RESUMEN
OBJECTIVE: Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions. PATIENTS AND METHODS: 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. RESULTS: Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001). CONCLUSIONS: This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.
Asunto(s)
Bloqueo Cardíaco/etiología , Bloqueo Cardíaco/fisiopatología , Corazón/fisiopatología , Diálisis Renal/efectos adversos , Adulto , Función del Atrio Izquierdo/fisiología , Estudios de Casos y Controles , Ecocardiografía , Electrocardiografía , Femenino , Atrios Cardíacos/fisiopatología , Humanos , Enfermedades Renales/fisiopatología , Enfermedades Renales/terapia , Masculino , Diálisis Renal/métodosRESUMEN
Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16,270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1,000 primary care units in Turkey. The mean age of the patients was 60+/-11 years (60.1% women). Of 16,270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1,083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15,187 treated patients, 4,912 (30.2%) had a controlled systolic blood pressure, 7,063 (43.4%) a controlled diastolic blood pressure, and in 3,931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.
Asunto(s)
Hipertensión/prevención & control , Atención Primaria de Salud , Adulto , Anciano , Antihipertensivos/uso terapéutico , Índice de Masa Corporal , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Humanos , Hipertensión/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Encuestas y Cuestionarios , Turquía/epidemiologíaRESUMEN
OBJECTIVES: Adrenomedullin (ADM) production and secretion have been reported in endothelial cells. The present study was designed to assess whether coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) affect plasma ADM levels. DESIGN AND METHODS: We measured plasma concentrations of ADM using a specific radioimmunoassay method in patients undergoing coronary angiography or PTCA before and after a 5-minute procedure. Patients were divided into three groups; group I: normal coronary angiography group (11 males, 10 females; mean age 55.90 +/- 11.03 yrs), group II: coronary artery disease (CAD), only coronary angiography performed (14 males, 8 females; mean age 60.95 +/- 9.80 yrs), group III: PTCA performed in patients with CAD (35 males, 11 females; mean age 55.89 +/- 10.41 yrs). RESULTS: The plasma ADM levels and left ventricular end diastolic pressures measured before the procedure were similar in the three groups (p > 0.05). Plasma ADM levels were 13.98 +/- 2.26, 15.59 +/- 6.70, 17.15 +/- 8.47 pg/ml respectively. ADM levels measured after CA showed no significant difference in group I (13.75 +/- 1.75 pg/ml) or group II (16.50 +/- 7.18 pg/ml) (p > 0.05). A marked elevation was observed in group III with ADM levels of 27.31 +/- 12.27 pg/ml after PTCA (p < 0.01). The ADM levels observed in group III after PTCA were significantly higher than those of group I and group II after coronary angiography (p < 0.001). CONCLUSION: The results of our study show an increase of ADM after PTCA but not after coronary angiography in patients with or without CAD. We think that the increase of ADM levels may be due to cardiac secretion from endothelial and smooth muscle cells following balloon injury.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/sangre , Enfermedad Coronaria/terapia , Péptidos/sangre , Adrenomedulina , Presión Sanguínea , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
In order to assess the value of dobutamine stress echocardiography (DSE) for detecting coronary artery disease (CAD), 67 consecutive patients (mean age +/- SD was 58 +/- 8 years, range 35 to 75; 46 men and 21 women) with known or suspected CAD undergoing selective coronary angiography within the week following the DSE were studied. Two patients were excluded from the study because of insufficient echocardiographic imaging. Dobutamine (5 to 30 micrograms/kg/min by 5 micrograms/kg/min increments) was infused in 5-minute intervals. All the patients had 12-lead electrocardiogram (ECG) recorded at rest and at each stage of dobutamine infusion. There was significant CAD (> or = 50% diameter stenosis) in 42 patients (64.6%) with 16 patients having 1-vessel, 7 patients having 2-vessel and 19 patients having 3-vessel CAD. In 22 patients coronary angiogram was normal. DSE was positive in 33 of 42 patients with CAD. The test was negative in 20 of 23 patients without CAD. Compared with coronary angiography, the overall sensitivity of DSE for detecting CAD was 78.6% specificity 87%, positive predictive value 91.7%, negative predictive value 69%, and accuracy 81.5%. The sensitivity in those with one-vessel, two-vessel, three-vessel and multivessel disease was 62.5%, 85.7%, 94.7%, and 92.3% respectively. DSE was well tolerated in all patients. The study was not prematurely terminated due to a side effect in any patient. This study indicated that DSE is a practical method for the non-invasive assessment of significant CAD, for determining the patients who require invasive tests, and for predicting the extent of disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Dobutamina , Ecocardiografía , Adulto , Anciano , Angiografía Coronaria , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
A 23-year-old man had been coughing with hemoptysis, and had received tuberculostatic medication for four months without any benefit. Upon referral, two-dimensional echocardiography showed a cystic mass located in the anterior right-ventricular wall, without any protrusion into the ventricular cavity. CT examination revealed three cysts in the lung fields bilaterally, additionally a multilocular cystic image in the right-ventricular wall was observed. All components of hydatid cysts in the heart and lungs were removed in the same session by median sternotomy. Extracorporeal bypass was used in this operation.
Asunto(s)
Equinococosis Pulmonar/diagnóstico , Equinococosis/diagnóstico , Cardiopatías/diagnóstico , Adulto , Equinococosis/complicaciones , Equinococosis/cirugía , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/cirugía , Ecocardiografía , Cardiopatías/complicaciones , Cardiopatías/cirugía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
To determine the effect of Superoxide Dismutase (SOD) and Reduced Glutathione (GSH) as free-radical scavengers on cardiac performance in the reperfusion period up to 60 minutes after occlusion of the Left Anterior Descending artery (LAD), 16 dogs were selected for study. In the 30th and 60th minutes of LAD occlusion and reperfusion periods Cardiac Output (CO), Heart Rate (HR), Mean Arterial Pressure (MAP), Pulmonary Capillary Wedge Pressure (PCWP), Coronary Perfusion Pressure (CPP), Rate Pressure Product (RPP) and Triple Index (TI) values were determined. Of the 16 dogs, 7 as controls and 7 treated with SOD and GSH could be included in the study, and 2 had to be excluded because of death. In the 30th and 60th minutes of reperfusion period, the treated dogs had higher CO and CPP (p less than 0.05, p less than 0.01 respectively), MAP values were different (p greater than 0.05, p less than 0.05 respectively) from controls, whereas lower HR (p less than 0.05, p greater than 0.05, respectively), RPP and TI values (p less than 0.05) were determined. It was concluded that the combination of SOD and GSH may improve cardiac performance in the reperfusion period.