RESUMEN
AIM: The aim of this study was to describe and classify the various anatomical pattern of patent foramen ovale (PFO) with transesophageal echocardiography (TEE) and to relate such classification to the selection of PFO closure devices. METHODS: This study enrolled 216 PFO patients (118 females) mostly with previous cryptogenic stroke or transitory ischemic attack (TIA) who underwent percutaneous closure of PFO with deep sedation under TEE control. Anatomical patterns were classified as follows: simple: PFO characterised by central/superior eccentric shunt or with a valve mechanism (45%); reduse: widely redundant septum primum (22%); ASA: atrial septal aneurysm (11%); EASA: entire atrial septal aneurysm (1.4%); CRIB: cribriform septum primum (9%); tunnel: tunnel between septum primum and secundum >10 mm (11%). Degree of right-to-left shunt, either at basal condition or at Valsalva manoeuvre, was classified as: 1=mild (45%); 2=moderate (42%); 3=severe (13%). Additional right-atrium anatomical features are also described. RESULTS: Procedure was successful in 100% of the cases. At follow-up recurrent TIA occurred in two patients. Residual shunts were present in 4.9% of the patients after Valsalva manoeuvre. Palpitations were reported in 4%. CONCLUSIONS: Closing the PFO choosing the device following strict anatomical criteria based on TEE assessment allowed excellent immediate and late results minimizing residual shunts.
Asunto(s)
Oclusión con Balón , Cateterismo Cardíaco , Foramen Oval Permeable/patología , Foramen Oval Permeable/terapia , Adulto , Anciano , Oclusión con Balón/métodos , Cateterismo Cardíaco/métodos , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Foramen Oval Permeable/clasificación , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/diagnóstico por imagen , Humanos , Italia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
Cardiovascular disorders in patients affected with hyperthyroidism are very common; the increase in the heart rate and in inotropism combines with a rise in the cardiac index towards which the reduction in peripheral resistances and an increase in the venous return to the heart contribute. The increase in myocardial excitabi1ity, caused above all by triiodothyronine, may be attended with atrial extrasystoles or even with atrial fibrillation. Congestive heart failure during hyperthyroidism, even if rare, may either reveal itself in association with pre-existent cardiopathy or to be precipitated by tachyar-rhythrmia, particu1arly, by paroxysmal atrial fibrillation. The case is described of a young woman affected with Graves' disease, presenting an ingravescent dyspnoea, in which sinusal tachycardia, the S1Q3 electrocardiographic figure and the echocardiographic reports of a right ventricu1ar overload with pulmonary hypertension and systemic venous congestion, suggest picture of acute pulmonary embolism. The isolated dysfunction of the right ventricle resolved quickly after an adequate antithyroid therapy. The oddness of presentation of Graves' disease in this case would suggest the execution of the thyroid profile for all patients with a primary diagnosis of heart failure, in order to single out hyperthyroid subjects with reversible myocardial dysfunction.
Asunto(s)
Insuficiencia Cardíaca/etiología , Hipertiroidismo/complicaciones , Adulto , Femenino , HumanosRESUMEN
The finding of normocholesterolaemia, characterized by plasmatic values of total cholesterol < 2 g/l, which may hide silent lipidic alterations, is not by itself sufficient to rule out the existence of cardiovascular risk. First level screening of patients exposed to atherogenic risk must begin from dosage of three basic lipidic indicators, represented by total cholesterol, triglycerides, and HDL cholesterol. By using the values of the three above-mentioned indicators and by applying Friedewald's formula, it is possible to calculate LDL cholesterol indirectly. Atherogenic risk is present when HDL cholesterol and LDL cholesterol show plasmatic concentration inferior to 0.35 g/l and superior to 1,3 g/l respectively. The European Atherosclerosis Society lists five hyperlipidaemic classes, from A to E, determined on the basis of plasmatic levels of cholesterol and triglycerides. Mild hypercolesterolaemia associated with modest atherogenic risk and which largely occurs in people and is frequently underestimated form a diagnostic point of view, contributes to cardiovascular mortality more considerably than more serious forms of hypercholesterolaemia. On the basis of this observation, there originated the programmatic proposal for the prevention of hyperlipidaemic complications, presented by the Authors.
Asunto(s)
Hipercolesterolemia/clasificación , Hipercolesterolemia/diagnóstico , Arteriosclerosis/etiología , Arteriosclerosis/mortalidad , Índice de Masa Corporal , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Humanos , Hipercolesterolemia/sangre , Hipercolesterolemia/complicaciones , Anamnesis , Obesidad/sangre , Examen Físico , Pronóstico , Riesgo , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
1. The calcium-channel blocking activity of lacidipine has been studied compared with that of nifedipine and verapamil on the isolated rabbit heart and aorta. 2. All the compounds induced a dose-dependent negative inotropic effect (10(-8)-10(-5) M); although lacidipine showed less, but longer lasting, activity. 3. Lacidipine showed a weak negative chronotropic effect and nifedipine was ineffective. Only verapamil strongly decreased the heart rate. 4. The three calcium antagonists abolished vasopressin-induced coronary spasm and inhibited partially metoxamine-induced coronary spasm. Only lacidipine reduced basal coronary pressure. 5. In the aortic strips, all the compounds antagonized KCl-induced contractions, and they exerted a partial effect on noradrenaline- and angiotensin II-induced contractions.
Asunto(s)
Bloqueadores de los Canales de Calcio/farmacología , Dihidropiridinas/farmacología , Animales , Aorta Torácica/efectos de los fármacos , Circulación Coronaria/efectos de los fármacos , Femenino , Corazón/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Técnicas In Vitro , Masculino , Contracción Muscular/efectos de los fármacos , Músculo Liso Vascular/efectos de los fármacos , Contracción Miocárdica/efectos de los fármacos , Nifedipino/farmacología , Conejos , Presión Ventricular/efectos de los fármacos , Verapamilo/farmacologíaRESUMEN
Despite the progress of the medical and surgical therapy of cardiac failure, the prognosis of this syndrome remains severe. We studied in a group of cardiac failure patients (n = 203; 18-74 years old) admitted in our division from 1982 to 1987 the most significant clinical and instrumental parameters of prognostic importance. The clinical parameters considered were: age, sex, heart rate, blood pressure, NYHA class, presence of mitral insufficiency, episodes of acute heart failure. The instrumental parameters were: presence of complete left bundle branch block (LBBB), atrial fibrillation, episodes of ventricular tachycardia, cardiothoracic index (C/T), end-diastolic and end-systolic diameters, ejection fraction (EF). Statistical analysis was performed in order to correlate single parameters with mortality. The total survival at 5 years was 50%, being higher in patients with coronary artery disease than in patients with primary dilated cardiomyopathy. The parameters worsening the prognosis were: mitral insufficiency, III-IV NYHA class, occurrence of repeated episodes of acute heart failure in the last year, complete LBBB, C/T greater than 0.55 and EF less than 20%. In conclusion, considering instrumental parameters high risk patients are detected with a precision of 80%.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Adolescente , Adulto , Anciano , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Humanos , Italia , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de SupervivenciaRESUMEN
The hemodynamic effects of combined administration of ibopamine (Ib) (150 mg orally) with nitroprusside (NP) (50-150 micrograms/min intravenously) were compared with those of NP alone in 17 patients with severe congestive heart failure due to coronary artery disease (7 patients) or idiopathic cardiomyopathy (10 patients). Hemodynamic measurements were obtained using a Swan-Ganz thermodilution catheter and a bedside thermodilution cardiac output computer. Nitroprusside alone produced a significant decrease (-12.4%) in mean arterial pressure, mean pulmonary arterial pressure (-28.3%), and systemic vascular resistance (-22.6%), and a significant increase in stroke volume index (23.1%). The administration of combined NP and Ib produced a further significant increase of stroke volume index (20.1%) with a concomitant and significant reduction of systemic vascular resistance (-19.4%); heart rate, mean systemic and pulmonary arterial pressures did not change significantly from the values observed with NP alone. Moreover, stroke work index, although not significantly modified with the vasodilator alone, was significantly increased over control values with NP + Ib association. Although NP alone induced similar effects in both the ischemic and idiopathic cardiomyopathies, the association of Ib gave a more favorable, though not significant, hemodynamic response in the subjects with primitive cardiomyopathy than in the ischemic ones. Thus, the association of Ib to NP therapy, in patients with congestive heart failure, further increases stroke volume index and stroke work index with a concomitant reduction of systemic vascular resistance, without any significant change in mean systemic and pulmonary arterial pressures, or heart rate. These results point out the possibility of associating Ib with other orally active vasodilators in the chronic treatment of congestive heart failure.
Asunto(s)
Cardiomiopatía Dilatada/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Enfermedad Coronaria/tratamiento farmacológico , Desoxiepinefrina/análogos & derivados , Dopamina/análogos & derivados , Ferricianuros/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Nitroprusiato/uso terapéutico , Adulto , Anciano , Desoxiepinefrina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Cardiotónicos/uso terapéutico , Desoxiepinefrina/análogos & derivados , Dopamina/análogos & derivados , Ferricianuros/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Nitroprusiato/uso terapéutico , Adulto , Anciano , Desoxiepinefrina/uso terapéutico , Quimioterapia Combinada , Femenino , Insuficiencia Cardíaca/fisiopatología , Hemodinámica/efectos de los fármacos , Humanos , MasculinoRESUMEN
We administered 150 mg of ibopamine orally to 10 patients suffering from idiopathic congestive cardiomyopathy. Hemodynamic function was evaluated by right heart catheterization and by measurement of cardiac output with the thermodilution technique. Ibopamine caused no significant change in heart rate or mean arterial pressure. Cardiac index, stroke volume index, and left ventricular work index all increased significantly by about 30%. Mean pulmonary arterial pressure decreased by about 30%, and systemic vascular resistance decreased by about 20%. The effects peaked at about 3 h and lasted 5-7 h. No side effects were noted. These findings with invasive techniques confirm those of others using noninvasive techniques, and suggest that ibopamine may be useful in the treatment of congestive heart failure.
Asunto(s)
Cardiomiopatías/fisiopatología , Cardiotónicos/farmacología , Desoxiepinefrina/análogos & derivados , Dopamina/análogos & derivados , Insuficiencia Cardíaca/fisiopatología , Hemodinámica/efectos de los fármacos , Adulto , Presión Sanguínea/efectos de los fármacos , Desoxiepinefrina/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The anti-anginal activity of nifedipine was studied after a dosage of 10 and 20 mg in nine patients suffering from a typical, stable effort angina pectoris. The effectiveness and the duration of action of nifedipine was evaluated by serial cycloergometer exercise testing repeated after the administration of the two dosage of nifedipine, for six hours. Nifedipine significantly increased exercise tolerance before angina pectoris, with an action lasting at least two hours after 10 mg and six hours after 20 mg. We also evaluated the changing of hemodynamic parameters (heart rate, blood pressure, double product) before and after the drug in the same day.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Nifedipino/uso terapéutico , Piridinas/uso terapéutico , Adulto , Prueba de Esfuerzo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The hemodynamic effects induced by the injection in the pulmonary artery of the new nonionic water soluble contrast medium Iopamidol were compared with those obtained by the injection of two other currently used contrast media (meglumine diatrizoate and sodium iothalamate). The experiments were carried out in nine mongrel dogs. Hemodynamic variables were continuously measured prior to, during, and for 8 minutes after injection of the contrast media. Injections of iopamidol produced significantly smaller decreases in aortic pressure (p less than 0.01), contractile indices (p less than 0.01), and peripheral resistances (p less than 0.01), and changes in heart rate and in cardiac output were less pronounced. At 3-4 minutes after injection, an increase in Vmaxd was observed with all three contrast media, but it was significantly lower after injecting Iopamidol. The role of hyperosmolality in causing cardiovascular changes is discussed. The less significant changes induced by Iopamidol appear to be the result of its lower osmolality, which is about a third that of meglumine diatrizoate or sodium iothalamate.
Asunto(s)
Hemodinámica/efectos de los fármacos , Ácido Yotalámico/análogos & derivados , Animales , Diatrizoato de Meglumina/farmacología , Perros , Yotalamato de Meglumina/farmacología , Ácido Yotalámico/farmacología , Contracción Miocárdica/efectos de los fármacos , Concentración OsmolarAsunto(s)
Medios de Contraste/toxicidad , Contracción Miocárdica/efectos de los fármacos , Animales , Cateterismo Cardíaco , Gasto Cardíaco/efectos de los fármacos , Diatrizoato de Meglumina/toxicidad , Perros , Técnica de Dilución de Colorante , Solución Hipertónica de Glucosa , Iodamida/toxicidad , Yodo/toxicidad , Meglumina/toxicidad , Concentración Osmolar , Resistencia Vascular/efectos de los fármacosAsunto(s)
Gasto Cardíaco/efectos de los fármacos , Glicósidos Digitálicos/farmacología , Volumen Sistólico/efectos de los fármacos , Enfermedad Coronaria/tratamiento farmacológico , Glicósidos Digitálicos/uso terapéutico , Humanos , Contracción Miocárdica/efectos de los fármacos , Estrofantinas/farmacologíaAsunto(s)
Medios de Contraste/farmacología , Glucosa/farmacología , Contracción Miocárdica/efectos de los fármacos , Animales , Diatrizoato de Meglumina/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Ácido Yotalámico/análogos & derivados , Ácido Yotalámico/farmacología , Concentración Osmolar , ConejosAsunto(s)
Volumen Cardíaco/efectos de los fármacos , Medios de Contraste/farmacología , Ventrículos Cardíacos/efectos de los fármacos , Contracción Miocárdica/efectos de los fármacos , Animales , Diatrizoato de Meglumina/farmacología , Perros , Combinación de Medicamentos , Yotalamato de Meglumina/farmacología , Ácido Yotalámico/análogos & derivados , Ácido Yotalámico/farmacologíaRESUMEN
In nine closed chest mongrel dogs 42 left ventricular cineangiographies for determination of left ventricular muscle mass were carried out. Buetterich's method was verified and a different procedure of calculation of myocardial wall thickens was proposed. By this method a better correlation line between calculated and weighed left muscle mass and a lower standard error of estimate is obtained.