ABSTRACT
Heart failure with preserved ejection fraction (HFpEF) is a common condition, especially in the elderly. The principal symptom is dyspnea on exertion, which is often the reason for emergency medical consultation. As HFpEF is associated with a significant mortality, early diagnosis is warranted. Herein, the potential of bedside echocardiography is presented.
Subject(s)
Echocardiography/methods , Heart Failure , Aged , Diastole , Heart Failure/diagnostic imaging , Humans , Stroke Volume , Ventricular Function, LeftABSTRACT
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to risk stratification and follow-up assessment of patients with PAH. This manuscript summarizes the results and recommendations of this working group.
Subject(s)
Blood Pressure Determination/standards , Cardiology/standards , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapy , Practice Guidelines as Topic , Pulmonary Medicine/standards , Germany , Humans , Hypertension, Pulmonary/classification , Prognosis , Risk Assessment/standards , Treatment OutcomeABSTRACT
In approximately one third of patients presenting with suspected severe aortic stenosis, there is a discrepancy between a severely reduced aortic valve opening area (< 1 cm(2)) and a non-severe increase of the mean transvalvular gradient (< 40 mmHg). In a substantial number of these cases there is evidence of a severe paradoxical low-flow low-gradient aortic stenosis, characterized by a reduced stroke volume index in the setting of a normal left ventricular ejection fraction. This finding should trigger an extensive diagnostic work-up, including echocardiography, stress echocardiography and computed tomography to rule out measurement errors and to identify the cause(s) of the hemodynamic discrepancy. If the diagnosis of a severe paradoxical low-flow low-gradient aortic stenosis is confirmed and, furthermore, the patient is normotensive and reports stenosis-associated symptoms, the feasibility of an aortic valve replacement should be considered.
Subject(s)
Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/therapy , Heart Valve Prosthesis Implantation , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/prevention & control , Aortic Valve Stenosis/complications , Diagnosis, Differential , Echocardiography/methods , Evidence-Based Medicine , Humans , Preoperative Care/methods , Tomography, X-Ray Computed/methods , Treatment Outcome , Ventricular Dysfunction, Left/etiologyABSTRACT
Human immunodeficiency virus (HIV) infection is associated with an increased risk for pulmonary arterial hypertension (PAH). Upon the screening of 220 asymptomatic HIV-positive individuals by echocardiography, we detected and confirmed HIV-associated PAH in 0.45 % of cases. Mild elevations of systolic pulmonary arterial pressure most probably owing to left ventricular diastolic dysfunction were found in 7.7 % of cases, without progress after 2 years. We suggest that the screening of asymptomatic HIV-positive patients for PAH should not be performed.
Subject(s)
Echocardiography , HIV Infections/complications , Hypertension, Pulmonary/diagnosis , Mass Screening/methods , Adult , Aged , Cohort Studies , Female , Humans , Hypertension, Pulmonary/epidemiology , Male , Middle Aged , Prospective Studies , Young AdultSubject(s)
Angina Pectoris/etiology , Chest Pain/etiology , Coronary Artery Bypass , Dizziness/etiology , Postoperative Complications/etiology , Subclavian Steal Syndrome/diagnosis , Cardiac Catheterization , Diagnosis, Differential , Echocardiography, Doppler , Female , Humans , Middle Aged , Postoperative Complications/diagnosisABSTRACT
The incidence of pseudoaneurysms after percutaneus arterial procedures is a quite common complication. Ultrasound-guided thrombin injection is an effective and elegant therapy with a low procedural risk, when the physician is trained in the technique. This paper provides a tutorial for physicians including tips and pitfalls.
Subject(s)
Aneurysm, False/therapy , Injections, Intra-Arterial/methods , Thrombin/administration & dosage , Ultrasonography, Interventional/methods , Aneurysm, False/diagnostic imaging , Humans , Injections, Intra-Arterial/instrumentation , Pressure , Ultrasonography, Doppler, Color , Ultrasonography, Interventional/instrumentationABSTRACT
The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more frequent forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, so that it may be speculated whether selected patients may benefit from targeted PH therapy. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH due to left heart disease. This commentary summarizes the results and recommendations of this working group.
Subject(s)
Heart Failure/complications , Hypertension, Pulmonary/etiology , Ventricular Dysfunction, Left/complications , Germany , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/therapy , Hemodynamics/physiology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/mortality , Hypertension, Pulmonary/therapy , Prognosis , Survival Analysis , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/therapyABSTRACT
Symptomatic HIV-associated pulmonary artery hypertension (PHT) is a thousand times more frequent than idiopathic PHT and has a clearly worse prognosis. Using echocardiographic criteria the prevalence of PHT in HIV-positive patients, including all degrees of clinical severity, is about 7.5 %, half of those affected being asymptomatic (NYHA class I). The only available data are from just one controlled trial of drug treatment of HIV-associated PHT (BREATH-4-Trial), in which the endothelin-receptor antagonist bosentan was found to bring significant improvement in clinical parameters (NYHA functional class, walking distance). Further trials are required to test other therapeutic options such as prostanoids and phosphodiesterase-5-inhibitors.
