Contribution of Doppler echocardiography to the evaluation of systolic and diastolic function of obese women versus a control group.

OBJECTIVE: To study by doppler echocardiography the cardiac systolic and diastolic functions of health, uncomplicated obese subjects. METHODS: Fifty-nine obese women with an average body mass index (BMI) of 35 kg/m2 were evaluated and compared with 19 subjects with an average BMI of 23 kg/m2 (control group). RESULTS: In the obese group, a clear tendency was observed toward higher systolic pressure, increased wall thickness and, consequently, myocardial mass, elevation on the circumference stress of the left ventricular wall, and an indisputable presence of diastolic abnormalities. Filling abnormalities were observed with impaired relaxation, with prolonged isovolumic relaxation time (IVRT) and augmented atrium contribution representing early indexes of cardiac dysfunction when systolic performance is still normal. CONCLUSION: Obesity is generally a chronic condition, and doppler echocardiography can be used as a noninvasive instrument for early evaluation of left ventricular diastolic indexes.

Indicaçöes clínico-epidemiológicas para investigação ecocardiográfica no período neonatal: valor dos grupos de risco / Clinical-epidemiologic indications for echocardiography investigation in the neonatal period: value of risk groups

OBJETIVO - Estudo ecocardiográfico em recém-nascido (RN) de grupos de risco para cardiopatia congênita, a fim de se determinar a prevalência que justifique esse exame no período neonatal. MÉTODOS - Estudaram-se, de novembro/91 a abril/93, 156 RN do berçário anexo à Maternidade do HC-FMUSP, sendo RN de mães com cardiopatia congênita ou diabetes mellitus, crianças de muito baixo peso, com malformaçöes extracardíacas ou presença de sinais cardíacos, caracterizados por sopro, cianose, ou arritmia, todos submetidos ao ecocardiograma. RESULTADOS - A prevalência encontrada foi de 21,8 'por cento', superior ao da população geral (0,8 a 1,2 'por cento'), sendo que a maior entre os grupos, de 40,7 'por cento', ocorreu no grupo de malformaçöes extracardíacas. CONCLUSÄO - Nossos dados justificam a realização de ecocardiograma em RN pertencentes a um destes grupos de risco para cardiopatia congênita.

[Clinical-epidemiologic indications for echocardiographic assessment in the neonatal period. Value of risk groups]. / Indicações clínico-epidemiológicas para investigação ecocardiográfica no período neonatal. Valor dos grupos de risco.

PURPOSE: An echocardiographic study was performed in newborns from risk groups, with the aim of to determining prevalence and to evaluate the indications for this test in the neonatal period. METHODS: One hundred fifty six newborns were studied. They were admitted to the Newborn ward of the Department of Obstetric of the HC-FMUSP, in the period of November 91 to April 93, from mothers with congenital heart disease or diabetes, low birth weight newborns, with extracardiac malformations, cardiac signs and/or congenital infections. RESULTS: The observed prevalence was 21.8%, greater than that of the general population (0.8-1.2%). The group composed by 27 children with extracardiac abnormalities presented the largest prevalence when compared with the other groups (40.7%). These data justify the use of echocardiography in high risk newborns for the detection of congenital heart disease.

[Cardiac manifestations of hyperthyroidism in the elderly]. / Manifestações cardíacas do hipertireoidismo no idoso.

PURPOSE: To evaluate the cardiocirculatory abnormalities of hyperthyroidism in the elderly. PATIENTS AND METHODS: Twenty-four hyperthyroid patients, 18 women and six men, aged 60 to 87 (average 73.5) years were studied. Seventeen (70.9%) patients had associated cardiocirculatory diseases. The evaluation was made on clinical grounds complemented by electrocardiographic, radiologic, phonomechanocardiographic and echocardiographic examinations. RESULTS: Cardiocirculatory symptoms were observed in 17 (70.9%) patients and congestive heart failure in nine (37.5%) of them. The electrocardiogram was abnormal in 20 (83.3%) patients and the tachyarrhythmias were the commonest abnormality (62.5%). Eight (33.3%) patients had chronic atrial fibrillation and five (20.8%) had sinus tachycardia. There was no significant statistical difference on the electrocardiograms of patients with and without cardiocirculatory abnormalities. Cardiomegaly was significantly more prevalent in hyperthyroid patients, with (64.7%) or without (57.1%) cardiocirculatory abnormalities, than in normal elderly (23.9%). Left ventricular performance was studied in 14 patients through the systolic quotient and was found normal or high in 12 (85.7%). The percentage of fractional shortening (delta D%) was higher than 30 in all patients. None of the patients was found to have symmetric or asymmetric hypertrophic cardiomyopathy and mitral valve prolapse on echocardiogram. CONCLUSION: Hyperthyroidism in the elderly patient determines frequently cardiocirculatory abnormalities that may be misdiagnosed with those caused by the ageing process or by associated cardiopathies. This diagnosis should be suspected in all elderly patients having tachyarrhythmias and/or cardiac failure resistant to usual therapy, mainly in patients without clear cardiocirculatory pathology.

Left ventricular hypertrophy is more marked in salt-sensitive than in salt-resistant hypertensive patients.

Besides the duration and severity of hypertension, several other factors have been shown to be related to left ventricular hypertrophy (LVH) in essential hypertension. The present study was conducted to examine the influence of salt sensitivity on LVH. Fifteen essential hypertensive ambulatory patients were submitted to a low-salt (30 mEq of Na/day for 7 days) and a high-salt (200 mEq of Na/day for 7 days) diet after 12 weeks on placebo. Daily urine collection was obtained during the whole study. After the placebo period, all patients were submitted to a complete clinical and laboratory investigation that included an echocardiogram (M-mode and two-dimensional). Five patients were salt-sensitive (mean blood pressure (BP) increase from the seventh day of the low- to the seventh day of the high-salt diet greater than 10%). No differences in weight, sex ratio, and duration of hypertension were obtained between salt-sensitive and -resistant patients. The initial BP was higher in the salt-sensitive patients. However, the difference was small and without statistical significance. The left ventricular weight was higher in the salt-sensitive than in salt-resistant patients (148 +/- 51 vs. 109 +/- 32 g/m2, p less than 0.05). The left ventricular end-diastolic diameter was also higher in the salt-sensitive patients (50 +/- 10 vs. 43 +/- 6 mm, p less than 0.05). The interventricular septum and posterior wall thicknesses were higher in salt-sensitive patients, although they did not reach statistical significance. In conclusion, salt-sensitive essential hypertensive patients are at a higher risk to develop LVH.

[Prenatal diagnosis of congenital heart diseases and cardiac arrhythmias by Doppler echocardiography]. / Diagnóstico pré-natal das cardiopatias congênitas e arritmias pela ecodopplercardiografia.

PURPOSE: To detect in prenatal life fetal arrhythmia and congenital heart disease. We performed fetal echocardiography following classical indications according to the literature. PATIENTS AND METHODS: Two-dimensional echocardiography associated with M-mode and Doppler was performed in 200 patients according to the indications: maternal diabetes, fetal arrhythmia, maternal congenital heart disease, previous fetus with cardiac defect, intrauterine growth retardation, nonimmune fetal hydrops, rubeola, isoimmunization, fetal malformation by ultrasound, polyhydramnios, gemelarity, oligohydramnios, maternal ingestion of drugs, lupus and others. RESULTS: Structural abnormalities of the heart were found in 6 cases and associated with bradiarrhythmia in 5 cases (total of 5.5%). Fetal arrhythmias without cardiac malformation were found in 35 cases (17.5%) and premature atrial contractions were the most frequent. CONCLUSION: The findings in this study indicate that it is possible the accurate definition of the cardiac anatomy and function. We have emphasized the method trying to spread it, objecting to improve assistance to the fetus and newborn with arrhythmias and/or congenital heart disease.

[Surgical treatment of right ventricular fibroma in infants. Report of 2 cases]. / Tratamento cirúrgico de fibroma de ventrículo direito em lactentes. Relato de dois casos.

Two patients under 8 months of age, with right ventricular fibroma, presented with clinical manifestations of pulmonary stenosis. The diagnosis was established in one by echocardiography and in the other by echocardiography. CT scan and angiocardiographic study. The patients were operated and the tumors were successfully resected.

[The importance of mitral calcification in the elderly]. / A importância da calcificação mitral no idoso.

The echocardiographic study of 480 patients over 60 years (medium age: 75.4) revealed 37 (33 women) of them having mitral calcification (MC). The analysis of clinical and metabolic data of these 37 patients plus their electro, phono and echocardiographic assessment revealed: 1) MC was observed in 7.7% of this elderly population and its incidence tended to increase with age; 2) MC was more frequent and more pronounced in women; 3) cardiocirculatory abnormalities responsible for a high systolic pressure in the left ventricle, such as hypertension (64.9%) and aortic stenosis (10.8%) were the most commonly associated cardiac pathologies; 4) no history of illnesses usually aggressive to the mitral valve was detected; 5) plasma lipids and calcium were normal; 6) in 27.0% of patients with MC there was some degree of mitral stenosis and/or insufficiency and surgical correction has been considered in some cases; 7) changes in production and/or conduction properties were frequent, causing bradyarrhythmias, tachyarrhythmias and intraventricular block. Taking these points into consideration, a careful follow-up of confirmed cases is suggested, in order to detect and treat any complications without delay.

Contribuição da ecocardiográfia bidimensional nos implantes endocavitários de marca-passo / Bidimensional echocardiography in endocardial pacemaker implantation

A identificacao da posicao assumida pelos eletrodos endocavitorios atraves da ecocardiografia bidimensional foi efetuada em cinco implantes endocavitarios de marca-passo. Atraves do acesso subcostal com o corte de "quatro camaras" e da abordagem paraesternal com os cortes longitudinal e transversal ao nivel dos vasos de base foi possivel o perfeito seguimento do eletrodo durante as fases do implante, principalmente nos casos em que se utilizou um eletrodo bipolar coaxial. Conclui-se que a ecocardiografia bidimensional e um metodo que, em pacientes selecionados, possibilita o acompanhamento do implante de eletrodos endocavitarios de marca-passo, constituindo-se num metodo alternativo a radioscopia, nos casos em que essa tecnica esta contra-indicada

Estudo ecocardiográfico da dinâmica atrial esquerda em indivíduos sadios, nas condições de repouso e de exercício isométrico / Echocardiographic study of the left atrial dynamics in normal subjects, under conditions of rest and isometric exercise

Foram estudados pela ecocardiografia, com analise computadorizada dos dados obtidos, 40 individuos sadios, 20 de cada sexo, com idades variando entre 20 e 40 anos. Visando a avaliar o efeito do exercicio isometrico sobre a dinamica do atrio esquerdo (AE), os individuos foram estudados em repouso e durante esforco realizado em dinamometro manual de pressao ("handgrip").Foram estudados as seguintes variaveis:velocidade de enchimento do AE (VE), velocidade de esvaziamento rapido do AE (VR), velocidade de esvaziamento lento do AE (VL) e velocidade de esvaziamento sistolitico AE (VS). O tratamento estatistico das variaveis obtidas permitiu as seguintes conclusoes: 1 - O valor medio da VE em repouso foi 33 mm/s nao havendo diferenca entre os sexos ou entre as condicoes de repouso e esforco. 2 - O valor medio da VR em repouso foi 68 mm/s, nao havendo diferenca entre os sexos ou entre o exercicio e repouso. 3 - O valor medio da VS em repouso foi 59 mm/s nao havendo diferenca entre os sexos sendo maior durante o exercicio