Mês: maio 2011

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A longevidade é uma questão vascular, que foi bem expressa no axioma de que o homem é tão velho quanto suas artérias. Para a maioria dos homens, chega a morte primária ou secundariamente através deste portal. O início do que pode ser chamado de arterioesclerose fisiológica depende, em primeiro lugar, da qualidade do tecido arterial que o indivíduo que herdou e, secundariamente, da quantidade de desgaste a que foi sujeita.
-Sir William Osler, 1891
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Existem muitos médicos brilhantes.
Poucos são geniais.
Por definição, quem faz o convencional de forma inimitável, é brilhante.
Quem inventa o que se tornará convencional, é genial.
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Vamos extrapolar os números da pesquisa acima, com os risco de toda extrapolação:
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65% dos leitores do blog pedem cintilografia uma vez ou outra.
40% pedem, provavelmente, em metade das indicações de imagem e isquemia.
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Na região de Campinas, são feitas 400 cintilografias de perfusão miocárdica por mês.
Então, 200 poderiam ser Ecostress.
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Para 1 milhão de habitantes, 200 ecostress não pedidos.
Para 180 milhões de habitante, descontando a diferença de renda e acesso, no máximo 36 mil e provavelmente 20 mil exames de Ecostress.
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Interessante…
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Quantos laboratórios de ecocardiografia oferecem vagas plenas de Ecostress?
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Depois dizem que a ecocardiografia está em declínio como negócio!
Faltam emprendedores e sobram reclamações…
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Effect of positional changes on inferior vena cava size
Eur J Echocardiogr (2011) 12 (4): 322-325
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Aim To study the effect of positional change on inferior vena cava (IVC) diameter. The influence of positional change on IVC size is not well studied. Although the American Society of Echocardiography guidelines for chamber quantification recommend imaging the IVC in the left lateral position, many labs routinely image the IVC from the supine position.
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Conclusions The IVC dimension is larger in the supine position independent of the cardiac cycle. This may be due to increased intra-abdominal pressure and compression of the IVC by the liver in the left lateral position. HV systolic and diastolic peak Doppler velocities were not influenced by position.
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Alguém mede a veia cava inferior no decúbito lateral?
Apesar da diretriz, sempre buscamos o decúbito dorsal para avaliar o subcostal.
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Negative Stress Echocardiography in Severely Obese Patients has Good Prognostic Value: P1-09
Murphy, Michele A.
Author Information
Medical College of Georgia, Augusta, GA
Background: The evaluation of severely obese patients with chest pain is very challenging with any noninvasive testing modality, and there is limited evidence to guide clinical evaluation of these patients. We sought to evaluate the prognostic value of normal stress echocardiography (SE) in obese patients. Methods: Chart review of consecutive 1446 patients undergoing SE was performed. Medical records were reviewed and telephone contact was made to determine Major Adverse Cardiac Events (MACE: Myocardial infarction and cardiac death), subsequent hospitalization for cardiac events and cardiac intervention and ER visits at 1 year. After excluding patients with a BMI of 25-29.9 kg/m2, abnormal SE, and those who were lost to follow-up, a retrospective analysis of 508 patients was performed. There were 366 obese patients (BMI >= 30) and 142 patients with normal BMI (18.5-24.9 kg/m2). Baseline characteristics and MACE were compared between two groups using [chi]2, and Fisher’s exact test. Results: Obese patients had a mean BMI of 37.3 ±0.3 vs. 22.6±0.13 kg/m2 in normal. Age in normal patients was 53.2±1.2 years vs. 50.3±0.6 in obese. There were more whites (p= 0.0093) in the normal group and more blacks (p= 0.0095) in the obese group. More patients had hypertension (p=0.0199) and diabetes (p =0.0001) in the obese group. Obese patients also had more complaints of chest pain (p=0.0165) during initial evaluation. Definity was used more often in obese patients (p=0.0058). There were no MACE observed in the obese or the normal weight group at 1 year follow-up after a normal SE. Patients lost to follow up had similar numbers of obese and non obese subjects and similar clinical characteristics as the overall group mentioned above. Conclusions: In this large cohort of patients, normal SE has a good prognostic value at one year, even in severely obese patients with multiple cardiac risk factors including diabetes and hypertension. SE is an effective and reliable noninvasive tool in the evaluation of obese patients with chest pain.

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Tendência muito observada na prática diária, janela acústica dificilmente atrapalha o exame de ecostress, principalmente com esforço, quando a janela tende a melhorar com o aumento do espaço intercostal durante o exame…

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AQUI
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the internal carotid artery and the ratio of the peak systolic velocity in the internal carotid artery to that in the ipsilateral common carotid artery correlate with angiographically deter- mined stenosis.
Typically, 2 categories of internal CAS severity are defined by ultrasound, one (50% to 69% stenosis) that represents the inflection point at which flow velocity accelerates above normal because of atherosclerotic plaque and the other (70% to 99% stenosis) representing more severe nonocclusive disease. Subtotal arterial occlusion may sometimes be mis- taken for total occlusion, and it is sometimes difficult to distinguish 70% stenosis from less severe stenosis, which supports the use of corroborating vascular imaging methods in equivocal cases.
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Método de escolha para diagnóstico de Ateromatose nas Carótidas: Doppler.
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Na dúvida, Angiotomo.
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