Mês: outubro 2015

Elastografia: O mesmo caminho do Strain

Beto Matos-Souza

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Ultrasonic imaging of myocardial strain using cardiac elastography

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file:///C:/Users/me00934/Downloads/0c96051c89ae4010a6000000%20(1).pdf

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Cardiac elastography has the potential to provide global and regional spatial and temporal quantitative information of the degree of deformity, its delay in diseased myocardium in comparison with normal myocardium and thus may in the future provide specific noninvasive patterns in patients with coronary artery disease, left ventricular hypertrophy or congestive heart failure.

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No início do uso do Strain, os artigos eram indecifráveis, como o acima, de Elastografia.

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É importante acompanhar a evolução do método ecocardiográfico, muitas vezes pioneiro, mas superado pela peso dos investimentos nas áreas de RM e Tomo.

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A informação da elastografia no miocárdio vai ser usada, com certeza.

Mas depende de nós que seu uso fique em evidência na ecocardiografia.

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Serve para o quê?

Só para o diagnóstico não invasivo de isquemia! 

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http://search.proquest.com/docview/205438074

Ecoestresse na pediatria

Beto Matos-Souza

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http://ehjcimaging.oxfordjournals.org/content/16/10/1051

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Stress echocardiography is a well-established technique in adult cardiology and is mainly used for assessing regional myocardial function in patients with known or suspected coronary artery disease (CAD). Apart from detecting ischaemia, stress echocardiography has found its place in the assessment of the haemodynamic significance of valve disease, particularly in selected patients with aortic stenosis and mitral regurgitation. Also in the paediatric population, stress imaging is most commonly used for the detection of ischaemia in patients with CADs such as post heart transplantation, Kawasaki Disease, and abnormal origin of coronary arteries. Other paediatric indications include the haemodynamic and myocardial response in patients with different types of congenital heart disease, the early detection of myocardial dysfunction in specific populations such as patients after anthracycline exposure, and the evaluation of pulmonary artery pressures and the right ventricular functional response.

RM tem efeitos indesejáveis (Completo)

Beto Matos-Souza

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Agora foi liberado o artigo completo sobre o efeito da RM no sangue.

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http://circimaging.ahajournals.org/content/8/9/e003697.full

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Na beira do leito tinha uma pedra. Tinha . 

Beto Matos-Souza


Os exames à beira do leito são os mais difíceis da ecocardiografia

Ventilador ligado, tubos e drenos, decúbito dorsal…

Para esses exames temos agora um portátil que resolve.

Chega de usar os velhos aparelhos para ver o mais difícil:

Vegetações e trombos !

Esse paciente é um bom candidato? Pergunta básica antes de um procedimento

Beto Matos-Souza

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http://onlinelibrary.wiley.com/doi/10.1111/echo.12879/abstract

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basal-interpapillary muscle distance (IPMD) diastolic-to-systolic ratio (DSR) (P = 0.008)

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Among all TTE indices, LVEF, LVESV, and basal-IPMD DSR were helpful to differentiate between the successful and unsuccessful MVA results. We believe the basal-IPMD DSR as a novel index could be targeted in the future studies.

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Of the total of 126 cases, 68 had successful and 58 had unsuccessful MVA.

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Com uma taxa altíssima de insucesso, o procedimento deveria ser melhor analisado na seleção dos pacientes.

A distância entre os papilares é uma medida simples mas muito inteligente e funcional.

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O mundo real do Ecoestresse na dor torácica aguda

Beto Matos-Souza

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Incremental Diagnostic and Prognostic Value of Contemporary Stress Echocardiography in a Chest Pain Unit

Mortality and Morbidity Outcomes From a Real-World Setting

  1. Benoy N. Shah, BSc, MBBS, MRCP*,
  2. Gothandaraman Balaji, MBBS, MRCP*,
  3. Abdalla Alhajiri, MB, MRCP, MSc,
  4. Ihab S. Ramzy, MD, PhD,
  5. Shahram Ahmadvazir, MD, MRCP and
  6. Roxy Senior, MD, DM, FRCP, FESC

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http://circimaging.ahajournals.org/content/6/2/202?ijkey=cacfab404b714d33e06639cb52e9b129f3ea3199&keytype2=tf_ipsecsha

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The 30-day readmission rate was 0.5%. During long-term follow-up of 27±11 months, 39 hard events (30 deaths and 9 acute myocardial infarctions) occurred. Kaplan-Meier estimates of hard events were 0.5% versus 6.6% in the normal versus abnormal SE groups, respectively, in the first year of follow-up

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Conclusions—SE incorporated into a chest pain unit has excellent feasibility and provides rapid assessment and discharge with accurate risk stratification of patients with suspected acute coronary syndrome but nondiagnostic ECG and negative 12-hour troponin.

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O exame de ecocardiograma com esforço em bicicleta horizontal é tão barato e eficiente que o dia que os convênios e o governo o descobrirem,  vão torná-lo obrigatório até na Av. Dr. Enéas de Carvalho Aguiar!!!!

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Ecocardiograma na Síndrome Coronária Aguda : Europeu

Beto Matos-Souza

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http://ehjcimaging.oxfordjournals.org/content/16/2/119

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ACSs

Rest echocardiography

In acute ischaemic chest pain, the primary role of rest echocardiography is to assess the presence and extent of regional wall motion abnormalities, encountered in different types of myocardial injury (ischaemia, stunning, hibernation or necrosis). Echocardiography alone cannot distinguish between ischaemia and infarction; however, the absence of wall motion abnormalities, especially in patients with ongoing or prolonged chest pain (> 45 min), excludes major myocardial ischaemia. Of note, normal resting echocardiography cannot definitively rule out a transient episode of ischaemia, especially in patients with chest pain of short duration. In patients with suspected ACS, deformation imaging of the LV (strain and strain rate) is a potentially useful technique to reveal subtle wall motion abnormalities (including post-systolic shortening) when standard visual assessment of wall motion fails to detect any abnormalities.26,27 It is important to remember that segmental wall motion abnormalities are not synonymous with ischaemia, and can also occur in other conditions, such as myocarditis, right ventricular (RV) pressure/volume overload states, LV pre-excitation, Takotsubo cardiomyopathy, left bundle branch block or in the presence of a paced rhythm. During the hospital stay, echocardiography is used to assess LV function.

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http://ehjcimaging.oxfordjournals.org/content/11/6/501

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É incrível como a ecocardiografia já tem ferramentas confiáveis para uso no paciente de pronto socorro e que são de baixo custo e alta confiabilidade.

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O exame do paciente com dor torácica na emergência não pode mais analisar apenas a fração de ejeção e paredes.

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O uso do Strain é obrigatório.

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Repetimos aqui que o método de imagem depende de um defensor examinador.

As ferramentas estão à disposição do ecocardiografista. Basta ele estar disposto a dar uma resposta confiável usando a tecnologia.

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Você está pronto?

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