RESUMO
OBJECTIVES: We studied the value of a rapid beta-blocker injection at peak dobutamine-atropine stress echocardiography (DASE) for the detection of coronary artery disease (CAD). BACKGROUND: The presence of tachycardia and hyperdynamic wall motion may make it difficult to recognize a new wall motion abnormality (NWMA) at peak stress. METHODS: We studied 101 patients (mean age 58.2 +/- 9.8 years) who underwent effective DASE and coronary angiography. All patients received a rapid intravenous injection of metoprolol immediately after peak DASE image acquisition. Positivity in combined peak plus post-metoprolol images was defined when there was only peak NWMA, maintenance of peak NWMA, or NWMA detected only after metoprolol injection. Significant CAD was defined as >or=50% stenosis by quantitative angiography. RESULTS: There were 37 patients without and 64 with CAD. The sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of CAD at peak stress were 84%, 92%, 87%, 95%, and 77%, respectively. Five patients with CAD had negative peak images that became positive only after metoprolol. Extension of peak NWMA during metoprolol was observed in 14 patients, and multivessel CAD was detected in 10 of them. The sensitivity, specificity, accuracy, and positive and negative predictive values for peak plus metoprolol images were 92%, 89%, 91%, 94%, and 87%, respectively. CONCLUSIONS: The use of metoprolol injected at peak of dobutamine infusion improved the detection of CAD by DASE.
Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Antiarrítmicos , Atropina , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse , Metoprolol/administração & dosagem , Idoso , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de TempoRESUMO
Involvement of the heart and pericardium by cancer is not uncommon, with metastases being more frequent than primary cardiac neoplasms. We present a case of a metastatic lung cancer for which the primary manifestation was chest pain mimicking an acute myocardial infarction.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/secundário , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Infarto do Miocárdio/diagnóstico , Aorta/diagnóstico por imagem , Aorta/patologia , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/patologia , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologiaRESUMO
Os autores propõem um sistema de nomenclatura para cardiopatias congênitas baseado no princípio da análise segmentar seqüencial. Apresentam a lista curta de diagnósticos e discutem a importância da uniformização dos nomes para facilitar a troca de informações entre instituições...
Assuntos
Humanos , Cardiopatias Congênitas/classificação , Unified Medical Language System/classificação , TerminologiaRESUMO
A ecodopplercardiografia ocupa lugar de destaque, como metodo nao-invasivo no diagnostico das cardiopatias. Neste trabalho, procuramos rever os principais aspectos ecocardiograficos das cardiopatias congenitas acianogenicas e cianogenicas mais frequentes. Foi dada a enfase as caracteristicas anatomicas, aos plano ecocardiograficos utilizados nos diversos diagnosticos e as principais limitacoes do metado