Frequency of Electrocardiographic Alterations and Pericardial Effusion in Patients With Uncomplicated Malaria.

Studies have proposed that malaria may lead to electrocardiographic (ECG) changes and pericardial inflammation. We aimed to investigate the frequency of ECG alterations, determined by ECG and Holter monitoring, and pericardial effusion in patients with malaria infection. We performed a prospective observational study of adult patients with uncomplicated malaria in Amazonas, Brazil. Peripheral blood smears, ECG, and bedside echocardiography were conducted before antimalarial treatment and repeated at follow-up after completed treatment. We evaluated the diagnostic value of PR-segment depression, PR-segment elevation, and Spodick's sign for detecting pericardial effusion. A subset of patients underwent Holter monitoring at baseline. Among 98 cases of uncomplicated malaria (55% men; mean age 40 years; median parasite density 1,774/µl), 75 had Plasmodium vivax, 22 Plasmodium falciparum, and 1 had mixed infection. At baseline, 17% (n = 17) had PR-segment depression, 12% (n = 12) PR-segment elevation, 3% (n = 2) Spodick's sign, and the prevalence of pericardial effusion was 9% (n = 9). ECG alterations had sensitivities of 22% to 89% and specificities of 88% to 100% for detecting pericardial effusion at baseline. PR-segment depression had the best accuracy (sensitivity 89%, specificity 90%). Of the 25 patients, 4 patients who did not have pericardial effusion, displayed nonsustained ventricular tachycardia, determined by Holter monitoring (median duration 43 hours). Follow-up examination data were obtained for 71 patients (median 31 days), for whom PR-segment depression, elevation, and pericardial effusion had reduced significantly (p <0.05). In conclusion, our findings suggest that ECG alterations may be useful to detect pericardial effusion in malaria and that these findings decrease after completed antimalarial treatment.

Prevalencia de derrame pericárdico en enfermedades sistémicas.

INTRODUCTION: The presence of 50 mL of fluid or more in the pericardial sac is known as pericardial effusion. OBJECTIVE: To determine the prevalence of pericardial effusion in patients with systemic diseases. METHOD: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. RESULTS: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). CONCLUSIONS: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

INTRODUCCIÓN: La presencia de 50 mL o más de líquido dentro del saco pericárdico se denomina derrame pericárdico. OBJETIVO: Determinar la prevalencia de derrame pericárdico en pacientes con enfermedades sistémicas. MÉTODO: Se revisaron los estudios ecocardiográficos efectuados en el Servicio de Cardiología del Hospital de Especialidades del Centro Médico Nacional Siglo XXI, entre 2006 y 2016. Conforme los criterios de Weitzman, el derrame pericárdico se clasificó en ligero, < 10 mm, moderado de 10 a 20 mm y severo, > 20 mm. RESULTADOS: Se revisaron 10 653 estudios; la prevalencia del derrame pericárdico fue de 3.5 % (380), 209 mujeres (55 %, 45.9 ± 19.0 años) y 171 hombres (45 %, 41.9 ± 18.5 años). La etiología fue urémica en 227 (59.7 %), reducción del drenaje linfático en 73 (15.8 %), enfermedades autoinmunes en 30 (7.9 %), neoplásicas en 26 (6.8 %), infecciosas en 19 (5 %), idiopáticas en 14 (3.7 %), hipotiroidismo en dos (0.5 %), iatrogénica en uno (0.3 %) y posinfarto en uno (0.3 %). La severidad fue ligera en 87 (22.9 %), moderada en 147 (38.7 %) y severa en 146 (38.4 %). CONCLUSIONES: La prevalencia de derrame pericárdico fue de 3.5 % en pacientes con enfermedades sistémicas.

Prevalence of pericardial effusion in systemic diseases / Prevalencia de derrame pericárdico en enfermedades sistémicas

Abstract Introduction: The presence of 50 ml of fluid or more in the pericardial sac is known as pericardial effusion. Objective: To determine the prevalence of pericardial effusion in patients with systemic diseases. Method: Echocardiographic studies performed at the National Medical Center Siglo XXI Specialty Hospital Cardiology Department between 2006 and 2016 were reviewed. According to Weitzman's criteria, pericardial effusion was classified as mild, < 10 mm, moderate, 10 to 20 mm and severe, > 20 mm. Results: In total, 10,653 studies were reviewed; the prevalence of pericardial effusion was 3.5 % (380), in 209 women (55 %, 45.9 ± 19.0 years) and 171 men (45 %, 41.9 ± 18.5 years). Etiology was uremic in 227 (59.7 %), lymphatic drainage reduction in 73 (15.8 %), autoimmune diseases in 30 (7.9 %), neoplastic in 26 (6.8 %), infectious in 19 (5 %), idiopathic in 14 (3.7 %), hypothyroidism in two (0.5 %), iatrogenic in one (0.3 %) and post-infarction in one (0.3 %). Severity was mild in 87 (22.9 %), moderate in 147 (38.7 %) and severe in 146 (38.4 %). Conclusions: The prevalence of pericardial effusion was 3.5% in patients with systemic diseases.

Serum NT pro-BNP: relation to systolic and diastolic function in cardiomyopathies and pericardiopathies.

BACKGROUND: NT pro-BNP is a marker of systolic and diastolic dysfunction. OBJECTIVE: To determine NT pro-BNP levels in patients with chagasic, hypertrophic, and restrictive heart diseases, as well as with pericardial diseases, and their relation to echocardiographic measurements of systolic and diastolic dysfunction. METHODS: A total of 145 patients were divided into the following groups: 1) Chagas' heart disease (CHD)--14 patients; 2) hypertrophic cardiomyopathy (HCM)--71 patients; 3) endomyocardial fibrosis (EMF)--26 patients; 4) pericardial effusion (PE)--18 patients; and 5) constrictive pericarditis (CP)--16 patients. The control group was comprised of 40 individuals with no heart disease. The degree of myocardial impairment and pericardial effusion were assessed by two-dimensional echocardiography and the degree of restriction by pulsed Doppler transmitral flow. The diagnosis of CP was confirmed through magnetic resonance imaging. NT pro-BNP levels were determined through electrochemiluminescence immunoassay. RESULTS: NT pro-BNP was increased (p < 0.001) in CHD (median = 513.8 pg/ml), HCM (median = 848 pg/ml), EMF (median = 633 pg/ml), CP (median = 568 pg/ml), and PE (median = 124 pg/ml), when compared with the control group (median = 28 pg/ml). No statistically significant differences were found between CP and EMF (p = 0.14). In the hypertrophic group, NT pro-BNP was correlated with left atrial size (r = 0.40; p < 0.001) and with E/Ea ratio (p < 0.01). In the restrictive group, there was a trend of correlation with E-wave peak velocity (r = 0.439; p = 0.06). CONCLUSION: NT pro-BNP is increased in the different cardiomyopathies and pericardial diseases and is correlated with the degree of systolic and diastolic dysfunction.

Níveis séricos de NT pro-BNP: relação com função sistólica e diastólica nas miocardiopatias e pericardiopatias / Serum NT pro-BNP: relation to systolic and diastolic function in cardiomyopathies and pericardiopathies

FUNDAMENTO: O NT pro-BNP é marcador de disfunção sistólica e diastólica. OBJETIVO: Determinar os níveis de NT pro-BNP em pacientes com cardiopatia chagásica, hipertrófica, restritiva e afecções pericárdicas, e sua relação com medidas ecocardiográficas de disfunção sistólica e diastólica. MÉTODOS: Cento e quarenta e cinco pacientes foram divididos nos respectivos grupos: 1) cardiopatia chagásica (CCh) - 14 pacientes; 2) miocardiopatia hipertrófica (CMH) - 71 pacientes; 3) endomiocardiofibrose (EMF) - 26 pacientes; 4) derrame pericárdico (DP) - 18 pacientes; 5) e pericardite constritiva (PC) - 16 pacientes. Foi constituído um grupo-controle de 40 indivíduos sem doença cardíaca. O grau de acometimento miocárdico e o derrame pericárdico foram avaliados pelo ecocardiograma bidimensional e a restrição pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: O NT pro-BNP esteve aumentado (p < 0,001) na CCh (mediana 513,8 pg/ml), CMH (mediana 848 pg/ml), EMF (mediana 633 pg/ml), PC (mediana 568 pg/ml), DP (mediana 124 pg/ml), quando comparados ao grupo-controle (mediana 28 pg/ml). Não foram observadas diferenças estatisticamente significativas entre PC e EMF (p = 0,14). No grupo hipertrófico, o NT pro-BNP correlacionou-se com tamanho de átrio esquerdo (r = 0,40; p < 0,001) e relação E/Ea (p < 0,01). No grupo restritivo, houve uma tendência de correlação com pico de velocidade de onda E (r = 0,439; p = 0,06). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas diversas miocardiopatias e afecções pericárdicas, e apresenta relação com o grau de disfunção sistólica e diastólica.

BACKGROUND: NT pro-BNP is a marker of systolic and diastolic dysfunction. OBJECTIVE: To determine NT pro-BNP levels in patients with chagasic, hypertrophic, and restrictive heart diseases, as well as with pericardial diseases, and their relation to echocardiographic measurements of systolic and diastolic dysfunction. METHODS: A total of 145 patients were divided into the following groups: 1) Chagas' heart disease (CHD) - 14 patients; 2) hypertrophic cardiomyopathy (HCM) - 71 patients; 3) endomyocardial fibrosis (EMF) - 26 patients; 4) pericardial effusion (PE) - 18 patients; and 5) constrictive pericarditis (CP) - 16 patients. The control group was comprised of 40 individuals with no heart disease. The degree of myocardial impairment and pericardial effusion were assessed by two-dimensional echocardiography and the degree of restriction by pulsed Doppler transmitral flow. The diagnosis of CP was confirmed through magnetic resonance imaging. NT pro-BNP levels were determined through electrochemiluminescence immunoassay. RESULTS: NT pro-BNP was increased (p < 0.001) in CHD (median = 513.8 pg/ml), HCM (median = 848 pg/ml), EMF (median = 633 pg/ml), CP (median = 568 pg/ml), and PE (median = 124 pg/ml), when compared with the control group (median = 28 pg/ml). No statistically significant differences were found between CP and EMF (p = 0.14). In the hypertrophic group, NT pro-BNP was correlated with left atrial size (r = 0.40; p < 0.001) and with E/Ea ratio (p < 0.01). In the restrictive group, there was a trend of correlation with E-wave peak velocity (r = 0.439; p = 0.06). CONCLUSION: NT pro-BNP is increased in the different cardiomyopathies and pericardial diseases and is correlated with the degree of systolic and diastolic dysfunction.

The role of videopericardioscopy in evaluating indeterminate pericardial effusions.

BACKGROUND: The pericardial biopsy has opened a new perspective for the etiologic diagnosis of pericardial effusions, because adequate pericardial visualization via the use of a video camera can provide more accurate results. We assessed the usefulness of videopericardioscopy for the diagnosis and treatment of pericardial effusion of indeterminate origin. METHODS: We conducted a retrospective study of clinical data from patients who underwent videopericardioscopy examination for pericardial effusion without an established diagnosis. The video-assisted pericardioscopy procedure was performed through a small incision in the xiphoid area. RESULTS: From January 1998 to January 2007, 101 consecutive patients underwent videopericardioscopy evaluation for pericardial effusion. Ten patients were excluded because of lack of data. Fifty men and 41 women were included (mean age, 50 years; range, 14-76 years). All of the patients had moderate or significant pericardial effusion as demonstrated by echocardiography or computed tomography. The following diagnoses for the pericardial effusions were established: nonspecific inflammation, 50 cases (54.94%); neoplastic disorders, 22 cases (24.17%); tuberculous, 11 cases (12.08%); bacterial inflammatory process, 3 cases (3.29%); chylopericardial, 2 cases (2.19%); fungal infection, 2 cases (2.19%); and viral infection, 1 case (1.09%). Pericardioscopy evaluation provided the definitive diagnosis via the pericardial biopsy in 36.26% of the cases and via the results of fluid analyses in 13.18% of the cases; the use of both methods established the definitive diagnosis in 45.05% of the cases in this group of patients. The overall morbidity rate was 4.3%, and the most common complication was arrhythmia due to intraoperative manipulation, which ceased with the removal of the instruments from the pericardial cavity. We had 1 death, by cardiac tamponade, in the perioperative period. CONCLUSION: Videopericardioscopy is a safe and efficient method for obtaining a better diagnosis of and satisfactory therapeutic results for pericardial effusions of indeterminate cause, and such results are obtained via an improved exploration of the pericardial cavity.

Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature.

Actinomycosis is a rare, chronic disease caused by a group of anaerobic Gram-positive bacteria that normally colonize the mouth, colon, and urogenital tract. Infection involving the cervicofacial area is the most common clinical presentation, followed by pelvic region and thoracic involvement. Due to its propensity to mimic many other diseases and its wide variety of symptoms, clinicians should be aware of its multiple presentations and its ability to be a 'great pretender'. We describe herein three cases of unusual presentation: an inferior caval vein syndrome, an acute cholecystitis, and an acute cardiac tamponade. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institution’s protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.(AU)

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institutionãs protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.(AU)

Tamponamento cardíaco no pós-operatório de cirurgia cardíaca / Cardiac tamponade in the postoperative period after cardiac surgery

O derrame pericárdico ocorre, comumente, após os diferentes tipos de cirurgia cardíaca; entretanto, apenas alguns casos desenvolverão tamponamento cardíaco, sendo cruciais o diagnóstico e o tratamento precoces, pois ele se associa a alta morbidade e a alta mortalidade. A apresentação clínica pode ser insidiosa, com sintomas inespecíficos, incluindo mal-estar, fraqueza, dor torácica e anorexia. As manifestações do comprometimento cardíaco (dispnéia, hipotensão, taquicardia, diaforese e hepatomegalia) em geral aparecem tardiamente no curso clínico. Quando não diagnosticado e prontamente tratado, seguem-se, rapidamente, manifestações clínicas de choque. Em alguns casos, a deterioração clínica aparece poucas horas após o início dos primeiros sintomas. O ecocardiograma, tanto o transtorácico como o transesofágico, é a melhor técnica estabelecida para o diagnóstico de efusão pericárdica ou hematoma localizado após a cirurgia cardíaca, porque pode ser feito junto do leito do paciente, é rápido, apresenta ótima resolução, aplica-se em casos instáveis e seu custo é baixo. Assim, o tamponamento cardíaco após cirurgia cardíaca é uma síndrome clínica de hipotensão, com ou sem elevação da pressão venosa e diminuição do débito cardíaco resultante do aumento da pressão intrapericárdica causada pelo acúmulo de fluido ou hematoma localizado. Os efeitos hemodinâmicos são geralmente resultantes da compressão de uma ou de ambas as cavidades cardíacas direitas e/ou esquerdas, e seu diagnóstico clínico com ou sem confirmação por método gráfico requer tratamento urgente (drenagem ou esternotomia).

Causes of increasing pericardial pressure in experimental cardiac tamponade induced by ventricular perforation.

It has been shown that the intravenous infusion of saline solution in a dog with stabilized cardiac tamponade produced an increase in pericardial pressure. To demonstrate that this pressure increase is the result of bleeding into the pericardial sac, an experimental study was conducted, consisting of the injection of red cells marked with 51Cr during the intravenous infusion of saline solution in dogs with and without progressive tamponade. The results showed that in the dogs without progressive tamponade, both the pericardial pressure and the red cell count in the pericardial cavity remained stable during the infusion of saline solution, whereas in dogs with progressive tamponade, the numbers of marked cells and the pericardial pressure increased significantly, following a similar pattern.

Hemodialysis changes the QRS amplitude in the electrocardiogram.

We studied eight patients to determine whether changes occur in the QRS amplitude when these patients are submitted to hemodialysis. The following variables were assessed before and after each (N = 28) hemodialysis session: (1) plasma sodium and potassium concentrations, (2) QRS amplitude, (3) the heart rate and its variability, (4) ventricular volumes, ventricular mass, ejection fraction and circumferential fiber shortening, (5) arterial pressure and end systolic stress, and (6) body weight. QRS amplitude was computed as the algebraic sum of the positive and negative waves of each QRS complex of the electrocardiogram. QRS amplitude changes were compared to body weight, ventricular volumes, ventricular mass, ejection fraction, circumferential fiber shortening, plasma potassium and sodium concentrations, arterial pressure, end systolic stress, heart rate, and R-R variability. After the hemodialysis sessions we found a significant increase (P = 0.0006) in QRS amplitude and a significant decrease in body weight (P = 0.0001), end diastolic volume (P = 0.043), plasma potassium concentration (P = 0.000001), end systolic stress (P = 0.025) and systolic arterial pressure (P = 0.023). Hemodialysis did not produce significant changes in the other variables. The statistical analyses performed did not show any significant influence of any of the measured variables on the QRS amplitude change. The QRS amplitude increases after hemodialysis but the cause of this increase is still unclear.

Variaciones de la reserva pericárdica y masa ventricular izquierda en derrame pericárdico

Se evaluan los análisis clínicos y paraclínicos del derrame pericardico en 12 pacientes estudiados por ecografía "M" bidimensional; se observan tendencias y correlaciones entre los distintos hallazgos tales como signos, síntomas, patología sistémica asociada y seguimiento de tiempo. Se hace énfasis en el análisis ecocardiográfico de signos de derrame pericardico, especialmente en las variaciones del espesor de la pared y la masa del ventrículo izquierdo. Siendo una patología que ha sido ampliamente estudiada por ecografía con parámetro bien definido, se llama la atención sobre datos significativos para el estudio