[Assessment of pulmonary arterial pressure in adults with Doppler echocardiography]. / Avaliação da pressão arterial pulmonar em adultos pela Eco-Dopplercardiografia.

PURPOSE: To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS: Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS: An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p < 0.05) in patients with severe PH (mean PAP > or = 40 mmHg), comparing with patients with PAP < 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p < 0.05) excluding patients with atrial fibrillation (19 cases). CONCLUSION: PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.

[Fascicular block of the His bundle: critical approach for its identification]. / Bloqueios das divisões fasciculares do feixe de His: abordagem crítica para a sua identificação.

The correct identification of the left and right fascicles blocks of the His bundle will permit to explain different patterns of the ECG and VCG. The differentiation between the right peripheral bundle branch and the left bundle branch division is not only important in anatomic and physiologic grounds, but also in a clinic viewpoint. So, trying to refine the diagnostic criteria and improve the recognition of these intraventricular conduction disturbances, we developed this study. Eighty five patients were evaluated and divided into two groups. Group I included 65 patients with cardiac disease; group II consisted of 20 normal subjects taken as a control. Some classic ECG and VCG criteria were tested as well as new ones. We confirmed the significance of the S2/S3 relation to distinguish the right superior divisional block (RSDB) from the left anterior hemiblock (LAH), and added some new criteria: 1) C morphology in horizontal plane (HP) to the right divisional block (RDB); 2) assessment of aVL lead to separate RSDB from LAH--qR pattern in the last, and different one to RSDB; 3) the qR' pattern in L2, L3 and aVF leads associated with left ventricular hypertrophy (LVH) pattern screened the left posterior hemiblock (LPH). We found no significance in R3/R2 relation to the right inferior divisional block (RIDB). Similarly to what happened to the left bundle branch block in the 70's decade, we expect that an adequate assessment of the RDB can permit a better understanding of its real clinical value.

[Pulmonary artery pressure evaluation in adults by Doppler echocardiography]. / Avaliação da pressão arterial pulmonar em adultos pela ecodopplercardiografia.

PURPOSE: To assess the role of pulsed Doppler echocardiography (PDE) in the indirect assessment of pulmonary artery (PA) pressure (P), analysing the pulmonary velocity blood flow curves (PVBFC) profile. PATIENTS AND METHODS: Sixty-one adults with several kinds of heart disease were submitted to heart catheterization to obtain PAP (systolic, diastolic, mean), and other hemodynamic variables. A PDE examination was performed in all to obtain the PVBFC at the level of the pulmonic annulus. Qualitative features of the curve were analysed (morphological pattern, presence of pulmonic regurgitation) as well as quantitative data (acceleration time = AT, right ventricle ejection time = RVET index, AT/RVET index AT corrected for heart rate = ATC), which were compared to the invasive measurements. RESULTS: An abnormal rapid acceleration of the PVBFC, with triangular configuration, was noted in patient with pulmonary hypertension (PH), in contrast to the dome-like shape of the PVBFC in normal PAP. Pulmonary regurgitation was more frequent (p less than 0.05) in patients with severe PH (mean PAP greater than or equal to 40 mmHg), comparing with patients with PAP less than 40 mmHg. Inverse linear correlations were observed between AT and mean PAP, particularly when sinus rhythm was present (r = 0.89; p less than 0.05) excluding patients with atrial fibrilation (19 cases). CONCLUSION: PDE is an useful and noninvasive method for indirect evaluation of PAP in adults, especially during stable sinus rhythm, in heart rate range from 60 to 115 bpm.

A discordância na interpretação dos testes ergométricos / Disagreement in the interpretation of ergometric tests

Quarenta e um pacientes foram submetidos ao teste de esforco e a cinecoronariografia. Os testes foram avaliados por tres observadores pertencentes a diferentes servicos. A discordancia na avaliacao nos testes atingiu a 68% quanto a presenca de isquemia miocardica e a 38% quanto a suficiencia do esforco realizado. A discordancia global nos relatorios foi de 71%. Houve concordancia com a conduta do experimentador em suspender o exercicio ao teste (92%). Em relacao aos testes "positivos" e "negativos" segundo a opiniao predominante entre os observadores, a discordancia foi de, respectivamente, 67% e 39%. Nos testes duvidosos e inconclusivos atingiu a 100%. Em relacao a morfologia do segmento ST no tracado de controle, morfologias normais e patologicas corresponderam a 55% e 84%, respectivamente, de discordancia na avaliacao do teste. Em relacao a morfologia do segmento ST, a frequencia-pico,as discordancias na interpretacao do teste atingiram a 28%, 64% e 75% nos casos com segmento ST respectivamente normal, ascendente e descendente ou horizontal. A sensibilidade e a especificidade dos observadores na deteccao da molestia coronaria atraves do TE variaram, respectivamente, entre 19 a 63%, e 60% a 94%; no entanto a "performance" e a eficacia dos mesmos foi semelhante (p > 0,05)

Análise do teste ergométrico em pacientes sintomáticos na detecção da moléstia coronária. Novos critérios / Analysis of the ergometric test in symptomatic patients in the detection of coronary disease. New criteria

Os autores submeteram ao teste ergometrico maximo em bicicleta 153 pacientes (110 homens e 43 mulheres) sendo os registros eletrocardiograficos realizados em derivacao CM5. A analise dos testes pelos criterios classicos usuais revelou sensibilidade de 43% e especificidade de 87%. A aplicacao de criterios especiais aumentou a sensibilidade para 83%, permanecendo a especificidade 73%. O valor de previsao positivo chegou a 92% nos homens e o valor negativo a 86%, em mulheres. A ocorrencia de dor precordial, disritmia cardiaca, hipotensao, incompetencia cronotropica, alteracao de amplitude de onda R e de polaridade de onda T nao discriminou os portadores de molestia coronaria. A ocorrencia de angina foi significativamente maior entre homens com lesoes obstrutivas (p igual 0,001). Em portadores de infarto de miocardio previo e lesoes coronarias uniarteriais, 100% dos testes foram negativos. Em portadores de infarto de miocardio previo e lesoes coronarias multiarteriais, 36,1% dos testes foram positivos, sendo a diferenca entre estas proporcoes significativas (p < 0,05)