RESUMEN
INTRODUCTION: Only a little is known about the frequency of use of supraglottic airway devices (SADs) and intraosseous (IO) access in patients who have had out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We analyzed data from all patients who had had OHCA admitted to our hospital between 1 January 2008 and 31 December 2017. RESULTS: A total of 135 (33.8%) patients who had had OHCA were admitted with a SAD, 223 (55.8%) with an endotracheal tube, 3 (0.8%) with mask ventilation, and 32 (8.0%) breathed spontaneously on admission to hospital. Three hundred and twenty-eight patients (82.0%) were admitted with a peripheral intravenous line, one (0.3%) with a central venous catheter, one (0.3%) with a port catheter, and 32 (8.0%) with IO access. CONCLUSIONS: Irrespective of an increasing number of studies that raise the question whether the airway management of patients who have had OHCA using an SGA might be inferior to that with endotracheal tubes, approximately one third of all patients who have had OHCA were admitted with an SAD in this study. On the other hand, IO access is significantly less frequently used, despite fewer critical study results overall.
Asunto(s)
Manejo de la Vía Aérea/métodos , Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/instrumentación , Reanimación Cardiopulmonar/métodos , Servicios Médicos de Urgencia/métodos , Femenino , Humanos , Intubación Intratraqueal/métodos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/terapia , Evaluación de Resultado en la Atención de Salud , Adulto JovenRESUMEN
BACKGROUND: Survival rate after out-of-hospital cardiac arrest (OHCA) is increasing. However, there is a lack of data concerning long-term quality of life of affected patients. OBJECTIVES: This study aims to investigate the psychological effects of out-of-hospital cardiopulmonary resuscitation. METHODS: All patients who were admitted to our hospital after OHCA between 01 January 2008 and 30 June 2015 and could be discharged in good neurological condition were asked to fill out the Impact of Event Scale-Revised (IES-R) and 36-Item Short Form Health Survey (SF-36). For statistical analysis, the mean, standard deviation and student's ttest were used (level of significance p < 0.05). RESULTS: Of 280 OHCA survivors, 56 patients (20.0%) were discharged from the hospital in good neurological condition. Of those, 20 patients (35.7%) were willing to participate in this study, among them 11 women and 9 men. Compared to the cohort of the German normative data, the results of the SF-36 questionnaire of OHCA survivors showed significantly lower values in all SF-36 subscales and also for the summary scores. There was no significant difference compared to patients with myocardial infarction. Average values of the IES-R subscales for intrusion and avoidance were 9.9 ± 9.3 and 9.7 ± 7.7, respectively, and 11.3 ± 7.4 for hyperarousal. Calculations indicated the suspected diagnosis of posttraumatic stress disorder in 2 of the 20 patients (10%). DISCUSSION: Even in patients who could be discharged from the hospital after OHCA in good neurological condition, the quality of life is significantly lower compared to the standard population but not compared to patients with myocardial infarction. The data also suggest that a relevant number of patients after OHCA is affected by posttraumatic stress disorder. Further research efforts on optimization of post-resuscitation care should not only focus on survival rates but also on improving quality of life.
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Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Trastornos por Estrés Postraumático , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/psicología , Calidad de Vida , Sobrevivientes , Resultado del TratamientoRESUMEN
The 12-lead surface electrocardiogram (ECG) is of great importance for the diagnostics of cardiac arrhythmias. For the correct and systematic analysis it has a sensitivity and specificity for the correct diagnosis of supraventricular tachycardia or ventricular tachycardia of more than 95%. Nevertheless, the assessment of cardiac rhythm disorders is difficult for many physicians. In this way errors can occur, frequently due to a non-systematic analysis of the ECG; therefore, the aim of this article is to present the techniques and the necessary knowledge for assessment of the most frequent bradycardiac and tachycardiac heart rhythm disorders. Additionally, special features in the analysis of the ECG results in children are discussed.
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Bradicardia/diagnóstico , Electrocardiografía , Taquicardia/diagnóstico , Síndrome Coronario Agudo/diagnóstico , Adolescente , Adulto , Bradicardia/etiología , Niño , Preescolar , Muerte Súbita Cardíaca/etiología , Humanos , Lactante , Síndromes de Preexcitación/diagnóstico , Síndromes de Preexcitación/etiología , Factores de Riesgo , Sensibilidad y Especificidad , Taquicardia/etiología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Adulto JovenRESUMEN
BACKGROUND: In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise. MATERIALS AND METHODS: Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed. DISCUSSION AND CONCLUSION: It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.
Asunto(s)
Cuidados Críticos/ética , Desfibriladores Implantables/ética , Remoción de Dispositivos/ética , Ética Médica , Eutanasia/ética , Cuidado Terminal/ética , Insuficiencia Cardíaca/terapia , Humanos , Cuidados Paliativos/ética , Defensa del Paciente/ética , Órdenes de Resucitación/ética , Suicidio Asistido/éticaRESUMEN
INTRODUCTION: Emergency physicians are responsible for the out-of-hospital treatment of victims from out-of-hospital cardiac arrest (OHCA), not only with regard on the medical treatment, but also in terms of the choice of the most suitable hospital. We therefore wanted to determine whether nonmedical processes such as hospital alliances lead to changing rates of hospital admissions of patients following OHCA. MATERIALS AND METHODS: All patients who were admitted in our hospital following OHCA between 1 January 2008 and 30 June 2015 were identified and their data were anonymously stored in a central database. Afterward, we divided the study period into three periods: (1) the period prior to the publication of the ERC guidelines 2010, (2) the period after the publication of the ERC guidelines 2010, and (3) the period after a contract for hospital alliances with another hospital in town was signed. RESULTS: Of the 280 OHCA victims, we could analyze the emergency physician's reports of 238 victims from nontraumatic OHCA; there were 143 men (60.1 %) and 95 women (39.9 %) with an age of 69.1 ± 13.7 years. Following the changes in the guidelines in 2010, we observed a 42.8 % increase of hospital admissions from 2.15 admissions per month to 3.07 in period 2 following OHCA compared to period 1. After signing of the hospital alliance, there was an additional increase of 42.3 % to an average of 4.37 hospital admissions per month. DISCUSSION AND CONCLUSION: According to our data, it might be possible that not only medical influences (e.g., changes in the guidelines) but also nonmedical aspects (e.g., hospital alliances) might influence the choice of hospital for the further treatment of victims from OHCA.
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Actitud del Personal de Salud , Conducta de Elección , Servicios Médicos de Urgencia , Servicios Hospitalarios Compartidos , Paro Cardíaco Extrahospitalario/terapia , Admisión del Paciente , Rol del Médico , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Adhesión a Directriz , Instituciones Asociadas de Salud , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The surface electrocardiogram (ECG) is an important diagnostic tool for the diagnosis of arrhythmias and acute coronary syndrome. Arrhythmias are divided into bradycardias (heart rate < 50/min) and tachycardias (heart rate > 100/min). Among tachycardias, differentiation between small QRS complexes (QRS width < 0.12 s) and broad QRS compexes (≥ 0.12 s) during tachycardia is necessary. It is important to analyze the relationship between P wave and QRS complex, to look for an electric alternans as a leading finding for an accessory pathway. Wide QRS complex tachycardias (QRS width ≥ 0.12 s) occur in supraventricular tachycardias (SVT) with aberrant conduction, SVT with bundle branch block or ventricular tachycardia (VT). In broad complex tachycardias, atrioventricular (AV) dissociation, negative or positive concordant pattern in V1-V6, a notch in V1, and qR complexes in V6 in tachycardias with left bundle branch block morphologies are findings indicating VT. In addition, an R/S relationship < 1 in V6 favors VT when right bundle branch block tachycardia morphologies are present. By correctly analyzing the surface ECG with a systematic approach, the specificity and sensitivity of correctly identifying a SVT or VT can be increased to greater than 95 %. The12-lead surface ECG is an important diagnostic tool for intensive care medicine. However, good ECG knowledge and systematic analysis are necessary to make the right diagnosis.
Asunto(s)
Cuidados Críticos , Electrocardiografía , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/diagnóstico , Bloqueo de Rama , Diagnóstico Diferencial , HumanosRESUMEN
INTRODUCTION: Despite an increasing attention to living wills, the effects of such living wills on patient care in the emergency departments remains unknown. MATERIAL AND METHODS: All patients who were admitted to our emergency department between September 24th, 2014 and November 23th, 2014 were asked, whether they have signed living wills previously and if so, whether they have it on hand at admission. RESULTS: 496 patients (229 men (46.2â %), 267 women (53.8â %)) with a mean age of 64.9â ±â 18.8 years were included in this survey. 138 patients (27.8â %) had a living will but only 16 patients (3.2â %) had it on hand.Altogether, the existence of living wills increased with an increasing patient`s age; only 5 of 117 patients aged 50 years old or younger (4,3â %) had a living will, but 133 of 379 patients older than 50 years (35,1â %). DISCUSSION AND CONCLUSION: Despite an obviously broad acceptance of living wills especially in the elderly population, there are hardly any consequences on the daily patient care in an emergency department by now, as hardly any patient has hers or his living will on hand at admission. We therefore see the need for further educational work to guarantee that living wills get adequate priority in patient care at emergency departments.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Voluntad en Vida/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Comunicación Interdisciplinaria , Masculino , Persona de Mediana Edad , Atención al Paciente , Encuestas y CuestionariosRESUMEN
Johann Sebastian Bach was born on 1685 in Eisenach. By the time he turned 10, Bach found himself an orphan after the death of both of his parents. After working in Weimar, Arnstadt, Mühlhausen, and Köthen Bach signed a contract to become the new organist and teacher at St. Thomas Church Leipzig in 1723 and stayed there until his death. In 1749, Bach tried to fix his failing sight by having surgery the following year, but the operation ended up leaving him completely blind. Few months later, Bach suffered a stroke. He died in Leipzig on July 28, 1750. In recent years, there were some questions whether music of different styles can directly alter cardiovascular parameters, particularly by using Bach's music. In some studies it has been shown that cardiovascular parameters (blood pressure, heart rate) are influenced by music. Listening to classic music (Bach) leads to positive erffects, also music by Italian composters. In contrast, "modern" music, vocal music or songs had no positive effects on cardiovascular parameters. In addition, positive effects on cardiovascular parameters and behavioural patters have been shown in an animal study recently, by Bach's music. Recent studies showed clearly that music influences cardiovascular parameters. It is obvious that classical music (Bach) has benefitial effects, both in humans and in animals. Therefore, the music of the "Thomaskantor" will improve both, quality of life and cardiovascular health.
Asunto(s)
Cardiología/historia , Personajes , Musicoterapia/historia , Música/historia , Animales , Alemania , Historia del Siglo XVII , Historia del Siglo XVIII , HumanosRESUMEN
INTRODUCTION: It still remains unknown why there are so poor rates of lay-resuscitation in Germany. We wanted to find out who observes the out-of-hospital cardiac arrests (OHCA) in Germany. PATIENTS AND METHODS: All patients who were admitted in our hospital between January, 1st 2008 and December, 31st 2013 following non-traumatic OHCA were identified and the patients' data were stored on a central data base. RESULTS: Data on 204 patients (124 male [60,8â%], 80 female [39,2â%], aged 69,1â±â14,2 years [range 18-97 years]) were analysed. Altogether, 137 OHCA were witnessed (67,2â%): 83 cases (40,7â%) by laypersons and 54 further cases (26,5â%) by medical professionals. Among laypersons, most OHCA were witnessed by the partner (17,2â%) and further relatives (11,8â%) but resuscitation rates among partner (3,9â%) and relatives (5,9â%) were poor. Altogether, immediate resuscitation attempts were started in 93 patients, hereunder in 35 cases (17,2â%) by layperson and 58 cases (28,4â%) by medical professionals. CONCLUSION: Rates of lay-resuscitation remain poor despite high rates of witnessed events: unfortunately, especially partner and relatives act too rarely. However, the motivation to approve their knowledge in first-aid and resuscitation might rise among lays if they are informed that it is more likely to observe a partner's or relative´s OHCA than a stranger's.
Asunto(s)
Reanimación Cardiopulmonar/estadística & datos numéricos , Cuidadores/estadística & datos numéricos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Socorristas , Femenino , Alemania , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/epidemiología , Revisión de Utilización de Recursos/estadística & datos numéricos , Adulto JovenAsunto(s)
Estenosis de la Válvula Aórtica/etiología , Aortitis/diagnóstico , Aortitis/etiología , Endocarditis/complicaciones , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/etiología , Choque Cardiogénico/etiología , Estenosis de la Válvula Aórtica/diagnóstico , Diagnóstico Diferencial , Endocarditis/diagnóstico , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico , Choque Cardiogénico/diagnósticoRESUMEN
HISTORY AND ADMISSION FINDINGS: A 70-year-old woman was admitted to hospital with progressive chest pain. Coronary angiography demonstrated a significant stenosis of the left descending artery (LAD), which was treated by percutaneous coronary intervention (PCI) and stent implantation. During this intervention, a coronary perforation occurred which was remedied immediately. Five days after the intervention, the patient complained about severe atypical chest and abdominal pain with nausea and vomitting, but no fever. Physical examination revealed an acute abdomen of uncertain origin. INVESTIGATIONS: Laboratory tests revealed leukocytosis and elevated levels of C-reactive protein while cardiac enzymes were in normal range. The electrocardiogram showed no signs of acute myocardial ischemia. Abdominal x-ray was performed without any pathological findings. Further diagnostic tests, especially computed tomography of the abdomen, revealed an ingestion of a blister-wrapped tablet which had caused small bowel perforation and peritonitis. DIAGNOSIS, TREATMENT AND COURSE: An acute abdomen due to ingestion of a foreign body was diagnosed and an emergency laparotomy was performed immediately. The blister pack was removed by ileostomy. The further course was uneventful. CONCLUSION: The clinical presentation of abdominal pain is a frequent medical condition in hospital. Determining the cause requires precise assessment and examination and implicates a variety of differential diagnosis including non-cardiac and cardiac pain. Iatrogenic causes must be considered in differential diagnosis.
Asunto(s)
Abdomen Agudo/etiología , Antagonistas Adrenérgicos beta , Angioplastia Coronaria con Balón , Estenosis Coronaria/terapia , Vasos Coronarios/lesiones , Embalaje de Medicamentos , Migración de Cuerpo Extraño/etiología , Íleon/lesiones , Perforación Intestinal/etiología , Metoprolol/análogos & derivados , Peritonitis/etiología , Stents , Comprimidos , Abdomen Agudo/diagnóstico por imagen , Abdomen Agudo/cirugía , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Anciano , Cateterismo Cardíaco , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Enfermedad Iatrogénica , Ileostomía , Íleon/diagnóstico por imagen , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Tomografía Computarizada Multidetector , Peritonitis/diagnóstico por imagen , Peritonitis/cirugíaRESUMEN
BACKGROUND AND AIM: Although most laypersons have incomplete knowledge of first aid, the placement of automated external defibrillators (AED) on public places suggests AED application by laypersons. Unfortunately, previous results are disappointing; many people don't even recognize AED. Therefore, most authors suggest to force medical education about sudden cardiac death and AED use among laypersons. We wanted to find out whether intensive medical education can improve the recognition of AED at public places and the attendance to acquire knowledge in first aid. METHODS: In 2001 eight AED were placed in the amusement swimming park "LAGO - die Therme". Contemporaneously, we started public education regarding sudden cardiac death, resuscitation and AED among layperson visiting the LAGO. After 10 years we interviewed the visitors with special regard to their knowledge of first aid and AED use. RESULTS: 531 persons (260 men, age 48,4 ± 21,9 [range 8-95] years) fulfilled the questionnaire. 59 (11,1%) stated heart disorder, 219 (41,2%) at least one cardiovascular risk factor. As ten years ago, knowledge of first-aid (59,1%) and AED use (45,2%) was poor, especially among persons younger than 17 years or older than 67 years. 398 (75%) of the interviewed visitors recognized the installed AED, 511 (96,2%) supported the placement of AED. CONCLUSION: The placement of AED on public places in combination with an intensive medical education results in a high acceptance and recognition of AED. Nevertheless, following our date it seems to be doubtful that this results automatically in a higher attendance to acquire knowledge in first-aid and AED use.
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Reanimación Cardiopulmonar/educación , Muerte Súbita Cardíaca/prevención & control , Desfibriladores , Educación Médica , Primeros Auxilios , Consentimiento Informado/legislación & jurisprudencia , Educación del Paciente como Asunto/legislación & jurisprudencia , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Balneología , Niño , Estudios Transversales , Muerte Súbita Cardíaca/etiología , Femenino , Alemania , Colonias de Salud , Encuestas Epidemiológicas , Cardiopatías/complicaciones , Cardiopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Sudden cardiac death (SCD) is one of the major problems in the western world with approximately 70.000-100.000 SCD patients (pts) in Germany and 450.000 SCD victims in the US. SCD is not caused by a single factor but is a multifactorial problem. SCD is caused by ventricular tachyarrhythmias in approximately 90% of pts, whereas SCD is caused by bradyarrhythmias in 5-10%. In 50% of SCD victims, sudden cardiac death is the first manifestation of a heart disease. There is general agreement that early defibrillation with automated external defibrillators (AED) is an effective tool to treat pts with ventricular fibrillation. Nevertheless, further stragies on cardiopulmonary resuscitation and AED therapy are necessary to improve survival of patients with cardiac arrest.
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Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/prevención & control , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/prevención & control , Desfibriladores/estadística & datos numéricos , Causalidad , Comorbilidad , Alemania/epidemiología , Humanos , Prevalencia , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Arritmias Cardíacas/terapia , Unidades de Cuidados Intensivos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Conducta Cooperativa , Electrocardiografía , Paro Cardíaco/prevención & control , Humanos , Comunicación Interdisciplinaria , Pronóstico , Procesamiento de Señales Asistido por Computador , Taquicardia/diagnóstico , Taquicardia/etiología , Taquicardia/terapiaRESUMEN
Clinical characteristics and the surface electrocardiogram (ECG) are important diagnostic tools for patients with tachycardias. Tachycardias are characterized by a ventricular heart rate > 100/min and have been divided into those with narrow (QRS width < 0.12 s) or wide QRS complex tachycardias (QRS width ≥ 0.12 s). In broad complex tachycardias, AV dissociation, negative or positive concordant pattern in V(1)-V(6), a notch in V(1) and qR complexes in V(6) in tachycardias with left bundle-branch block morphologies are findings indicating ventricular tachycardia (VT). In addition, an R/S relation <1 in V(6) favors VT when right bundle-branch block tachycardia morphologies are present. By analyzing the surface ECG in the right way with a systematic approach, the specificity and sensitivity of correctly identifying supraventricular tachycardia or VT can be > 95%. Therapeutic options in supraventricular or ventricular tachyarrhythmias are preferentially adenosine, ajmaline, amiodarone, and adrenaline. If antiarrhythmic drugs fail, electric cardioversion using short-acting anesthesia is recommended.
Asunto(s)
Servicio de Urgencia en Hospital , Taquicardia/terapia , Antiarrítmicos/uso terapéutico , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/etiología , Bloqueo de Rama/terapia , Diagnóstico Diferencial , Cardioversión Eléctrica , Electrocardiografía , Bloqueo Cardíaco/diagnóstico , Bloqueo Cardíaco/etiología , Bloqueo Cardíaco/terapia , Humanos , Pronóstico , Procesamiento de Señales Asistido por Computador , Taquicardia/diagnóstico , Taquicardia/etiología , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiología , Taquicardia Supraventricular/terapiaRESUMEN
We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.
Asunto(s)
Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/cirugía , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/cirugía , Aneurisma Cardíaco/complicaciones , Humanos , Deportes , Resultado del Tratamiento , Disfunción Ventricular Izquierda/etiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Echocardiographic Tissue Doppler Imaging (TDI) has been proposed for the differentiation of pathological left ventricular hypertrophy (e. g. hypertrophic cardiomyopathy, HCM) and physiologic left ventricular hypertrophy (athlete's heart). The aim of this study was the TDI analysis of the systolic (S') and early diastolic (E') velocities in patients (pts.) with non-obstructive hypertrophic cardiomyopathy (HCM) and in top-level athletes in consideration of the previously published cut-off values (S' < 9 cm/s, E' < 9 cm/s). PATIENTS AND METHODS: Pulsed-wave TDI of the systolic and early-diastolic velocities was performed at the lateral and septal mitral annulus in the four-chamber view in 17 HCM pts (12 men; mean age 44 ± 16 years) and 80 consecutive athletes (80 men; mean age 26 ± 5 years). RESULTS: Pts with HCM showed significantly decreased systolic velocities of the septal (S' septal: 5.1 ± 1.2 cm/s versus 9.5 ± 1.5 cm/s, p < 0.001) and lateral mitral annulus (S' lateral: 6.4 ± 2.0 cm/s vs. 10.5 ± 2.1 cm/s, p < 0.001). The early diastolic velocity of the mitral annulus E' was significantly decreased in HCM, too (E' septal: 5.9 ± 2.2 cm/s vs. 13.1 ± 2.9 cm/s, p < 0.001; E' lateral: 8.2 ± 3.0 cm/s vs. 16.5 ± 3.4 cm/s, p < 0.001). CONCLUSION: Tissue Doppler Imaging of the systolic and early diastolic velocity of the mitral annulus might be helpful as a promising additional method for the echocardiographic differentiation between pathological and physiologic left ventricular hypertrophy.
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Velocidad del Flujo Sanguíneo/fisiología , Cardiomegalia Inducida por el Ejercicio/fisiología , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Ecocardiografía Doppler/métodos , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Deportes/fisiología , Adulto , Diagnóstico Diferencial , Diástole/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Sístole/fisiología , Adulto JovenRESUMEN
Two-dimensional strain (2DS) is a novel method to measure strain from standard two-dimensional echocardiographic images by speckle tracking, which is less angle dependent and more reproducible than conventional Doppler-derived strain. The objective of our study was to characterize global and regional function abnormalities using 2DS and strain rate analysis in patients (pts) with pathological left ventricular hypertrophy (LVH) caused by non-obstructive hypertrophic cardiomyopathy (HCM), in top level athletes, and in healthy controls. The hypothetical question was, if 2DS might be useful as additional tool in differentiating between pathologic and physiologic hypertrophy in top-level athletes. We consecutively studied 53 subjects, 15 pts with hypertrophic cardiomyopathy (HCM), 20 competitive top-level athletes, and a control group of 18 sedentary normal subjects by standard echocardiography according to ASE guidelines. Global longitudinal strain (GLS) and regional peak systolic strain (PSS) was assessed by 2DS in the apical four-chamber-view using a dedicated software. All components of strain were significantly reduced in pts with HCM (GLS: -8.1 ± 3.8%; P < 0.001) when compared with athletes (-15.2 ± 3.6%) and control subjects (-16.0 ± 2.8%). In general, there was no significant difference between the strain values of the athletes and the control group, but in some of the segments, the strain values of the control group were significantly higher than those in the athletes. A cut-off value of GLS less than -10% for the diagnosis of pathologic hypertrophy (HCM) resulted in a sensitivity of 80.0% and a specificity of 95.0%. The combination of TDI (averaged S', E') and 2DS (GLS) cut-off values for the detection of pathologic LVH in HCM demonstrated a sensitivity of 100%, and a specificity of 95%. Two-dimensional strain is a new simple and rapid method to measure GLS and PSS as components of systolic strain. This technique could offer a unique approach to quantify global as well as regional systolic dysfunction, and might be used as new additional tool for the differentiation between physiologic and pathologic LVH.
Asunto(s)
Atletas , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Ecocardiografía Doppler , Ejercicio Físico , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Contracción Miocárdica , Función Ventricular Izquierda , Adaptación Fisiológica , Adulto , Análisis de Varianza , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Programas Informáticos , Adulto JovenRESUMEN
A 72-year-old woman was admitted to our hospital with exertional dyspnea and atrial tachycardia due to atypical atrial flutter. Comprehensive three-dimensional transesophageal echocardiography (3D-TEE) with offline reconstruction of the dataset (Siemens Foursight TEE, Erlangen, Germany) allowed visualization of the origin of the tumor and gave important additional information about the tumor: the tumor surface was floppy, it had the appearance of a "sea anemone", and it was attached to the endocardium of the head of the papillary muscle by a short stalk. The tumor was assessed to be 1.9 × 1.4 × 0.9 cm, and a prolapsing of the tumor into the left ventricular outflow tract during systole was demonstrated.A tumor size of 8 × 10 mm and an infiltration of the head of the anterior papillary muscle were found during surgery. The histopathological findings were typical for a papillary fibroelastoma (PFE) with involvement of the head of the papillary muscle.Our case indicates that a PFE might be difficult to distinguish from myxoma by echocardiography. Thus, the multimodal imaging approach and the three-dimensional visualization of the surface, the localization, and the attachment of the tumor to the head of a papillary muscle were very helpful for the identification of a fibroelastoma in this particular case.
Asunto(s)
Fibroma/complicaciones , Fibroma/diagnóstico por imagen , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Músculos Papilares/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiología , Anciano , Diagnóstico Diferencial , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Femenino , Humanos , Mixoma/diagnóstico por imagen , ProlapsoRESUMEN
Background/Objectives. Rapid risk stratification of the patient with acute chest pain is essential to select the best management. We investigated the value of the ECG at first medical contact to determine size of the ischaemic myocardial area and thereby severity of risk.Methods. In 386 patients with acute chest pain, ECG findings were correlated with the coronary angiogram. Using ST-segment deviation patterns the location of the coronary culprit lesion was predicted and thereby size of the area at risk. Four groups of patients were present. Those with a narrow QRS and a total 12-lead ST-segment deviation score of >/=5 mm (group 1) or =4 mm (group 2); a QRS width of >/=120 ms (group 3), and patients with previous coronary bypass grafting (CABG) or percutaneous coronary intervention (PCI) (group 4).Results. Correct coronary culprit lesion localisation was possible in 84% of the 185 patients in group 1, 40% of the total cohort. Accurate prediction was not possible in most patients in groups 2, 3 and 4, in spite of extensive coronary artery disease in group 3 and 4. Conclusions. Using the 12-lead ECG the size of the myocardial area at risk can be accurately predicted when the total ST-segment deviation score is >/=5 mm, allowing identification of those in need of a PCI. In most patients with bundle branch block, previous CABG or PCI, the ECG can not localise the culprit lesion. This approach simplifies and accelerates decision-making at first medical contact. (Neth Heart J 2010;18:301-6.).