Cardiac disease
Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
The clinical manifestations of acute aortic dissection are well documented and reflect the site of the tear.10 Nearly all of them present with sudden-onset severe back or chest pain that is classically described as stabbing or tearing. Aortic valve involvement that produces regurgitation may occur in up to 50% of cases, and coronary artery flow may be compromised. Obstruction of branches of the aorta can produce organ ischaemia. The diagnosis of acute aortic dissection is frequently missed at first presentation, as in this case and many others reported to the CEMD. However, delay in diagnosis is not always associated with poor outcome.11 Thorough investigation is required to exclude other possible causes of severe chest pain, such as pulmonary embolism and myocardial infarction. Chest X-ray shows a widened mediastinum in 50% of cases. Concerns about exposure to radiation are overstated when dealing with potentially life-threatening situations. ECG changes are non-specific, most commonly involving ST segments and T-waves. Transthoracic echocardiography is more useful, but may still miss 20% of cases due to technical limitations. These are overcome using trans-oesophageal echocardiography, although an experienced operator is required. Alternatively, CT or MRI scanning may aid diagnosis.12
Chronic Dyspnea
Donald A. Mahler, Denis E. O’Donnell in Dyspnea, 2014
An exhaustive discussion of the diagnostic accuracy and caveats of various procedures that can be brought to bear on the workup of chronic dyspnea is beyond the scope of this chapter; however, the modalities covered herein are helpful and widely available. In general, the use of diagnostic tests to evaluate dyspnea has increased dramatically in the past decade. Between 2000 and 2008 at a single academic medical center, Rahimi et al. [71] observed an 85% increase in outpatient referrals for transthoracic echocardiography. The most frequent indication in both years was to investigate symptoms associated with suspected cardiac disease, including dyspnea. For patients of all ages with chronic dyspnea of suspected pulmonary origin and unrevealing chest radiograph (CXR), physical examination, and laboratory studies, the American College of Radiology recommends obtaining a high-resolution chest CT scan without intravenous contrast as the next imaging modality to evaluate this symptom [72]. With proper equipment and patient technique, office-based spirometry is effective in finding cases of asthma and COPD in the community [73,74], and testing only smokers would have reduced the number of COPD diagnoses by 26% in one study [75].
Cardiac Diagnostic Testing in Pregnancy
Afshan B. Hameed, Diana S. Wolfe in Cardio-Obstetrics, 2020
Transthoracic echocardiography can be used to evaluate ventricular function, valvular abnormalities, and pericardial disease. It uses high-frequency sound waves to image cardiac structures. Ultrasound waves are harmless to the tissues at the intensities used in diagnostic imaging. Echocardiography should be obtained in pregnant women who complain of chest pain, syncope, shortness of breath out of proportion to pregnancy, and palpitations. Furthermore, an echocardiogram should be performed on women with documented arrhythmia during pregnancy and those with known heart disease, stroke, or prior history of chemotherapy or radiation [20]. Serial echocardiography may be indicated during pregnancy based on the underlying cardiac disease.
Rationale and design of the Brazilian diabetes study: a prospective cohort of type 2 diabetes
Published in Current Medical Research and Opinion, 2022
Joaquim Barreto, Vaneza Wolf, Isabella Bonilha, Beatriz Luchiari, Marcus Lima, Alessandra Oliveira, Sofia Vitte, Gabriela Machado, Jessica Cunha, Cynthia Borges, Daniel Munhoz, Vicente Fernandes, Sheila Tatsumi Kimura-Medorima, Ikaro Breder, Marta Duran Fernandez, Thiago Quinaglia, Rodrigo B. Oliveira, Fernando Chaves, Carlos Arieta, Gil Guerra-Júnior, Sandra Avila, Wilson Nadruz, Luiz Sergio F. Carvalho, Andrei C. Sposito
Transthoracic echocardiography is performed by fully licensed cardiologists with specialization in cardiovascular imaging, following technical recommendations and measurement techniques according to the latest American Society of Echocardiography guidelines29. Heart scan images were acquired with a 1.5–4.5 MHz phased array transducer (Epiq CVX, Philips, Eindhoven, The Netherlands), and images processing with the Echo PAC software version 8.0 (GE Healthcare). Variable assessment and interpretation followed their respective guidelines: cardiac chambers diameters, chambers volumes, left ventricle (LV) mass, LV and right ventricular (RV) systolic function and global longitudinal, circumferential, and radial strain assessed by speckle tracking. For the LV diastolic function analysis, it considered tissue Doppler myocardial velocities, mitral wave inflow velocities, indexed left atrial volume, and tricuspid regurgitation peak velocities as recommended in ASE guidelines30,31.
Reduced longitudinal cardiac strain in asthma patients
Published in Journal of Asthma, 2019
I. Tuleta, N. Eckstein, F. Aurich, G. Nickenig, C. Schaefer, D. Skowasch, R. Schueler
Transthoracic echocardiography was performed using a commercially available ultrasound equipment with a 2.5-MHz phased array transducer (Vivid 7, General Electric Medical Health, Waukesha, Wisconsin, United States; iE 33 Philips Medical Systems, Koninklijke N.V.), according to the recommendations of the American Society of Echocardiography (13). Parasternal, apical and subcostal views were acquired. LVEF was calculated using the modified Simpson's method from apical four-chamber view. Diastolic function was determined by the measurements of the peak early (E) and late (A) mitral inflow velocity by the pulsed-wave Doppler and of the peak early (E′) and late (A′) diastolic velocity of the septal and lateral mitral valve annuli by the pulsed-wave tissue Doppler. Based on the guidelines of the American Society of Echocardiography (13), the diastolic function was classified as follows: grade 0 (normal) if E/A ratio > 0.8 and average E/E′ ratio < 10, grade I if E/A ratio ≤ 0.8 and average E/E′ ratio < 10, grade II if E/A ratio > 0.8–< 2.0 and average E/E′ ratio = 10–14, and grade III if E/A ratio ≥ 2.0 and average E/E′ ratio > 14. Right ventricular systolic function was assessed as the TAPSE in the apical four-chamber view. TAPSE < 20 mm determined right ventricular systolic dysfunction. The systolic pulmonary artery pressure (sPAP) was calculated using the tricuspid regurgitation peak velocity measured by the continuous wave Doppler. sPAP > 30 mmHg was defined as pulmonary hypertension.
Cardiopulmonary exercise performance of cancer survivors and patients with stable coronary artery disease with preserved ejection fraction compared to healthy controls
Published in Cogent Medicine, 2019
A physical exam by a certified physician and a 12-lead ECG were conducted prior to CPET to assess health status and eligibility for maximal exercise testing. Standard transthoracic echocardiography was performed if the last available echo was longer than three months in the past. Exclusion criteria were an EF <50%, diminished right heart function (tricuspid annular plane systolic excursion, TAPSE <15mm) and significant valvular disease (grade two or higher). Patients’ mean weekly endurance activity during the last six months was assessed via questionnaire and an extensive medical history regarding cardiovascular risk factors and drugs was taken. Participants were briefed about the importance of maximal exertion and were asked to report thoracic pain, disproportional dyspnea and dizziness during the exam.
Related Knowledge Centers
- Doppler Echocardiography
- Myocardial Infarction
- Cardiovascular Disease
- Diastole
- Ejection Fraction
- Heart
- Cardiac Output
- Medical Ultrasound
- Medical Imaging
- Heart Failure