RESUMO
OBJECTIVE: Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope. METHOD: Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews. RESULTS: A head-up tilt test was realized in 77 patients (47.8±20years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32±11months (range 6-54months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n=5/48; 10%) or a negative head-up tilt test response (n=2/19; 10%). CONCLUSION: The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.
Assuntos
Transtornos Psicofisiológicos/diagnóstico , Síncope Vasovagal/diagnóstico , Síncope/psicologia , Teste da Mesa Inclinada , Anti-Hipertensivos/administração & dosagem , Diuréticos/administração & dosagem , Feminino , Seguimentos , França , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Prognóstico , RecidivaRESUMO
BACKGROUND AND OBJECTIVE: Despite recent advances in diagnostic procedures, syncope remains unexplained in 15 to 35% of patients. If implantable loop recorder is a validated diagnostic tool for unexplained syncope, results of this strategy are largely issued from randomized studies. We lack the results of surveys. The aim of this study was to report a single center experience with implantable loop recorders, in patients with unexplained syncope. METHODS AND RESULTS: A device (Medtronic Reveal DX or XT) was implanted in 31 patients between January 2009 and January 2012. During a mean follow-up of 10.5±8.5 months, loop recording definitively determined that an arrhythmia was the cause of symptoms in 10 patients (32%). Fourteen patients (45%) experienced syncope or pre-syncope. In eight of the 14 patients with syncope, during follow-up, no arrhythmic diagnosis could be made (one patient has been diagnosed as presenting epilepsy and seven as having hypotensive vasovagal syncope). In six patients, the ILR showed an arrhythmic aetiology. Four other patients presented an abnormal ILR result without symptoms. Diagnosis included sinusal arrest in four patients, bradycardia in one patient, advanced atrioventricular block in two patients, ventricular arrythmias in two patients, and supraventricular tachycardia of 180/min in one patient. Therapy was instituted in all patients, in whom an arrhythmic cause was found except one who refused the therapy (six pacemaker, two implantable cardioverter-defibrillator implantations, and one cryoablation of atrioventricular nodal reentrant tachycardia confirmed by an invasive exploration). CONCLUSION: In this survey, implantable loop recorder implantation led to the diagnosis of an arrhythmic cause in 32% of patients and excluded an arrhythmic cause in 26% of patient with a mean follow-up of 10.5 months.
Assuntos
Arritmias Cardíacas/complicações , Arritmias Cardíacas/terapia , Desfibriladores Implantáveis , Marca-Passo Artificial , Síncope/etiologia , Síncope/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Bradicardia/complicações , Bradicardia/terapia , Feminino , Seguimentos , França , Pesquisas sobre Atenção à Saúde , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/terapia , Síncope/diagnóstico , Síncope Vasovagal/complicações , Síncope Vasovagal/terapia , Taquicardia Supraventricular/complicações , Taquicardia Supraventricular/terapia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/terapia , Resultado do TratamentoRESUMO
A 68-year old woman was hospitalised because of isolated right heart failure. Doppler echocardiography revealed severe tricuspid regurgitation with thickened, shortened, hypomobile leaflets. Pulmonary valve was thickened with mild pulmonary regurgitation. Mitral and aortic valves were normal. The patient was finally diagnosed with carcinoid heart disease from an isolated ovarian carcinoid cancer without hepatic metastases. Ovarectomy was performed and the patient was considered cured of her cancer. Because of refractory right heart failure, she underwent tricuspid valve replacement with a bioprosthesis. Such cardiovascular manifestations are rarely the presenting symptoms of carcinoid disease. Carcinoid heart disease from ovarian primary cancer is exceptional. In this circumstance, carcinoid cardiac lesions may develop in the absence of hepatic metastases because the venous blood from the ovaries drains into the inferior vena cava without hepatic first past effect. Surgical resection of primary ovarian carcinoid tumor is often curative and the prognosis depends mainly on the cardiac condition. The diagnosis of carcinoid syndrome should be discussed in patients with organic tricuspid regurgitation without left valvular disease.
Assuntos
Doença Cardíaca Carcinoide/etiologia , Tumor Carcinoide/secundário , Neoplasias Ovarianas/patologia , Insuficiência da Valva Tricúspide/etiologia , Idoso , Doença Cardíaca Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico , Valva TricúspideRESUMO
The authors report a case of constrictive pericarditis occurring two years after surgical repair of an atrial septal defect in a 37 year-old-man. The diagnosis was made by right heart catheterisation and magnetic resonance imaging. The special feature of this clinical case was the exclusive localisation of the fibrosis on the visceral pericardium or epicarditis. The outcome was favourable after resection of the visceral pericardium respecting the parietal pericardium. Magnetic resonance imaging and right heart catheterisation performed 6 months after surgery were normal. Constrictive pericarditis is a classical complication of cardiac surgery but relatively rare after repair of an atrial septal defect. Isolated involvement of the visceral pericardium is rare and allows surgical correction by exclusive epicardectomy respecting the parietal pericardium.
Assuntos
Comunicação Interatrial/cirurgia , Pericardite Constritiva/etiologia , Adulto , Cateterismo Cardíaco , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pericardiectomia , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/cirurgia , Pericárdio/patologia , Pericárdio/cirurgia , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
The purpose of the retrospective epidemiologic study was to determine smoking prevalence and its correlates among pregnant women. Data for the study were collected from 477 randomly selected medical records of pregnant women attending a Kentucky obstetrical clinic. Logistic regression analysis, when controlling for age and education, showed that significant predictors of smoking prior to pregnancy were being married and being a woman of color. Significant demographic predictors of smoking at initiation of antenatal care were being married, being a woman of color, early age at onset of smoking, and number of cigarettes smoked per day.
Assuntos
Cuidado Pré-Natal , Fumar/epidemiologia , Adolescente , Adulto , Demografia , Feminino , Humanos , Modelos Logísticos , Valor Preditivo dos Testes , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fumar/psicologia , Prevenção do Hábito de FumarAssuntos
Mamoplastia , Próteses e Implantes/efeitos adversos , Doenças Reumáticas/etiologia , Silicones/efeitos adversos , Animais , Doenças do Tecido Conjuntivo/epidemiologia , Doenças do Tecido Conjuntivo/etiologia , Feminino , Humanos , Sistema Imunitário/efeitos dos fármacos , Incidência , Fatores de RiscoRESUMO
2D echocardiography has become one of the most important investigations in the preoperative assessment of mitral stenosis. This study was undertaken to determine the reliability of the information so obtained, by comparison with the surgical appearances. The study population consisted of 104 patients (average age 45 years, 76% women) undergoing open heart surgery for pure mitral stenosis (72%) or mixed mitral valve disease (28%) between 1980 and 1981. All underwent 2D echo using a phased array Aloka SSD 800 80 degrees sector scanner. Cardiac catheterisation was performed in 102 cases and left ventricular angiography in 89 cases. The echocardiogramme was interpreted by an observer who had no knowledge of the surgical results. The mitral surface area, the condition of the valves and subvalvular apparatus and the predictive value of the possible surgical technique were analysed. The 2D echo mitral surface area was estimated by planimetry and quantitatively by using the Gorlin formula during catheterisation and by the surgical description preoperatively. 2D echo was more sensitive than M mode in the detection of severe mitral stenosis (90% vs 73%, p less than 0,01). The 2D echo-Gorlin correlation was quite good (R = 0,70, p less than 0,01) but was worse when the valves were very thickened. When compared with the surgical observations, 87% of the 2D echo data was correct. The thickness of the valves, their amplitude, the diastolic bowing of the anterior leaflet and the presence of calcification were assessed by 2D echo. The echo-surgical results matched perfectly in 76% of cases. The usual cause of error was underestimation of the degree of valvular damage. The valvular bowing and thickness were the most useful signs. Dense, brilliant echos of valvular calcification were found in only 58% of surgically proven cases of valvular calcification, but the error was often related to fine calcification, not visible on fluoroscopy, or to its localisation on the posterior leaflet. The subvalvular apparatus was evaluated in over 93% of patients, a complete study being possible in 73% of them. The 2D echo-surgical correlations were excellent in 90% of the cases in which it had been completely visualised. The chordal thickening was correctly predicted in 79% of cases. The surgical assessment was more pessimistic in 1/3 of cases in which the chordae appeared to be of normal thickness. The length of the chordae was correctly predicted in 68% of cases. The surgical assessment was more pessimistic in 1/2 of cases in which the chordae appeared to be of normal length.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Ecocardiografia/métodos , Estenose da Valva Mitral/diagnóstico , Adulto , Calcinose/diagnóstico , Cateterismo Cardíaco , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Estenose da Valva Mitral/cirurgia , Cuidados Pré-Operatórios , RadiografiaRESUMO
Three patients with severe, deforming, and long-standing rheumatoid arthritis developed pure red cell aplasia that did not remit after withdrawal of medications, ran a chronic course, and in two patients remitted only after cytotoxic immunosuppressive treatment. An IgG inhibitor of autologous erythroid colony-forming and burst-forming unit growth in vitro was found in the serum of one patient. This specific erythropoietic inhibitor persisted in lower titer in the patient's serum even after an azathioprine-induced remission of pure red cell aplasia, indicating the possible need for maintenance immunosuppressive therapy. Chronic pure red cell aplasia may be another extra-articular manifestation of rheumatoid arthritis and should be considered when severe anemia develops in the absence of blood loss or hemolysis.
Assuntos
Anemia Aplástica/etiologia , Artrite Reumatoide/complicações , Idoso , Anemia Aplástica/imunologia , Artrite Reumatoide/sangue , Artrite Reumatoide/imunologia , Exame de Medula Óssea , Ensaio de Unidades Formadoras de Colônias , Eritropoese , Feminino , Humanos , Imunoglobulina G , Pessoa de Meia-IdadeRESUMO
The development of generalized necrotizing vasculitis in association with hepatitis B antigenemia is the first example in man of a chronic rheumatic disease presumably caused by a viral infection. This report reviews the experience in nine biopsy-proven cases of hepatitis B-associated necrotizing vasculitis followed for up to six years. The natural history of the disease is emphasized and the manifestations of patients with vasculitis who carry hepatitis B antigen are compared with those of vasculitis patients who are antigen negative.