China
Africa
Explore chapters and articles related to this topic
Fetal echocardiography
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Caroline K. Lee, Erik C. Michelfelder, Gautam K. Singh
In the past, assessment of fetal ventricular systolic function has often consisted of qualitative assessments. Current practice is generally more quantitative. On initial 2D imaging of the fetus, it is important to note the presence of hydrops fetalis and/or its component findings. Overall, cardiac size is often a sign of altered hemodynamics in the fetus; in addition to qualitative assessment, the cardiothoracic ratio can be used to quantitatively express the degree of cardiac enlargement. In our lab, we utilize the ratio of the cardiac area (in the four-chamber view) to the thoracic area in the same view (Fig. 12), with normal values generally being <0.35 (30). It is also useful to examine why the heart is large, which may be due to ventricular enlargement, atrial dilation, ventricular hypertrophy, or a combination of these findings, as this may provide further clues as to the etiology of the cardiac abnormality. On 2D and/or M-mode imaging of the RV and LV, quantitative assessment of both RV and LV shortening fraction is also possible (27,31–33) (Fig. 12). In addition to subjective assessment of ventricular wall thickness, quantitation of RV and LV wall thickness is possible, and there are published normal values against which measurements can be compared (34).
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Pulmonary oedema is commonly due to cardiac failure or fluid overload. The earliest feature is upper lobe diversion. Following this, interstitial oedema develops, causing ground glass opacification and interlobular septal thickening. Alveolar oedema will develop if the condition continues to progress and this manifests as consolidation. Cardiomegaly may be present and can be assessed by measuring the cardiothoracic ratio.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
A postero-anterior (PA) chest radiograph is routinely performed to assess the shape and size of the heart. When the PA image is assessed, the relationship between the width of the heart shadow to the internal thoracic measurement is assessed. This is known as the cardiothoracic ratio (CTR) and is normally less than 1:2. When the CTR is greater than 1:2 this may indicate dilated cardiac disease that requires further investigation. The assessment may be supplemented with a lateral chest radiograph.
The clinical associations with cardiomegaly in patients undergoing evaluation for pulmonary hypertension
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Benjamin Daines, Sanjana Rao, Omid Hosseini, Sofia Prieto, John Abdelmalek, Mohamed Elmassry, Pooja Sethi, Victor Test, Kenneth Nugent
Cardiomegaly has important associations in autopsy studies, exercise studies, and outcomes studies. The cardiothoracic ratio measured by plain radiography and computed tomography in postmortem studies is correlated with heart weight. Michiue et al. used plain radiography of open chests in postmortem studies to determine the cardiothoracic ratio and its correlation with heart size [10]. There was a significant correlation between this ratio and heart weight in patients who had significant heart disease at the time of death (N = 50, r = 0.63, p < 0.0001). Winklhofer and colleagues used postmortem computed tomography to evaluate cardiothoracic ratio in 170 deceased adults [11]. Depending on the criterion used for normal heart weights, 57% to 67% of the adults in this autopsy study had enlarged hearts. The mean cardiothoracic ratio was 0.513 ± 0.07 with a range of 0.28–0.69, and a cardiothoracic ratio of 0.5 had a sensitivity of 78% and a specificity of 71% for detecting increased heart weights. These two studies suggest that increased cardiothoracic ratios in patients should correlate with a heavier heart provided that significant chamber dilatation and pericardial effusion are excluded.
Detoxification with intravenous lipid emulsion for fatal hydroxychloroquine poisoning
Published in Modern Rheumatology, 2021
Kanako Noda, Shinji Akioka, Hiroshi Kubo, Hajime Hosoi
Urination was not observed after taking HCQ. She presented with writhing and groaning. She did not show apparent loss of consciousness, and the Glasgow Coma Scale score was 14 points. Abnormalities in the central nervous system (e.g. speech/eye movements) were not observed. Voluntary movements were poor due to muscle weakness, but decline in muscle tone was not detected. She complained of a tingling sensation in all limbs. Her body temperature was 36.0 °C, blood pressure was 85/52 mmHg, pulse rate was 85 bpm, and oxygen saturation was 99% in ambient air. Analyses of venous-blood gases showed pH of 7.33, bicarbonate level of 24.7 mEq/L, and lactic-acid level of 2.7 mmol/L. Laboratory tests revealed a sodium level of 144 mEq/L, potassium concentration of 2.9 mEq/L, chloride level of 102 mEq/L, and glucose concentration of 85 mg/dL. The first ECG showed sinus rhythm at 84 bpm and the T wave was flat at V1, V5 and V6. QRS was 0.079 sec. QTc interval was 0.424 sec. with Bazett correction and 0.401 sec. with Fridericia correction. Echocardiography showed no obvious abnormal heart movements: left ventricular fractional shortening was 29% and a ratio of early to late atrial mitral Doppler peak flow velocity was more than 1.0. No valvular regurgitation was detected. Cardio-thoracic ratio on chest radiograph was 52%. She was judged to be in circulatory failure with hypokalemia due to HCQ overdose.
Relationship between doses of antihypertensive drugs and left ventricular mass index changes in hemodialysis patients in a Japanese cohort
Published in Renal Failure, 2021
Fumiya Kitamura, Makoto Yamaguchi, Takayuki Katsuno, Hironobu Nobata, Shiho Iwagaitsu, Hirokazu Sugiyama, Hiroshi Kinashi, Shogo Banno, Masahiko Ando, Yoko Kubo, Yasumasa Kawade, Iwashima Shigejiro, Yutaka Ito, Takuji Ishimoto, Yasuhiko Ito
Clinical data were obtained from medical records. The following baseline characteristics were defined at the time of the first echocardiography: age, sex, the primary cause of end-stage renal disease, comorbidities, diabetes, history of previous CVD including coronary heart disease (angina and myocardial infarction), arrhythmia including atrial fibrillation, cardiac arrest, congestive heart failure, and valvular heart disease. We also considered other cardiovascular conditions, such as both pre- and post-dialysis BP, body weight, vascular access type (including arteriovenous fistula or prosthetic graft), weekly erythropoiesis-stimulating agents, dosage, single-pool Kt/V, duration of dialysis treatment (hours per week), and serum laboratory data (including hemoglobin, serum albumin, C-reactive protein, serum creatinine, blood urea nitrogen, serum calcium, serum phosphate, intact parathyroid hormone, and serum magnesium levels). Chest radiographs were used to examine pre-dialysis after a 2-day interdialytic interval in an upright posterior-anterior view, according to the Japanese guidelines [16]. Cardiothoracic ratio, the maximal horizontal diameter of the heart divided by the horizontal inner width of the rib cage, was measured.