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1.
Cuad. Hosp. Clín ; 61(1): [9], jul. 2020. ilus.
Article in Spanish | LILACS (Americas), LIBOCS | ID: biblio-1118905

ABSTRACT

OBJETIVO: informar acerca de un caso de endocarditis bacteriana. Paciente varón de 34 años de edad, con único antecedente de rinitis alérgica con tratamiento irregular. Él es procedente de Valparaiso Chile, se encuentra en sus vacaciones en la ciudad de La Paz, acude al servicio de medicina interna ­ emergencias, con clínica compatible con edema agudo de pulmón de la altura y edema cerebral de la altura, asociado a sepsis de foco pulmonar, que progresa a choque séptico, durante su internación intercurre con alzas térmicas continuas, asociado a hallazgo ecocardiográfico de vegetación en ventrículo derecho con hemocultivo positivo, por lo que se llega al diagnóstico de endocarditis bacteriana, se realizó el tratamiento correspondiente, y resolución del cuadro.


OBJECTIVE: to report a case of bacterial endocarditis A 34-year-old male patient with a unique history of allergic rhinitis with irregular treatment. He comes from Valparaiso Chile, is on vacation in the city of La Paz, goes to the service of internal medicine - emergencies with compatible clinical with acute pulmonary edema of height and cerebral edema of height, associated with sepsis of focus pulmonary disease, which progresses to septic shock, during internment with continuous hyperthermia, associated vegetation in right ventricle for echocardiography, also positive blood culture, so that a diagnosis of bacterial endocarditis is reached, Corresponding treatment was carried out, and resolution of pathology..


Subject(s)
Male , Adult , Pulmonary Edema , Shock, Septic , Endocarditis, Bacterial , Pathology , Echocardiography , Lung
2.
Rev. habanera cienc. méd ; 19(1): 76-91, ene.-feb. 2020. tab
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1099147

ABSTRACT

Introducción: La adaptación del corazón humano al acondicionamiento físico ha sido un tema de interés médico-científico, pues el remodelado cardíaco que comprende variación en el tamaño, forma, grosor de las paredes, y masa ventricular responde al tipo de actividad física. Objetivo: Determinar las modificaciones anatómicas del ventrículo izquierdo en kayacistas y canoístas femeninos y masculinos de alto rendimiento. Material y Métodos: Se realizó un estudio prospectivo, descriptivo de corte transversal en deportistas de canotaje de alto rendimiento que acudieron al Instituto de Medicina del Deporte durante la preparación especial con vistas a participar en los Juegos Olímpicos de Rio de Janeiro 2016. La muestra se conformó con 20 deportistas que cumplieron los criterios de inclusión establecidos, se recogieron los resultados de los diferentes parámetros ecocardiográficos que fueron estudiados para comprobar si existía modificación anatómica del ventrículo izquierdo (MAVI). Se empleó la estadística descriptiva e inferencial. Resultados: Edad promedio 20,9 ± 1,18 años, predominio del sexo masculino (65 por ciento); kayak (60 por ciento) y velocidad (55 por ciento) fueron las disciplinas deportivas y modalidades competitivas predominantes , fue frecuente la hipertrofia concéntrica en ambos sexos (65 por ciento), la edad deportiva de igual o menos de 10 años (60 por ciento), espesor relativo de la pared aumentado (65 por ciento), el índice AKS mayor se encontró en la hipertrofia excéntrica (1,3 por ciento) y el porciento de grasa predominante fue en la hipertrofia concéntrica para un (7,9 por ciento). Conclusiones: El espesor relativo de la pared ventricular tuvo una relación significativa con la modalidad competitiva(AU)


Introduction: The adaptation of the human heart to physical conditioning has been a medical and scientific topic of interest where cardiac remodeling involving changes in size, form, thickness of the walls and ventricular mass responds to the type of physical activity. Objective: To determine the anatomical modifications of the left ventricle in high performance male and female canoeing and kayaking athletes. Material and methods: A prospective, descriptive, cross-sectional study was conducted in high performance canoeing athletes that attended the Instituto de Medicina del Deporte during the special training in view of the preparation for the Olympic Games in Rio de Janeiro, 2016. The sample was composed of 20 athletes that fulfilled the established inclusion criteria. The results of the different echocardiographic parameters were collected and analyzed in order to check whether there were anatomical modifications of the left ventricle (AMLV). Differential and descriptive statistics were used. Results: The average age was 20, 9 ± 1, 18 years, the male sex predominated in the study (65 percent), kayak (60 percent) and velocity (55 percent) were the predominant sports disciplines and competitive modalities, respectively. Concentric hypertrophy in both sexes (65 percent), sporting age of 10 years or less (60 percent), and increase in relative wall thickness (65 percent) were frequent; the highest AKS index was found in eccentric hypertrophy (1,3 percent) and predominant fat percentage was observed in concentric hypertrophy (7,9 percent). Conclusions: The relative thickness of the ventricular wall had a significant relationship with the competitive modalities(AU)


Subject(s)
Male , Female , Adolescent , Adult , Water Sports/injuries , Heart Ventricles/physiopathology , Heart Ventricles/diagnostic imaging , Echocardiography/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies
4.
Yonsei Medical Journal ; : 30-39, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-782126

ABSTRACT

PURPOSE: We aimed to compare the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (sAVR) on recovery of left ventricular (LV) diastolic function and afterload through serial echocardiographic examinations in patients with symptomatic high-risk severe aortic stenosis during early follow-up.MATERIALS AND METHODS: We included 38 patients undergoing TAVR (mean age, 80±6 years; male:female=18:20) and 27 patients undergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterload before, immediately after, and 3 months after the procedure using serial transthoracic echocardiography.RESULTS: Immediately after the procedure, 16 (42%) and 3 (11%) patients in the TAVR and sAVR groups, respectively, showed rapid improvement in diastolic filling patterns. E wave to e′ ratio (E/e′) and right ventricular systolic pressure (RVSP) decreased significantly in the TAVR group (E/e′: TAVR, from 24.6±12.9 to 20±9.5, p=0.048 vs. sAVR, from 21.5±9.4 to 20.64±6.4, p=0.361; RVSP: TAVR, 38.4±17.2 vs. 34±12.4, p=0.032 vs. sAVR, 32.2±11.7 vs. 30±6.8, p=0.27). After 3 months, diastolic grade distribution, E/e′, and RVSP were similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from 5.1±1.4 to 3.1±1.0 vs. sAVR, from 4.5±1.5 to 3.1±0.8 mm Hg · mL⁻¹ · m⁻², p=0.001), but after 3 months, decreases were greater in the sAVR group (from 3.1±0.8 to 2.2±1.5 mm Hg · mL⁻¹ · m⁻², p=0.093).CONCLUSION: LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated with sAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediately after the TAVR procedure than sAVR.


Subject(s)
Aortic Valve , Aortic Valve Stenosis , Blood Pressure , Echocardiography , Electric Impedance , Follow-Up Studies , Humans , Transcatheter Aortic Valve Replacement
5.
Article in English | WPRIM (Western Pacific) | ID: wprim-782109

ABSTRACT

OBJECTIVE: To identify the preoperative cardiac computed tomography (CT) factors influencing postoperative recurrent aortic regurgitation (AR) in patients who underwent aortic valve repair with the re-implantation technique (David operation) due to AR.MATERIALS AND METHODS: A total of 117 patients (age, 49.4 ± 15.6 years; 83 males) who underwent the David operation for AR were included in this retrospective study. Aortic root profiles including the aortic regurgitant orifice area (ARO) and the aortic cusp asymmetry ratio of the areas (ASR(area)), which is defined as the maximum/minimum areas among the three cusp areas at the level of the commissures, were measured on preoperative cardiac CT scans. Clinical and CT findings were compared between a group with recurrent AR grade 24 mm² (sensitivity, 76.5%; specificity 64.8%), and the area under the ROC curve (AUC) was 0.72. For ASR(area), the cut-off value was > 1.58 (sensitivity, 76.5%; specificity, 58.0%) and the AUC was 0.64. Multivariable Cox regression showed that ARO > 24 mm² (hazard ratio = 3.79, p = 0.020) was a potential independent parameter for recurrent 3 + AR. ROC for the linear regression model showed that the AUC for both ARO and ASR(area) was 0.73 (95% confidence interval, 0.64–0.81, p < 0.001).CONCLUSION: ARO and ASR(area) detected on preoperative cardiac CT would be potentially helpful for identifying AR patients who may benefit from the David operation.


Subject(s)
Aortic Valve Insufficiency , Aortic Valve , Area Under Curve , Echocardiography , Humans , Linear Models , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Tomography, X-Ray Computed
6.
Article in English | WPRIM (Western Pacific) | ID: wprim-782047

ABSTRACT

BACKGROUND: The impact of myocardial damage on the prognosis of patients with septic shock is not clearly elucidated because complex hemodynamic changes in sepsis obscure the direct relationship. We evaluated left ventricular (LV) conditions that reflect myocardial damage independently from hemodynamic changes in septic shock and their influence on the prognosis of patients.METHODS: We retrospectively enrolled 208 adult patients who were admitted to the intensive care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal.RESULTS: There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04–3.75; P = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19–4.36; P = 0.013) than in those with a normal LV systolic function.CONCLUSION: Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.


Subject(s)
Adult , Coronary Artery Disease , Diagnosis , Echocardiography , Heart Diseases , Hemodynamics , Hospital Mortality , Humans , Intensive Care Units , Mortality , Prognosis , Retrospective Studies , Sepsis , Shock, Septic , Stroke Volume
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-810987

ABSTRACT

OBJECTIVE: To determine the most valuable cardiac magnetic resonance feature tracking (CMR-FT) parameters for evaluating aortic stenosis (AS) and determine whether they can predict the prognosis in asymptomatic AS patients with preserved ejection fraction (pEF).MATERIALS AND METHODS: A prospective cohort of 123 moderate to severe AS patients (60 males, 68.6 ± 9.2 years) and 32 control subjects (14 males, 67.9 ± 4.4 years) underwent echocardiography and 3T CMR imaging from 2011–2015. CMR cine images were analyzed using CMR-FT to assess the left ventricular radial, circumferential, and longitudinal peak strain (PS) in 2- and 3-dimensions. The primary endpoints were clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development. For statistical analysis, logistic regression and log-rank tests were used.RESULTS: Global PSs differed between AS patients and controls and between severe and moderate AS patients (p < 0.05). Two-dimensional (2D) global radial and longitudinal PSs changed gradually with the severity of AS groups (p < 0.001). Twenty-two of 67 asymptomatic AS patients with pEF experienced CCEs during the follow-up (median: 31.1 months). 2D global longitudinal PS (GLPS) was the single risk factor for CCE (p = 0.017). The relative risk for CCE was 3.9 (p = 0.016, 95% confidence interval: 1.2–11.9) based on 2D GLPS with a cutoff of −17.9% according to receiver operating characteristic curve analysis. Survival analysis demonstrated that asymptomatic AS patients with pEF having impaired 2D GLPS experienced worse event-free survival than the others (p = 0.041).CONCLUSION: 2D global longitudinal and radial PSs may reflect cardiac dysfunction according to the degree of AS. 2D GLPS might be a prognostic predictor of CCEs in asymptomatic AS patients with pEF.


Subject(s)
Aortic Valve Stenosis , Cohort Studies , Death , Disease-Free Survival , Echocardiography , Follow-Up Studies , Heart Failure , Humans , Logistic Models , Male , Prognosis , Prospective Studies , Risk Factors , ROC Curve
19.
Revista Espaço para a Saúde ; 21(1): [47 - 58], 2020. tab, ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1116006

ABSTRACT

Estudio exploratorio descriptivo con enfoque cuantitativo, cuyo objetivo fue analizar el conocimiento del equipo de enfermería en sectores críticos mediante la realización e interpretación del electrocardiograma. Los participantes fueron 35 profesionales, incluidas enfermeras y técnicos de enfermería, de sectores críticos de un hospital privado en Curitiba. Para la recopilación de datos, se utilizó un formulario con veinte preguntas de opción múltiple preparadas por el investigador y aplicadas a través de los formularios de Google. El estudio fue estadístico descriptivo, realizado con el software Microsoft Excel. Se concluyó al darse cuenta de que el uso de ECG es esencial en sectores críticos, y que el equipo de enfermería necesita capacitación principalmente en lectura e interpretación de este examen, también se destaca la importancia de la educación continua y la falta literaria sobre este tema dirigido al equipo técnico de enfermería.


Subject(s)
Humans , Echocardiography , Education, Nursing, Continuing
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