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C Cotrim

Publications and source records attributed to C Cotrim.

At least 19 recordsLinked to original sources
PubMed2001

Acute type A aortic dissection involving the left main coronary artery and the aortic valve--a case report.

The authors report a case study of a 60 year-old-male admitted to the Coronary Care Unit with severe chest pain, hypertension and ST depression on the anterior and lateral leads of the electrocardiogram. A diastolic murmur was heard in the aortic area. The chest X-ray showed an enlarged superior mediastinum. The transthoracic echocardiogram revealed an image that indicated an intimal flap above the aortic plane with severe aortic regurgitation. An aortography was performed and confirmed the diagnosis of acute type A aortic dissection with partial obstruction of the left main coronary artery, probably due to compression by the haematoma. The patient underwent emergency surgical repair with replacement of the aortic valve and ascending aorta. The patient survived without complications post surgery and was discharged ten days after onset of symptoms. Twenty months later, the patient was asymptomatic and the transesophageal echocardiogram showed a dissection of the descending thoracic aorta, mild aortic regurgitation and good left ventricular systolic function.

Acute Disease↗
PubMed2001

[Changes in regional wall contractility induced by effort in women with normal coronary angiography --report of a clinical case].

The diagnosis of coronary artery disease in women has been thought to be more difficult than in men, owing to the lower overall prevalence of disease in women, as well as more subtle clinical presentations and unspecific changes in ST segment. The authors report a clinical case of a 61-year old woman, with low cardiovascular risk and history of atypical chest pain and a positive treadmill exercise test on the inferior leads. She did an exercise echocardiogram that revealed severe hypokinesis on the anterior wall and septum with late normalization. The patient was submitted to a coronary angiography that revealed normal arteries. An echocardiogram with hyperventilation was later performed and showed the same ischemic changes as exercise did, on the inferior leads but no regional wall motions abnormalities occurred. The patient is currently asymptomatic under calcium antagonist treatment.

Coronary Angiography↗
PubMed2001

[Assessment of aortic atherosclerosis with transesophageal echocardiography].

OBJECTIVE: To image the thoracic aorta by transesophageal echocardiography (TEE) and study atherosis (morphology and extent of atheroma plaques) and sclerosis (stiffness) and secondarily correlate them with serum lipid levels (cholesterol, HDL, LDL and triglycerides). METHODS: We studied 29 patients (pts) who underwent TEE electively (male 18 pts, age 57.8 +/- 14.6 years). The parameters evaluated were: the stiffness coefficient = ln (PAsist/PAdiast)/(Dsyst/Dmin), and the morphology, location and extent of atheroma plaques. The systolic distension (Dsyst) was the difference between the maximal and the minimal dimensions (Dmin) of the aortic diameter measured by M mode. The lesions were classified in 4 degrees (0-3): 0--normal intima, 1--intimal thickening, 2--atheroma, 3--complicated lesion. Five aortic segments were studied: arch, D1-D4 (descending aorta at 5 cm intervals from the first 25 cm distal of the incisors line). We calculated the individual score = 1 x theta 1/180 + 2 x theta 2/180 + 3 x theta 3/180, theta n represents the angles occupied by the lesions and n (1-3) the severity of atherosis of each lesion. The total atherosis index (TAI) was sigma scores/(n. degree of visualized segments). RESULTS: The arch was not visualized in 3 pts, and the segment D4 was only visualized in 3 pts. TAI mean = 0.82 +/- 0.74, stiffness coefficient mean (SC) = 9.56 +/- 15.072. There were no significant correlations between the lipid levels and the TAI or SC. The only significant positive correlations were: TAI vs age (r = 0.62, p < 0.001) and SC and diastolic blood pressure (BP) (r = 0.42, p < 0.05). CONCLUSIONS: The best visualized segments belong to the descending aorta (25 to 40 cm from the incisors). In this group of patients the lipid levels did not seem to be a preponderant factor in aortic atherosclerosis. The most important factors were age for atherosis and BP for sclerosis.

Aorta, Thoracic↗
PubMed2001

Acute type A aortic dissection involving the left main coronary artery and the aortic valve--a case report.

The authors report a case study of a 60 year-old-male admitted to the Coronary Care Unit with severe chest pain, hypertension and ST depression on the anterior and lateral leads of the electrocardiogram. A diastolic murmur was heard in the aortic area. The chest X-ray showed an enlarged superior mediastinum. The transthoracic echocardiogram revealed an image that indicated an intimal flap above the aortic plane with severe aortic regurgitation. An aortography was performed and confirmed the diagnosis of acute type A aortic dissection with partial obstruction of the left main coronary artery, probably due to compression by the hematoma. The patient underwent emergency surgical repair with replacement of the aortic valve and ascending aorta. The patient survived without complications post surgery and was discharged ten days after onset of symptoms. Twenty months later, the patient was asymptomatic and the transesophageal echocardiogram showed a dissection of the descending thoracic aorta, mild aortic regurgitation and good left ventricular systolic function.

Acute Disease↗
PubMed2001

Atropine in exercise stress echocardiography? Case report.

Stress echocardiography is widely used in the investigation of coronary heart disease. Exercise stress echocardiography offers the advantage of visualizing myocardial motion abnormalities during physiological stress testing. The authors report the use of atropine, as an adjunct to exercise echocardiography, in risk stratification after myocardial infarction.

Atropine↗
PubMed2000

Cardiac rupture during exercise stress echocardiography: a case report.

Stress echocardiography is widely used in the evaluation of coronary artery disease. Dobutamine stress echocardiography has been the preferred method, but many centers have adopted exercise stress echocardiography, which can visualize myocardial motion during physiologic stress testing. The complications of this method in the post-myocardial infarction period are the same as those identified in conventional exercise testing. We report a case of myocardial rupture in the postinfarction period during exercise stress echocardiography.

Aged↗
PubMed2000

[Stress-exercise echocardiography].

The authors review the methodology and clinical applications of exercise echocardiography. This is a method that can be done in most of the patients with indication to the treadmill exercise test. There is an excellent relationship between costs and benefits associated to high sensitivities and specificities in the diagnosis of ischemia. This can lead to the preferential use of this technique, in the opinion of the authors, when it is indicated and in all patients that can do exercise.

Angioplasty, Balloon, Coronary↗
PubMed1999

[The sinus venosus type of interatrial communication: its diagnosis by transesophageal echocardiography].

Transthoracic echocardiography has important limitations in the diagnosis of sinus venosus atrial septal defects in adults because of the posterior location of the defect. We review the role of transesophageal echocardiography in the diagnosis of this congenital heart disease in nine patients, as well as in the identification of associated abnormal pulmonary venous connections.

Adult↗
PubMed1999

[Time integral of oxygen pulse for exercise submaximal levels in patients with heart insufficiency--correlation with maximal oxygen consumption].

UNLABELLED: Maximal oxygen consumption (VO2max) has an important prognostic value in patients with congestive heart failure (CHF). However, it requires a maximal exercise test, not often available for these patients. To overcome this limitation, we examined whether a simple time integral of oxygen pulse (OP) to submaximal exercise levels correlates with VO2max. METHODS: We performed a maximal symptom-limited treadmill exercise test, while measuring breath-by-breath oxygen consumption, using the CAEP protocol, in 24 patients with CHF (51 +/- 11 years, 18 males, sinus rhythm). No exercise was terminated due to ischemia or arrhythmias. All patients attained anaerobic threshold. Besides standard parameters, OP (ml) and time integral of OP (OPTI) were calculated at 2 minutes (OP-2 min and OPTI-2 min) and at 4 minutes (OP-4 min and OPTI-4 min) of exercise. Patients were divided in two groups according to VO2max: group I--VO2max > or = 16 ml/kg/min (14 patients) and group II--VO2max < 16 (10 patients). RESULTS: Age, sex, body surface and CHF etiology were similar in both groups. Exercise duration, maximal OP, time to anaerobic there shold, VO2 and OP at anaerobic there shold were higher in group I (p < 0.05). Comparing group I vs group II--OP-2 min: 6.2 +/- 1.5 vs 5.0 +/- 1.2 ml (p = 0.026); OP-4 min: 7.6 +/- 1.9 vs 5.4 +/- 1.2 (p = 0.001); OPTI-2 min: 3.1 +/- 1.1 vs 2.2 +/- 0.9 (p = 0.021) and OPTI-4 min: 15.2 +/- 4.4 vs 9.3 +/- 3.1 (p = 0.0007). The best correlation with VO2max was obtained for OPTI-4 min (r = 0.696). An OPTI-4 min value > or = 10 occurred in 13 patients of group I and in two patients of group II (p = 0.00013), with a predictive value of 87% for VO2max > 16 (sensitivity = 93%, specificity = 80%)--kappa index = 0.739. CONCLUSIONS: OPTI-4 min can be a useful tool for assessing cardiocirculatory functional status in patients with CHF and unable to perform a maximal exercise test.

Adult↗
PubMed1999

[The metabolic-chronotropic relation in patients with heart failure--a correlation with functional capacity].

UNLABELLED: Previous studies on chronotropic incompetence (CI) in patients with congestive heart failure (CHF) have defined it as the inability to achieve > 80% of age predicted maximum heart rate (HR) (adequacy of HR response to submaximal exercise levels not being considered). The metabolic chronotropic relation (MCR) concept proposed by Wilkoff allows the assessment of the entire chronotropic function. The value of such an approach for the evaluation of CI in patients with CHF, and its relation to exercise capacity, is unclear at present. METHODS: We imposed maximal symptom-limited treadmill exercise testing while measuring breath-by-breath oxygen consumption, using CAEP protocol, in 25 patients (19 men), 49 +/- 10 years, all in sinus rhythm, with CHF secondary to dilated cardiomyopathy (17) or ischemic heart disease (8), NYHA class II-III. Anaerobic threshold (AT) was attained by all. No exercise was terminated due to arrhythmia or ischemia. MCR was calculated as the slope of the relation between the percentages of HR and metabolic reserves achieved at the end of each exercise stage. Using 2.0 standard deviations below the mean level of MCR in healthy controls, we defined an MCR value < 0.84 as abnormal. The parameters analysed were: age, drug therapy, fractional shortening (FS-%), resting HR (RHR-bpm), exercise duration (DUR-min), peak HR (HRp), peak oxygen consumption (VO2p-ml/kg/min), percentages of predicted maximal HR (% PMHR) and VO2 (% PMVO2), peak ventilatory equivalent for CO2 (VE/VCO2-L/min), time to AT (T-AT), and VO2 at AT (VO2-AT). RESULTS: MCR was normal (1.01 +/- 0.18-0.86 to 1.19) in 10 patients--Group I, and abnormal (0.66 +/- 0.13-0.42 to 0.81) in 15 (60%) patients--Group II. A similar proportion of patients in both groups were taking ACE inhibitors, digoxin and amiodarone. [table: see text] CI defined as an inability to achieve a % PMHR > 80% occurred only in 6 (24%) patients, all in Group 2 (p = 0.022 versus abnormal MCR). CONCLUSIONS: In CHF patients, CI assessed as an abnormal MCR is frequent, and relates to an impaired exercise capacity.

Adult↗
PubMed1998

[Recovery of respiratory parameters and oxygen consumption during the recovery phase of cardiopulmonary exercise test in patients with dilated cardiomyopathy].

OBJECTIVE: To analyse the recovery of oxygen consumption (VO2), ventilation (VE) and carbon dioxide production (VCO2) after maximal cardiopulmonary exercise testing, and to assess the possibility of recovery parameters becoming new markers of functional impairment. METHODS: Thirty-eight patients (30 males, mean age 56 +/- 11 years) with dilated cardiomyopathy performed maximal, symptom limited, treadmill exercise test with breath-by-breath respiratory gas analysis. The patients were divided in two groups, according to maximal oxygen consumption above or below 14 ml/kg/min (group I and group II, respectively). During the recovery, we analyzed the time to reach 50% of the maximal values of VO2 (T1/2 r VO2), VE (T1/2 e VE) and VCO2 (T1/2 r VCO2) in each group. RESULTS: Twenty-seven patients had a VO2max above 14 ml/kg/min (group I) and 11 had a VO2max below 14 ml/kg/min (group II). The results were as follows: T1/2 r VO2max 109 +/- 21 sec in group I versus 177 +/- 79 sec in group II (p = 0.0001). T1/2 r VCO2max 124 +/- 28 sec in group I versus 201 +/- 88 sec in group II (p = 0.0001) and T1/2 rVEmax 146 +/- 47 sec in group I versus 229 +/- 47 sec in group II (p = 0.0002). CONCLUSIONS: Patients with a poor functional capacity show a delay in the half recovery times of oxygen consumption, ventilation and carbon dioxide production. These data suggest that these parameters may be used as new markers of the level of functional impairment.

Cardiomyopathy, Dilated↗
PubMed1998

[Can the ventilatory equivalent for carbon dioxide predict the severity of functional impairment in patients with cardiac insufficiency?].

OBJECTIVE: To evaluate whether the changes in the ventilatory equivalent for carbon dioxide (VE/VCO2), during the early stages of cardiopulmonary exercise testing, can predict maximal oxygen consumption (VO2max) in patients with chronic heart failure. METHODS: We studied 38 patients (30 males, mean age 56 +/- 11 years) with chronic heart failure. All patients performed maximal symptom limited, treadmill exercise test with breath-by-breath respiratory gas analysis. They were divided in two groups according to their maximal oxygen consumption (group I-VO2max above 14 ml/kg/min and group II-VO2max below 14 ml/kg/min). In both groups, we analysed VE/VCO2 at rest, at the anaerobic threshold (AT) and at peak exercise, and the percentage of VE/VCO2 reduction from rest to AT. RESULTS: Eleven patients had a VO2max below 14 ml/kg/min (group II). At rest VE/VCO2 = 53 +/- 13 in group II versus 47 +/- 10 in group I (p = 0.048), at the AT VE/VCO2 = 46 +/- 12 in group II versus 36 +/- 7 in group I (p = 0.001) and at peak exercise VE/VCO2 = 46.2 +/- 13 in group II versus 36.2 +/- 6 in group I (p = 0.0002). There was a 24% reduction in the VE/VCO2, from rest to AT in group I, compared to a 16% reduction in group II (p = 0.004). A reduction in the VE/VCO2 from rest to AT less than 16% predicted a VO2max below 14 ml/kg/min with a sensitivity of 60% and a specificity of 93%. CONCLUSIONS: Patients with severe functional impairment have higher values of VE/VCO2 in all exercise stages. A reduction of VE/VCO2 from rest to anaerobic threshold of less than 16% is a high specific predictor of a VO2max below 14 ml/kg/min.

Carbon Dioxide↗
PubMed1997

[Guided anti-arrhythmia therapy by programmed ventricular stimulation. A case of arrhythmogenic dysplasia of the right ventricle].

Right ventricle dysplasia (RVD) is a rare clinical entity, described in young people, and a known cause of ventricular arrhythmias and sudden death. A genetic transmission has been suggested from the study of familial cases. The disease is characterized by a dilated right ventricle, cardiac infiltration with fatty tissue and focal fibrosis. Lymphoplasmocyte infiltrates are documented. The diagnosis is based on electrocardiography, echocardiography, magnetic resonance imaging and right ventricular endomyocardial biopsy. The authors report a case of a young woman with symptomatic ventricular tachycardia (VT) in whom the diagnosis of RVD was established. Programmed ventricular stimulation was used to reproduce the clinical VT and to test the efficacy of the anti-arrhythmic drug therapy. The diagnosis criteria and therapeutic options are discussed.

Adult↗
PubMed1996

[Mitral prosthesis dysfunction--report of 3 clinical cases with unusual ultrasonography features].

Prosthetic valve obstruction is one of the most serious complications of mechanical cardiac valves. Clinicians must be aware of this diagnosis in patients with a worsening of functional NYHA class. Over the past years, echocardiography has imposed itself as the method of choice to diagnose and evaluate patients with suspected prosthetic valve obstruction. We present three clinical reports of prosthetic valve malfunction that have unusual echocardiographic features.

Echocardiography↗
PubMed1995

Prediction of right ventricular ejection fraction by Doppler determination of right systolic time intervals.

OBJECTIVES: This study was designed to evaluate the right ventricular function by means of the determination of right ventricular systolic time intervals measured in pulmonary artery flow detected by Doppler. BACKGROUND: Left ventricular systolic time intervals have been used to evaluate left ventricular performance. There is, however, no information as to whether right ventricular systolic time intervals may be useful in the evaluation of right ventricular function. METHODS: Simultaneous measurements of right ventricular ejection fraction and Doppler determination of right systolic time intervals were made in four pigs in 47 different hemodynamic conditions that permit the modification of the right ventricular ejection fraction from 15% to 68%. The preejection time, the ratio of right preejection time to right ventricular ejection time, with and without correction by the heart rate, were correlated simultaneously to invasively determined right ventricular ejection fraction and other hemodynamic parameters, measured with a modified pulmonary artery catheter with a rapidly responding thermistor. RESULTS: There was a significant linear correlation between Doppler determination of right systolic time intervals and right ventricular ejection fraction. A similar correlation was found for preejection time (r = .80, p < .0001) and the ratio of right preejection time to right ventricular ejection time with correction by the heart rate (r = .83, p < .0001). When we used a preejection time > 70 msec as a criterion to detect a ejection fraction < 40% we found a sensitivity of 89% and specificity of 88%. A preejection time > 80 msec, as criterion of more severe ventricular disfunction (ejection fraction < 30%), displayed a sensitivity of 76% and specificity of 100%. CONCLUSION: These results show that right ventricular systolic time intervals determined by Doppler study correlate significantly with the right ventricular ejection fraction. In view of its simplicity and its accuracy in the prediction of right ventricular ejection fraction, this method may provide useful non-invasive alternative in the prediction of right ventricular ejection fraction.

Animals↗
PubMed1995

[The QTc interval and its dispersion in hypertrophic myocardiopathy--its relation to complex ventricular arrhythmias and the effect of anti-arrhythmia agents].

UNLABELLED: The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HCM): 1. The relation of rate corrected QT interval (QTc) and of QTc interlead variability (QTc dispersion) to complex ventricular arrhythmias (CVA); 2. The effects of amiodarone (Am), beta-blockers (beta B) and calcium antagonists (CA) on QTc and on QTc dispersion. Surface 12 leads ECG was analysed in 55 patients with HCM (39 +/- 12 years, 32 males). All patients were in sinus rhythm, without bundle branch block. Maximum (max), minimum (min) and mean QTc values were considered. QTc dispersion was calculated as: a) max QTc - min QTc (max-min); b) dispersion index (DI) = standard deviation of QTc/mean QTcx100. Patients groups were defined accordingly to: 1--the absence (group A1-35 patients) or the presence (group A2-20 patients) of CVA on 24 hours Holter monitoring; II--absence of cardioactive medication (group B1-20 patients) versus monotherapy with Am (group B3-10 patients), or beta B (group B4-15 patients), or CA (group B5-10 patients). Age, gender, type of HCM (asymmetric versus concentric) and echocardiographic fractional shortening were not different in the studied groups. RESULTS: [table: see text] CONCLUSIONS: 1. Maximum QTc interlead QTc dispersion are increased in patients with HCM that show CVA on Holter monitoring; 2. Amiodarone prolongs QTc but reduces QTc dispersion, while beta-blockers and calcium antagonists do not significantly change neither the duration nor the dispersion of ventricular repolarization.

Adrenergic beta-Antagonists↗