RESUMO
Hypertrophic cardiomyopathy is a commonly encountered inheritable cardiac disorder with variable phenotypic expression. Although most patients will have no or mild symptoms, 10% will develop heart failure symptoms refractory to medical management. This article discusses the mechanisms through which hypertrophic cardiomyopathy induces heart failure and how alcohol septal ablation can reverse each of these mechanisms to lead to clinical improvement.
Assuntos
Técnicas de Ablação/métodos , Etanol/farmacologia , Insuficiência Cardíaca/terapia , Septos Cardíacos/efeitos dos fármacos , Progressão da Doença , HumanosAssuntos
Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Ecocardiografia Doppler , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Falha de Prótese , Tomografia Computadorizada por Raios X , Obstrução do Fluxo Ventricular Externo/diagnósticoRESUMO
The purpose of this investigation was to quantify the cardiovascular, respiratory, and cerebrovascular effects of two common yogic breathing exercises (YBE): bhastrika and chaturbhuj; and to determine the effect of their consistent practice on chemosensitivity. The first study was cross-sectional and compared experienced yogic breathers (YB) with matched controls; whereas the second was a 10-week longitudinal training study. The results support four major findings. First chaturbhuj resulted in a hypoxic stimulus in experienced YB compared to control [end-tidal oxygen tension (PETO2), YB: 77.5±5.7mmHg, P<0.05; control: 94.3±12.0mmHg]. Second, performance of chaturbhuj resulted in cyclic oscillations of mean arterial pressure (MAP), heart rate (HR), and middle cerebral artery velocity (MCAv) consistent with the phases of respiration. Third, post training, performance of bhastrika reduced PETO2 (end breath-hold: 90.8 8±12.1mmHg) compared to rest (100.1±7.4, P<0.05); it also resulted in significantly increased MAP at end breath-hold (96.7±13.0mmHg) compared to rest (83.0±6.6mmHg, P<0.05) and significantly increased mean MCAv (end breath-hold: 87.4±23.0cm/s, P<0.05; rest: 55.8±26.3cm/s). Fourth, experienced YB had lower central chemosensitivity than controls (YB: 3.4±0.4; control: 4.6±1.2L/min/mmHg; P<0.05). In conclusion, YBE significantly alter end-tidal gases, resulting in complex oscillations of cardiovascular and cerebrovascular variables, and if practiced consistently, may reduce chemosensitivity.
Assuntos
Pressão Sanguínea/fisiologia , Exercícios Respiratórios/métodos , Fenômenos Fisiológicos Cardiovasculares , Respiração , Adulto , Gasometria , Circulação Cerebrovascular/fisiologia , Estudos Transversais , Seguimentos , Frequência Cardíaca , Humanos , Masculino , Oxiemoglobinas/metabolismo , Ventilação Pulmonar/fisiologia , Espirometria , Volume de Ventilação Pulmonar/fisiologia , Ultrassonografia Doppler Transcraniana , Capacidade Vital/fisiologia , Adulto JovemAssuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/cirurgia , Idoso , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Feminino , Humanos , Dispositivo para Oclusão Septal , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologiaRESUMO
BACKGROUND: Regadenoson (REGA), a selective adenosine A2A receptor agonist, is the most widely used stress agent for SPECT myocardial perfusion imaging (MPI) in the United States. The diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, but its prognostic value is not well defined. METHODS: We categorized 1,400 patients (700 consecutive normal and 700 consecutive abnormal REGA-MPIs) into 4 groups based on the perfusion defect size using automated quantitative analysis: Group 1: normal perfusion; Group 2: <10% of left ventricle; Group 3: 10%-20%; Group 4: >20%. The primary outcome was a composite of cardiac death, myocardial infarction (MI), and late coronary revascularization (CR >90 days after MPI). RESULTS: Of the 1,400 patients (42% male, 37% diabetes, 21% heart failure, 26% end-stage renal disease), the primary outcome occurred in 23% (17% cardiac death, 4% MI, 6% late CR) during 46 ± 18 months of follow-up and 8% had early CR (within 90 days of MPI). Early CR occurred in 0.4%, 9%, 17%, and 17% and the primary outcome in 10%, 27%, 31%, and 43% in Groups 1-4, respectively (P < .001 for both). In an adjusted Cox proportional model, the hazard ratio for the primary outcome was 2.68 (1.77-4.06), 3.32 (2.28-4.83), and 4.05 (2.78-5.91) for Groups 2-4 compared to Group 1. CONCLUSION: REGA MPI provides powerful prognostic information that has important implications in patient management and can guide clinical practice.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Teste de Esforço/estatística & dados numéricos , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Purinas , Pirazóis , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Agonistas do Receptor A2 de Adenosina , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Taxa de Sobrevida , Estados Unidos/epidemiologiaAssuntos
Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Contusões Miocárdicas/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Acidentes de Trânsito , Adulto , Biópsia , Anuloplastia da Valva Cardíaca , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Contusões Miocárdicas/etiologia , Contusões Miocárdicas/cirurgia , Resultado do Tratamento , Valva Tricúspide/lesões , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
We present an adult with metastatic carcinoid disease affecting the heart, in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over two-dimensional transthoracic echocardiography (2DTTE). Initial 2DTTE was able to demonstrate severe pulmonic and tricuspid regurgitation, but was unable to visualize the posterior leaflet of the tricuspid valve or the right (right anterior) leaflet of the pulmonic valve. Further analysis with 3DTTE demonstrated thickening, restricted mobility, and noncoaptation of all three leaflets of both the tricuspid and the pulmonary valves. En face viewing of tricuspid and pulmonary regurgitation vena contractas permitted more reliable quantification of regurgitation severity. In addition, localized, linear, echogenic areas consistent with carcinoid deposits were noted along the inner walls of the right atrium, atrial septum, and inferior vena cava. To the best of our knowledge, endocardial carcinoid deposits have never been reported by 2D or 3D echocardiography. En face viewing of these deposits by 3DTTE enabled measurement of their dimensions and areas. Subcostal examination also identified large circumscribed hepatic lesions consistent with metastatic disease. Neither the carcinoid deposits nor the metastatic lesions were detected by 2DTTE. This case demonstrates the usefulness of 3DTTE as a supplement to 2DTTE in more comprehensively assessing carcinoid involvement of the heart.
Assuntos
Doença Cardíaca Carcinoide/complicações , Doença Cardíaca Carcinoide/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etiologia , Valvas Cardíacas/diagnóstico por imagem , Sistemas Computacionais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Percutaneous closure of secundum atrial defects has become an accepted treatment in part because it is minimally invasive and relatively low risk. Despite recent advances in implantation technique and device improvements, complications occur. Here, we report a case of device embolization during percutaneous repair of an atrial septal defect (ASD) with multiple fenestrations. We highlight the value of using live/real time three-dimensional transesophageal echocardiography to help plan the percutaneous procedure and detect complications.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Embolização Terapêutica/instrumentação , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Artéria Ilíaca/cirurgia , Cirurgia Assistida por Computador/métodos , Humanos , Masculino , Dispositivo para Oclusão Septal , Resultado do TratamentoRESUMO
We present an adult with metastatic carcinoid disease affecting the heart, in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over two-dimensional transthoracic echocardiography (2DTTE). Initial 2DTTE was able to demonstrate severe pulmonic and tricuspid regurgitation, but was unable to visualize the posterior leaflet of the tricuspid valve or the right (right anterior) leaflet of the pulmonic valve. Further analysis with 3DTTE demonstrated thickening, restricted mobility, and noncoaptation of all three leaflets of both the tricuspid and the pulmonary valves. En face viewing of tricuspid and pulmonary regurgitation vena contractas permitted more reliable quantification of regurgitation severity. In addition, localized, linear, echogenic areas consistent with carcinoid deposits were noted along the inner walls of the right atrium, atrial septum, and inferior vena cava. To the best of our knowledge, endocardial carcinoid deposits have never been reported by 2D or 3D echocardiography. En face viewing of these deposits by 3DTTE enabled measurement of their dimensions and areas. Subcostal examination also identified large circumscribed hepatic lesions consistent with metastatic disease. Neither the carcinoid deposits nor the metastatic lesions were detected by 2DTTE. This case demonstrates the usefulness of 3DTTE as a supplement to 2DTTE in more comprehensively assessing carcinoid involvement of the heart.