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At least 1,405 records · Page 78Linked to original sources
PubMed2000

[Acute right heart failure. Etiology--pathophysiology--diagnosis--therapy].

Impaired right ventricular (RV) function may be caused by pulmonary hypertension or myocardial ischemia. It is characterized by a dilation of the RV, which is followed by an increase of wall tension and O2-consumption and a decrease of RV ejection fraction (RV 'dysfunction'). If a drop of arterial pressure occurs this my precipitate RV failure and shock (RV 'insufficiency'). Diagnosis of RV failure and monitoring of RV function is difficult. Sometimes, even a severe impairment of RV function goes undetected or is misinterpreted. Patients in the operating room or on intensive care units seem to be especially prone to RV dysfunction and failure. Since a causative therapy often is not readily available, adequate symptomatic therapy is of utmost importance. Four basic principles have to be considered: 1) Optimizing preload: The failing RV requires adequate filling for preservation of stroke volume. On the other hand, overdistension of the RV may result in RV ischemia, thereby further deteriorating RV function Hence, volume loading is important, but requires continuous monitoring. 2) Maintenance of aortic pressure: Vasopressors are indicated if there is a critical drop of coronary perfusion pressure. Norepinephrine presently is the drug of choice for this purpose. 3) Reduction of RV afterload: Whereas intravenous vasodilators are limited in their efficacy in dilating pulmonary vessels due to systemic side effects, inhaled vasodilators result in selective pulmonary vasodilation and may improve RV function. 4) Increase of RV contractility: In RV failure and shock, norepinephrine and epinephrine are the drugs of choice. Inodilators are well suited for reducing pulmonary vascular resistance due to their positive inotropic and vasodilating effects. Since systemic vasodilation may occur, these drugs must only be used in hemodynamically stable patients.

Acute Disease↗
PubMed1999

Electrocardiographic diagnosis of right ventricular infarction in the presence of left ventricular posterior infarction.

Conventional criteria of ST segment elevation in right sided chest leads or loss of initial 'r' wave in leads V3R or V4R have low sensitivity and specificity in diagnosing right ventricular involvement in the presence of left ventricular posterior infarction. Slurring of R wave either in right sided chest leads or in lead aVR can diagnose right ventricular involvement in such a setting with a sensitivity of 70% and specificity of 94%.

Echocardiography↗
PubMed2001

Myocardial flow reserve in patients with a systemic right ventricle after atrial switch repair.

OBJECTIVES: The purpose of this study was to assess myocardial blood flow (MBF) and flow reserve in systemic right ventricles (RV) in long-term survivors of the Mustard operation. BACKGROUND: There is a high prevalence of systemic RV dysfunction and impaired exercise performance in long-term survivors of the Mustard operation. A mismatch between myocardial blood supply and systemic ventricular work demand has been proposed as a potential mechanism. METHODS: We assessed MBF at rest and during intravenous adenosine hyperemia in 11 long-term survivors of a Mustard repair (age 18+/-5 years, median age at repair 0.7 years, follow-up after repair 17+/-5 years) and 13 healthy control subjects (age 23+/-7 years), using N-13 ammonia and positron emission tomography imaging. RESULTS: There was no difference in basal MBF between the systemic RV of survivors of the Mustard operation and the systemic left ventricle (LV) of healthy control subjects (0.80+/-0.19 vs. 0.74+/-0.15 ml/g/min, respectively, p = NS). However, the hyperemic flows were significantly lower in systemic RVs than they were in systemic LVs (2.34+/-0.0.69 vs. 3.44+/-0.62 ml/g/min respectively, p < 0.01). As a result, myocardial flow reserve was lower in systemic RVs than it was in systemic LVs (2.93+/-0.63 vs. 4.74+/-1.09, respectively, p < 0.01). CONCLUSIONS: Myocardial flow reserve is impaired in systemic RVs in survivors of the Mustard operation. This may contribute to systemic ventricular dysfunction in these patients.

Adolescent↗
PubMed2004

The role of nitric oxide and vasopressin in refractory right heart failure.

The standard treatment for right heart failure includes aggressive fluid resuscitation, inotropic agents, and avoiding drugs, such as diuretics or nitrates, or maneuvers that decrease pre-load. Even an increase in vagal tone caused by the insertion of a bladder catheter can acutely decrease preload and lead to cardiogenic shock. Other modalities include early reperfusion therapy and pacemaker implantation for complete heart block or loss of atrioventricular synchrony. Acute right heart failure carries a very high mortality because of the limited options available for its management. Among newer treatments, inhaled nitric oxide and intravenous vasopressin have shown promise for acute right ventricular failure.

Administration, Inhalation↗
PubMed1997

[Assessment of 123I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) myocardial scintigraphy in patients of chronic right ventricular overload--fatty acid metabolism in right ventricular myocardium].

An investigation on the right ventricular pressure level and the abnormalities in the fatty acid metabolism of myocardium was made using 123I-beta-methyl-iodophenyl pentadecanoic acid (BMIPP) myocardial SPECT in patients with chronic right ventricular overloading. Twenty patients who presented with right ventricular systolic pressure (RVSP) of 35 mmHg or more were used as the subjects. Dual myocardial SPECT with 201TlCl (Tl) and BMIPP was carried out for the subjects and RVc/LVc, a ratio of radioactivity count incorporated in the right ventricular free wall to the left one was determined for Tl and BMIPP. And the correlations between RVc/LVc and RVSP, and RVc/LVc and RVSP/LVSP were examined. The subjects were classified into 3 groups based on the RVSP levels and the count ratio, BMIPP/Tl was compared among the three groups. With respect of Tl uptake, there were significant, positive correlations between RVc/LVc and RVSP (correlation coefficient r = 0.51, p < 0.05) and between RVc/LVc and RVSP/LVSP (correlation coefficient r = 0.59, p < 0.01). On the other hand, no significant correlation was found between them with respect of the uptake of BMIPP. The BMIPP/Tl ratio in the group with higher than 80 mmHg of RVSP was 0.82 +/- 0.06, which was significantly lower than the ratio's for two groups of less than 80 mmHg; 0.91 +/- 0.07 and 0.98 +/- 0.04 in the group with 35-49 and 50-79 mmHg of RVSP, respectively. These results show that when compared with BMIPP, Tl is superior for the estimation of right ventricular pressure. For the patients with right ventricular overloading, it was suggested that when RVSP reaches 80 mmHg or more, there appear some disorders in the fatty acid metabolism in the right ventricular myocardium.

Aged↗
PubMed1996

[Endomyocardial fibrosis of the right heart in Behçet disease].

Cardiac involvement is rare in Behçet's disease. Endomyocardial fibrosis of the right heart is exceptionally rare and is associated with right ventricular thrombosis. The authors report the case of a 27 year old man who died of a massive pulmonary embolism and who suffered from right-sided endomyocardial fibrosis with intraventricular thrombi. The diagnosis was made at autopsy. Behçet's disease was diagnosed on the finding of bipolar aphthous ulcers and skin hypersensitivity. The authors support previous workers in stating that Behçet's disease should be considered as a possible cause of endomyocardial fibrosis of the right heart.

Adult↗
PubMed2004

The use of isovolumic contraction velocity to determine right ventricular state of contractility and filling pressures A pulsed Doppler tissue imaging study.

AIMS: Echocardiographic techniques have not so far been able to provide a good estimation of myocardial contractility in humans. Myocardial motion during the isovolumic contraction phase, measured by Doppler tissue imaging, has only recently in experimental models been shown to describe myocardial contractility. The aim of the present clinical study was to investigate the relationship between right ventricular isovolumic contraction velocity and right ventricular state of contractility. METHODS AND RESULTS: Doppler tissue imaging and cardiac catheterization were performed simultaneously in 26 consecutive patients with different cardiac diseases (18 males, mean age 52 +/- 12, range 23-75 years). Peak isovolumic contraction velocity was measured using Doppler tissue imaging at 2 levels of the right ventricular free wall. During cardiac catheterization, the first derivative of right ventricular pressure related to the pulmonary artery peak pressure (dP/dt/P(max)) was measured. Furthermore, right ventricular end diastolic pressure, right atrial mean pressure, pulmonary artery systolic pressure, and pulmonary artery resistance, were also measured. A significant relationship was found between isovolumic contraction velocity and dP/dt/P(max) (r = 0.59, p < 0.01). This relationship was strengthened after excluding patients with elevated right atrial pressures (r = 0.77, p < 0.001). Furthermore, a correlation was also found between basal and mid cavity isovolumic contraction velocity and right ventricular end diastolic pressure (r = -0.47, r = -0.49, p < 0.05) as well as right atrial mean pressure (r = -0.63, r = -0.55, p < 0.01). CONCLUSION: Isovolumic contraction velocity is a reproducible and easily obtainable non-invasive parameter which correlates with invasive measurements of right ventricular state of contractility and right ventricular filling pressures.

Adult↗
PubMed2000

Left bundle branch block and right axis deviation: a report of 36 cases.

Right axis deviation (RAD) with left bundle branch block (LBBB) is a rare combination. From a database of 636,000 electrocardiograms we report a series of 36 patients with this disorder. The majority of subjects had dilated cardiomyopathy with biventricular enlargement. LBBB was fixed in 21 of 36 cases. It was freshly acquired, episodic, intermittent, or physiologic in 15 of 36. The RAD was episodic in 30 of 36; it was fixed and concurrent with LBBB in only 2 cases, and never episodically concurrent. Reported for the first time here were 4 of 36 cases in which the combination of LBBB and RAD was elicited with atrial premature impulses as a rare form of QRS aberration. In one case where the combination was intermittent, a clear relationship with freshly acquired intermittent posterior fascicular block was demonstrated. The possible relationship of the deviation with variable degrees of right ventricular overload is discussed.

Aged↗
PubMed1998

Diagnosis of arrhythmogenic right ventricular cardiomyopathy by fourier analysis of gated blood pool single-photon emission tomography.

To evaluate the diagnostic performance of Fourier phase analysis of gated blood pool single-photon emission computed tomography (GBP SPECT) in arrhythmogenic right ventricular (RV) cardiomyopathy, 18 patients with confirmed arrhythmogenic RV cardiomyopathy underwent GBP SPECT and x-ray cineangiography. Results were compared with data obtained with GBP SPECT in 10 control subjects. This 3-dimensional method demonstrated good correlation with cineangiography for measurements of RV enlargement and extent of the disease; RV and left ventricular segments were analyzed with the same accuracy. Tomographic abnormalities were significant decreased RV ejection fraction, RV dilatation, nonsynchronized contraction of the ventricles, increased RV contraction dispersion, presence of segmental RV wall motion disorders and/or phase delays, and occasionally regional left ventricular abnormalities. RV-delayed phase areas were always present in our population. A scoring system with RV criteria was proposed to diagnose RV disease. Because Fourier analysis of GBP SPECT provides ventricular morphologic information for the right ventricle with the same accuracy as for the left ventricle, it may replace planar radionuclide studies. Therefore, this method is helpful in patients with a strong clinical suspicion of arrhythmogenic RV cardiomyopathy, and should be used as a screening method before right ventriculography.

Adolescent↗
PubMed2003

Decreased plasma neurohormones and improved cardiac performance after surgical treatment of chronic pulmonary embolism.

The findings of this case report suggest that quantitative assessment of plasma neurohormones and magnetic resonance imaging functional parameters in patients with right ventricular pressure overload due to chronic pulmonary embolism might be used as indicators for right ventricular function before and after intervention. Monitoring of changes in these parameters may provide quantitative follow-up of right ventricular function in these patients.

Biomarkers↗