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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).
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.
Cardiovascular responses in pathological situations
Published in Neil Herring, David J. Paterson, Levick's Introduction to Cardiovascular Physiology, 2018
Neil Herring, David J. Paterson
The ventricular function (Starling) curve, pump function curve and ejection fraction are depressed. The heart is enlarged (cardiothoracic ratio >0.5 or, more accurately, dilatation on echocardiography or cardiac MRI), due to a raised filling pressure. In mild, compensated failure, the stroke volume and output are almost normal at rest, due to the raised filling pressure (Frank-Starling mechanism) and raised plasma catecholamines. In severe failure, the output is low even at rest, due to further Starling curve depression, mechanical inefficiency caused by dilatation (Laplace’s law; mitral/tricuspid regurgitation) and β1 adrenergic receptor downregulation.
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.
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.
An unusual pituitary adenoma coexistent with bilateral meningiomas: case report
Published in British Journal of Neurosurgery, 2019
Ashwin Kumaria, Ian S. Scott, Iain J. Robertson
In view of increasing problems with fatigue, lethargy and weight loss, she underwent evaluation of the pituitary lesion in July 2014 which had displayed unchanged/stable appearances since first diagnosed incidentally. There were no visual problems or other signs or symptoms attributable to sellar mass effect. There were no symptoms or clinical signs of acromegaly or Cushing’s disease. Thyroid function and prolactin were within normal limits. She had normal electrolytes. The peak cortisol in short Synacthen test was normal at 493 nmol/l. The IGF-1 (Insulin like Growth Factor-1) level came back at 899 microgram/l, suggestive of excess growth hormone secretion. Subsequent glucose tolerance test showed failure of suppression of Growth Hormone levels with a nadir value of 1.2 microgram/l (3.6 mU/l), thus confirming a biochemical diagnosis of acromegaly. In retrospect, the cardiothoracic ratio on her chest x-ray was slightly increased, possibly in keeping with cardiomegaly although she remained asymptomatic from this point of view.