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Abstract: Background: Echocardiogram is an important diagnostic tool to evaluate cardiac disease and very usefull in diagnosis and management. It is important to know the spectrum of cardiac abnormalities detected by transthoracic echocardiography, the frequency of findings that may vary depending on the prevalence of the disease and type of studied population. Objective: To know the spectrum of findings identified in resting transthoracic echocardiography in 1,468 patients. Material and methods: A 3 years retrospective review of resting transthoracic echocardiograms in 1,468 patients. Results: The age range of the 1,468 patients was from 1 day to 94 years with mean (SD) age 51 ± 7.2 years; females 52.9% (n = 776) and males 47.1% (n = 692). One hundred thirty three patients (9.05%) had normal echocardiograms; 1,335 patients had an average of 1.8 findings/patient; 2,464 findings were classified in ten different categories: heart valves abnormalities was the most frequent alteration detected in 36.47% (n = 487); diastolic dysfunction 30.71% (n = 410); and cardiac chambers dilation 27.79% (n = 371). Conclusions: Clinical history and physical examination can not be substituted by an imaging test, but with the clinical data obtained, in conjunction with an echocardiographic study, gives us clues to the diagnosis and pathophysiology of heart disease essential for the properly evaluation and management.
Resumen: Antecedentes: La ecocardiografía es una herramienta indispensable para evaluar y manejar a las enfermedades cardiacas. Es importante conocer el espectro de anormalidades cardiacas detectadas por ecocardiografía transtorácica en reposo y la frecuencia de esos hallazgos, los cuales varían de acuerdo a cada enfermedad cardiaca. Objetivo: Reportar el espectro de hallazgos ecocardiográficos en 1,468 pacientes. Material y métodos: Los estudios ecocardiográficos transtorácicos en reposo realizados durante un período de 3 años. Resultados: Un total de 1,468 pacientes con edades comprendidas entre el primer día de vida y 94 años con edad promedio y desviación estándar de 51 ± 7.2 años; correspondiendo 52.9% (n = 776) al género femenino y 47.1% al masculino (n = 692). De los estudios, 9.05% (n = 133) fueron normales; 1,335 pacientes presentaron un promedio de1.8 hallazgos/paciente; se detectaron 2,464 hallazgos catalogándose en 10 capítulos. Los tres hallazgos más frecuentes fueron: valvulares 36.47% (n = 487); disfunción diastólica 30.71% (n = 410); y dilatación de cámaras cardiacas 27.79% (n = 371). Conclusiones: Una imagen no puede sustituir a la historia clínica y a la exploración física, siendo la ecocardiografía una prolongación de esta última, permitiendo valorar la estructura y fisiología cardiaca así como sus alteraciones, por lo que actualmente es esencial su realización en la valoración cardiaca.
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Background: Mean pulmonary arterial pressure (PAP) estimation is possible by echocardiography through the pulmonary acceleration time measurement using mathematical equations; also, using the systolic pulmonary arterial pressure calculated from de tricuspid gradient assessed by continuous Doppler is a good method, having a 0.7 correlation with the catheter hemodynamic studies. Objective: To compare three different equations and define its usefulness on mean pulmonary arterial pressure estimation. Material and methods: From 4,000 echocardiograms performed, a sample of 187 studies were obtained; we used three different equations to calculate mean PAP, a cutoff of ≥ 25 mmHg was used as high PAP. Results: 187 patients aged 54.5 ± 22.6 years; corresponding to 87 men (46.5%) and 100 women (53.5%). Equation 1, with 50 cases (26.7%) with PAH were detected; 69 cases (36.8%) with equation 2; and only 23 patients (12.3%) with equation 3. Conclusions: Equations 1 and 2 are useful as screening, while equation 3 has higher degree of discrimination.
Introducción: La estimación de la presión arterial media pulmonar es posible por ecocardiografía a través de la medición del tiempo de aceleración pulmonar utilizando ecuaciones matemáticas; así mismo, a partir del cálculo de la presión arterial sistólica utilizando el gradiente tricuspídeo medido por Doppler continuo, ya que presenta una correlación media de 0.7 al compararla con el estudio hemodinámico con catéter. Objetivo: comparar la aplicación de 3 diferentes ecuaciones para estimar la presión arterial pulmonar media. Material y métodos: En una muestra de 187 estudios ecocardiográficos de un total de 4,000 efectuados, se realizaron los cálculos con cada una de las ecuaciones establecidas, tomando como punto de corte la PAP media ≥ a 25mmHg. Resultados: 187 pacientes con edad X y DE de 54.5 ± 22.6 y variación de 18 a 94 años, correspondiendo a 87 hombres (46.5%) y 100 mujeres (53.5%); con la ecuación 1 se detectaron 50 casos (26.7%) con hipertensión arterial pulmonar, 69 casos (36.8%) con la ecuación 2, y solamente 23 casos (12.3%) con la ecuación 3. Conclusiones: las ecuaciones 1 y 2 resultan útiles como tamizaje, teniendo la ecuación 3 mayor grado de discriminación.
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Background: Effusive-constrictive pericarditis is an uncommon clinical hemodynamic syndrome in which constriction of the heart by the visceral pericardium occurs in the presence of tense effusion in a free pericardial space. This variety of constrictive pericarditis was observed and characterized by Hancock in 1971. The hallmark of effusive-constrictive pericarditis is the persistence of elevated right atrial pressure after intrapericardial pressure has been reduced to normal levels by removal of pericardial fluid. The causes are diverse and its course may be reversible or more frequently requiring extensive pericardiectomy. Clinical case: 35 year old male without an important medical history, with dyspnea and chest pain secondary to airway infection, in whom a diagnosis of pericardial effusion was made, handled with colchicine and NSAIDs, he presented decreased of pericardial effusion but worsening hemodynamic alterations corroborated by echocardiography. Diagnosed as an effusive-constrictive pericarditis a pericardiectomy was performed with excellent evolution. After multiple diagnostic tests the disease was catalogued like an idiopathic form. Conclusions: Effusive-constrictive pericarditis is a rare syndrome and it should be considered in the evolution of patients with pericardial effusion.
Antecedentes: La pericarditis efusivo-constrictiva es un síndrome hemodinámico poco frecuente, en el cual el pericardio visceral constriñe al corazón con la presencia de líquido libre en el espacio pericárdico; fue descrito y caracterizado por Hancock en 1971. Se caracteriza por la presencia de presión elevada en la aurícula derecha persistente después de pericardiocentesis del derrame pericárdico; su etiología es diversa y su curso incierto, llegando a ser reversible o más frecuentemente requerir pericardiectomía extensa. Caso clínico: Masculino de 35 años sin antecedentes de importancia, con evolución de disnea progresiva y dolor torácico secundarios a infección de vías aéreas, en quien se efectuó diagnóstico de derrame pericárdico, manejado con colchicina y AINEs, evolucionando con disminución del derrame pero empeorando las alteraciones hemodinámicas, corroboradas por ecocardiografía. Con diagnóstico de pericarditis efusivo-constrictiva fue sometido a pericardiectomía con excelente evolución, clasificando el cuadro como idiopático después de múltiples pruebas diagnósticas en busca de la etiología. Conclusiones: La pericarditis efusivo-constrictiva es un síndrome poco frecuente que debe tenerse presente en la evolución de los pacientes con derrame pericárdico.
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BACKGROUND AND OBJECTIVE: About 70% of hypertensive patients need more than one drug to control their blood pressure (BP). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends a two-drug combination as initial drug therapy for patients with stage 2 hypertension. The aim of this study was to determine if a fixed-dose combination of trandolapril-verapamil is effective and safe in the treatment of stage 2 (moderate to severe) hypertension in hypertensive Mexican patients not controlled by monotherapy. METHODS: Forty hypertensive patients with BP >160/100mm Hg despite >6 months of drug treatment were given the fixed-dose combination of trandolapril-verapamil (2mg/180mg) for 12 weeks. Before taking the drug, they measured their own blood pressure (self-measured BP [SMBP]) several times a day for 3 days using a validated Omrom HEM 713C BP measuring device. At the end of the 12-week treatment period, the patients performed a second series of SMBPs in the same way as before treatment. A washout period was not included because the patients did not have an adequate response to previous antihypertensive treatment. Antihypertensive control during the 3-day SMBP period was evaluated. RESULTS: Patients experienced a significant reduction in mean BP (from 180/100mm Hg to 135/78mm Hg; p < 0.001). Seventy-five percent of patients reached their therapeutic goals (BP <140/90mm Hg). The SMBP records showed that BP values were maintained throughout the entire 3 days. One patient experienced headache and one had constipation; no patients discontinued the treatment. CONCLUSION: A fixed-dose combination of trandolapril-verapamil seems to be an effective and safe option for the management of stage 2 hypertension in Mexican patients uncontrolled by monotherapy.
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OBJECTIVE: To compare the effect of fixed-dose trandolapril-verapamil (FDTV) with that of trandolapril on proteinuria in normotensive, type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 60 normotensive, type 2 diabetic patients with 24-h proteinuria >300 mg were randomly assigned to two groups for open-label treatment. One group received 2 mg trandolapril/180 mg verapamil FDTV once daily; the other group received 2 mg trandolapril once daily. Study drugs were administered for 6 months in both groups. Creatinine clearance and 24-h urinary protein excretion were measured at the beginning and the end of the study. Patients were evaluated monthly for blood pressure, fasting blood glucose level, heart rate, and adverse events. Statistical analysis was performed using ANOVA. RESULTS: Both groups experienced a statistically significant (P < 0.005) mean decrease in mean proteinuria from baseline: FDTV ([mean +/- SD] 1200 +/- 200 to 540 +/- 79 mg; P < 0.001) and trandolapril (1,105 +/- 212 to 750.9 +/- 134 mg; P < 0.005). A significantly greater reduction from baseline in proteinuria was observed in the FDTV group compared with the trandolapril group. Patients who received trandolapril experienced a statistically significant (P < 0.05) decrease in mean creatinine clearance (91.1 +/- 3.4 to 75.3 +/- 3 ml/min; P < 0.05) compared with patients who received FDTV (88.3 +/- 3.6 to 82.9 +/- 3.5 ml/min; P > 0.05). Final fasting blood glucose was significantly lower in the FDTV group (139 +/- 19) compared with the trandolapril group (154 +/- 22; P < 0.001). No significant differences were observed between the two groups in mean baseline or final measurements of blood pressure, mean heart rate, or frequency of adverse events. CONCLUSIONS: Our results suggest that FDTV is more effective than trandolapril in reducing proteinuria in normotensive, type 2 diabetic patients. This effect on proteinuria is not related with blood pressure reduction.
