Daniel J. Piñeiro

Effect of Left and Right Lateral Decubitus Positions on Doppler Mitral Flow Patterns in Patients With Severe Congestive Heart Failure

Patients with severe congestive heart failure (SCHF) complain of increasing dyspnea when adopting left lateral decubitus (LLD) position that improves when turning over to the right lateral decubitus (RLD) position (trepopnea). We hypothesize that this clinical sign is due to changes in left ventricular (LV) preload and such changes would modify mitral flow. This study analyzes the effect of RLD and LLD positions on LV filling pattern assessed by Doppler echocardiography in patients with SCHF. Seventeen men and seven women (aged 56.22 +/- 18.52 years) with SCHF in New York Heart Association functional class III-IV and nine normal control subjects (eight men and one woman aged 56.96 +/- 18.14 years) were studied. We analyzed early (E) and late (A) LV filling velocities, E/A ratios, deceleration time, mitral time-velocity integral in each decubitus position, and the differences between them. Patients with SCHF have smaller mitral time-velocity integral, shorter deceleration time, greater E velocity and E/A ratio, and lower A velocity in LLD position than do normal control subjects. On assuming RLD position, patients with SCHF show decreases in E velocity and E/A ratio and lengthening of the deceleration time, suggesting a decrease in LV preload on changing position. This pathophysiologic mechanism may explain why patients with SCHF willingly adopt RLD position.

Continuous Improvement of Arterial Compliance Beyond Blood Pressure Decrease After 5 Years of Antihypertensive Treatmente

Pulse wave velocity is a reliable marker of arterial compliance. Stiffness of large and elastic arteries leads to a faster propagation of pulse wave. The aim of this study was to evaluate changes in arterial distensibility using antihypertensive drugs. This treatment focused on the inhibition of the renin‐angiotensin‐aldosterone system and the changes produced in blood pressure. Measurements were taken at baseline and throughout 60 months in 66 previously untreated hypertensive patients (22 men and 44 women, aged 54±9.5 years, range 38–73 years at baseline). All patients received either angiotensin‐converting enzyme inhibitors or, in case of adverse effects, angiotensin receptor blockers. To control blood pressure, diuretics, calcium channel blocking agents, or â blockers were added when appropriate. Statistical analysis was performed by means of ANOVA with á=0.05. Systolic and diastolic blood pressure decreased during the first year without significant changes thereafter. There were no significant changes in pulse pressure. Pulse wave velocity showed a continuous and significant decrease throughout the follow‐up period, but its reduction since the third year was more evident than the decrease in systolic and diastolic blood pressure (p<0.0001 for both). This observation could be related to changes in arterial remodeling probably due to angiotensin‐converting enzyme inhibition or renin angiotensin system blockade. Further investigations are needed to establish this relationship.

Holter monitoring in ankylosing spondylitis patients during methylprednisolone pulse therapy

SummarySudden death following steroid pulse therapy has been recently reported. Continuous electrocardiographic recording was performed 24 hours before, during, and 24 hours after each one to three high dose intravenous methyl prednisolone pulses administered of five patients with severe ankylosing spondylitis unresponsive to conventional therapy. No increase in supraventricular or ventricular arrythmias was observed. Bradiarrythmias, conduction disturbances or ischemic changes were not found. Cardiovascular symptoms did not occur in any case; there were no significative changes in any of the clinical controls. Transient elevations of serum glucose were observed in all patients. Although a transient increase in potassium and decrease in sodium urinary excretion was noted, serum levels remained within normal values.