Value of Contrast Transesophageal Echocardiography in the Detection of Intrapulmonary Vascular Dilatations in Hepatosplenic Schistosomiasis / Valor do Ecocardiograma Transesofágico com Contraste no Diagnóstico da Dilatação Vascular Intrapulmonar na Esquistossomose Hepatoesplênica

Abstract Background: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. Objective: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. Methods: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). Results: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). Conclusion: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.

Resumo Fundamento: A síndrome hepatopulmonar (SHP), presente em pacientes cirróticos, é pouco estudada na esquistossomose hepatoesplênica (EHE) e inclui a ocorrência de dilatações vasculares intrapulmonares (DVP). O ecocardiograma transesofágico com contraste (ETEc) de microbolhas é mais sensível que o ecocardiograma transtorácico com contraste (ETTc) de microbolhas na identificação de DVP na cirrose. Objetivo: Avaliar o desempenho do ETEc comparado ao ETTc na identificação de DVP para diagnóstico de SHP em pacientes com EHE. Métodos: Incluímos 22 pacientes com EHE submetidos a ETEc e ETTc para pesquisa de DVP, além de exames laboratoriais. Os ETEc e ETTc foram realizados empregando-se solução salina agitada, injetada em veia periférica. A visualização tardia das microbolhas em câmaras esquerdas indicava presença de DVP. Os resultados foram comparados entre os dois métodos pelos testes t de Stu dent e qui-quadrado (significância p < 0,05). Resultados: Todos os 22 pacientes realizaram ETEc sem intercorrências. Foram excluídos três pela presença de forame oval patente (FOP), e a análise final foi realizada nos outros 19. A DVP esteve presente ao ETEc em 13 pacientes (68%) e em apenas seis ao ETTc (32%, p < 0,01). Não houve diferenças significativas nos dados clínicos e laboratoriais entre os grupos com e sem DVP, incluindo a diferença alveoloarterial de oxigênio. O diagnóstico de SHP (presença de DVP com alterações gasométricas) ocorreu em cinco pacientes pelo ETEc e em apenas um pelo ETTc (p = 0,09). Conclusão: Em pacientes com EHE, o ETEc foi seguro e superior ao ETTc na detecção de DVP não identificada ao ETTc, o que possibilitou adicionalmente excluir FOP.

Value of Contrast Transesophageal Echocardiography in the Detection of Intrapulmonary Vascular Dilatations in Hepatosplenic Schistosomiasis.

BACKGROUND: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. OBJECTIVE: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. METHODS: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). RESULTS: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). CONCLUSION: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.

Athlete's heart in a Brazilian paralympic judo team. Case series study.

BACKGROUND: Athlete's heart is a term describing the cardiovascular effects of long-term conditioning among highly trained athletes. It is a variation of normal standards. DESIGN AND SETTING: Case series study at the cardiology division of a public university hospital. METHODS: We studied 14 visually handicapped paralympic athletes (8 men) in the national judo team. They were 26.3 ± 6.4 years old, with body mass index 25 ± 14, and had been practicing judo for 9.2 ± 7.9 years. Clinical evaluations, electrocardiograms, exercise testing and echocardiograms were performed by independent observers. RESULTS: Signs of athlete's heart were found in all athletes, comprising left ventricular hypertrophy (5 cases), sinus bradycardia (5), T-wave juvenile pattern (3), T wave juvenile pattern (3), left atrial hypertrophy (2) and increased left ventricular volume (9 cases; 62.22 ± 6.46 ml/m2). There were very strong correlations between left ventricular mass/body surface and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8). The correlations between left ventricular internal diastolic dimension and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8) were strong. Despite increased left ventricular dimensions (4 cases), atrial dimensions (1) and relative wall thickness (4), all athletes had normal left ventricular mass/body surface (89.98 ± 21.93 g/m²). The exercise testing was normal: exercise duration 706 ± 45 seconds and estimated peak oxygen uptake 62.70 ± 9.99 mlO2/min. CONCLUSIONS: Signs of athlete's heart were seen frequently in the paralympic judo team. These demonstrated the presence of mild cardiac adaptations to training.

Athlete's heart in a Brazilian paralympic judo team. Case series study

ABSTRACT BACKGROUND: Athlete's heart is a term describing the cardiovascular effects of long-term conditioning among highly trained athletes. It is a variation of normal standards. DESIGN AND SETTING: Case series study at the cardiology division of a public university hospital. METHODS: We studied 14 visually handicapped paralympic athletes (8 men) in the national judo team. They were 26.3 ± 6.4 years old, with body mass index 25 ± 14, and had been practicing judo for 9.2 ± 7.9 years. Clinical evaluations, electrocardiograms, exercise testing and echocardiograms were performed by independent observers. RESULTS: Signs of athlete's heart were found in all athletes, comprising left ventricular hypertrophy (5 cases), sinus bradycardia (5), T-wave juvenile pattern (3), T wave juvenile pattern (3), left atrial hypertrophy (2) and increased left ventricular volume (9 cases; 62.22 ± 6.46 ml/m2). There were very strong correlations between left ventricular mass/body surface and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8). The correlations between left ventricular internal diastolic dimension and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8) were strong. Despite increased left ventricular dimensions (4 cases), atrial dimensions (1) and relative wall thickness (4), all athletes had normal left ventricular mass/body surface (89.98 ± 21.93 g/m²). The exercise testing was normal: exercise duration 706 ± 45 seconds and estimated peak oxygen uptake 62.70 ± 9.99 mlO2/min. CONCLUSIONS: Signs of athlete's heart were seen frequently in the paralympic judo team. These demonstrated the presence of mild cardiac adaptations to training.

Espasmo coronariano durante a realização de ecocardiograma sob estresse com dobutamina / Coronaty spasm during the dobutamine stress echocardiography / Espasmo Coronario durante la Realización de Ecocardiograma bajo Estrés con Dobutamina

Stress echocardiography is an imaging method whose main objective is the diagnostic and prognostic evaluation of patients with known or suspected coronary artery disease. It is a safe method with few complications, even when used in large scale1... .

La ecocardiografía bajo estrés es un método de imagen cuyo principal objetivo es la evaluación diagnóstica y pronóstica de pacientes con enfermedad arterial coronaria conocida o sospechada. Es un método seguro, con pocas complicaciones, aun usado en gran escala1...

A ecocardiografia sob estresse é um método de imagem cujo principal objetivo é a avaliação diagnóstica e prognóstica de pacientes com doença arterial coronariana conhecida ou suspeitada. É um método seguro, com poucas complicações, mesmo quando usado em grande escala1... .

Relação entre volume do átrio esquerdo e disfunção diastólica em 500 casos de uma população brasileira / Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients

FUNDAMENTO: O aumento do Volume do Átrio Esquerdo Indexado (VAEi) tem sido associado à Disfunção Diastólica (DD) do Ventrículo Esquerdo (VE), considerado marcador de eventos cardiovasculares (fibrilação atrial, acidente vascular cerebral, insuficiência cardíaca, e óbito). OBJETIVO: Avaliar a relação entre VAEi e diferentes graus de DD em pacientes brasileiros submetidos ao ecocardiograma, estudando os determinantes do aumento do VAEi nesta amostra. MÉTODOS: Selecionamos 500 pacientes ambulatoriais submetidos a ecocardiografia, após exclusão de arritmia, cardiopatia valvar ou congênita, marca-passo permanente ou janela ecocardiográfica inadequada. O VAEi foi obtido pelo método de Simpson; classificou-se a DD segundo diretrizes atuais. Variáveis clínicas e ecocardiográficas foram submetidas a análise multivariada de regressão linear. RESULTADOS: A idade média foi de 52 ± 15 anos, 53% do sexo masculino, 55% hipertensos, 9% coronariopatas, 8% diabéticos, 24% obesos, 47% com hipertrofia VE, fração de ejeção média do VE: 69,6 ± 7,2%. A prevalência de DD na amostra foi de 33,8% (grau I: 66%, grau II: 29% e grau III: 5%). Houve aumento progressivo das dimensões do VAEi conforme o grau de DD: 21 ± 4 mL/m² (ausente), 26 ± 7 mL/m² (grau I), 33 ± 5 mL/m² (grau II), 50 ± 5 mL/m2 (grau III) (p < 0,001). Os preditores independentes de aumento do VAEi nesta amostra foram idade, massa ventricular esquerda, espessura relativa de parede, fração de ejeção do VE e relação E/e'. CONCLUSÃO: A DD contribui para o remodelamento atrial esquerdo. O aumento do VAEi expressa a gravidade da DD e está associado de forma independente com idade, hipertrofia ventricular esquerda, disfunção sistólica e aumento das pressões de enchimento do VE.

BACKGROUND: Left atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. RESULTS: Mean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m² (absent), 26 ± 7 mL/m² (grade I), 33 ± 5 mL/m² (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. CONCLUSION: DD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients.

BACKGROUND: Left atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. RESULTS: Mean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m² (absent), 26 ± 7 mL/m² (grade I), 33 ± 5 mL/m² (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. CONCLUSION: DD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Linfoma primário não Hodgkin em ventrículo esquerdo detectado ao ecocardiograma em pacientes submetido a transplante cardíaco / Primary non-Hodgkin lymphoma in the left ventricle detected by echocardiography in a patient after heart transplant

O caso ilustra o papel do ecocardiograma no diagnóstico e acompanhamento terapêutico de linfoma primário intracardíaco, em pacientesubmetido a transplante cardíaco há 11 anos. No ecocardiograma transtorácico foi visibilizada massa que ocupava a cavidade ventricular esquerda, confirmada por ecocardiograma transesofágico e tomografia computadorizada. Não havia disseminação do tumor em outrosórgãos. A massa foi ressecada cirurgicamente e enviada para análise histopatológica e imuno-histoquímica que revelou linfoma não Hodgkin. O ecocardiograma, após a cirurgia, comprovou ausência do tumor, com função ventricular esquerda preservada. O paciente veio a falecer, quatro meses após, por complicações infecciosas. Destacamos a raridade desta apresentação clínica do paciente transplantado, sobretudo a localização no ventrículo esquerdo e o diagnóstico em vida possibilitado pelo ecocardiograma.

Trombo pedunculado com aspecto de rato branco ao nível da transição entre a aorta ascendente e o arco aórtico. Importância da janela supraesternal / Pedunculated thrombus liked

Neste relato, é apresentado um caso de placa aterosclerótica complicada, com trombo móvel pedunculado ao nível da transição da aorta ascendente para o arco aórtico, demonstrando a importância da realização da investigação ecocardiográfica, com a inclusão da janela supraesternal, muitas vezes, negligenciada nos exames ecocardiograficos transtorácicos de rotina. O termo rato branco deve-se ao fato de a estrutura adquirir esse aspecto ao exame em tempo real.

Correlação entre qualidade de vida e capacidade funcional na insuficiência cardíaca / Correlation between quality of life and functional capacity in cardiac failure

FUNDAMENTO: Pacientes com insuficiência cardíaca (IC) apresentam progressiva incapacidade e declínio na qualidade de vida, ambos relacionados com dispneia e fadiga. Dessa forma, há interesse crescente em mensurar a qualidade de vida (QV), seja por instrumento genérico, tal como o 36-item Short-Form Health Survey (SF-36), seja por específico, tal como o Minnesota Living with Heart Failure (MLHFQ). OBJETIVO: Este estudo objetivou correlacionar os questionários de QV, SF-36 e MLHFQ, com a capacidade funcional de pacientes com IC, expressa pelo teste cardiopulmonar e o TC6M. MÉTODOS: Utilizaram-se os questionários SF-36 e MLHFQ para avaliação da QV. Para avaliação da capacidade funcional, utilizou-se o teste cardiopulmonar, sendo executado em esteira com protocolo de Weber, bem como a distância percorrida no teste da caminhada de seis minutos (TC6M). RESULTADOS: Foram selecionados 46 pacientes com diagnóstico de IC (22 homens, idade média de 52 anos), classes II e III da New York Heart Association. Observou-se correlação fraca entre os domínios aspectos físico e emocional do SF-36 e o VE/VCO2pico (r=-0,3; p<0,05) e a distância percorrida no TC6M (r=0,4; p<0,05), respectivamente. Observaram-se ainda correlações de fraca a moderada do escore total do MLHFQ com o VO2pico (r=-0,5; p<0,05), o limiar anaeróbio (r=-0,4; p<0,05) e a distância percorrida no TC6M (r=-0,5; p<0,05). CONCLUSÃO: Os dados sugerem que a aplicação de ambos os instrumentos de avaliação da QV, genérico (SF-36) e específico (MLHFQ) em pacientes com IC, evidenciaram de fraca a moderada correlação com as variáveis do teste cardiopulmonar e a distância percorrida no TC6M.

BACKGROUND: Patients with cardiac failure (CF) present progressive incapacity and decreased quality of life, both related to dyspnea and fatigue. Thus, there is the increasing interest in measring the quality of life (QL), by generic instrument, such as the 36-item Short-Form Health Survey (SF-36), by specific instrument, such as Minnesota Living with Heart Failure (MLHFQ). OBJECTIVE: This study has the objective to correlate the QL surveys, SF-36 and MLHFQ, with the functional capacity of patients with CF, expressed by the cardiopulmonary test and the TC6M. METHODS: Using the SF-36 and MLHFQ surveys for QL evaluation, for the evaluation of the functional capacity, it was used the cardiopulmonary test, being executed using a tredmill with Weber protocol, as well sa the distance covered in the walk test of six minutes (TC6M). RESULTS: Forty-six patients were selected with CF diagnosis (22 men, average age of 52 years old), classes II and III of New York Heart Association. It was observed that the mild correlation between the physical and emotional domains of SF-36 and VE/VCO2.peak (r=-0.3; p<0.05) and the distance covered in TC6M (r=0.4; p<0.05), respectively. It was also observed the mild to moderate correlations of MLHFQ total score with VO2.peak (r=-0.5; p<0.05), the aerobic threshold (r=-0.4; p<0.05) and the distance covered in TC6M (r=-0.5; p<0.05). CONCLUSION: The data suggest that the application of both evaluation instruments of QL, generic (SF-36) and specific (MLHFQ) in patients with CF, showed mild and moderate correlation with the variable of the cardiopulmonary test with the variables of the cardiopulmonary test and the distance covered in TC6M.

[Chronic left ventricular pseudoaneurism of undetermined etiology]. / Pseudoaneurisma crônico do ventrículo esquerdo de etiologia indeterminada.

Pseudoaneurysms occur as a rare complication of the myocardial infarction, of which hemorrhagic process is contained by adherences of the visceral or parietal pericardium - or of both - preventing the development of cardiac tamponade. We report the case of a 55-year-old patient, with a chronic left ventricular pseudoaneurysm of undetermined etiology, who was submitted to a conservative treatment.

Pseudoaneurisma crônico do ventrículo esquerdo de etiologia indeterminada / Chronic left ventricular pseudoaneurism of undetermined etiology / Pseudoaneurisma crónico del ventrículo izquierdo de etiología indeterminada

Os pseudoaneurismas ocorrem como rara complicação do infarto do miocárdio, após rotura miocárdica, cujo processo hemorrágico é contido por aderências do pericárdio visceral, parietal - ou de ambos -, impedindo o desenvolvimento de tamponamento cardíaco. Relatamos o caso de um paciente de 55 anos, com pseudoaneurisma crônico do ventrículo esquerdo de etiologia indefinida, de longa evolução, que foi submetido a tratamento conservador.

Pseudoaneurysms occur as a rare complication of the myocardial infarction, of which hemorrhagic process is contained by adherences of the visceral or parietal pericardium - or of both - preventing the development of cardiac tamponade. We report the case of a 55-year-old patient, with a chronic left ventricular pseudoaneurysm of undetermined etiology, who was submitted to a conservative treatment.

Los pseudoaneurismas ocurren como rara complicación del infarto de miocardio, tras rotura miocárdica, con detención del proceso hemorrágico por las adherencias del pericardio visceral, parietal - o de ambos -, impidiendo el desarrollo de taponamiento cardiaco. Relatamos el caso de un paciente de 55 años, con pseudoaneurisma crónico del ventrículo izquierdo de etiología indefinida, de larga evolución, que se sometió a tratamiento conservador.

Ecocardiografia nas doenças não-coronárias / Role of echocardiography in noncoronary diseases

A ecocardiografia representa hoje técnica não-invasiva de investigação diagnóstica amplamente empregada na avaliação de pacientes portadores de valvopatias, de cardiomiopatias não relacionadas a doença arterial coronária, assim como de indivíduos apresentando doenças do pericárdio. A ecocardiografia caracteriza-se por ser método de investigação cardíaca anatômica não-invasiva, não-radioativa, apresentando alta reprodutibilidade, fácil acesso, baixo custo e grande correlação com métodos invasivos hemodinâmicos de aferição de pressões cardíacas...

Efeito a curto prazo do losartan comparado ao enalapril na função ventricular esquerda e na capacidade de pacientes com insuficiência aórtica crônica grave oligo grave ou assintomáticos / Effect in short term of losartan compared with the enalapril in the left ventricular function and the physical capacity of patients with asymptomatic or minimally symptomatic chronic severe aortic regurgitation

Objetivo: analisar o efeito a curto prazo do lasartan comparado ao enalapril sobre a função ventricular esquerda em pacientes com insuficiência valvar aórtica grave, oligo ou assintomáticos, testar a segurança do lasartan nessas condições e estudar o impacto destas drogas sobre a capacidade física. Métodos: Dez pacientes com insuficiência valvar aórtica (IAo)crônica grave e com função ventricular esquerda preservada (fração de ejeção menor ou igual 0,55), foram estudados de forma prospectiva em um estudo de intervenção medicamentosa cross-over, comparando-se duas drogas: losartan e o enalapril, através de avaliação clínico-laboratorial, ecocardiograma de repouso e teste cardiopulmonar em três momentos diferentes: sem medicação, em uso de losartan, em uso de enalapril. Resultados: Foram estudados 7 (70 por cento homens e 3 (30 por cento) mulheres com idade entre 15 e 41 anos (média de 26 anos). A dose média diária de enalapril foi de 38mg com tempo médio de 3,9 meses e a de losartan foi de 90mg com tempo médio de três meses. Não houve efeitos adversos graves....

Complicações embólicas de trombo móvel em átrio esquerdo na estenose mitral / Free-floating left atrial thrombus with multiple embolic episodes in a patient with mitral stenosis: a case report

Trombo móvel em átrio esquerdo é uma rara complicação da estenose mitral com alto potencial embólico. O presente caso ilustrra esta condição, detectada ao ecocardiograma transtorácico e confirmada ao ecocardiograma transesofágico. A ocorrência de múltiplos episódios embólicos determinou o desfecho fatal. Os autores enfatizam a necessidade do diagnóstico precoce para previnir estas graves complicações embólicas.

Topical betablocker use can result in inconclusive dobutamine stress echocardiography in patients with glaucoma.

Dobutamine stress echocardiography is a well-established method to assess coronary artery disease, of which sensitivity has been enhanced by adding atropine at the end of the protocol. Individuals with glaucoma, a disease with a high prevalence in patients with cardiac diseases older than 40 years, cannot benefit from the use of atropine as it is contraindicated for this group of patients. Additionally, these individuals are often treated with topical betablockers (eye drops), which can have systemic effects by decreasing cardiac frequency, blood pressure and pulmonary capacity. The aim of our study was to verify whether a possible systemic effect caused by the use of these eye drops, yielding a low chronotropic response, could result in inconclusive dobutamine stress echocardiography in patients with glaucoma.