NON-INVASIVE ASSESSMENT OF THE PERFORMANCE OF THE RIGHT HEART DURING DYNAMIC EXERCISE, A STUDY OF LEFT-SIDED HEART DISEASE
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A simplified, non-invasive method for assessment of the performance of the right heart during supine leg exercise was described, which necessitated no more than a bicycle"ergometer"for leg exercise, a radiocardiograph for recording cardiac index (CI) and a"water"manometer for measuring cubital venous pressure (VP). Because the use of a cardiac catheter was omitted, right atrial pressure (RA), right ventricular diastolic pressure (RVd) or pulmonary arterial pressure (PA) were not measured. In 11 healthy subjects and 25 patients with primarily left-sided valvular disease and hypertension, the observed shift of CI-VP plot with exercise was similar to the published records of exercise-induced shift of CI-RA plot or CI-RVd plot in normal subjects and the same types of heart disease. With levels of load used in this study, a dividing line separating normal from abnormal elevation of VP during supine leg exercise (ΔVP) could be drawn at ΔVP=35 mm H2O and (2) in these types of heart disease, ΔVP in excess of 35 mm H2O was always associated with a"subnormal"increase in CI (ΔCI < 0.8 lit. min-1. M-2) with exercise, except in a few cases who appeared, clinically, to be in what may be termed"latent heart failure". Factors probably responsible for an impaired pumping ability of the right heart during exercise in left-sided heart disease were discussed, in relation to ΔVP.Keywords:
Supine position
Hypertensive heart disease
It is well known that the diastolic dysfunction of the left ventricle plays an important ole in the pathophysiology of heart failure in the various cardiac diseas. And many hypertensive patinents manifest diastolic dysfunction of the left ventricle in its early stage. Thus, early detection of left ventricular diastolic dysfunction has clinical importance in management and prognosis of hypertensive heart disease.For the evaluation of the left ventricular diastolic function in the hypertensive patients, 30 normotensive control subject and 30 untreated essential hypertensive patients were studied by pulsed Doppler echocardiography at the left ventricular inflow, and then E/A velocity ratio [E/A (v)], early diastolic deceleration time(EDDT), and late diastolic time(LDT) were measured after confirming normal ejection fraction by M-mode echocardiography. The hypertensive patients were subgrouped according to the level of the diastolic pressure(Group A : mild, Group B: moderate, Group C: severe) and the each parameters of different groups were compared with those of the normal control group.The result were as follows :1) In the 30 noraml control group. ejection fraction was 69.4±4.6% and in the 30 hypertensive patients group, it was 66.7±5.3%. There was no significant differences between the normal control and the hypertensive patients group.2) In the normal control group, E/A (v) was 1.54±0.32, EDDT was 147±13.4msec, LDT was 159±14.8 msec, and in all hypertensive patients group, mean E/A (v) was 0.80±0.38, mean EDDT was 165±19.4 msec, mean LDT was 149±14.9 msec. E/A (v) was significantly decreased(P<0.005) and EDDT was prolonged(P<0.025), compared with those of the normal control group, but there was no significant difference in LDT.3) In Group A, E/A (v) was significantly decreased(0.98±0.36, P<0.005), compared with those of the normal control group, but there was no significant difference in EDDT(155±18.5 msec).4) In Group B, E/A (v) was markedly decreased(0.76±0.45, P<0.005), and EDDT was significantly prolonged(170±24.8 msec, P<0.025), compared with those of the normal control group.5) In Group C, E/A (v) was significantly decreased(0.66±0.32, P<0.005), and EDDT was prolonged(171±21.3 msec, P<0.01), compared with those of the normal control group.Above results suggest that diastolic dysfunction of the left ventricle can precede the systolic dysfunction and clinical deterioration even in the mild hypertensive patients, and pulsed Doppler echocardiographic diastolic indices such as E/A (v) and EDDT play an important role in the early detection of the left ventricular diastolic dysfunction in the hypertensive patients.
Hypertensive heart disease
Diastolic heart failure
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Analysis of the data from 7188 cases seen in the 1980s two general hospitals in Shanghai and comparison of the data with those in the 1950s, 1960s and 1970s revealed that the percentage of heart diseases among the inpatients in medical wards increased in each decades, from 9.89%, 15.69% 20.91% to 23.54% respectively. The constituent ratios of different etiologic types of heart diseases changed. Coronary heart disease constituted the largest proportion, next in number was rheumatic heart disease and congenital heart disease was in the third place. The incidence of congenital heart diseases, myocarditis, cardiac dysrhythmias without organic heart diseases, cardiomyopathy and endocarditis increased and that of rheumatic heart disease, pulmonary heart disease and hypertensive heart disease apparently decreased, syphilitic heart disease was rarely encountered.
Hypertensive heart disease
Pulmonary heart disease
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Central venous pressure (CVP) was measured in 14 males during 23.3 +/- 0.6 s (mean +/- SE) of weightlessness (0.00 +/- 0.05 G) achieved in a Gulfstream-3 jet aircraft performing parabolic flight maneuvers and during either 60 or 120 s of +2 Gz (2.0 +/- 0.1 Gz). CVP was obtained using central venous catheters and strain-gauge pressure transducers. Heart rate (HR) was measured simultaneously in seven of the subjects. Measurements were compared with values obtained inflight at 1 G with the subjects in the supine (+1 Gx) and upright sitting (+1 Gz) positions, respectively. CVP was 2.6 +/- 1.5 mmHg during upright sitting and 5.0 +/- 0.7 mmHg in the supine position. During weightlessness, CVP increased significantly to 6.8 +/- 0.8 mmHg (P less than 0.005 compared with both upright sitting and supine inflight). During +2 Gz, CVP was 2.8 +/- 1.4 mmHg and only significantly lower than CVP during weightlessness (P less than 0.05). HR increased from 65 +/- 7 beats/min at supine and 70 +/- 5 beats/min during upright sitting to 79 +/- 7 beats/min (P less than 0.01 compared with supine) during weightlessness and to 80 +/- 6 beats/min (P less than 0.01 compared with upright sitting and P less than 0.001 compared with supine) during +2 Gz. We conclude that the immediate onset of weightlessness induces a significant increase in CVP, not only compared with the upright sitting position but also compared with the supine position at 1 G.
Supine position
Weightlessness
Sitting
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Central venous pressure (CVP) was measured in 14 males during 23.3 +/- 0.6 s (mean +/- SE) of weightlessness (0.00 +/- 0.05 G) achieved in a Gulfstream-3 jet aircraft performing parabolic flight maneuvers and during either 60 or 120 s of +2 Gz (2.0 +/- 0.1 Gz). CVP was obtained using central venous catheters and strain-gauge pressure transducers. Heart rate (HR) was measured simultaneously in seven of the subjects. Measurements were compared with values obtained inflight at 1 G with the subjects in the supine (+1 Gx) and upright sitting (+1 Gz) positions, respectively. CVP was 2.6 +/- 1.5 mmHg during upright sitting and 5.0 +/- 0.7 mmHg in the supine position. During weightlessness, CVP increased significantly to 6.8 +/- 0.8 mmHg (P less than 0.005 compared with both upright sitting and supine inflight). During +2 Gz, CVP was 2.8 +/- 1.4 mmHg and only significantly lower than CVP during weightlessness (P less than 0.05). HR increased from 65 +/- 7 beats/min at supine and 70 +/- 5 beats/min during upright sitting to 79 +/- 7 beats/min (P less than 0.01 compared with supine) during weightlessness and to 80 +/- 6 beats/min (P less than 0.01 compared with upright sitting and P less than 0.001 compared with supine) during +2 Gz. We conclude that the immediate onset of weightlessness induces a significant increase in CVP, not only compared with the upright sitting position but also compared with the supine position at 1 G.
Supine position
Weightlessness
Sitting
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Objective To explore the changes on the value of CVP with different body postures after upper abdominal surgery in order to provide accurate basis for better monitoring of central venous pressure(CVP). Methods The CVP, blood pressure,pulse,respiration of 43 patients after upper abdom-inal surgery with indwelling central venous catheter were measured under supine position, 15°dorsal ele-vated position and 30°dorsal elevated position.The data were collected for correlation and regression analysis. Results The CVP value increased with the elevation of body postures,the CVP value under supine position was linearly positively correlated with the other two positions(P<0.01).The regression e-quation of supine position and 15°dorsal elevated position was:Y=1.009X1+0.811; the regression equation of supine position and 30°dorsal elevated position was:Y=1.005X2+1.630. Conclusions Through moni-toring the CVP value under 15°dorsal elevated position and 30°dorsal elevated position,and substitute it in equation,we can evaluate the CVP value under supine position.
Key words:
Central venous pressure; Body postures; Measurement
Supine position
Position (finance)
Body position
Venous return curve
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Diastolic dysfunction is an important factor contributing to the appearance of symptomatic heart failure, particularly among elderly women with arterial hypertension. In hypertensive heart disease, the presence of cardiac fibrosis is an important determinant of abnormal myocardial stiffness that contributes to diastolic dysfunction. Recent studies indicate the feasibility of a pharmacology-based regression of fibrosis and improvement in diastolic stiffness.
Myocardial fibrosis
Hypertensive heart disease
Diastolic heart failure
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Part 1 Normal heart and cardiac response to disease: anatomy of the heart remodelling heart failure/low output and high output arrhythmias. Part 2 Specific heart diseases: coronary artery disease valvular heart disease congenital heart disease myocardial heart disease pericardial heart disease pulmonary heart disease infective endocarditis cardiovascular trauma diseases of the aorta peripheral vascular disease. Part 3 The heart and other conditions: hypertension hyperlipidaemia exercise and the heart obesity and the heart ageing and the heart alcohol and the heart cocaine and the heart neoplastic and haematologic diseases of the heart cerebrovascular diseases endocrine diseases and the heart diseases affecting the heart and kidneys pregnancy and the heart collagen vascular disease and the heart.
Hypertensive heart disease
valvular heart disease
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Based on the results of head-down simulation studies and the results of parabolic flights, the hypothesis was tested that central venous pressure (CVP) in humans increases during microgravity (weightlessness) compared with during the ground-based supine position. CVP was recorded with an intravascular pressure transducer in seven healthy humans during short (20-s) periods of microgravity created by parabolic-flight maneuvers and in one astronaut before, during, and up to 3 h after launch of the Spacelab D-2 mission (Space Transport System-55). When the subjects were supine during the parabolic maneuver, CVP decreased during microgravity from 6.5 +/- 1.3 to 5.0 +/- 1.4 mmHg (P < 0.05). during the Spacelab D-2 mission, CVP was 6.2 mmHg during the initial minutes of microgravity, which was very similar to the value of 6.5 mmHg in the supine position 3.5 h before launch of the space shuttle. During the subsequent 3 h of weightlessness, CVP during rest varied between 2.0 and 6.2 mmHg. We conclude that CVP during short (20-s) and longer (3-h) periods of microgravity is close to or below that of the supine position on the ground.
Supine position
Weightlessness
Head-Down Tilt
Spaceflight
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Objective To investigate the incidence,types and outcomes of heart diseases in pregnant women and the current obstetric management methods.Methods Clinical data of 159 cases of pregnant women with heart diseases from April 2004 to April 2009 were analyzed retrospectively.Results ①The highest incidence of cardiac disease in the local region was 31.45% for congenital heart disease(50 cases).The incidence of heart disease caused by hypertensive disorders in pregnancy was 27.04%(43 cases),higher than that of rheumatic heart disease(25 cases,15.72%).②Grade Ⅳ cardiac function was mainly related to heart disease caused by hypertensive disorders in pregnancy.The pregnant women with grade Ⅰ-Ⅱ heart function after heart operation accounted for 84.62%.③The incidence of premature delivery,low weight of newborns and perinatal mortality were higher in women with grade Ⅲ-Ⅳ heart function than in those with grade Ⅰ-Ⅱ heart function.Conclusion The incidences of congenital heart disease and heart disease caused by hypertensive disorders in pregnancy are the highest in the local region.Prenatal monitor,systematic prenatal care and termination of the pregnancy in time can improve the outcome of both mothers and babies.
Hypertensive heart disease
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Acoustic quantification (AQ) and color kinesis (CK) are techniques that involve automated detection and tracking of endocardial borders. These methods are useful for the evaluation of global and regional left ventricular (LV) systolic function and more recently have been applied to evaluating LV diastolic performance. Assessment of diastolic dysfunction in hypertensive heart disease is a relevant clinical issue in which these techniques have proven useful. The diastolic portion of left atrium and LV AQ area waveforms are frequently abnormal in patients with left ventricular hypertrophy (LVH). Left ventricular AQ curves consistently demonstrate reduced rapid filling fraction (RFF) and peak rapid filling rate (PRFR), elevated atrial filling fraction (AFF), peak atrial filling rate (PAFR), and reductions in the ratio PRFR/PAFR. Acoustic quantification complements traditional Doppler echocardiographic evaluation of global diastolic function. Many patients with significant LVH and normal Doppler diastolic parameters can be identified as having diastolic dysfunction with AQ. In addition, CK has allowed the evaluation of regional diastolic performance in hypertensive patients. Regional filling curves obtained from CK have demonstrated that endocardial diastolic motion is commonly delayed and heterogeneous in patients with LVH.
Hypertensive heart disease
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