Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease / Utilidade da segunda bulha cardíaca na predição de hipertensão pulmonar em portadores de doenças intersticiais pulmonares

CONTEXT AND OBJECTIVE: P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease. DESIGN AND SETTING: Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal. METHODS: Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated. RESULTS: There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%. CONCLUSIONS: The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.

RESUMO CONTEXTO E OBJETIVO: Hiperfonese de P2 tem sido considerada como achado valoroso no diagnóstico semiológico de hipertensão pulmonar (HP). O objetivo foi de avaliar a acurácia do componente pulmonar da segunda bulha cardíaca em predizer HP nos pacientes portadores de doenças intersticiais pulmonares. TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade de Brasília e Hospital de Base do Distrito Federal. MÉTODOS: Os sons cardíacos foram adquiridos com estetoscópio eletrônico e analisados por fonocardiografia. Os sinais clínicos sugestivos de HP, como B2 mais intensamente audível em área pulmonar que aórtica, P2 > A2 na área pulmonar e P2 presente em área mitral foram confrontados com parâmetros cardiográficos no exame de Doppler sugestivos de HP. Sensibilidade (S), especificidade (E), razões de verossimilhança positiva (RV+) e negativa (RV-) foram avaliados. RESULTADOS: Não houve correlação significativa entre amplitude de B2 e P2 e a PSAP (pressão sistólica arterial pulmonar) (P = 0,185 e 0,115; P = 0,13 e 0,34; respectivamente). A análise da presença de B2 mais intensa na área pulmonar que aórtica, quando comparada a todos os critérios sugestivos de HP, mostrou S = 60%; E = 22%; RV+ = 0,7; RV- = 1,7; enquanto P2 > A2 mostrou: S = 57%; E = 39%; RV+ = 0,9; RV- = 1,1; e P2 no foco mitral mostrou: S = 68%; E = 41%; RV+ = 1,1; RV- = 0,7. Todos os sinais juntos mostraram S = 50%; E = 56%. CONCLUSÃO: Os sinais semiológicos indicativos de HP apresentam baixos valores de especificidade e sensibilidade para diagnóstico clínico dessa comorbidade.

Evaluation of Arterial Pulse Amplitude Ratio and Valsalva Ratio in Different Age Groups.

Aims: To construct normal values of Valsalva ratio for heart rate responses during Valsalva maneuver (VM) and arterial pulse amplitude ratio as reference values for different age groups, and to investigate the effect of aging alone , without , the presence of risk factors, on autonomic nervous system. This is a case control study, performed in Marjan teaching hospital, in Hilla city, from February 2012 to June 2012. Methodology: 40 subjects were included in this study, all were healthy males, group 1 (G1) mean age 28.3±9.7 years, group 2 (G2) mean age 48.4±7.1 years. Strips of lead II of ECG were recorded during performance of VM for calculation R-R intervals and measurement of blood pressure during phase I and phase II by mercury sphygmomanometer. Calculation of Valsalva ratio for heart rate and arterial pulse amplitude ratio for both groups were done. Results: The systolic and diastolic blood pressures of G2 were significantly higher than values of systolic and diastolic blood pressures of G1 at phase I and phase II of VM (P=0.05). Pulse pressure for the two groups at phase I (G1:51±11, G2: 53±13mmHg) and phase II (G1:41±5, G2:41±3.99) of VM were not significant (P>0.05). Valsalva ratio for G1 was (1.5±0.3) and for G2 was (1.39±0.29), pulse amplitude ratio for G1 was (0.80±0.19) and for G2 was (0.77±0.19). There were no significant differences between the two groups (P>0.05). All values were expressed as mean±SD. Conclusions: The results showed that the autonomic nervous system is intact in the older group. The aging process, without the presence of risk factors, does not affect the autonomic nervous system.

Ausculta cardíaca: bases fisiológicas - fisiopatológicas / Cardiac auscultation: physiological and physiopathological mechanisms

São revistos os mecanismos básicos, determinantes dos sons cardíacos, normais e anormais, com ênfase nas suas implicações para a ausculta cardíaca à beira do leito

Soplos cardíacos funcionales en niños: ¿usted está capacitado para distinguir un soplo funcional de uno patológico? / Functional heart murmurs in children: you is trained for differentiate a functional murmur of a pathologic murmur?

Cerca del 70 por ciento de los soplos cardíacos detectados en la edad pediátrica son soplos originados en estructuras cardíacas normales. La incorrecta catalogación de un soplo cardíaco como soplo anormal genera gran inquietud en la familia y muchas veces también en el mismo niño, por lo tanto el pediatra debe poder definir los soplos funcionales. Este artículo es una guía para ayudar en dicho pronóstico

Implementaçäo de filtros de Weiner para imagems de emissäo / Implementation of Wiener filter for emission images

Neste trabalho é apresentado um procedimento para utilização do filtro de Wiener com dados correlacionados. As medidas são representadas por um modelo de interação espacial não causal que descreve a dependência estatística entre os valores da imagem e seus vizinhos priori à restauração de Wiener. Imagens de raios gama planares do ciclo cardíaco são usadas na implementação.

ln this paper a procedure to use Wiener filter with correlated data is presented. The measurements are represented by a spacial non-causal interaction model which describes the statistical dependence among the image values and their neighbourhood before Wiener restoration. Gamma-ray planar images of cardiac cycle are user in the implementation of the algorithms

Intrapartum electronic fetal heart rate assessment in low and moderate risk patients: intermittent or continuous monitoring

Over a period of 12 months, pregnant women [1008 women] with low or moderate risk factors were studied to compare the intermittent versus continuous fetal heart rate monitoring during first stage of labour for early detection of fetal distress, as well as mode of delivery and neonatal outcome. 503 women were randomly allocated to continuous monitoring [C-group] and 508 women to intermittent monitoring [I-group]. There was no significant difference between the two groups in the incidence of abnormal FHR tracing, however suspicious FHR tracing was significantly [P < 0.05] more frequent in C group. In I-group, FHR monitoring was performed for 52.3% of first stage time, compared with 88.5% in the C-group [P < 0.001]. Ventose or forceps deliveries were significantly [P < 0.05] more in C group than in I group. The incidence of cesarean section for fetal distress was non significantly different [1.4% and 1.8% in I group and C-group respectively]. There was no significant differences in the neonatal outcome as regard the Apgar scoring, umbilical artery blood pH, admission to neonatal care unit or neonatal death. In pregnant women with mild or moderate risk factors, intermittent FHR monitoring can be considered safe and effective, and at the same time less costy when compared to continuous monitoring

Semiologia da 2§ bulha / Semiology of the 2nd sound

Descreve-se a gense da segunda bulha cardíaca bem como seus componentes, sua valorizaçäo hemodinâmica e melhores condiçÖes de ausculta, tanto no coracao normal como nas diversas patologias que alteram suas características de intensidade e desdobramento.

Ausculta cardíaca: bases fisiológicas / Cardiac auscultation: physiological mechanisms

Sao revistos os mecanismos básicos determinantes dos sons cardíacos normais e anormais com ênfase nas suas implicaçoes para a ausculta cardíaca à beira do leito.

Heart murmur in Pediatrics: innocent or pathologic?

In a sample of 256 children referred to the Säo Paulo Hospital for consultation because of heart murmurs the incidence of innocent murmur was 41%. A clinical history and physical examination was performed in every child. The diagnosis was confirmed without the use of laboratory tests in only 5.5% of the cases: 32% of the children were submitted to chest x-ray and eletrocardiogram; an ecocardiogram had to be performed in 61% of the children and in 1.1% the catheterism was necessary to make the diagnosis. In the great majority of children with high suspicion of innocent murmur a good history and physical examination will suffice to confirm the diagnosis. If heart disease is suspected, laboratory tests should be performed for further evaluation. Any physician should be able to distinguish between pathologic and innocent murmurs based on their clinic features. The authors present a short review about the subject