RESUMO
Transthoracic Doppler echocardiography has been shown to be a sensitive modality for the diagnosis of acute septal ruptures after myocardial infarctions. Transesophageal echocardiography has been shown to improve diagnostic accuracy and image quality in many clinical settings. We performed transesophageal Doppler echocardiography in 10 patients with acute septal ruptures. Transesophageal echocardiography provided improved visualization of the rupture morphology (6 of 10 by transthoracic versus 10 of 10 by transesophageal imaging), better detection of multiple rupture sites (2 by transthoracic, 5 by transesophageal study) and better detail of the direction of shunt flow. On the basis of the transesophageal echocardiographic appearance, we propose that septal ruptures after acute myocardial infarctions be classified as simple or complex, consistent with pathologic criteria for left ventricular septal and free wall ruptures. Transesophageal echocardiography proved a useful and safe adjunct to transthoracic imaging, overcoming the technical limitations in these critically ill patients.
Assuntos
Ecocardiografia Transesofagiana , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Idoso , Débito Cardíaco , Angiografia Coronária , Estado Terminal , Ecocardiografia/métodos , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Ruptura Cardíaca Pós-Infarto/classificação , Ruptura Cardíaca Pós-Infarto/patologia , Ruptura Cardíaca Pós-Infarto/cirurgia , Septos Cardíacos/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Aumento da Imagem/métodos , Masculino , Pericárdio/diagnóstico por imagem , Pericárdio/patologiaRESUMO
Eight patients with atypical pneumonia caused by the Legionnaires' disease organism were seen during the spring and summer of 1977. Two died of the acute illness. All patients were febrile and presented with symptoms of acute respiratory infection. Other symptoms included malaise, anorexia, chills, myalgia, and headache. Severe hypoxemia was a striking feature. Conventional methods to determine the etiology of these pneumonias were unsuccessful but subsequent serological studies confirmed the diagnosis of Legionnaires' disease. Seven patients were treated with beta-lactam antibiotics alone or with an aminoglycoside and all failed to respond. Six were subsequently treated with erythromycin and five who received this drug for at least 48 hours were markedly improved within this time period. We believe that erythromycin is effective in the treatment of Legionnaires' disease.