An observational study of correlation of cardiac manifestations with severity of COPD.

Introduction: Various systemic manifestations and complications have been observed throughout the course of Chronic Obstructive Pulmonary Disease. Out of those manifestations one of the important manifestations is cardiac involvement. The major and well-known cardiac complications of COPD are pulmonary vascular disease and its impact on right ventricular function, higher incidence of myocardial infarction and arrhythmias. These complications correlate inversely with survival. Aim: To study cardiac manifestations in COPD patients and its correlation with severity of the disease. Methodology: This observational study was conducted in the department of medicine at a tertiary care hospital in Solapur, Maharashtra. Data of 80 patients diagnosed and their cardiac status assessed on the basis of clinical findings, radiological changes and spirometry, electrocardiography and echocardiography. All patients were analyzed for cardiac involvement based on symptomatology, ECG and 2D-ECHO results. Results: Out of 80 COPD patients 6 patients were GOLD class 1 (mild), 28 in class 2 (moderate), 36 in class 3 (severe) and 10 patients belonged to GOLD class 4 (very severe). Cardiovascular complications were found in 40 patients out of 80. Of these, pulmonary hypertension was found in 45%, IHD in 30%, cor-pulmonale in 20% and arrhythmias were found in 10% of which supraventricular arrhythmias were seen in 75% and ventricular arrhythmia in25%. Conclusion:Our study concluded that patients with mild to moderate COPD may also have cardiac complications. Due to common symptomatology, they are difficult to diagnose. Hence, it is necessary at the time of initial diagnosis to carry out ECG and 2DECHO for early detection and for better management of these patients

Clinical study of cardiovascular abnormalities with Down′s syndrome in 96 children / 中华实用儿科临床杂志

Objective To investigate the spectrum,diagnosis,time of therapy and management of the congeni-tal heart disease(CHD)in patients with Down′s syndrome(DS).Methods A retrospective report was undertaken of 96 cases in children with DS accompanied by CHD in Department of Pediatric Cardiology,Beijing Anzhen Hospital Af-filiated to Capital Medical University.Data were collected and analyzed about their clinical characteristics,and types of cardiovascular abnormalities,and the important laboratory examinations such as echocardiography and catheterization as well as the procedures of diagnosis and treatments were summarized.Then the interventions,complications and prognosis of different patients were estimated.Results (1)Single congenital heart disease was found in 33 cases (34.38%),a-mong which ventricular septal defect was the most common (14 cases,14.58%),followed by atrioventricular septal de-fect and atrial septal defect (equally,7 cases,7.29%).Multi -cardiovascular abnormalities were discovered in 63 ca-ses,and patent ductus arteriosus turned out to be the most common (42 cases,66.67%).(2)Cat-heterization was car-ried out in 18 cases of serious pulmonary arterial hypertension,and 8 cases were proved resistant pulmonary arterial hy-pertension without operation opportunity.The other 8 cases were estimated as high pulmonary arterial hypertension and medical therapy was suggested before reassessment to reduce surgical risks.(3)Operations were undertaken in 61 ca-ses,among which percutaneous interventional occlusion was performed in 7 cases and surgical interventions were per-formed in 54 patients,in which perioperation complications and death were found in 5 cases and 4 cases,respectively. Conclusions Operation interventions are practicable and most cases recovered well with systematic examinations and assessment in patients with DS and cardiovascular malformations.Early diagnosis and timely interventions are highly suggested.Also close attentions should be paid to follow -up and re -estimation after medical therapy.

Cor triatriatum sinister e hipertensão arterial pulmonar secundária em cão / Cor triatriatum sinister and secondary pulmonary arterial hypertension in a dog

This paper describes the occurrence of cor triatriatum sinister, a rare cardiac malformation in dogs, associated with pulmonary edema and pulmonary hypertension in a 5-year-old Poodle female with history of acute dyspnea and cyanosis. The animal presented acute respiratory failure, heart failure with low cardiac output, progressing to acute tubular necrosis and death. The diagnosis was made posmortem due to the clinical instability of the dog. This malformation was diagnosed by the subdivision of the left atrium into two compartments separated by an abnormal fibromuscular membrane, absence of structural abnormalities of the mitral valve and thickening of pulmonary artery tunica media associated with renal tubular degeneration. The occurrence of cor triatriatum in dogs is most common in the right atrium, defined as cor triatriatum dexter. Additionally, pulmonary arterial hypertension associated with this malformation is described only in humans with this heart defect.

Pulmonary vascular disease in children / 中华实用儿科临床杂志

Pulmonary vascular disease is a group of diseases,defined as the dysfunction of pulmonary artery,pulmonary vein and pulmonary capillary.Pulmonary vascular disease includes pulmonary hypertension,pulmonary vascular malformation,pulmonary vasculitis and pulmonary vascular thrombosis,et al.The manifestations of pulmonary vascular disease vary from recurrent wheezing,respiratory tract infection,short of breath and hemoptysis,et al.With the development of radiography investigations,the diagnosis of pulmonary vascular disease is improved.Pulmonary vascular disease in children is not uncommon therefore we should focus on it.

Study on lung biopsy in patients with severe pulmonary hypertension secondary to congenital heart disease / 重庆医学

Objective To investigate the nature of the pulmonary arterioles in the patients with severe pulmonary hypertension secondary to congenital heart disease .Methods All patients with congenital heart disease and secondary severe pulmonary hyper‐tension(PH) were selected by using diagnostic‐treatment to undergo the radical repair(n= 49) .The lung biopsy specimens were ob‐tained during operation .The nature of pulmonary vascular disease (PVD) was determined by Heath‐Edwards classification system . All specimens were quantitatively analyzed by calculating the arteriole medial area percentage ,medial thickness percentage and arte‐riole density .Results The transcutaneous oxygen saturation in all selected patients was increased significantly after diagnostic‐treatment(P< 0 .01) .There was no case of operative death .The postoperative mean pulmonary artery pressure and pulmonary vas‐cular resistance were decreased significantly (P < 0 .01) .38 cases (77 .6% ) showed the H‐E grade Ⅰ change ,5 cases (10 .2% ) showed the H‐E grade Ⅱ change ,4 cases(8 .2% ) showed the H‐E grade Ⅲ chfange and only 2 cases (4% ) showed the H‐E gradeⅣ change with plexiform lesion .Conclusion The pulmonary vessels in the selected patients with severe PH secondary to congenital heart disease by using the diagnostic‐treatment are generally reversible and still feasible for performing the radical operation .

Suprasternal notch echocardiography determination of right pulmonary artery lesions / 中华超声影像学杂志

Objective To evaluate the value of suprasternal long axis view in echocardiography for right pulmonary artery (RPA) lesions.Methods Echocardiography was performed in 31 patients with clinical suspicion of pulmonary vascular disease.Through suprasternal long axis view,RPA,right superior pulmonary artery and right inferior pulmonary artery were identified,and the vessel wall,intraluminal echoes,and location of the lesion were obtained.Blood flow in pulmonary artery was detected with color Doppler flow imaging.The results of echocardiography were compared with those of computer tomography of pulmonary angiography (CTPA) and clinical diagnosis.Results With suprasternal notch echocardiography,RPA lesions were identified in 27 patients.H owever,RPA could not be clearly identified in four patients.There were 22 patients with moderate or low echo mass in RPA,and five patients with intimal thickening and artery stenosis/obliteration.In the 27 patients with detected lesions,20 lesions were located in RPA,seven lesions were located in distal RPA or its branches.Among the results obtained with echocardiography,25 were in accordance with CT results,6 were not in accordance with CT results.Conclusions The suprasternal long axis view of RPA can be an important alternative imaging modality in identification of pulmonary vascular diseases.

Clinical Year in Review of Pulmonary Vascular Disease / 결핵및호흡기질환

Pulmonary vascular disease is a category of disorders, including pulmonary hypertension, pulmonary embolism or chronic thromboembolic pulmonary hypertension, pulmonary vasculitis, pulmonary vascular disease secondary to chronic respiratory disease, and pulmonary vascular tumor and malformations. This article reviews the recent advances in this wide spectrum of pulmonary vascular diseases.

Definition,classification and treatment of pulmonary hypertension / 中国实用内科杂志

In recent years,major advances have been made in our understanding of the pathogenesis,epidemiology,pathophysiology and in the treatment of pulmonary hypertension.Accordingly,the definition,clinical classification and treatment guidelines of pulmonary hypertension have been updated constantly.This article will focus on the new definition,classification and treatment of pulmonary hypertension.