (RHJ), descrito como sinal de regurgitação da valva tricúspide, pode refletir alterações estruturais e funcionais do VE no paciente hipertenso. O sinal pode estar presente na vigência de IC. Caso: homem, 49 anos compressão arterial não controlada. Ao exame físico apresentou turgência jugular, RHJ e pressão arterial elevada. Os exames complementares mostraram sinais de sobrecarga atrial e de ventrículo esquerdo no eletrocardiograma, e no ecocardiograma foi evidenciado aumento do volume do átrio esquerdo, hipertrofia concêntrica do VE e sinais de disfunção diastólica grau I. DISCUSSÃO: RHJ presente correlaciona-se com a pressão da artéria pulmonar e provavelmente reflete o aumento do volume sanguíneo central.
Subject(s)
Humans , Male , Stroke Volume/physiology , Tricuspid Valve Insufficiency/physiopathology , Ventricular Dysfunction, Left/physiopathology , Heart Failure/physiopathology , Jugular Veins/physiopathology , Tricuspid Valve Insufficiency , Echocardiography , Electrocardiography , Heart Failure/pathology , Hypertension/physiopathology , Jugular Veins/pathology , Middle AgedABSTRACT
ABSTRACT The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Objective: Our objective was to search for recurrence predictors in TGA patients. Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.
RESUMEN El riesgo de recurrencia de nuevos eventos de amnesia en pacientes que han experimentado previamente Amnesia Global Transitoria (AGT) oscila entre el 2.9-23.8%. Objetivo: Nuestro objetivo fue buscar predictores de recurrencia en pacientes con AGT. Métodos: Análisis retrospectivo de una cohorte de 203 pacientes con AGT de un único centro en Buenos Aires, Argentina, diagnosticados entre enero-2011 y marzo-2017 Se analizaron las características clínicas y los estudios complementarios (laboratorio, Doppler de vena yugular y RM encéfalo). Se comparó el grupo de AGT recurrente versus episodio único, aplicando un modelo de regresión logística multivariada. Resultados: la edad promedio de presentación fue de 65 años (20-84); 52% mujeres. La mediana del tiempo transcurrido entre el inicio de los síntomas y la visita a la sala de emergencia fue de 2 horas, con una duración promedio del episodio de 4 horas. El seguimiento medio fue de 22 meses. 66% de los pacientes tuvieron un desencadenante identificable. El reflujo yugular estuvo presente en el 66% de los pacientes y el 22% mostró imágenes restrictivas en DWI a nivel hipocampal. 8% de los pacientes presentaron recurrencia. Los pacientes con AGT recurrente tuvieron un historial de migraña más frecuente (37.5% vs. 14%; p=0.03). Ninguna de las otras características clínicas y estudios complementarios fueron predictores de mayor riesgo de recurrencia. Conclusiones: los pacientes con migraña pueden tener un mayor riesgo de recurrencia de AGT. Ninguna de las otras características clínicas evaluadas nos permitió predecir un mayor riesgo de recurrencia. Aunque los estudios complementarios nos permitieron orientar el diagnóstico, no pareció tener un impacto significativo en la predicción del riesgo de recurrencia.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Amnesia, Transient Global/etiology , Prognosis , Recurrence , Logistic Models , Retrospective Studies , Risk Factors , Amnesia, Transient Global/physiopathology , Amnesia, Transient Global/diagnostic imaging , Jugular Veins/physiopathology , Migraine Disorders/complications , Migraine Disorders/physiopathologyABSTRACT
Abstract Background: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial. Objective: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram. Methods: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%. Results: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66). Conclusion: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.
Resumo Fundamento: Exame físico e peptídeo natriurético do tipo B (BNP) foram usados para estimar a hemodinâmica e adequar a terapia de pacientes com insuficiência cardíaca aguda descompensada (ICAD). Entretanto, correlação entre esses parâmetros e a pressão de enchimento do ventrículo esquerdo é controversa. Objetivo: Avaliar a acurácia diagnóstica do exame físico, da radiografia de tórax (RT) e do BNP para estimar a pressão atrial esquerda (PAE) avaliada pelo ecodopplercardiograma tecidual. Métodos: Pacientes admitidos com ICAD foram avaliados prospectivamente. As características diagnósticas dos sinais físicos de insuficiência cardíaca, RT e BNP para predizer elevação da PAE (> 15 mmHg), isolados ou combinados, foram calculadas. Teste de Spearman foi usado para analisar a correlação entre variáveis de distribuição não normal. O nível de significância foi 5%. Resultados: Este estudo incluiu 43 pacientes com idade média de 69,9 ± 11,1 anos, fração de ejeção ventricular esquerda de 25 ± 8.0%, e BNP de 1057 ± 1024,21 pg/mL. Individualmente, todos os parâmetros clínicos, RT e BNP apresentaram fraco desempenho para predizer PAE ≥ 15 mmHg. O escore clínico de congestão teve o pior desempenho [área sob a curva receiver operating characteristic (AUC) 0,53], seguindo-se escore clínico + RT (AUC 0,60), escore clínico + RT + BNP > 400 pg/mL (AUC 0,62) e escore clínico + RT + BNP > 1000 pg/mL (AUC 0,66). Conclusão: Exame físico, RT e BNP tiveram desempenho fraco para predizer PAE ≥15 mmHg. O uso desses parâmetros isoladamente ou em combinação pode levar a estimativa imprecisa do perfil hemodinâmico. (Arq Bras Cardiol. 2018; 110(3):270-277)
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathology , Natriuretic Peptide, Brain/blood , Atrial Pressure/physiology , Heart Failure/diagnosis , Heart Failure/physiopathology , Physical Examination , Reference Values , Stroke Volume/physiology , Radiography, Thoracic/methods , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Ventricular Dysfunction, Left/blood , Echocardiography, Doppler, Pulsed/methods , Heart Failure/blood , Heart Failure/diagnostic imaging , Jugular Veins/physiopathologyABSTRACT
OBJECTIVES: To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD: Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS: Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION: Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery.
Subject(s)
Animals , Male , Female , Carotid Arteries/physiopathology , Carotid Arteries/surgery , Jugular Veins/physiopathology , Jugular Veins/transplantation , No-Reflow Phenomenon/diagnosis , Regional Blood Flow/physiology , Vascular Grafting/methods , Anastomosis, Surgical , Carotid Arteries/pathology , Fibrosis , Jugular Veins/pathology , Microsurgery/methods , Neovascularization, Physiologic , Postoperative Period , Rats, Wistar , Reproducibility of Results , Time Factors , Treatment Outcome , Vascular Grafting/adverse effectsABSTRACT
Objetivo: destacar la utilidad de la medición de la saturación de oxígeno en la sangre venosa del bulbo yugular (SatBYO2) en la vigilancia y manejo de la hipoxia o isquemia cerebral global en pacientes con traumatismo encéfalocraneano grave y sus correlaciones con las presiones arterial media, intracraneana y de perfusión cerebral. Pacientes y métodos: once niños (promedio de edades 98 meses, nueve varones), con traumatismo craneoencefálico grave (calificación de Glasgow igual o menor a 8), causado por impacto con vehículos en la vía pública, fueron admitidos a una unidad de cuidados intensivos pediátricos de un hospital suburbano de Santiago durante un período de 12 meses. En todos se introdujo un catéter en el bulbo yugular y se hicieron mediciones de SatBYO2. Resultados: la SatBYO2 era anormalmente baja en cuatro pacientes, en todos había acentuada hiperventilación y en dos hipertensión intracraneana, pero se normalizó mediante ajustes en los controles de los ventiladores mecánicos y el manejo efectivo de la hipertensión intracraneana. No se registraron complicaciones debidas al procedimiento. Todos los pacientes sobrevivieron. Conclusiones: el método es aplicable y seguro en pacientes de unidades pediátricas de cuidados intensivos. La medición de la SatBYO2 es útil como complemento en la evaluación de la oxigenación global cerebral en pacientes con traumatismo encéfalocraneano grave
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Catheterization, Central Venous , Craniocerebral Trauma/blood , Jugular Veins/physiopathology , Hemodynamics , Oxygenation , Tomography, X-Ray ComputedABSTRACT
El autor revisa las principales causas que provocan una tromboflebitis de la vena yugular interna, haciendo hincapié en que en la actualidad se dan las circunstancias para que este fenómeno sea mas frecuente y alerta a los médicos sobre este punto. Posteriormente, discute los hechos clínicos mas importantes, los elementos de diagnóstico mas útiles y la forma de tratar esta enfermedad
Subject(s)
Humans , Male , Adult , Aged , Thrombophlebitis/physiopathology , Jugular Veins/physiopathology , Thrombophlebitis/therapy , Tomography, X-Ray ComputedABSTRACT
En un lapso de 10 años se presentaron ocho casos de flebectasias y flebangiomas en el Servicio de Angiología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI. Estas lesiones, de acuerdo a la clasificación de Malan y Pouglionise, se catalogan como displasias venosas. Su estudio fue clínico y flebográfico; el tratamiento fue quirúrgico. Se obtuvieron buenos resultados. No hubo complicaciones ni recidivas
Subject(s)
Humans , Male , Female , Adult , Thrombosis/surgery , Thrombosis , Phlebography , Jugular Veins/surgery , Jugular Veins/physiopathologySubject(s)
Humans , Venous Pressure/physiology , Pulse , Jugular Veins/physiology , Jugular Veins/physiopathologyABSTRACT
Se analizó la curva de presión intracraneal, obtenida al ocluir la circulación de retorno venosos cerebral, por compresión del sistema yugular, en función del tiempo en que se obtenía el máximo incremento de la presión intracraneal, así como el necesario para obtener nuevamente las cifras basales