Minerva cardioangiologica
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Minerva cardioangiologica · Oct 1994
[An evaluation of the pulmonary venous flow pattern by transesophageal and transthoracic Doppler echocardiography in a normal subject].
Transesophageal echocardiographic studies have permitted a pulmonary venous flow velocity pattern to be identified which is comparable to that recorder using invasive methods. The pattern consists of 4 stages: an anterograde systolic flow with an early (S1) and late (S2) peak velocity, a diastolic anterograde flow (D) and a retrograde flow liked to atrial contraction (Ar). The aim of this study was to evaluate the pattern of pulmonary venous flow velocity using transesophageal and transthoracic colour Doppler echocardiography in normal subjects in an attempt to: 1) determine normal values derived from the pulmonary venous flow pattern which may contribute to future studies; 2) find correlations between the pattern of pulmonary venous flow and a number of physiological, hemodynamic and echocardiographic parameters which take account of the morphological variations of this flow pattern within a normal range; 3) demonstrate the possibility of being able to carry out study using transthoracic colour Doppler echocardiography. ⋯ The following parameters were measured: left atrium diameter, diameters and telediastolic and telesystolic volumes of the left ventricle, ejection fraction and systolic percentage shortening of the left ventricle, peak velocity of the mitral flow pattern and the pulmonary venous flow pattern. The results obtained show that: 1) the pattern of pulmonary venous flow alters with ageing causing the prevalence of systolic over diastolic peak velocity; 2) the pulmonary venous flow parameters which appear to be most significant in hemodynamic terms are the peak velocities of the early systolic flow and anterograde diastolic flow and the ratios S1/S2 and S2/D; 3) the echocardiographic parameters most closely correlated with the peak velocity of pulmonary venous flow are the dimensions of the left atrium, telediastolic and telesystolic ventricular volumes, and the pattern of transmitral flow; 4) heart rate does not appear to influence the pulmonary venous flow pattern significantly (at least within the range of 50-100 b/min), except for retrograde flow. Similar results were obtained using transesophageal and transthoracic Doppler echocardiography and therefore if future studies succeed in obtaining useful information, of not only speculative but also practical interest, from the evaluation of pulmonary venous flow, these can be obtained using a simple, widespread and completely non-invasive method such as transthoracic Doppler echocardiography.
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Minerva cardioangiologica · Jun 1994
Randomized Controlled Trial Comparative Study Clinical Trial[A comparison between propafenone and amiodarone in the conversion to sinus rhythm of atrial fibrillation of recent onset].
The effectiveness of propafenone versus amiodarone for conversion to sinus rhythm of paroxysmal atrial fibrillation was compared. Fifty-four consecutive adult patients affected by recent onset atrial fibrillation (< 7 days) were randomized to treatment with intravenous propafenone (27 patients) and amiodarone (27 patient). Sinus rhythm was restored respectively in 74.1% and 70.4% (p = ns); within 5 hours was obtained reconversion in 65% of propafenone and in 15.8% of amiodarone group (p < 0.05); the mean conversion time was 3.5 and 16.6 hours (p < 0.01). In conclusion propafenone seems to be as effective and safe as amiodarone, but is significantly fast in converting recent onset atrial fibrillation to sinus rhythm.
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Minerva cardioangiologica · May 1994
Clinical Trial[Value of the vena cava index in healthy young subjects. Echocardiographic study].
Echocardiographic analysis of inspiratory collapse of the inferior vena cava is useful in clinical practice as it reflects the events of right heart. The caval index was measured in subcostal views within 2 cm of the right atrium origin of IVC, in 64 young healthy subjects. ⋯ It seems not related to age, sex, body surface area, cardiac rhythm, condition of pulmonary circulation. This method appears to be useful for non-invasive estimation of central venous pressure.
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Minerva cardioangiologica · Apr 1994
Review[Hypertensive emergencies. Clinical evaluation and therapeutic methods].
Hypertensive crisis may be defined as a condition characterized by a sudden rise in blood pressure, of varying length, that can damage arteries, arteriolas, and capillary vessels, producing impairment of end-organs. Hypertensive crises may occur under different clinical conditions, for this reason it is necessary to classify them according to their clinical context. Hypertensive crises are generally classified as hypertensive emergencies or urgencies on the basis of the clinical evaluation and according to the level of blood pressure and the presence of acute or ongoing end-organ damage. ⋯ Hypertensive urgencies are conditions in which severe elevations in blood pressure do not cause immediate end-organ damages but should be controlled within 24 hours in order to reduce potential risk for the patient. This group includes accelerated hypertension, severe elevation of blood pressure with minimal end-organ damages and no impending complications. In order to formulate a correct therapeutic plan and make the best use of the powerful antihypertensive drugs at our disposal, it is therefore necessary to distinguish hypertensive emergencies from hypertensive urgencies.
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Minerva cardioangiologica · Oct 1993
[Non-invasive evaluation of central venous pressure derived from respiratory variations in the diameter of the inferior vena cava].
To evaluate non invasive means of estimating central venous pressure, the respiratory motion of the inferior vena cava (IVC) was analysed by echocardiography in 65 patients. The caval index was measured in subcostal views within 2 cm of the right atrium origin of IVC. Parameters were correlated with simultaneous measured central venous pressure (CVP) by catheter positioned in the internal jugular vein. ⋯ Caval index was inversely related to mean CVP. A caval index > or = 20% indicate normal CVP, a caval index < 20% is related to an elevated value of CVP. This method appears to be useful for noninvasive estimation of mean CVP.