An atypical assessment of Ebstein's anomaly in an 86-year-old man.

We present the echocardiographic analysis of an 86-year-old man affected by Ebstein's anomaly. In the natural history of this congenital disease only 5% of patients survive beyond the fifth decade. The patient presented severe right atrial dilatation and right heart failure, and he was referred to our institution for supraventricular tachycardia.

Evaluation of retinal abnormalities in essential hypertension: qualitative fundoscopy versus central retinal artery resistance index as indicators of target organ damage.

PURPOSE: To compare qualitative fundoscopy with resistance index (RI) of the central retinal artery determined using color Doppler examination as indicators of target organ damage in a large population of patients with essential hypertension. METHOD: We compared qualitative fundoscopy and central retinal artery RI (CRARI) in 459 patients with grade I and II essential hypertension. Correlations with left ventricular mass, carotid structural changes, and diastolic function were investigated. The results were analyzed according to the degree of retinopathy (grade I versus grade II) and CRARI (<0.70 versus >or=0.70). All patients underwent carotid sonography, echocardiography, diastolic function, a sonographic examination of the eye with measurement of CRARI, and examination of the fundus oculi. RESULTS: There was no statistical difference in the parameters studied between patients with grade I and patients with grade II retinopathy on fundoscopy. Patients with CRARI >or=0.70 were older and had higher systolic and pulse pressure, more years of hypertension, increased left ventricular mass index, carotid intima media thickness, and diastolic parameters compared with patients with CRARI <0.70 (p < 0.001). A positive correlation was found between CRARI and age, pulse pressure, carotid intima media thickness, systolic blood pressure, and duration of hypertension, whereas a negative correlation was found between CRARI and diastolic parameters. Age, pulse pressure, carotid intima media thickness, and left ventricular mass index were independently related to CRARI. CONCLUSION: Our findings indicate that CRARI is more reliable than traditional fundoscopy in the evaluation of hypertension-induced organ damage and should be used to measure global cardiovascular risk for tailored therapy.

Feasibility, accuracy, and clinical relevance of a rapid thyroid evaluation during carotid duplex ultrasonography in hypertensive patients.

Carotid ultrasonography can detect thyroid nodules without increasing examination duration. The authors analyzed whether management is influenced by reporting such findings during routine carotid ultrasonography in hypertensive patients vs waiting for 6 months to repeat them. This is a population-based study of 1216 hypertensive patients. During carotid ultrasonography, nodule cystic/solid characteristics and size of thyroid changes were recorded. Patients with nodules were divided into those with nodules reported at the moment of diagnosis (group A) and those reported 6 months after diagnosis (group B). The authors monitored patients who underwent thyroid treatment 12 months after carotid ultrasonography. A total of 255 participants had thyroid nodules detected on screening and 99 patients started therapy after discovery. Six months later, as expected, there were more patients undergoing thyroid treatment in the group with nodules reported at time of diagnosis. This difference between groups was not significant, however, 6 months after reporting the nodules, in group B, because the number of patients on therapy significantly increased. Thyroid nodules cannot be ignored during carotid ultrasonography, and reporting their presence is valuable to general practitioners. Thyroid screening during carotid ultrasonography is cost-effective, rapid, sensitive, and specific and may affect the patient's diagnostic and therapeutic management.