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At least 847 records · Page 47Linked to original sources
PubMed2005

Pulmonary emboli: the differential diagnosis dilemma.

Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. Many patients receiving physical therapy may be at risk for developing pulmonary embolism, especially after periods of immobilization or surgery. Patients presenting with dyspnea, chest pain, or tachypnea, particularly after trauma or surgery, have an increased likelihood of pulmonary embolism. Clinical prediction rules have been developed, which can aid the practitioners in assessing the risk a patient has for developing pulmonary embolism. The present clinical commentary discusses the existing evidence for screening patients for pulmonary embolism. To illustrate the importance of the screening examination, a patient is presented who was referred to physical therapy 5 days after cervical discectomy and fusion. This patient was subsequently referred for medical evaluation and a confirmatory diagnosis of pulmonary embolism.

Diagnosis, Differential↗
PubMed1993

Cardiopulmonary function in men with sickle cell trait who reside at moderately high altitude.

Sickle cell trait has been associated with an unexplained increased risk of sudden death during military basic training. Previous studies of cardiopulmonary function in persons with sickle cell trait at sea level or after brief exposure to moderately high altitude have not shown significant abnormalities. To determine whether cardiopulmonary function is impaired in men with sickle cell trait who chronically reside at moderately high altitude, we prospectively studied 17 men with sickle cell trait and 25 men with normal hemoglobin. All subjects had resided at > or = 1609 m above sea level for at least 10 years. Resting pulmonary function and cardiopulmonary performance during exercise to exhaustion were evaluated. No statistically significant differences were observed between subjects with sickle cell trait and controls for any of the resting pulmonary function variables measured. All parameters of exercise performance were not statistically different between the groups. Increasing age was associated with a similar decrease in work capacity and oxygen consumption in both groups. Electrocardiogram findings were not statistically different between groups. We conclude that chronic exposure to moderately high altitude does not impair cardiopulmonary function in men with sickle cell trait.

Adult↗
PubMed1990

A simplified normalized ejection phase index measured by Doppler echocardiography for the assessment of left ventricular performance.

Although useful for the assessment of directional changes in contractility in individual patients, resting peak aortic blood velocity is of limited value for differentiating among patients with different levels of basal cardiac function. A dimensional analysis based on fluid dynamics shows that peak aortic blood velocity is not only generated by the contracting myocardium but also reflects the convective acceleration of blood from the left ventricle to the aorta. The reduction of cross-sectional area from the midleft ventricle to the aorta at the time of peak aortic blood velocity generates the convective acceleration. Accordingly, a higher convective acceleration due to left ventricular (LV) enlargement as observed in cardiomyopathy may explain why peak aortic blood velocity can be maintained as normal although myocardial contractility is depressed. This study tested the hypothesis that peak aortic blood velocity normalized by the ratio of midleft ventricle to aortic cross-sectional areas might provide a reliable index of LV performance. Nine normal control subjects and 25 patients undergoing catheterization were studied by M-mode, 2-dimensional and Doppler echocardiography. The normalized peak velocity measured noninvasively showed a high correlation with angiographic ejection fraction (r = 0.90, p less than 0.0001). Peak aortic blood velocity and the ratio of midleft ventricle to aortic cross-sectional areas alone correlated less well with ejection fraction (r = 0.76 and r = 0.75, p less than 0.0001, respectively). Furthermore, peak aortic blood velocity showed a significant overlap between patients with normal and those with abnormal LV function, whereas normalized peak aortic blood velocity was a better discriminator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Effects of changes in preload, afterload and inotropic state on ejection and isovolumic phase measures of contractility in the conscious dog.

Despite much investigation, the usefulness of various indexes employed clinically for detecting alterations in ventricular contractility in the intact circulation remains controversial. The effects of acute preload, afterload and contractility changes on both ejection and isovolumic phase measures of left ventricular function were analyzed in normal, trained conscious dogs instrumented with micromanometers and endocardial ultrasonic diameter gauges. Rapid volume overload increased the excursion of the left ventricular diameter (delta LVD) by 7 percent above the control level, but mean velocity of circumferential shortening (VCF) did not change significantly; peak rate of left ventricular pressure rise (dP/dt) increased by 11 percent and (dP/dt)/DP40 (DP = developed pressure) was augmented by 10 percent, but maximal [(dP/dt)/LVP], or "Vpm," decreased by 20 percent. Pressure overload by phenylephrine infusion decreased delta LVD by 15 percent and mean VCF fell by 26 percent; peak dP/dt and (dP/dt)/DP40 remained unaltered, but VPM was reduced by 37 percent. Isoproterenol augmented peak dP/dt by 55 percent, and (dP/dt)/DP40, Vpm and mean VCF were increased comparably. Propranolol decreased these measures equally by about 16 percent. Therefore, in the conscious animal in the steady state, isovolumic phase indexes were mildly influenced by acute volume loading, wheras ejection phase indexes were not. Acute increases in aortic pressure markedly reduced ejection phase measures, whereas the isovolumic indexes were unaffected. All of the indexes studied were comparably sensitive to acute alterations in contractility, but we conclude that no single measure can always be used for defining an acute contractility change in the intact circulation.

Animals↗
PubMed1985

[Comparison of densitometric and morphometric measurements of global and regional functions using a fully digital subtraction unit].

The value of digital subtraction angiocardiography for evaluating left ventricular movement by a morphometric and densitometric technique was examined by animal experiments (dog). Reversible reduction of global and regional left ventricular function can be quantified by both methods equally well. For judging regional ejection fraction, sector display is more easily comprehended than an ejection-fraction map. For the estimation of global cardiac ejection fraction in 49 patients, morphometric diagnosis was clearly superior to cine cardio-angiography (rmorp. = 0.91; rdens = 0.65). For recognising and quantifying regional abnormalities of cardiac movement, semi-quantitative visual gradation is superior to densitometric measurements.

Absorptiometry, Photon↗
PubMed1995

Left ventricular geometry and cardiac function in mild to moderate essential hypertension.

To elucidate left ventricular (LV) cardiac structure and function in patients with mild to moderate essential hypertension, we studied the relationship between LV geometry and function. We evaluated LV diastolic and systolic functions by M-mode echocardiography in 91 age-matched normotensive control subjects (NT) and 124 patients with essential hypertension. Hypertensive patients were divided into two groups based on the WHO stage classification: WHO I (n = 76) and WHO II (n = 48). Patients in WHO I and WHO II were further categorized according to the relative wall thickness as normal left ventricle (n = 47), concentric remodeling (n = 29), concentric hypertrophy (n = 25), and eccentric hypertrophy (n = 23). LV diastolic function was significantly decreased in the hypertensive groups compared to NT. There was no significant difference in LV systolic performance among NT, WHO I and WHO II. LV contractility was significantly increased in WHO I compared to NT. In respect to ventricular geometric pattern, LV diastolic function was significantly decreased in both the concentric hypertrophy and eccentric hypertrophy groups. LV systolic dysfunction was noted only in the eccentric hypertrophy group. In conclusion, patients with concentric remodeling had normal systolic and diastolic functions. LV diastolic function was impaired in both the concentric and eccentric hypertrophy groups due to an increase in LVMi. Moreover, LV systolic impairment was noted in the eccentric hypertrophy group due to an inappropriate compensation to LV systolic load.

Adult↗
PubMed2001

[Present and future of cardiac function tests: electrophysiologic tests].

Various electrocardiographic and physiologic tests have been developing for almost 100 years since Einthoven established the standard 12 lead electrocardiogram(ECG) system. Recently, interest has focused on the new developing parameters associated with cardiac ventricular repolarization, such as transmural dispersion of repolarization, T wave alternans and QT dispersion. QT dispersion, measured as interlead difference of QT interval, has been suggested to reflect regional variation of ventricular repolarization. However, still unsolved basic problems give difficulties for clinical acceptance of this parameter. On the other hand, it is generally accepted that heart rate variability obtained from Holter ECG is useful tool to assess the autonomic tone. Head-up tilt test is a valuable diagnostic tool to identify patients with neurally mediated syncope and also useful for assessment of reflex cardiac autonomic function, such as baroreflex sensitivity. The number of electrophysiologic study(EPS) dramatically increased together with increase of radiofrequency catheter ablation. A new three-dimensional nonfluoroscopic electroanatomical mapping system(CARTO) is an exciting development in catheter ablation treatment. Transtelephonic ECG and its computer-assisted answering system are also useful for diagnose and treatment in the patients of paroxysmal cardiac symptoms.

Action Potentials↗