Biomedical subjects
Publications and source records attributed to D L Cunha.
Syncope is a frequent symptom, with an expensive protocol of difficult evaluation in face of its diverse causes. The authors describe the proper use of the tests available, particularly the tilt test, and conclude that nowadays only few syncopal episodes would remain unexplained.
The authors describe a case of a middle-age male with recurrent syncope, in whom the tilt test was useful in the diagnosis and therapeutic evaluation. Malignant criteria of vasovagal syncope were established and the beta blocking worsening effect was documented, in spite of the general agreement of the first choice drug.
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The authors report a case of right ventricle endomyocardial fibrosis in a 6-year-old boy. Particular attention is paid to the discussion of the new methods for diagnosing and treating these conditions, namely echocardiography, endomyocardial biopsy and surgery.
OBJECTIVE: The authors studied 14 children with myocarditis in order to correlate clinical and laboratorial data with evolution. DESIGN: Retrospective study of all cases with myocarditis admitted during a 2 year period. SETTING: Unidade de Cardiologia Pediátrica do HSJ. PATIENTS: 14 patients, aged 7 to 34 months, with the diagnosis of myocarditis on the ground of biopsy or necropsy findings. The clinical data analysed were: medical history, physical examinations, hematological and biochemical studies, chest X ray, electro and echocardiogram, virus and immunological studies and cardiac catheterization. RESULTS: All the patients had congestive heart failure and 10 had a history of a previous viral infection. Those who survived the first week were submitted to hematological and biochemical studies, chest X Ray, electrocardiogram, echocardiogram, virological and immunological studies and cardiac catheterization. All patients were treated with captopril and furosemide, 11 received dobutamine and 6 an immunosuppressive regime. Six patients died in the first week and one, nine months after diagnosis. One patient had an unfavourable course and the other six improved clinically. CONCLUSIONS: The authors were not able to find any correlation between laboratorial data and the disease outcome. Age less than one year and an abrupt onset were associated with 100% mortality. Immunosuppression was associated with improvement in 66% of the patients.
OBJECTIVE: To determine the echocardiographic end-systolic ventricular geometry value in evaluating right ventricular systolic pressure (RVSP). MATERIAL AND METHODS: We studied prospectively 68 patients (mean age = 6.0 +/- 5.0 years), submitted to cardiac catheterization for cardiac disorders not involving left ventricular (LV) outflow tract obstruction, within 24 hours after two-dimensional echocardiographic (2D echo) examination. 2D echo evaluation of RVSP was performed using end-systolic LV transverse orthogonal diameters (TDR). The LV transverse orthogonal diameters (antero-posterior and supero-inferior) were measured on a parasternal short-axis image, at the tips of papillary muscles. 2D echo semi-quantitative evaluation of RVSP was tested correlating TDR with hemodynamic RVSP/LV systolic pressure (LVSP) ratio--group 1. We also used regression equation derived from the first 35 patients to quantify RVSP in the last 33 patients--group 2. In these cases, systolic systemic arterial pressure measured by sphygmomanometry was taken as LVSP. RESULTS: The TDR ranged from 1.0 to 2.1 (mean = 1.5 +/- 0.3) and the RVSP/LVSP ratio from 0.3 to 1.7 (mean = 0.7 +/- 0.4). All patients with RVSP/LVSP greater than or equal to 65% have TDR greater than or equal to 1.3 and when RVSP less than or equal to 35 mmHg we always obtained TDR less than or equal to 1.2. The correlation between 2D echo estimated and catheter measured RVSP shows, for group 1, r = 0.88 and y = 1.1X-0.88 and, for group 2'. r = 0.88. CONCLUSION: In the absence of LV systolic obstruction, TDR is a reliable non invasive method in evaluating the RVSP.