Is there a utility for QRS dispersion in clinical practice?

Prognostic markers derived from standard ECG have always been seductive. Increased dispersion of durations of the P wave, of the QRS complex, or of the QT interval has been associated with the risk of atrial fibrillation, ventricular arrhythmias, sudden cardiac death, as well as with a general negative prognosis in various settings. However, these markers have intrinsic and methodological issues that question their utility. This paper presents data supporting the utility of QRS dispersion in clinical practice. Our investigation shows that QRS dispersion is a simple electrocardiographic marker with potential value in the assessment of patients in a variety of clinical settings: ischemic heart disease, heart failure, and cardiomyopathies. More studies are needed to validate QRS clinical utility for predicting the risk for ventricular arrhythmias and sudden cardiac death, and for the evaluation of the response to cardiac resynchronization therapy

The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart failure by atrio-ventricular, interventricular, or intraventricular conduction disorders, which lead to the desynchronization of electrical activity. Cardiac resynchronization therapy can effectively improve the clinical and haemodynamic status of these patients. According to literature data, CRT is performed only on well-selected patients (who qualify for CRT based on current indications), and approximately 70% of those patients respond favorably. We present the case of a patient responsive to cardiac resynchronization therapy which led to lowering of his NYHA classification and to improvement of left ventricle hemodynamics. The benefits of cardiac resynchronization therapy were multiple in this case, including improved tolerance to physical exercise and a decreased rate of hospitalization, which overall led to improved quality of life

Non-compaction cardiomyopathy – brief review

Left ventricular non-compaction cardiomyopathy is a genetic disorder characterized by the presence of two myocardial layers with numerous prominent trabeculations and deep inter-trabecular recesses that communicate with the ventricular cavity. The diagnosis is often challenging because excessive trabeculations may also be a normal finding in performance athletes and black people. Echocardiography is the gold standard for diagnosis of this condition, but other useful diagnostic techniques may include cardiac magnetic resonance imaging, computed tomography, and contrast ventriculography. Moreover, newer echocardiographic methods such as three-dimensional imaging and speckle tracking analysis promise to improve the diagnosis of left ventricular non-compaction cardiomyopathy. The purpose of this paper is to review the pathogenesis, diagnosis, and management of this disease

Endothelial dysfunction in adolescents and young adults with nonalcoholic liver disease

Nonalcoholic liver disease is a global public health problem that increases cardiovascular morbidity and mortality in these patients. This paper discusses endothelial dysfunction among patients (adolescents and young adults) with nonalcoholic liver disease. On the one hand, evidence suggests that cardiovascular disease is the leading cause of mortality in patients with advanced nonalcoholic liver disease and that nonalcoholic fatty liver is associated with an increased risk of cardiovascular disease independent of the presence of cardiovascular risk factors and metabolic syndrome components. On the other hand, nonalcoholic liver disease, especially the non-inflammatory form of nonalcoholic steatohepatitis, may not only be a marker of cardiovascular damage but also a factor involved in its pathogenesis. Such patients are candidates not only for the treatment of liver disease but also for the early treatment of cardiovascular risk factors because many of them, especially those with severe nonalcoholic liver disease, will develop major cardiovascular events and may eventually die of cardiovascular disease before the advanced liver disease occurs

Taquicardia auricular intermitente que simula un flutter auricular

A 59-year-old woman presented in the emergency department accusing palpitations and chest pain, started two hours prior. She was being treated for hypertension with indapamide and an angiotensin converting enzyme inhibitor, and has had an episode of paroxysmal atrial fibrillation in the last year. The thyroid function was normal six months prior to the admission.Mujer de 59 años de edad que acudió al Servicio de Urgencias por presentar palpitaciones y dolor en el pecho, que habían comenzado dos horas antes. Llevaba tratamiento con indapamida y un inhibidor de la enzima conversora de la angiotensina para su hipertensión arterial, y había tenido un episodio de fibrilación auricular paroxística el año anterior. La función tiroidea era normal seis meses antes

Flujo pericárdico por Doppler en un infarto agudo de miocardio

Pericardial Doppler flow in acute myocardial infarctionFlujo pericárdico por Doppler en un infarto agudo de miocardi

Neumopericardio en un paciente joven con pericarditis tuberculosa

A 19-year old male presented in the Emergency Room complaining of dyspnea that progressively worsened in the previous week. He also reported asthenia and dry cough in the last month. Clinical exam showed altered general status, pale skin, polypnea, tachycardia at 124 heart beats/min, deafened heart sounds, blood pressure of 100/60 mmHg and jugular vein turgescence. Auscultation of the lungs revealed no abnormal findings. The chest X-ray showed the presence of air surrounding the heart with a sharply outlined pericardium (Panel A, arrows). The CT scan showed minimal pericardial fluid effusion and a remarkable pneumopericardium (Panel B). The patient was sent to the Thoracic Surgery Department where pericardial drainage was done. The biological exam of the pericardial liquid confirmed the suspicion of tuberculous pericarditis. He was discharged with standard antituberculous treatmentHombre de 19 años que acudió al Servicio de Urgencias con disnea, empeorada desde la semana anterior. También informó astenia y tos seca en el último mes. El examen clínico mostró toma del estado general, piel pálida, polipnea, taquicardia a 124 latidos por minuto, ruidos cardíacos apagados, presión arterial de 100/60 mmHg e ingurgitación yugular. La auscultación pulmonar no reveló hallazgos anormales. La radiografía de tórax mostró la presencia de aire alrededor del corazón, con un pericardio marcadamente delineado. La tomografía computarizada mostró un derrame pericárdico mínimo y un neumopericardio significativo. El paciente fue enviado al Departamento de Cirugía Torácica donde se le realizó el drenaje pericárdico y el examen biológico del líquido confirmó la sospecha de pericarditis tuberculosa. Fue egresado con tratamiento antituberculoso estándar

Correlaciones de la función diastólica en pacientes con cirrosis hepática alcohólica

Introduction: There are few established correlations between echocardiographic and biological parameters, and the severity of hepatic alcoholic disease; and even fewer prognostic correlations. Objective: The present study is aiming at establishing correlations between severity of hepatic alcoholic disease and cardiac structural and functional alterations, as well as their prognostic implications.Method: We investigated a group of 50 patients with liver cirrhosis of alcoholic etiology, classified by Child-Pugh score. Routine laboratory tests and transthoracic echocardiography were performed, NT-proBNP level was measured in each.Results: We found that patients with more severe liver dysfunction have a significantly worse diastolic profile. The peak early diastolic filling velocity of the left ventricle (E wave) was significantly higher, with lower tissue Doppler velocities at annular level and high ratio between E and e’, which point to the severity of the diastolic dysfunction. When comparing the indexed volumes of heart cavities, we did not find significant differences regarding left atrium indexed volume, left ventricle end-diastolic or end-systolic indexed volumes. Patients with Child class B liver disease had significantly lower levels of NT-proBNP.Conclusions: This study is revealing the significant association between diastolic dysfunction of the left ventricle and severity of the alcoholic liver cirrhosis, as well as the correlation between E/e’ ratio value, Child-Pugh class and also higher values of NT-proBNP. The benefit is that patients with alcoholic cirrhosis can be also classified according to the existence and severity of left ventricular diastolic dysfunction so that these patients could benefit from a stricter monitoring and closer follow-up. Introducción: Existen pocas correlaciones establecidas entre los parámetros ecocardiográficos y biológicos con la gravedad de la enfermedad hepática alcohólica, y aún menos parámetros asociados al pronóstico.Objetivo: Establecer la asociación entre la gravedad de la enfermedad hepática alcohólica y las alteraciones estructurales y funcionales cardíacas, así como sus implicaciones pronósticas.Método: Se investigó un grupo de 50 pacientes con cirrosis hepática de origen alcohólico, clasificados según la puntuación Child-Pugh. A todos los pacientes se les realizaron pruebas de laboratorio de rutina, determinación de los niveles de NT-proBNP, y ecocardiograma transtorácico. Resultados: Los pacientes con disfunción hepática más grave tuvieron un perfil diastólico significativamente peor. La velocidad máxima de llenado protodiastólico del ventrículo izquierdo (onda E) fue significativamente más alta, con velocidades inferiores en el Doppler tisular a nivel del anillo, y una relación E/e' elevada, lo que apunta a la gravedad de la disfunción diastólica. No se encontraron diferencias significativas con respecto a los volúmenes indexados de la aurícula izquierda y del ventrículo izquierdo en telediástole y telesístole. Los pacientes con enfermedad hepática en clase B de Child tuvieron niveles significativamente más bajos de NT-proBNP.Conclusiones: Existe asociación significativa entre la disfunción diastólica del ventrículo izquierdo y la gravedad de la cirrosis hepática alcohólica, así como entre el valor de la relación E/e', la clase de Child-Pugh y los valores más elevados de NT-proBNP. Los pacientes con cirrosis alcohólica también se pueden clasificar según la existencia y gravedad de la disfunción diastólica del ventrículo izquierdo, de modo que estos pacientes puedan beneficiarse de una evaluación más certera y un seguimiento más estrecho