RESUMO
BACKGROUND: This study aimed to describe the pulmonary hemodynamic changes during the course of pregnancy and to observe any significant effects on symptomatology and outcome of pregnancy due to these changes. METHODS: A total of 75 patients were recruited for the study, 60 pregnant women from first trimester to third trimester and 6 weeks of puerperium for the study group and 15 non-pregnant patients. All the subjects were interrogated about their complaints like excessive cough, exertional dyspnea, palpitations, orthopnea, syncope, exertional chest pain and lower extremity edema along with their duration. Baseline investigations, echocardiography (ECG) and Doppler echo were done. RESULTS: The commonest symptoms were palpitations (40%), exertional dyspnea (35%) and lower extremity edema (47%). Palpitations and dyspnea were also present in control group. Right axis deviation was the next most common abnormality in study group (12.3% patients). Pulmonary blood flow was decreased by more than 50% of predelivery value at the end of puerperium. Fall in pulmonary vascular resistance returned to base line values. Increased pulmonary artery pressure was seen during the pregnancy, which was not statistically significant. CONCLUSION: During pregnancy, though the pulmonary blood flow increases significantly, the pulmonary artery pressure remains unchanged due to substantial fall in pulmonary vascular resistance in early gestation.
RESUMO
INTRODUCTION: Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy preceding changes in systolic function, reinforcing the importance of early examination of ventricular function in individuals with diabetes mellitus (DM). This cross-sectional study was conducted to determine the incidence of asymptomatic LVDD in newly diagnosed normotensive cases of type 2 diabetes subjects, and its relation to glycosylated haemoglobin (HbA1C), age at the time of diagnosis, body mass index (BMI) and serum total cholesterol. AIM AND OBJECTIVE: To study the incidence of left ventricular diastolic dysfunction (LVDD) and its correlation with HbA1C in normotensive, newly diagnosed type 2 diabetic patients. MATERIALS AND METHODS: This cross-sectional study was done in western U.P. on 100 patients of newly diagnosed (within 1 month) type 2 DM between patients 30 and 60 years of age, visiting the Medicine and Endocrinology outpatient Department of LLRM Medical College, Meerut. Patients with established type 2 diabetes and already taking antidiabetic treatment, cardiac diseases like valvular heart disease, ischemic and hypertensive heart disease, congestive heart failure, cardiomyopathy, renal failure, chronic pulmonary disease, severe anaemia and haemoglobinopathies were excluded from the study. These patients were informed about the study and informed consent was obtained before proceeding with the investigations. Patients selected were evaluated with relevant investigations like fasting and post prandial blood sugar, HbA1C level, lipid profile and 2D echocardiography to assess LVDD. These selected patients were divided in 2 groups; one with left ventricular diastolic dysfunction (LVDD) and second group of subjects without LVDD. Various parameters like HbA1C, age, body mass index and serum cholesterol were evaluated between these 2 groups. Statistical analysis was performed using Student t-test, Chi-square and Fisher Exact-test. RESULTS: Out of 100 patients 65 were males and 35 females. Mean age of the population was 50.08 ± 6.32 years. Overall incidence of LVDD was 41%. Grade 1 LVDD was most common. Mean HbA1C level of LVDD group was found higher as compared to those without LVDD. CONCLUSION: LVDD is very common at the time of diagnosis of type 2 DM even in normotensive patients independent of confounding effect of hypertension, ischemia and BMI. HbA1C and age, were found to be strong indicators of LVDD in newly diagnosed cases of Type 2 DM.
