RESUMO
The most common cardiovascular arrhythmia is atrial fibrillation (AF), with an estimated prevalence of 2.5 million in 1994. The extent of this public health problem is enormous, particularly in its stroke sequelae. Routine management of this public health problem includes anticoagulation as the primary stroke-preventive measure. Echocardiography has been an important adjunctive tool in the evaluation of AF. More innovative and controversial is the putative role of transesophageal echocardiography in the treatment strategy of AF cardioversion to sinus rhythm. The standard of care for AF of less than 1-year duration is to attempt cardioversion to sinus rhythm. An alternative strategy is to utilize the assets of transesophageal echocardiography to visually screen the left atrium for thrombus, thereby playing an active role in the treatment strategy of AF. This review will discuss the role of echocardiography in AF as it was initially used as a diagnostic tool with weak prognostic features, and, more recently, as it can be used today as an adjunctive tool to guide therapy with excellent stroke risk-stratification features.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Anticoagulantes/uso terapêutico , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Função Atrial , Cardioversão Elétrica , Hemodinâmica , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
In this pilot study, we sought to compare the vasodilatory and hemodynamic properties of the peripheral vasculature in the forearms of young, healthy African-American females to similarly matched white females. We used high-resolution ultrasound of the brachial artery to evaluate 11 African-American females and 8 white females. When normalized to nitrate-induced dilation, endothelium-dependent dilation was reduced in young African American females compared to white females (0.6 in African American females compared to 1.0 in white females). These results indicate the need for a larger study to examine this phenomenon.
Assuntos
Negro ou Afro-Americano , Artéria Braquial/diagnóstico por imagem , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Nitroglicerina/farmacologia , População Branca , Adulto , Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiologia , Feminino , Humanos , Projetos Piloto , Probabilidade , Estudos Prospectivos , Valores de Referência , Estudos de Amostragem , Sensibilidade e Especificidade , Ultrassonografia , Extremidade Superior , Vasoconstrição/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Sistema Vasomotor/fisiologiaRESUMO
Coronary heart disease is the leading cause of death in the United States in both men and women. Much has been written on the ill effects of this disease in the general population; however, its ramifications in African-American women have been overlooked. Without a doubt, this group has a higher mortality and morbidity than African-American men and white women below the age of 55. Despite the lower angiographic prevalence of disease, when symptomatic coronary heart disease develops, the outlook is dismal. Today's research must concentrate on the ramifications of coronary heart disease in this population to improve the health standard of the general populace.
