RESUMEN
Several publications over the last ten years have addressed the problem of genetic mutation coding platelet membrane glycoproteins and thrombotic arterial disease. The principal polymorphisms studied are those of glycoproteins GPIIIa, GPIb and the GPIa-IIa complex. The relationships of each of these polymorphisms and myocardial infarction or coronary artery disease are reported and are often subject to controversy. The polymorphism PLA2 of the GPIIIa has been shown to be a risk factor for infarction in young people, especially when associated with cigarette smoking. Its role in triggering myocardial infarction or in the severity of coronary artery disease is not so clear in the general population. Two types of polymorphism concerning the GPIb and that of the GPIa-IIa complex should also predispose to early coronary thrombotic complications. In addition, the study of these platelet polymorphisms gives a better insight into individual sensitivity to platelet antiaggregant therapy.
Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Predisposición Genética a la Enfermedad , Infarto del Miocardio/genética , Glicoproteínas de Membrana Plaquetaria/genética , Polimorfismo Genético , Adulto , Edad de Inicio , Anciano , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/patología , Humanos , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/patología , Factores de RiesgoRESUMEN
UNLABELLED: This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina-like chest pain but without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients. METHODS: DE (5-40 microg/kg/min) was performed in 52 consecutive patients with angina-like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 +/- 10 years (27 men, 25 women). Dobutamine-induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle. RESULTS: Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02). CONCLUSION: Dynamic LVO is common during DE in a population of patients with angina-like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.
Asunto(s)
Agonistas Adrenérgicos beta/efectos adversos , Angiografía Coronaria , Dobutamina/efectos adversos , Ecocardiografía , Obstrucción del Flujo Ventricular Externo/inducido químicamente , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Angina de Pecho/diagnóstico por imagen , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Despite the development of non-invasive diagnostic techniques, the absence of significant coronary stenosis is observed in 10 to 30% of coronary angiographic studies. The authors report the survival and functional status at 6 years of 172 consecutive patients with symptoms of angina without significant angiographic coronary stenosis. The average age was 60.8 years with a sex ratio of 1.1 and chest pain as the indication for coronary angiography in over 90% of cases. The global mortality after an average of 75.6 months follow-up was 11%, lower in women (8.5%) than in men (13.3%) with an annual mortality of 16.3 per thousand. Sudden death was observed in 4 patients and a third of deaths was of cardiac origin. The persistence of symptoms was reported by 58% of patients, mainly atypical chest pain. Despite the result of coronary angiography, nearly half of the patients were followed up annually by a cardiologist, two thirds remained on anti-anginal therapy, 20% were treated by psychotropic agents and hospital admission to the cardiology department was required in 22% of cases during follow-up. None of the patients had myocardial infarction. Survival and myocardial function after normal coronary angiography therefore appear to be good in contrast with the functional status of these patients.
Asunto(s)
Angina de Pecho/patología , Angiografía Coronaria , Adulto , Anciano , Anciano de 80 o más Años , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de Supervivencia , Vasodilatadores/uso terapéuticoRESUMEN
Myocardial infarction is a rare complication of traumatic thoracic deceleration. The authors report the case of anterior myocardial infarction with dissection of the left anterior descending artery in a 16 year old boy who was injured in a motorbike accident without a penetrating thoracic wound. Therefore, the only pathological mechanism was deceleration. The authors review the 12 previously reported cases.
Asunto(s)
Vasos Coronarios/lesiones , Lesiones Cardíacas/etiología , Infarto del Miocardio/etiología , Accidentes de Tránsito , Adolescente , Vasos Coronarios/fisiopatología , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Humanos , Masculino , Traumatismo Múltiple , Infarto del Miocardio/fisiopatologíaRESUMEN
Embolic infarction is a rare complication of mitral valve endocarditis. The authors present the case of a patient with a linear vegetation of the anterior mitral leaflet measuring over 15 mm and entering the aortic valve orifice at each systole. This valvular infarction was the cause of an extensive anterior wall infarct treated by primary angioplasty because of haemodynamic instability. The outcome at 3 months was very favourable with regards to the mitral valve. However, a large mycotic coronary aneurysm developed at the site of angioplasty and there were sequellae of a large anterior wall infarction.
Asunto(s)
Aneurisma Infectado/etiología , Disección Aórtica/etiología , Enfermedad Coronaria/etiología , Embolia/etiología , Endocarditis Bacteriana/complicaciones , Válvula Mitral , Infarto del Miocardio/etiología , Infecciones Estafilocócicas/complicaciones , Angioplastia de Balón/efectos adversos , Terapia Combinada , Aneurisma Coronario/etiología , Angiografía Coronaria , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/terapia , Gentamicinas/uso terapéutico , Hepatitis C Crónica/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Oxacilina/uso terapéutico , Choque Cardiogénico/etiología , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/terapia , UltrasonografíaRESUMEN
In the face of the general aging of the population and technical improvements, cardiologists are more commonly faced with the decision of whether to perform coronary angiography in octogenarians who are often in good general health. The morbidity and mortality of this investigation, its therapeutic impact and medium-term survival were analysed in 145 consecutive octogenarians who underwent coronary angiography between 1988 and 1996. In this study, coronary angiography was performed essentially for angina refractory to medical treatment and confirmed the severity of the lesions with stenosis of the left main stem in 7.6% of cases and multiple vessel disease in 67.5% of cases. The mortality related to the investigation was nil in this series. Revascularisation was feasible clinically and angiographically in 38% of cases (84% by angioplasty). The actuarial survival at 3 years was 65% in the group who underwent revascularisation and in the group treated medically.
Asunto(s)
Angiografía Coronaria/efectos adversos , Revascularización Miocárdica/mortalidad , Anciano , Anciano de 80 o más Años , Angina de Pecho/diagnóstico , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The authors report the case of a patient presenting with atypical features of Candida albicans cardiac infection, with unusual infectious destructive lesions. While the initial hypothesis was that of aortic endocarditis, the clinical course and operative findings showed echocardiographic features of septal micro-abscesses adjacent to the aortic orifice, which was devoid of any infectious lesions.
Asunto(s)
Candidiasis/diagnóstico por imagen , Endocarditis/microbiología , Miocarditis/microbiología , Adulto , Diagnóstico Diferencial , Ecocardiografía Doppler , Endocarditis/diagnóstico por imagen , Humanos , Masculino , Miocarditis/diagnóstico por imagenRESUMEN
Power Doppler imaging is an ultrasonic technique representing circulating red cells as a colour signal independent of their direction and angle of analysis. This noninvasive technique provides a morphological representation of blood flow within a blood vessel. This in vitro study in pulsed flow enabled three-dimensional reconstruction of blood flow in the bifurcation of the pulmonary artery with automatic shifting of the ultrasound probe and an integral digital transfer of the echographic data. The software for treating the images and for volumic reconstruction of the flow is explained. This technique provides a quantitative method of assessing residual intrastenotic flow with a simple computer system.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Arteria Pulmonar/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Sistemas de Computación , Constricción Patológica/diagnóstico por imagen , Hemorreología , Humanos , Flujo Pulsátil , Flujo Sanguíneo Regional , Programas InformáticosRESUMEN
Acute occlusion of the left main coronary artery is usually responsible for cardiogenic shock, severe arrhythmias or sudden death. Despite the widespread use of emergency coronary angiography in acute myocardial infarction, occlusion of the left main coronary artery is rarely observed and its treatment remains controversial. The authors report the case of a young man with a previous history of radiotherapy for Hodgkin's disease, admitted for acute myocardial infarction due to complete thrombosis of the left main coronary artery treated as an emergency by percutaneous transluminal angioplasty and implantation of a Palmaz Schatz stent. There were no complications of the procedure and the patient was asymptomatic one year later.
Asunto(s)
Trombosis Coronaria/complicaciones , Trombosis Coronaria/terapia , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Adulto , Angioplastia Coronaria con Balón , Humanos , Masculino , StentsRESUMEN
The reproducibility of blood gas exchange measurements on exercise in chronic cardiac failure has already been established in patients familiar with this technique. The aim of this prospective study was to evaluate the reproducibility of cardiopulmonary parameters on exercise in a population of patients who had never undergone this type of investigation. Twenty patients with chronic cardiac failure in classes I to III of the NYHA classification, with a mean age of 55 +/- 11.5 years and a mean LV ejection fraction of 31.2 +/- 9%, underwent two cardiopulmonary exercise tests (CPX Medgraphic) performed on a bicycle ergometer. Patients underwent maximal exercise stress testing attaining 89% of the theoretical maximal heart rate and 1.14 of the respiratory quotient during the first test. There was no significant change in peak VO2 (22.5 ml/min/kg vs 22.6 ml/min/kg) or in ventilatory anaerobic threshold (12.8 ml/min/kg vs 12.7 ml/min/kg) between the two tests. The ventilatory anaerobic threshold could not be measured in one patient and seemed less reproducible than peak VO2 with a standard deviation of relative differences (T2-T1/T1) of 10.4 versus 7.8%. There was a significant increase in the duration of exercise (7.4 +/- 9.2%; p < 0.002) and a ventilatory flow (4.5 +/-, p = 0.03). This study shows that peak VO2 is a reproducible measurement in mild to moderate chronic cardiac failure, even in the absence of a preliminary test to familiarize the patient with the equipment. The reproducibility of the ventricular anaerobic threshold is less satisfactory than that of peak VO2. The increase in the duration of exercise is more dependent on motivation and should not be taken into account alone in the functional evaluation of chronic cardiac failure.
Asunto(s)
Insuficiencia Cardíaca/fisiopatología , Intercambio Gaseoso Pulmonar , Adulto , Anciano , Umbral Anaerobio , Enfermedad Crónica , Prueba de Esfuerzo , Femenino , Insuficiencia Cardíaca/sangre , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
Cardiac lymphoma is becoming increasingly frequent, especially in the context of acquired immune deficiency syndrome, and due to progress in imaging, particularly echocardiography. The authors report the case of a 49-year-old patient in whom the diagnosis of cardiac lymphoma was established in the presence of complete atrioventricular block, tamponade and right atrial tumour. The authors review the various electrocardiographic and echocardiographic features of cardiac lymphoma.
Asunto(s)
Taponamiento Cardíaco/etiología , Bloqueo Cardíaco/etiología , Neoplasias Cardíacas/complicaciones , Linfoma de Células B/complicaciones , Taponamiento Cardíaco/cirugía , Femenino , Bloqueo Cardíaco/cirugía , Neoplasias Cardíacas/cirugía , Humanos , Linfoma de Células B/cirugía , Persona de Mediana EdadRESUMEN
The authors report the case of a patient presenting with isolated left superior vena cava, for which intracardiac implantation of a cardiac pacemaker was facilitated by intraoperative transthoracic ultrasonographic detection of the course of the ventricular catheter. Transoesophageal ultrasonography confirmed the diagnosis and eliminated a possible associated malformation.
Asunto(s)
Ecocardiografía , Marcapaso Artificial , Vena Cava Superior/anomalías , Anciano , Bloqueo Cardíaco/terapia , Humanos , Periodo Intraoperatorio , MasculinoRESUMEN
Proper function of a coronary bypass using the internal mammary artery obviously depends upon the quality of the mammary artery used and of the distal coronary system, but also the absence of any significant stenosis of the first centimetres of the homolateral subclavian artery. The authors report the case of a patient in whom angina was destabilized by dysfunction of a bypass between the left internal mammary artery and the left anterior descending coronary artery. This mammary bypass dysfunction was related not to stenosis of the bypass but to stenosis of the proximal part of the left subclavian artery. Angioplasty of this stenosis led to disappearance of anterior myocardial circulatory impairment and of angina attacks.
Asunto(s)
Anastomosis Interna Mamario-Coronaria/efectos adversos , Arteria Subclavia/patología , Anciano , Cateterismo , Constricción Patológica/terapia , Femenino , HumanosRESUMEN
Non-invasive assessment of the stenotic mitral valve area is often difficult when the mitral stenosis is associated with atrial fibrillation. In this study, 16 patients with mitral stenosis and atrial fibrillation were evaluated by transthoracic Doppler echocardiography. The mitral valve area calculated by the pressure half-time method was 1.65 +/- 0.73 cm2. The enddiastolic mitral gradient was obtained from the enddiastolic forward mitral flow velocity by application of the simplified Bernoulli equation. For each patient there was a linear relationship between the enddiastolic mitral gradient and the corresponding RR interval. The slope and intercept of this relationship were significantly correlated with the mitral valve area. From the regression equations describing these correlations we established a nomogram ascertaining mitral valve area from enddiastolic mitral gradient and corresponding heart rate. This nomogram was helpful in the non-invasive assessment of stenotic mitral valve area in the presence of atrial fibrillation.
Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Ecocardiografía Doppler , Estenosis de la Válvula Mitral/diagnóstico por imagen , Anciano , Fibrilación Atrial/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Diástole , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Modelos Lineales , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/fisiopatología , Análisis Multivariante , Análisis de RegresiónRESUMEN
We present a case study of a 54-year-old patient with a perforated aneurysm of the anterior mitral valve leaflet, diagnosed 13 years after an episode of bacterial endocarditis by transesophageal echocardiography. This report illustrates the superiority of transesophageal echocardiography in the diagnosis and management of valvular endocarditis.
Asunto(s)
Aneurisma Infectado/diagnóstico por imagen , Aneurisma Roto/diagnóstico por imagen , Aneurisma Cardíaco/diagnóstico por imagen , Válvula Mitral , Adulto , Aneurisma Infectado/etiología , Aneurisma Roto/etiología , Ecocardiografía Transesofágica , Endocarditis Bacteriana/complicaciones , Aneurisma Cardíaco/etiología , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Rotura EspontáneaRESUMEN
Doppler echocardiographic evaluation of mitral stenosis is often difficult in patients with atrial fibrillation. Sixteen patients were examined by transthoracic Doppler echocardiography and the relation between the variations in transmitral end diastolic pressure gradient and the length of the corresponding cardiac cycles was analysed. Mitral valve surface area (1.65 +/- 0.73 cm2) was determined by the pressure half-time method. The end diastolic transmitral pressure gradient was calculated from the simplified Bernouilli formula applied to end diastolic mitral flow velocity. In each patient, a linear relationship was observed between the end diastolic mitral gradient and the corresponding RR interval. The slope and intercept of the graph correlated significantly to mitral valve surface area (r = 0.72, p < 0.002 and r = 0.93, p < 0.00001, respectively). Using regression equations describing these correlations, it has been possible to construct a nomogramme indicating mitral valve surface area as a function of mitral end diastolic pressure gradient and the duration of the corresponding RR cycle. This nomogramme facilitates Doppler evaluation of mitral stenosis in atrial fibrillation.
Asunto(s)
Ecocardiografía Doppler , Estenosis de la Válvula Mitral/diagnóstico por imagen , Anciano , Fibrilación Atrial/etiología , Interpretación Estadística de Datos , Diástole , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/complicaciones , PronósticoRESUMEN
A better selection of patients referred for cardiac transplantation should lead to better surgical results. The presence of severe and irreversible pulmonary hypertension is an important factor and its pretransplantation assessment requires pharmacodynamic testing with vasodilators and dobutamine. The aim of this study of 10 patients in congestive cardiac failure referred for cardiac transplantation was to evaluate enoximone in this indication by comparing it with sodium nitroprussiate (3 micrograms/kg/mn). Intravenous enoximone (total dose of 1.5 mg/kg) increased the cardiac index (+49%; p less than 0.01), slightly reduced the mean systemic blood pressure (-8%; p less than 0.05) whilst inducing a greater reduction in systemic arterial resistances (-36%; p less than 0.01); the fall in mean blood pressure was less than with sodium nitroprussiate (-23%; p less than 0.01). Myocardial oxygen consumption (rate-pressure product) did not increase in contrast to the effect of dobutamine (+21%; p less than 0.01). There was a significant reduction in pulmonary arteriolar resistances (p less than 0.01) with all three drugs but the interpretation of this response and its prognostic significance in patients with a low cardiac output and persistent pulmonary hypertension are discutable even when pulmonary arteriolar resistances are less than 6 Wood units. The value of using an inotropic agent such as Dobutamine or Enoximone is to unmask fixed pulmonary hypertension which may be missed in patients with low cardiac output even with vasodilator drugs, and also to mimic the haemodynamic result of transplantation. In this indication Enoximone may be used like Dobutamine but with the advantage of not increasing myocardial oxygen consumption and being probably less arrhythmogenic.