RESUMO
The clinical distinction between athlete's heart and structural heart disease in the echocardiography laboratory is often challenging. We present a case where athletic heart syndrome was promptly differentiated from pathology with a simple maneuver during echocardiography.
RESUMO
The physical examination skills of young physicians in training need careful examination as advancing technology seems to have replaced those skills compared to prior generations of physicians. A question to ponder is how should medical education address the convincing evidence that physician trainees of today are less astute at the physical examination than those that came before them? This inquiry must address whether the decline in physical examination skills hinders accurate, cost effective, and timely diagnoses. Additionally, it must consider whether the absence of a comprehensive physical examination impairs the patient-physician relationship. This type of inquiry leads to the conclusion that the physical examination and technology must be merged as the clinical situation dictates to provide accurate, cost effective and accurate diagnoses. The carefully performed physical examination in conjunction with a detailed history should dictate the use of our ever-advancing technologic advances in medicine.
Assuntos
Corpo Clínico Hospitalar , Exame Físico , Tecnologia Biomédica/educação , Competência Clínica , Educação/organização & administração , Avaliação Educacional/normas , Humanos , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/normas , Exame Físico/métodos , Exame Físico/normasRESUMO
Physicians may head off allegations of negligence by developing a comprehensive understanding of why patients sue physicians and by appreciating what activities commonly lead to patient injury. With this knowledge, physicians can develop risk management strategies to reduce the likelihood of being named in a negligence lawsuit. We outline the common reasons why patients sue physicians, and what activities frequently lead to patient harm. The case examples emphasize the factors that can lead to allegations of negligence and patient harm.
Assuntos
Responsabilidade Legal , Imperícia/legislação & jurisprudência , Relações Médico-Paciente , Administração da Prática Médica/normas , Gestão de Riscos/normas , Humanos , Anamnese/normas , Exame Físico/normas , Fatores de RiscoRESUMO
Left ventricular assist devices (LVAD) are being deployed increasingly in patients with severe left ventricular dysfunction and medically refractory congestive heart failure of any etiology. The United States Food and Drug Administration (FDA) recently approved the use of the Thoratec Heartmate II (Thoratec Corporation, Pleasanton, CA, USA) for outpatient use. Echocardiography is fundamental during each stage of patient management, pre-LVAD placement, during LVAD placement, for postoperative LVAD optimization and long-term follow-up. We present a pragmatic and systematic echocardiographic approach that serves as a guide for the management of left ventricular assist devices.
Assuntos
Ecocardiografia/métodos , Coração Auxiliar , Implantação de Prótese/métodos , Cirurgia Assistida por Computador/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/cirurgia , Humanos , Prognóstico , Resultado do TratamentoRESUMO
Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) represents a unique perioperative cardiovascular imaging tool which, without any need for off-line reconstruction, has been shown to be highly valuable for evaluating mitral valve and other intracardiac structures. It is highly probable that, in the near future, RT-3D-TEE will have a positive effect on the perioperative assessment of complex 3D mitral valve structures, as it provides important approaches to the pathophysiology of various mitral valve diseases, including prosthetic valves, and will become incorporated into everyday perioperative practice. The clinical applications and therapeutic implications of perioperative RT-3D-TEE in the thorough assessment of the mitral valve are briefly summarized in this review.
Assuntos
Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Adulto , Idoso , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Assistência Perioperatória , Valor Preditivo dos Testes , PrognósticoAssuntos
Função Atrial/fisiologia , Ecocardiografia/normas , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Sociedades Médicas , Função Ventricular/fisiologia , Adulto , Canadá , Cardiologia , Europa (Continente) , Humanos , Cooperação Internacional , Estados UnidosAssuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/terapia , Falha de Prótese , Dispositivo para Oclusão Septal , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Fluoroscopia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal-averaged P-wave. METHODS: The filtered P-wave duration (FPD) was measured by signal-averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root-mean-square voltage of the terminal 40 ms of the signal-averaged P-wave at 20 and 60 minutes and the difference between them were also determined. RESULTS: The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 +/- 19.1 vs 159.7 +/- 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root-mean-square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 +/- 3.0 vs 5.5 +/- 2.7; P = 0.14). CONCLUSIONS: We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.
Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Cardioversão Elétrica , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Análise de Regressão , Estatísticas não Paramétricas , Fatores de TempoRESUMO
OBJECTIVE: To study the feasibility of continuous intravenous SonoVue contrast echocardiography for qualitative assessment of reversible myocardial perfusion in dipyridamole stress tests. METHODS: Eleven patients (10 male and 1 female, mean age 66 years) with a history of chest pain and a clinical indication for stress sestamibi single photon emission computed tomography (SPECT) underwent concurrent SonoVue 99mTc myocardial contrast echocardiography (MCE). RESULTS: Of the total 176 segments obtained, 53 (30%) were regarded as indeterminate, 39 (22%) as discordant, and 84 (48%) as concordant between MCE and SPECT imaging. Two patients had abnormal SPECT results. The overall feasibility and specificity of MCE were 70 and 74%, respectively. The concordant (p = 0.59) and discordant (p = 0.55) segments were comparable with either MCE technique. However, continuous low-mechanical-index imaging produced fewer indeterminate segments (17 segments, 32%) than intermittent harmonic B-mode imaging (36 segments, 68%) (p = 0.04). Significantly more indeterminate segments were found in the left anterior descending artery territory. However, the overall concordance was similar (p = 0.5) in all three coronary artery territories. The concordance and discordance rates at different left ventricular levels (i.e., basal, mid, and apical) were similar (p = 0.50 and 0.08, respectively). CONCLUSION: Continuous-infusion SonoVue contrast echocardiography is feasible, with high specificity, for detecting myocardial perfusion defects as assessed by dipyridamole SPECT.
Assuntos
Cardiomiopatias/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Ecocardiografia sob Estresse/métodos , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Circulação Coronária , Dipiridamol , Estudos de Viabilidade , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos , Estatísticas não Paramétricas , Tecnécio Tc 99m Sestamibi , VasodilatadoresRESUMO
Atrial fibrillation is the most common sustained cardiac arrhythmia and an important health concern in the United States because of the increasing aging population. Cardioversion of atrial fibrillation to sinus rhythm to relieve symptoms and to reduce the incidence of thromboembolism is now common practice. Recently, transesophageal echocardiography (TEE)-facilitated cardioversion emerged as an acceptable therapeutic alternative owing to the assumption that early cardioversion can obviate many of the concerns and disadvantages associated with the conventional approach. We review the current standing of TEE-facilitated early cardioversion vis-à-vis the salient cardioversion issues and its potential future role amid evolving cardioversion paradigms.