Lipomatosis cardiaca masiva, hallazgo en la autopsia de un paciente con muerte súbita / Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death

La sustitución grasa de las células miocárdicas es un proceso degenerativo que afecta en mayor medida al ventrículo derecho y se encuentra en el 50% de las personas ancianas. El problema se origina cuando esta degeneración se produce en grado masivo, planteando la necesidad de realizar el diagnóstico diferencial con otras enfermedades. Se presenta el caso de un paciente que falleció de forma súbita y en su autopsia se encontró esta dolencia como única explicación del desenlace (AU)

The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome (AU)

[Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death]. / Lipomatosis cardiaca masiva, hallazgo en la autopsia de un paciente con muerte súbita.

The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome.

Dyspnea, ventilatory pattern, and changes in dynamic hyperinflation related to the intensity of constant work rate exercise in COPD.

STUDY OBJECTIVE: We undertook the present study to investigate the perception of dyspnea (with respect to changes in end-inspiratory and end-expiratory lung volumes), during four different levels of high-intensity constant work rate exercise (CWRE) in patients with severe COPD. DESIGN: Crossover descriptive study with consecutively recruited subjects. SETTING: Tertiary university hospital. PATIENTS: Twenty-seven subjects with severe COPD (mean [+/- SD] age, 65 +/- 5 years of age; mean FEV1, 43 +/- 8% predicted; and mean inspiratory capacity [IC]; 74 +/- 14% predicted). MEASUREMENTS AND RESULTS: Subjects randomly performed four high-intensity CWRE tests (conducted at 65%, 75%, 85%, and 95% of their symptom-limited peak work rate). Dyspnea, leg fatigue, and IC were determined every 2 min during exercise with breath-by-breath gas exchange and ventilatory measurements. There was a good correlation between the resting IC percent predicted and the oxygen uptake (V(O2)) peak (r = 0.64 to 0.69 between the IC percent predicted and V(O2) peak at the four work rates). There were significant differences (p < 0.01) in mean respiratory rate (33 +/- 6, 35 +/- 6, 37 +/- 6, and 38 +/- 6 min), peak dyspnea score (5.9 +/- 1.3, 6.3 +/- 1.4, 6.8 +/- 1.2, and 6.9 +/- 1.6), minute ventilation (45.0 +/- 8.7, 43.8 +/- 7.7, 43.1 +/- 8.7, and 42.8 +/- 8.0 L/min), leg fatigue (4.8 +/- 1.3, 5.1 +/- 1.3, 5.7 +/- 1.4, and 5.8 +/- 1.4), and end-tidal carbon dioxide partial pressure (4.41 +/- 0.36, 4.53 +/- 0.33, 4.66 +/- 0.31, and 4.76 +/- 0.24 kPa), respectively, for tests conducted at 65%, 75%, 85%, and 95% of their symptom-limited peak work rate, and in mean end-expiratory lung volume ([EELV] 4.55 +/- 0.44, 4.69 +/- 0.43, and 4.79 +/- 0.43 L), respectively, for tests conducted at 65%, 75%, and 85% of their symptom-limited peak work rate. In multivariable analysis, the factors that were independently correlated with dyspnea (p < 0.05) were EELV, peak inspiratory flow, and leg fatigue/discomfort. CONCLUSION: In COPD subjects with flow limitation at rest, the perception of dyspnea increased nonlinearly with the magnitude of high-intensity CWRE in association with a faster respiratory pattern and an increase in EELV. At the highest work rates, it appeared that a reduction in tidal volume and ventilation peak may have limited the tolerance to exercise.

Effects of training on the tolerance to high-intensity exercise in patients with severe COPD.

BACKGROUND: There has been no systemic investigation of the effects of training on endurance at different high-intensity work rates in patients with COPD to date. OBJECTIVES: We wanted to determine the effects of intense endurance training on tolerance to several high-intensity work rates and to establish the relationship between power (WR) and its tolerable duration (t) (t = W'/(WR - CP), being W', the curvature constant, thought to be reflective of anaerobic energy availability and/or tolerance to the uncomfortable sensations associated with the high-intensity exercise, and CP the critical power. METHODS: We studied 27 patients: age 62 +/- 5 years; FEV(1) 1.2 +/- 0.2 liters. Before and after the intervention, the subjects randomly underwent 4 high-intensity constant WR exercise tests. The endurance times of the highest 3 tests were used. RESULTS: Ventilation reached approximately the same level in each of the tests. In response to the training, the average peak increased by 9 +/- 5% (p < 0.0001), CP by 14 +/- 12% (p < 0.0001) and W' 18 +/- 22% (p = 0.002). In 67% of the patients, CP increased, accompanied by changes in other related physiological variables of aerobic capacity. In the remaining 33%, W' increased but not CP. Smaller or no changes in the other variables of aerobic capacity were found in those subjects. This latter group was significantly older and had more hyperinflation (i.e. higher RV/TLC%). CONCLUSIONS: Our results suggest that neither an incremental nor a single endurance test at constant WR provides an adequate characterisation of exercise tolerance at other WRs. CP and W' appear to be important parameters characterizing exercise tolerance over a range high-intensity work rates and identifying two distinct types of response to training.