Diagnosis and management of pericardial effusions.

Pericardial effusions are a relatively common phenomenon, largely in part due to its many possible etiologies. Although a considerable amount of cases are idiopathic, careful history and physical examination will reveal the etiology in a vast majority of patients. The most effective tools, echocardiography and right heart catheterization, should be aimed not only at the diagnosis of the pericardial effusion, but also to the assessment of the severity of the pericardial effusion, since this will determine that individual patient's management. A small, asymptomatic pleural effusion of known etiology can be treated conservatively, mostly by treating the underlying cause and with careful observation for signs or symptoms of deterioration. Large effusions can be treated with closed pericardiocentesis after routine evaluation for possible etiologies. For patients presenting actual or impending tamponade, the definitive treatment is either closed or open pericardiocentesis, depending on fluid accumulation characteristics, and it should not be delayed for the administration of medical treatment (inotropes, intravenous fluids). Routine evaluation of pericardial fluid is warranted in those cases in which a clear etiology was not established prior to pericardiocentesis.

The use of biosensors in pacemaker technology: experience with a ventricular rate responsive pacemaker

Ten elderly patientes each had a ventricular rate responsive pulse generator (Activitrax) placed in then to help correct severe conduction abnormalities; none had suspected ischemic heart disease. The pulse generator was programmed to a maximal pacing rate of 125 ppm, a medium activity threshold, and a rate response of 6. Six weeks after implantation of the pulse generator, the patients were evaluated before exercing and again when the pacing rate reached 125ppm. The evaluation protocol included an M-mode echocardiogram from which the following measurements were taken; the left ventricular end-diastolic volume (EDV), the end-systolic volume (ESV), the ejection fraction (EF), and the peak systolic pressure/end-systolic volume (PSP/ESV). The numerical values were recorded, clculated, and compared statically with the following results: the EDV increased from 91 ñ 10 to 125 ñ 20 cc (p < .05); the ESV decreased from 64 ñ 10 to 24 ñ 6cc (p < ..005); the EF increased from 41 ñ 5 to 61 ñ 10% (p < .05); and the PSP/ESV ratio increased from 1.70 ñ 1 to 4.10 ñ 2mm Hg/cc (p = 10). Also, during the maximal pacing rate, the septum of all patients showed paradoxical septal motion. All patients in our study have been asymptomatic and have shown an increase in their exercise capacity. We conclude that during exercise the left ventricular function ins influenced more by heart rate than by AV synchrony, as indicated by an elevated EDV in most patients

Pulmonary hypertension and congestive heart failure due to an intracerebral arteriovenous malformation

Se presenta el caso de una malformación cerebral arteriovenosa produciendo hipertensión pulmonar con fallo del ventrículo derecho. Esta es una manifestación rara de esta enfermedad