RESUMEN
BACKGROUND: Recent research based on large number of patients has demonstrated that there are strong exercise predictors of cardiovascular events other than ST-segment behaviour. Studies focused on non-ST segment variables in exercise testing (exercise capacity, chronotropic and pressure response, heart rate recovery) in diabetics are lacking. The aim of our study is to find out differences in the exercise-testing variables between diabetics and non and to evaluate their prognostic role. METHODS: We analyzed non ST-variables in 1172 patients undergoing exercise testing with Bruce protocol: diabetics vs. non diabetics: n=83 (7%) vs n=1089 (93%); mean age: 64.37 +/- 8.44 vs 60.44 +/- 11.44; males: n=56 (67.47%) vs n=665 (61.06%). Mean follow-up was 13.5 +/- 4 months. RESULTS: Follow-up data were available in 74 diabetics (89%), 14 (18,9%) presented cardiac events (death, infarction, coronaric revascularization, heart failure). Diabetics with events showed significantly worse 1st min Heart Rate (HR) and 3rd min Systolic Blood Pressure (SBP) recovery. CONCLUSIONS: Preliminary results highlight that non-ST variables (exercise time, chronotropic response, heart rate and blood pressure recovery) are significantly different in diabetics. Abnormal HR and SBP recovery identify a subgroup of diabetics at higher risk of cardiac events in the follow-up.
Asunto(s)
Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/diagnóstico , Complicaciones de la Diabetes , Electrocardiografía , Prueba de Esfuerzo , Anciano , Presión Sanguínea , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Valor Predictivo de las Pruebas , Pronóstico , Factores de RiesgoRESUMEN
The finding of transient ST-segment depression during episodes of supraventricular tachycardia is common but its ischemic significance is usually uncertain. Several authors came to the conclusion that in the absence of positive myocardial scintigraphy these alterations are not associated with a coronary flow-limiting stenosis. Our report tends to confirm this view but we suggest to observe the evolution of ST-segment changes at the very end of the episodes; these mechanisms have not been adequately addressed in previous studies and could provide useful clues to the ischemic or non-ischemic origin of ST-segment abnormalities.
Asunto(s)
Electrocardiografía , Taquicardia Supraventricular/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
It is obvious that sinus rhythm is preferable to atrial fibrillation for the improvement of the clinical conditions of patients and to avoid the risks of anticoagulation. This clinical reality associated with recent scientific evidence, i.e. atrial fibrillation can be treated with focal ablation, a fibrillating atrium undergoes an unfavorable remodeling that can negatively influence attempts of electrical cardioversion, results of clinical studies have demonstrated that a large atrial size and long-standing atrial fibrillation do not represent a contraindication to electrical cardioversion, explain why at present cardiologists try to maintain normal sinus rhythm more than in the past. Results of current studies that compare rate control versus sinus rhythm maintenance could solve the controversy.
Asunto(s)
Fibrilación Atrial/terapia , Cardioversión Eléctrica , HumanosRESUMEN
Left ventricular non-compaction (LVNC) is a myocardial disorder characterized by prominent trabeculations and deep intertrabecular recesses within the left ventricular wall. Multi-slice computed tomography (CT) might represent a valid non-invasive imaging technique for the diagnostic work-up of these patients, being able to visualize the compacted and non-compacted layers and to simultaneously rule out the presence of associated coronary artery disease and congenital heart disease. In the present report, the CT features of LVNC are described.
Asunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Ecocardiografía , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada MultidetectorRESUMEN
BACKGROUND: Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique. HYPOTHESIS: Myocardial damage may be associated with ECG changes in infarct-like AM. METHODS: Forty-one consecutive patients (36 males; mean age, 36 ± 12 years) with diagnosis of AM according to cardiac MRI Lake Louise criteria and infarct-like presentation were included. The relation between site of ST-segment elevation (STE), sum of STE (sumSTE), time to normalization of STE, and development of negative T wave with the extent of LGE (expressed as % of left ventricular mass [%LV LGE]), was evaluated. RESULTS: Most (80%) patients presented with inferolateral STE; mean sumSTE was 5 ± 3 mm. Normalization of STE occurred within 24 hours in 20 (49%) patients. Development of negative T wave occurred in 28 (68%) patients. Cardiac MRI showed LGE in all patients; mean %LV LGE was 9.6 ± 7.2%. Topographic agreement between site of STE and LGE was 68%. At multivariate analysis, sumSTE (ß = 0.42, P < 0.001), normalization of STE >24 hours (ß = 0.39, P < 0.001), and development of negative T wave (ß = 0.49, P < 0.001) were independently related to %LV LGE. CONCLUSIONS: Analysis of the site of STE underestimates the extent of myocardial injury among patients with infarct-like myocarditis. However, some ECG features (ie, sumSTE, normalization of STE >24 hours, and development of negative T wave) may help to identify patients with larger areas of myocardial damage.
Asunto(s)
Electrocardiografía , Imagen por Resonancia Cinemagnética , Infarto del Miocardio/diagnóstico , Miocarditis/diagnóstico , Miocardio/patología , Enfermedad Aguda , Adulto , Distribución de Chi-Cuadrado , Medios de Contraste , Diagnóstico Diferencial , Femenino , Gadolinio DTPA , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/patología , Infarto del Miocardio/fisiopatología , Miocarditis/patología , Miocarditis/fisiopatología , Valor Predictivo de las Pruebas , Volumen Sistólico , Función Ventricular Izquierda , Adulto JovenRESUMEN
BACKGROUND: In clinical practice, the identification of the culprit vessel and the localization of the occlusion site in ST-elevation myocardial infarction (STEMI) are provided by coronary angiography. Over the last few years, however, an increasing body of literature focused upon the reassessment of the ECG as a reliable technique to obtain this useful information. The aim of this study was to evaluate the accuracy of electrocardiographic criteria compared to coronary angiography. METHODS: On the basis of the available literature, we developed an electrocardiographic algorithm based on the analysis of ST-segment elevation and reciprocal depression, whose accuracy was verified through its use in our cohort of 343 consecutive patients during calendar years 2008-2010. All patients underwent emergent percutaneous coronary intervention in the setting of acute STEMI. Patients with left bundle branch block, pacemaker rhythm and/or with a history of previous reperfusion were excluded. The admission electrocardiograms were reviewed by experienced cardiologists blinded to the angiographic findings. RESULTS: The criteria adopted allowed a correct identification of the culprit vessel in 87.5% of cases. The sensitivity for left anterior descending, right coronary artery, left circumflex and diagonal branch/double anterior descending/ramus intermediate was 98.8%, 93.7%, 31.7% and 44.4%, respectively; the specificity was 94.3%, 87.6%, 99.0% and 99.1%, respectively. The proximal/distal location was correctly identified in 62.4% of cases. CONCLUSIONS: Our results confirm that careful interpretation of the ECG, which is a versatile and widely available tool, appears useful for the detection of the culprit vessel and the coronary occlusion site in STEMI patients, with relevant implications for clinical management and selection of appropriate therapeutic strategies.
Asunto(s)
Electrocardiografía , Infarto del Miocardio/diagnóstico , Anciano , Algoritmos , Femenino , Humanos , Masculino , Infarto del Miocardio/patologíaAsunto(s)
Función Atrial , Isquemia Miocárdica/fisiopatología , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Electrocardiografía , Prueba de Esfuerzo , Femenino , Atrios Cardíacos , Humanos , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Percutaneous coronary intervention is the first-line treatment for ST-elevation myocardial infarction. In the setting of multivessel disease, concomitant reperfusion of all obstructed vessels is controversial, notably when the culprit vessel cannot be easily identified. We describe two cases with acute inferior-posterior myocardial infarction (ST-segment elevation in the inferior leads and ST-segment depression in the precordial leads). In the first case, angiography revealed severe three-vessel disease and the culprit vessel could not be identified. Following standard pharmacological therapy, the clinical picture and the ECG pattern improved, so that coronary revascularization was postponed. In the second case, angiography showed two-vessel disease with total occlusion of the right coronary and left circumflex arteries, which was treated with coronary angioplasty and drug-eluting stent implantation on the right coronary artery. In patients who undergo coronary angioplasty immediately, careful reading of the ECG can be a reliable tool for the identification of the culprit vessel in ST-elevation myocardial infarction associated with multivessel disease, allowing to choose the appropriate reperfusion strategy.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Electrocardiografía , Infarto del Miocardio/terapia , Anciano , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnósticoRESUMEN
Exercise test is the first-line tool for the diagnosis of ischemic heart disease. Presently, high technology tests would appear to have lessened the value of this test. We report a case in which ST-segment abnormalities during exercise (ST-segment elevation in leads aVR and V1) allowed us to define the presence and severity of coronary artery disease.
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Enfermedad de la Arteria Coronaria/diagnóstico , Electrocardiografía , Prueba de Esfuerzo , Sistema de Conducción Cardíaco/fisiopatología , Anciano , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
Exercise test is the simplest, most thorough and cost-effective tool capable of providing diagnostic and prognostic evaluation of patients with known or suspected coronary heart disease. Imaging tests have been lately utilized with increasing frequency: while quite useful to define the presence and extent of ischemia, these tests do not have the prognostic insight offered by data derived from exercise parameters like effort duration, behavior of heart rate, blood pressure and occurrence of arrhythmias. The diagnostic and prognostic value of exercise test-derived data may be further enhanced by the utilization of scores. The authors have carried out a comprehensive review of the current literature on this topic.
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Enfermedad de la Arteria Coronaria/diagnóstico , Prueba de Esfuerzo , Enfermedad de la Arteria Coronaria/fisiopatología , Hemodinámica , Humanos , PronósticoRESUMEN
Anomalous origin of the right coronary artery from the left sinus is a rare congenital anomaly, possibly related to myocardial ischemia by dynamic compression. We present a case of percutaneous treatment of this coronary anomaly resulting in regression of inducible ischemia, as demonstrated by radionuclide scintigraphy.
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Angioplastia Coronaria con Balón/instrumentación , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Imagen de Perfusión Miocárdica , Stents , Anciano , Angiografía Coronaria , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/terapia , Femenino , Humanos , Isquemia Miocárdica/etiología , Isquemia Miocárdica/terapia , Resultado del TratamientoRESUMEN
We report two cases of young patients in whom a continuous murmur was the only abnormal physical finding. The diagnosis was artero-venous malformation (AVM) in the context of pulmonary sequestration in the first patient and AVM alone in the second. The aim is to stress the perennial role of physical examination, the role of Doppler echocardiography and the importance of a multidisciplinary approach in the study of a pathological process involving the pulmonary vascular system.
Asunto(s)
Malformaciones Arteriovenosas/complicaciones , Secuestro Broncopulmonar/complicaciones , Soplos Cardíacos/etiología , Pulmón/irrigación sanguínea , Adulto , Malformaciones Arteriovenosas/diagnóstico , Secuestro Broncopulmonar/diagnóstico , Humanos , Masculino , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalíasRESUMEN
A 57-year-old man presented with triple valve infective endocarditis. There were vegetations on the tricuspid, mitral, and aortic valve. He had multiple complications such as pulmonary abscess, severe anaemia, and congestive heart failure. His general condition was extremely poor. Intensive medical therapy, such as blood transfusion, mechanical ventilation, and inotropic support, allowed him to tolerate surgery. Triple valve replacement was successfully performed without major complication. Vegetation cultures grew Streptococcus bovis and Enterecoccus faecalis. At 1 year follow-up, the patient is alive in NYHA functional class I.
Asunto(s)
Válvula Aórtica/cirugía , Endocarditis Bacteriana/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral/cirugía , Válvula Tricúspide/cirugía , Anemia/microbiología , Anemia/cirugía , Antiinfecciosos/uso terapéutico , Válvula Aórtica/microbiología , Válvula Aórtica/patología , Transfusión Sanguínea , Cardiotónicos/uso terapéutico , Ecocardiografía , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/patología , Endocarditis Bacteriana/terapia , Enterococcus faecalis/aislamiento & purificación , Insuficiencia Cardíaca/microbiología , Insuficiencia Cardíaca/cirugía , Humanos , Absceso Pulmonar/microbiología , Absceso Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Válvula Mitral/patología , Respiración Artificial , Índice de Severidad de la Enfermedad , Streptococcus bovis/aislamiento & purificación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Válvula Tricúspide/microbiología , Válvula Tricúspide/patologíaRESUMEN
Atrial repolarization wave has been known since many years: it is opposite in direction to P wave, may have a magnitude of 100 to 200 microV and may extent into the ST segment (usually it is hidden in the QRS complex). It was hypothesized that this wave could cause ST-segment depression mimicking myocardial ischemia. The false positive response is characterized by marked downsloping of the PR segment at peak exercise, longer exercise time (> 6 min), peak exercise heart rate > 125 bpm, absence of chest pain and ST-segment normalization in the first minute of recovery. In our experience a role of atrial repolarization in ST-segment depression was found in 5.5% of 144 consecutive and non-selected individuals evaluated with exercise testing.