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R Pizzarello

Publications and source records attributed to R Pizzarello.

3 recordsLinked to original sources
PubMed1991

Enhanced left ventricular diastolic function in hyperthyroidism: noninvasive assessment and response to treatment.

Hyperthyroidism is associated with a marked effect on the cardiovascular system. Despite enhanced resting ventricular systolic performance, thyrotoxicosis has been implicated as a primary cause of cardiomegaly, congestive heart failure, and decreased exercise tolerance. To further assess potential alterations in ventricular function we have noninvasively studied diastolic performance in nine newly diagnosed and untreated hyperthyroid patients. Parameters including diastolic flow velocities, isovolumic relaxation time (IVRT), and the rate of diastolic flow deceleration were compared to those of an age- and sex-matched control population, and then repeat determinations were made after beta-adrenergic blockade and again when the patients were chemically and clinically euthyroid. Before treatment the IVRT was 33.0 ms, which was significantly (P less than 0.005) shorter than the control value (57.9 ms) and in combination with other measures of diastolic function indicated enhanced left ventricular relaxation. beta-Adrenergic blockade slowed the resting heart rate from 97 to 80 beats/min (P less than 0.005) and partially normalized the rate of diastolic deceleration, but had no effect on the IVRT (33.8 ms). When patients were euthyroid, the IVRT was 51.7 ms, and other measures of diastolic performance were the same as those in controls. The current data assessing resting diastolic function in hyperthyroidism are similar to those previously reported for systolic function. Our findings of enhanced cardiac diastolic performance do not support the hypothesis that thyrotoxicosis is associated with compromised left ventricular function and suggest the possibility that the cardiac symptoms that accompany hyperthyroidism may be due to noncardiac mechanisms.

Adult↗
PubMed1976

Cardiology. acute severe mitral regurgitation.

Acute mitral regurgitation occurs as a complication of myocardial infarction in perhaps 1% of cases. The characteristic clinical findings include a new systolic murmur occurring in the setting of sudden development of acute congestive heart failure, hypotension, and shock. S3 and S4 gallops and sinus rhythm usually are present, and gross left ventricular or left atrial enlargement usually is not evident radiologically. The immediate and long-term prognoses for patients with acute severe mitral regurgitation are poor without treatment. Although medical therapy can reverse temporarily some of the hemodynamic aberrations, it does not influence survival or eliminate the need for surgical treatment. Surgery consisting of mitral valve replacement and possibly simultaneous coronary revascularization appears to offer some hope in increasing the survival rate among these patients. When acute severe mitral regurgitation is secondary to rupture of chordae tendineae in circumstances other than coronary artery disease, the outlook is not as grim. These patients may show signs and symptoms of congestive heart failure for a few weeks or, at times, many months. Again, sinus rhythm usually is present, with slight left ventircular enlargement, a relatively normal left atrial size, and markedly elevated left atrial and pulmonary arterial pressures. This constellation of findings is indicative of a large mitral regurgitant flow with preservation of left ventricular function and suggests that the patient is likely to benefit greatly from surgical treatment. The prognosis for such patients is much better than it is for the patients with acute mitral regurgitation secondary to coronary artery disease.

Acute Disease↗