Accuracy of handheld echocardiography for bedside diagnostic evaluation in a tertiary cardiology center: comparison with standard echocardiography.

AIMS: We aimed to assess the clinical role of a basic handheld echocardiographic device (HHE) used during cardiology training in evaluating different functional and morphological elements of the heart. METHODS AND RESULTS: 56 consecutive patients (pts), 26 women, mean age 60.0 ± 11.9 years admitted in our Cardiology Department had an echocardiogram performed by both cardiology trainees using a HHE with B-mode capabilities only and by cardiologists with advanced training in echocardiography using a standard echocardiography device (SE). Several parameters were analyzed: the presence of wall motion abnormalities (WMA), aortic valve abnormalities (AVAbn), mitral valve abnormalities (MVAbn), the presence of pericardial effusion (PE), as well as the presence of a dilated (LVD) or hypertrophied left ventricle (LVH). The Kappa coefficient of correlation between the two methods (k) was determined, along with the sensitivity (Sn), specificity (Sp), negative predictive value (NPV), and positive predictive value (PPV). Both HHE and SED examinations were possible in 52 of the 56 pts (92.8% feasibility). There was a moderate correlation in the assessment of WMA (k = 0.56) with a substantial agreement for MVAbn (k = 0.72), AVAbn (k = 0.76), LVH (k = 0.67) There was excellent agreement for LVD (k = 0.81). Valvular diseases were determined by HHE with good Sp (MVAbn - 97.4%, AVAbn - 100%), although the Sn and NPV were lower. CONCLUSIONS: Bedside evaluation using HHE is helpful for assessing LV chamber and walls dimensions, LV regional function, and morphological abnormalities of the valves. The device can be used by cardiology trainees with limited experience in echocardiography but only in combination with a standard examination.

The electrocardiographic profile of patients with angina pectoris.

Angina pectoris is a common disabling disorder and a clinical syndrome, caused by myocardial ischemia; an imbalance between myocardial oxygen supply and myocardial oxygen consumption. Thus, ischemia produces a typical series of events such as metabolic and biochemical alterations which lead to impaired ventricular relaxation and diastolic dysfunction, impaired systolic function, and electrocardiographic abnormalities and painful symptoms of angina. Transmembrane ionic currents are responsible for the cardiac potentials that are recorded as the electrocardiogram (ECG). The electrocardiographic profile of patients with angina pectoris is variate. The electrocardiogram provides critical information for both diagnosis and prognosis, particularly when a tracing is obtained during the episodes of pain. A completely normal electrocardiogram does not exclude the possibility of acute coronary syndrome. Serial ECG tracings improve the clinician's ability to diagnose acute and chronic coronary syndromes. The ECG may assist in clarifying the differential diagnosis if taken in the presence of pain. The resting ECG also has an important role in risk stratification. Exercise ECG is more sensitive and specific than the resting ECG as far as myocardial ischemia detection is concerned, and it represents the test of choice which helps identifying inducible ischemia in the majority of patients suspected of stable angina.

Echocardiography in congenital mitral valve regurgitation--the liaison between cardiologist and surgeon.

Congenital heart diseases are broadly defined as those cardiac anomalies that are present at birth. By their very nature, such defects have their origin in embryonic development. Congenital mitral valve regurgitation is a rare disease occurring in infancy or childhood. In up to 60% of cases, congenital anomalies of the mitral valve occur in association with other cardiac lesions, and often more than one component of the mitral apparatus is involved. The true incidence of congenital mitral valve regurgitation (MVR) is difficult to determine accurately (0.21-0.42% from total mitral valve regurgitations); isolated congenital mitral regurgitation is uncommon. The Carpentier classification of congenital mitral valve disease is the most commonly used nomenclature based on a functional analysis of the mitral valve leaflet. The contemporary anatomic classification has the advantage of minimizing observer variability in the diagnosis and it offers a much better liaison between the cardiologist and surgeon.

Doppler flow patterns in the evaluation of pulmonary hypertension.

Pulmonary arterial hypertension is defined as a group of diseases characterised by a progressive increase in pulmonary vascular load, leading to marked increase in pulmonary artery pressure, right ventricular failure and premature death. Given the nonspecific nature of its early symptoms and signs, pulmonary arterial hypertension (PAH) is often diagnosed in its advanced stages. Although clinical assessment is essential when initially evaluating patients with suspected PAH, echocardiography is a key screening tool in the diagnostic algorithm, because, in comparison with invasive measurements, it has the advantages of being safe, portable, and repeatable. Therefore, Doppler echo is the modality most frequently used in pulmonary hypertension patients. Several echocardiographic techniques centered on the Doppler principle (both conventional Doppler parameters and tissue Doppler imaging) used in the assessment of PAH magnitude and its cardiac effects are presented in this paper. They provide important data on the severity, possible causes and consequences of pulmonary hypertension, both initially and during follow-up, therefore having the ability to estimate disease progression, prognosis, or to monitor therapeutic response. Doppler echocardiography allows to noninvasively estimate systolic pulmonary arterial pressure (SPAP), mean and end-diastolic pulmonary arterial pressure, as well as the quantification of right ventricular (RV) function and the evaluation of pulmonary vascular resistance (PVR).

["Needle-to-scalpel"--the benefit of urgent CABG in significant left main coronary artery stenosis]. / "Timpul de la ac la bisturiu": beneficiul interventiei chirurgicale prompte in stenoza de trunchi de coronara stâng.

UNLABELLED: Left main coronary artery (LMCA) stenosis is a relatively infrequent but important cause of symptomatic coronary artery disease. The diagnosis of left main coronary artery disease is made by coronary angiography. Coronary artery bypass grafting is the first-line therapy, the standard treatment for LMCA stenosis, which improves the likelihood of survival, while percutaneous coronary intervention (PCI) is emerging as a possible alternative to surgery. We present the case of a patient with history and symptoms of stable angina pectoris, especially associated with exercise, variable threshold, since four years, and who describes a worsening of symptoms in the last month; the angina had become more frequent, more prolonged and occurred at a lower threshold. At about 20 hours from getting admitted to our hospital, the patient had severe and prolonged rest angina, associated with important changes on ECG, which led to the indication of emergency coronary angiography. This investigation showed severe left main coronary artery stenosis and significant lesions in other important vessels (three-vessel disease), in a patient with normal left ventricular function. The recurrence and the intensity of prolonged angina of our patient have necessitated urgent myocardial revascularization surgery with quadruple coronary-artery bypass grafting. After surgery, the patient was asymptomatic and he was discharged 8 days after in a good clinical state. CONCLUSIONS: The advantage of coronary artery bypass grafting performed as urgent surgery for the treatment of our patient with left main coronary artery stenosis and concomitant acute coronary syndrome, shortly after coronary angiography, was obvious, significantly improved the clinical outcome, without postoperative ischemic complications.