[Assessment of pulmonary arterial pressure in adults with Doppler echocardiography]. / Avaliação da pressão arterial pulmonar em adultos pela Eco-Dopplercardiografia.

PURPOSE: To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS: Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS: An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p < 0.05) in patients with severe PH (mean PAP > or = 40 mmHg), comparing with patients with PAP < 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p < 0.05) excluding patients with atrial fibrillation (19 cases). CONCLUSION: PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.

[Electrocardiographic changes in accidental hypothermia]. / Alterações eletrocardiográficas na hipotermia acidental.

PURPOSE: Electrocardiographic alterations were evaluated in a group of accidental hypothermia patients, and correlated with values of core temperature, pH and plasmatic concentrations of Na+, K+ and Cl-. METHODS: Conventional 12-lead surface electrocardiograms were obtained in a group of 32 patients with accidental hypothermia after involuntary cold exposure. Cardiac arrhythmias, QRS configuration, ST-T segment and T wave alterations were analyzed. pH, Na+, K+ and Cl- serum concentrations were simultaneously measured. Electrocardiogram and electrolyte abnormalities were then correlated with the core temperature. RESULTS: Twenty-eight patients had abnormal electrocardiogram (90.6%). Sinus bradycardia and idioventricular rhythm were observed in 11 and 3 patients respectively. QT interval enlargement was found in 24 patients and Osborn wave in 28 cases. Altered T waves expressing an abnormal repolarization were observed in 23 cases. A significant negative correlation was obtained when J wave amplitude was correlated with core temperature levels. CONCLUSION: Hypothermia produces electrocardiographic abnormalities characterized by Osborn waves. Other minor findings include sinus bradycardia, idioventricular rhythm and long QT intervals.

[Pulmonary artery pressure evaluation in adults by Doppler echocardiography]. / Avaliação da pressão arterial pulmonar em adultos pela ecodopplercardiografia.

PURPOSE: To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS: Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS: An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p less than 0.05) in patients with severe PH (mean PAP greater than or equal to 40 mmHg), comparing with patients with PAP less than 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p less than 0.05) excluding patients with atrial fibrilation (19 cases). CONCLUSION: PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.

Echocardiographic and hemodynamic features of severe aortic regurgitation with diastolic opening of the aortic valve.

Severe aortic regurgitation may be associated with premature aortic valve opening. Several possible etiologies for this diastolic opening have been suggested. We present a patient with hemodynamic data, M-mode and 2-D echocardiography in the setting of severe aortic regurgitation and diastolic aortic valve opening. Our data lead us to conclude that aortic valve opening in this situation is neither from passive flotation nor dependent on atrial systole. We believe that active ventricular recoil mechanisms can facilitate increases in diastolic ventricular pressure which then can transiently exceed aortic pressure in the setting of severe aortic regurgitation. This hemodynamic observation suggests that the valve opening is an active process.