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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: echocardiography

Total plasma sulfide in mild to moderate diastolic heart dysfunction

Abstract

Background. The early pathophysiological mechanisms of diastolic dysfunction are not understood well. Hydrogen sulfide is an important endogenous gaseous transmitter that can influence heart remodeling. The aim was to determine total plasma sulfide (TPS) levels, as a surrogate marker of hydrogen sulfide, in patients with mild diastolic dysfunction.

Methods. Total plasma sulfide and N-terminal pro brain-type natriuretic peptide (NT-proBNP) levels were determined in ambulatory patients with arterial hypertension or diabetes mellitus and echocardiographically mild to moderate diastolic dysfunction.

Results. Twenty-four patients were included: nine with normal diastolic function (Grade 0), eight with an impaired relaxation pattern (Grade 1), and seven with a pseudo-normalized pattern (Grade 2). TPS levels were highest in patients with normal diastolic function (Grade 0), and lowest in patients with Grade 2 diastolic dysfunction, with this difference between Grade 0 and Grade 2 showing statistical significance (p = 0.017). NT-proBNP levels showed the reverse behavior, with this difference again showing statistical significance (p = 0.042).

Conclusions. Total plasma sulfide levels decrease with worsening of diastolic function from normal to moderate diastolic dysfunction.

Key words: total plasma sulfide, hydrogen sulfide, arterial hypertension, diastolic dysfunction, echocardiography

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Role of echocardiography in the management of shock

Abstract

Hemodynamic instability and inadequate cardiac performance is frequently found in critically ill patients. Transthoracic and transesophageal (in the case of inadequate visibility) echocardiography is increasingly used for non-invasive hemodynamic assessment and monitoring in the ICU setting. Using echocardiography, it is possible to assess preload, fluid responsiveness, systolic and diastolic cardiac function, and calculate cardiac output, intravascular and intra-cardiac pressures. It is the golden standard in the initial hemodynamic assessment and should be used as complementary tool in invasively monitored patients in the case of new circulatory or respiratory failure. Echocardiography is indispensable in the management of shock patients and is extremely powerful diagnostic role for the cardiac abnormalities (pericardial effusion and tamponade, acute cor pulmonale and acute or chronic valvular disorders) as a cause for hemodynamic instability. It is the most important and suitable method for assessment of right ventricular function, for diagnosis of septic cardiomyopathy and cardiac causes of weaning failure. Because of these advantages it should be routinely used by intensivists for hemodynamic assessment and monitoring and should be continuously available in the intensive care unit. The most important limitations of echocardiography are its inability to estimate adequacy of cardiac output and its intermittent nature. Therefore it should be used in rational combination with other complementary and continuous monitoring methods.

Key words: echocardiography, circulatory shock, critically ill patients

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Rare congenital coronary anomaly – unroofed coronary sinus

Abstract

In this paper we describe a case of an eight-month-old male infant who was diagnosed with an unroofed coronary sinus (UCS) that unusually presented with desaturation and cyanosis after surgical ventricular septal defect (VSD) closure. The patient was initially diagnosed with congenital heart disease (CHD), perimembranous VSD associated with mild stenosis of pulmonary arteries in early newborn period. Although the patient was regularly monitored by a paediatric cardiologist, and was even hospitalized twice due to deterioration of the initially diagnosed disease and the development of congestive heart failure (CHF) and arrhythmias, the UCS went unnoticed. The disease was unveiled completely after VSD was surgically closed and the patient’s condition deteriorated postoperatively with desaturation and cyanosis in the intensive care unit (ICU). On that same day the patient was reoperated on. UCS was closed with a pericardial patch, a persistent left superior vena cava ligated (PLSVC) and the patient successfully recovered. This case is an example that UCS is not only rare but is such an insidious congenital heart disease, often masked with associated heart defects. It should prompt every paediatric cardiologist to perform a careful examination of coronary sinus inflow tract or performance of contrast echocardiography in every suspicious case.

Key words: unroofed coronary sinus, coronary sinus septal defect, postoperative cyanosis, echocardiography

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Acute heart failure due to the left atrial myxoma causing mitral valve obstruction

Abstract

A 64 year-old woman without history of cardiovascular diseases and without cardiovascular risk factors was referred to our hospital because of acute heart failure. A real-time three-dimensional echocardiography (3D) revealed left atrium tumor causing mitral valve obstruction. 3D characteristics of the tumor were highly suggestive of cardiac myxoma. Surgical excision was successfully performed and myxoma was confirmed histologically. Although cardiac myxoma typically presents a silent heart failure, our case suggests that it should be even considered a cause of acute heart failure, especially in patients with no previous history or signs of cardiovascular disease.

Key words: acute heart failure, echocardiography, myxoma.

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Atypical presentation of thrombosis of a permanent pacemaker lead

Abstract

Pacemaker related infective endocarditis (PMIE) and pacemaker lead thrombosis (PMLT) are infrequent but potentially lethal complications of pacemaker (PM) therapy. Differences in clinical presentation, echocardiographic appearance and laboratory findings are usually helpful in making a confident diagnosis.  On the other hand, atypical clinical and echocardiographic findings may complicate their differentiation and result in a therapeutic dilemma. We present a 70-year-old man with a permanent PM hospitalized because of a 7-day history of fever and weakness. Elevated inflammatory parameters and atypical echocardiographic findings resulted in a diagnostic dilemma between PMIE and PMLT. In this paper, we discuss the pathogenesis of these entities, their clinical presentation and therapy.

Key words: echocardiography, endocarditis, pacemaker, lead, thrombosis

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