Isabel João

Evaluation of left ventricular outflow tract gradient during treadmill exercise and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy

Background-Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts) in their daily activities, neither during effort nor during orthostatic recovery.Aim-To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts.Methods-We studied 17 HCM pts (9 males, mean age 53 ± 16 years, 11 with obstructive HCM). Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD) and orthostatic position). The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position.Results-3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 ± 24 mmHg; in orthostatic position was 62 ± 29 mmHg (p < 0.001 versus in LLD); at peak exercise was 83 ± 35 mmHg (p < 0.001 versus supine rest); during recovery it was 96 ± 35 mmHg (p < 0.001 versus peak exercise)Conclusion-In HCM pts the intraventricular gradient increases in orthostatic position, increases significantly during treadmill exercise and continues increasing in the recovery period in orthostatic position. This type of evaluation can help us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

What Is Really a Nonobstructive Hypertrophic Cardiomyopathy? The Importance of Orthostatic Factor in Exercise Echocardiography

The authors report the case of a 23-year-old girl with nonobstructive hypertrophic cardiomyopathy evaluated by resting echocardiography. The patient complained of syncope after playing basketball. The patient was submitted to treadmill exercise echocardiogram, and she exercised for 9 minutes in standard Bruce protocol. The left ventricular outflow gradient did not occur at peak workload; however she developed intraventricular gradient greater than 100 mmHg after exercise in orthostatic position. There was fall in arterial pressure, and the patient was then put in supine position. The authors suggest the possible role of exercise stress echo in symptomatic patients with no significant gradient at baseline, as well as maintenance in orthostatic position after exercise, as an important stress factor. This can disclose the occurrence of left ventricular outflow tract obstruction that should not be detected in other way and has potential relevance in the patients symptoms understanding.

Um caso de tromboembolismo pulmonar e dissecção aórtica: importância do ecocardiograma

Please cite this article as: Cruz I, et al. Um caso de tromboembolismo pulmonar e dissecção aórtica: importância do ecocardiograma. Rev Port Cardiol. 2013. http://dx.doi.org/10.1016/j.repc.2012.12.010. ∗ Corresponding author. E-mail address: inesmariarosariocruz@gmail.com (I. Cruz). exertion, pain and edema in the right leg and muscle weakness in both legs rendering her unable to walk, over the previous two weeks. On physical examination she was cooperative, with blood pressure 100/40 mmHg, heart rate 70 bpm, good peripheral pulses, crackling rales in the lung bases, and flaccid

Documento de Consenso e Recomendações para a realização de Ecocardiografia Transtorácica em Portugal

Echocardiography is the most widely used imaging technique in modern cardiological clinical practice, since it is readily available, portable and safe, and provides a comprehensive morphological and functional assessment at low cost compared to other imaging modalities. Recent technological advances have introduced new echocardiographic techniques and widened the clinical applications of echocardiography. However, these developments have also led to an increase in information, rendering interpretation of the data provided by the exam more complex; this may result in assessment errors by less experienced operators. Standardization of procedures and training in echocardiography is therefore essential to ensure quality and safety for patients. The present document aims to contribute to this end, recommending quality requirements for operators and echocardiography laboratories in Portugal.

Complicações de enfarte do miocárdio: ecocardiograma para diagnóstico diferencial de sopro cardíaco

Figura 1 Eletrocardiograma de 12 derivações: ritmo sinusal, ondas Q e supradesnivelamento do segmento ST nas derivações precordiais, DII e DIII. Admitiu-se o diagnóstico de enfarte anterior em fase subaguda em classe Killip III, motivo pelo qual realizou angiografia coronária e angioplastia da descendente anterior média com implante de stent. Para estabilização hemodinâmica foi colocado balão intra-aórtico e iniciou perfusão de dobutamina (7 ug/kg/min).

Imagem em CardiologiaComplicações de enfarte do miocárdio: ecocardiograma para diagnóstico diferencial de sopro cardíacoComplications of myocardial infarction: Echocardiography for differential diagnosis of heart murmur

Figura 1 Eletrocardiograma de 12 derivações: ritmo sinusal, ondas Q e supradesnivelamento do segmento ST nas derivações precordiais, DII e DIII. Admitiu-se o diagnóstico de enfarte anterior em fase subaguda em classe Killip III, motivo pelo qual realizou angiografia coronária e angioplastia da descendente anterior média com implante de stent. Para estabilização hemodinâmica foi colocado balão intra-aórtico e iniciou perfusão de dobutamina (7 ug/kg/min).

Complications of myocardial infarction: Echocardiography for differential diagnosis of heart murmur.

Figura 1 Eletrocardiograma de 12 derivações: ritmo sinusal, ondas Q e supradesnivelamento do segmento ST nas derivações precordiais, DII e DIII. Admitiu-se o diagnóstico de enfarte anterior em fase subaguda em classe Killip III, motivo pelo qual realizou angiografia coronária e angioplastia da descendente anterior média com implante de stent. Para estabilização hemodinâmica foi colocado balão intra-aórtico e iniciou perfusão de dobutamina (7 ug/kg/min).

Dispneia na estenose aórtica: nem tudo o que parece é

Valvular aortic stenosis is the most common valvular disorder in Europe. Although recommended, stress exams are still underused in its evaluation. We report the case of a 60-year-old man who, following a routine electrocardiogram with abnormal ventricular repolarization, underwent stress testing, which was positive for myocardial ischemia, and an echocardiogram that revealed moderate aortic stenosis. Cardiac catheterization showed no angiographic coronary lesions and an intraventricular gradient of 45 mmHg. In view of the latter, stress echocardiography was performed, which documented an increase in the intraventricular gradient from 30 mmHg to 131 mmHg. Repeat stress echocardiography under treatment with bisoprolol showed an increase in test duration and a maximum intraventricular gradient at peak exercise of 36 mmHg. Stress exams may have an important role in the diagnostic and therapeutic management of patients with aortic stenosis.