RESUMO
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Assuntos
Humanos , Masculino , Adulto , Valva Aórtica/anormalidades , Valva Mitral/anormalidades , Anormalidades Cardiovasculares/diagnóstico por imagem , Sopros Cardíacos/diagnóstico por imagemRESUMO
El término insuficiencia cardíaca aguda se emplea exclusivamente para definir una disnea aguda (de origen cardíaco) caracterizada por signos de congestión pulmonar, incluyéndose el edema pulmonar. No obstante, este término también puede ser aplicable al shock cardiogénico. Cuando se utiliza el término insuficiencia cardíaca generalmente se refiere a insuficiencia cardíaca crónica. El término congestiva hace referencia a la presencia de signos o síntomas de congestión pulmonar o periférica, lo que refleja una situación algo más avanzada o de cierta desestabilización (AU)
Assuntos
Humanos , Insuficiência Cardíaca/tratamento farmacológico , Pacientes Ambulatoriais , Doença Aguda , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
La insuficiencia cardíaca es un síndrome final en el que terminan muchas enfermedades cardíacas de gravedad y pronóstico diferentes. Nunca debería realizarse el diagnóstico de la cardiopatía de base en este estadio final pues esta situación se asocia a una disminución de la esperanza de vida, por lo que es fundamental la prevención del síndrome, lo que equivale al tratamiento correcto de la cardiopatía causante en fases precoces, incluso asintomáticas (AU)
Assuntos
Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Prognóstico , Fatores de RiscoRESUMO
The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.
Assuntos
Ecocardiografia Transesofagiana , Ecocardiografia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/patologia , Humanos , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Increasingly patients are surviving after reconstructive surgery of the ascending aorta. These patients require follow-up to detect postoperative prognostic markers, such as persistence of the flow in a false lumen, intimal rupture, or graft complications. We conducted a study with transthoracic and transesophageal echocardiography in order to detect residual abnormalities and establish the usefulness of this technique in a group of patients after Bono-Bentall surgery for ascending aorta pathology. PATIENTS AND METHODS: Twelve patients were studied with transthoracic and transesophageal echocardiography, four after surgery for annulo-aortic ectasia with severe aortic insufficiency and eight for type A aortic dissection. The Bono-Bentall surgical procedure was used in all the patients with Cabrol's modification being added in three. RESULTS: Seven of the eight (87%) patients with aortic dissection had residual abnormalities: five persistence of the distal dissection, one pseudo-aneurysm, and one peritubular haematoma. A residual lesion (pseudo-aneurysm) was found in just one of the four patients (25%) who underwent surgery for annulo-aortic ectasia. The ejection fraction was normal in those patients who had been operated on for aortic dissection and depressed in those who had annulo-aortic ectasia (60 +/- 9 vs 40 +/- 10; p = 0.005). CONCLUSIONS: In patients undergoing surgery with the Bono-Bentall procedure there is a high incidence of residual aortic abnormalities, especially when the operation is for aortic dissection. Transesophageal echocardiography is an ideal diagnostic method for the detection and follow up of residual abnormalities after ascending aorta surgery. We believe this technique should be included in the periodic follow up of these patients.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Ecocardiografia Transesofagiana , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Valva Aórtica/cirurgia , Implante de Prótese Vascular , Ecocardiografia/métodos , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
INTRODUCTION: It is known, that there is a high prevalence of left ventricular diastolic disfunction, which precedes left ventricular hypertrophy in hypertensive people, but there is little published in literature about the relationship between these findings and the presence of microalbuminuria. OBJECTIVE: In our study, we pretend to evaluate prevalence and eventual relation among microalbuminuria, diastolic disfunction and left ventricular hypertrophy, in young mild to moderate hypertensive patients, non diabetic and without previous treatment. MATERIAL AND METHODS: We studied prospectively 80 untreated hypertensive patients, with normal serum creatinine, and non diabetic (52.5% women and 47.5% men, mean age 41.4 +/- 9.6 years). We evaluated filling indexes by Doppler Echocardiography: Ratio of early to late diastolic peak filling velocity and early filling deceleration time. Left ventricular hypertrophy was defined by Devereux's criteria. Microalbuminuria in twenty four hours was measured by radioimmunoassay in hypertensive patients (microalbuminuria: 30-300 mg/24 hours). RESULTS: Microalbuminuria occurred in 23.7%, left ventricular hypertrophy 40%, and diastolic disfunction 48.8%, no significant correlation existed between the same. Only 29.5% had no cardiac or renal disease. Statistically significant differences were found in ratio of early to late diastolic peak filling velocity and microalbuminuria, between the two study populations, but multiple regression analysis didn't prove such correlation. Ratio of early to late diastolic peak filling velocity was independently related to age and diastolic blood pressure. CONCLUSIONS: There is a high prevalence of cardiac and/or renal disease in mild hypertensive patients, only 29.5% of these patients are free of disease. We don't find relation between lesions in these organs.
Assuntos
Albuminúria/epidemiologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/epidemiologia , Adulto , Albuminúria/complicações , Diástole/fisiologia , Ecocardiografia , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Ultrassonografia DopplerRESUMO
Almost 90% of primary acute pericarditis are idiopathic. Between specifics forms, a very low percentage of cases are due to chronic rheumatic diseases. A case of adult Still's disease (juvenile chronic rheumatoid arthritis) with acute pericarditis being the first clinical manifestation (besides fever and general syndrome) is presented. Therapy with oral prednisone was rapidly effective, and pericardial effusion resolved after 3 weeks of treatment, as echocardiography showed.