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valsalva maneuver in coronary artery disease

André Viveiros Monteiro, António Fiarresga, Duarte Cacela, Lídia de Sousa, Ruben Ramos, Ana Galrinho, Luísa Branco, Rui Cruz Ferreira
Acromegaly is a rare disease, mostly caused by a growth hormone (GH)-secreting benign pituitary tumor, with an increased production of GH and insulin-like growth factor 1 (IGF-1). Cardiovascular complications are common and are associated with cardiomyocyte apoptosis and concentric cardiac hypertrophy. Suppression of GH and IGF-1 appears to improve cardiac function only in the short term, with little or no decrease in left ventricular mass or improvement in cardiac function after prolonged treatment. Alcohol septal ablation (ASA) has emerged as a minimally invasive alternative to septal myectomy, with significant improvement in symptoms, gradients and left ventricular remodeling...
September 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
M Vallverdú, C Crexells, P Caminal
Several studies have suggested that the Valsalva maneuver may predispose potential lethal arrhythmias in patients with coronary artery disease, since this maneuver induces diminished coronary flow. On the other hand some studies have suggested that the Valsalva maneuver abruptly reduces determinants of cardiac oxygen demand, relieving angina pectoris. In order to study the variations of the myocardial oxygen supply-demand relation, during different applications of the maneuver, a mathematical model of the human cardiovascular system is presented...
January 1, 1994: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
Froukje Nolte, Eoin R Hyde, Cristina Rolandi, Jack Lee, Pepijn van Horssen, Kal Asrress, Jeroen P H M van den Wijngaard, Andrew N Cookson, Tim van de Hoef, Radomir Chabiniok, Reza Razavi, Christian Michler, Gilion L T F Hautvast, Jan J Piek, Marcel Breeuwer, Maria Siebes, Eike Nagel, Nic P Smith, Jos A E Spaan
Coronary artery disease, CAD, is associated with both narrowing of the epicardial coronary arteries and microvascular disease, thereby limiting coronary flow and myocardial perfusion. CAD accounts for almost 2 million deaths within the European Union on an annual basis. In this paper, we review the physiological and pathophysiological processes underlying clinical decision making in coronary disease as well as the models for interpretation of the underlying physiological mechanisms. Presently, clinical decision making is based on non-invasive magnetic resonance imaging, MRI, of myocardial perfusion and invasive coronary hemodynamic measurements of coronary pressure and Doppler flow velocity signals obtained during catheterization...
November 2013: Medical & Biological Engineering & Computing
N R Shrestha, S K Sharma, P Karki, N K Shrestha, P Acharya
INTRODUCTION: Diabetes mellitus is an established risk factor for congestive cardiac failure in which the diastolic function is impaired earlier than the systolic function and majority of these patients maybe asymptomatic without signs of overt heart failure. METHODS: A cross sectional hospital based study was done which included 100 asymptomatic patients with type 2 diabetes without evidence of coronary artery disease, congestive heart failure, thyroid or overt renal disease...
January 2009: JNMA; Journal of the Nepal Medical Association
G Piccirillo, F Vetta, S Ronzoni, V Rizzo, F L Fimognari, C Bucca, E Santagada, G Monteforte, M Durante, L Palleschi, E Viola, J L Valdivia, S Tarantini, M Cacciafesta, M Villani, G Iannucci, V Marigliano
In order to assess high-pressure baroceptor sensitivity and parasympathetic function in elderly patients with silent myocardial ischemia, we selected 45 inpatients in our geriatric unit for a prospective cohort study of patients with coronary heart disease. All patients were over 65 years of age (37 men and 8 women) and had coronary heart disease, documented by an angiographic study and electrocardiographic evidence of myocardial ischemia during exercise stress testing, performed according to the Bruce protocol...
January 1998: Archives of Gerontology and Geriatrics
N K Subbalakshmi, P M R Adhikari, A Rajeev, K Asha, P S Jeganathan
INTRODUCTION: Although the clinical implications of diabetic autonomic neuropathy have been described, the clinical determinants of parasympathetic dysfunction in type 2 diabetes mellitus are not clear. We investigated the clinical determinants of heart rate response to deep breathing in type 2 diabetes mellitus. METHODS: This study involved 207 randomly selected patients with type 2 diabetes mellitus and 141 healthy controls. Heart rate response to deep breathing was measured in all the subjects...
February 2008: Singapore Medical Journal
Karina Wierzbowska-Drabik, Jaroslaw Drozdz, Michal Plewka, Malgorzata Kurpesa, Maria Krzemińska-Pakula, Jaroslaw D Kasprzak
BACKGROUND: We assessed the changes of mitral inflow during Valsalva maneuver (VM) in patients with different stages of left ventricular dysfunction and evaluated their value for the differentiation between normal and pseudonormal filling pattern. METHODS: A total of 190 patients (120 with coronary artery disease, and 70 healthy subjects) were examined by transthoracic echocardiography. Mitral E/A ratio, early wave deceleration time (Edt), and pulmonary vein flow (especially atrial reversal parameters (Ar)), were used for the initial stratification to normal, delayed relaxation, pseudonormal, and restrictive profiles...
May 2007: Echocardiography
A-Ching Chao, Ruey-Tay Lin, Ching-Kuan Liu, Pao-Yu Wang, Hung-Yi Hsu
Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough-induced syncope were examined. All patients were asked to cough and to perform VM several times under continuous cerebral blood-flow velocity and blood pressure (BP) monitoring by transcranial Doppler and finger plethysmography...
February 2007: Kaohsiung Journal of Medical Sciences
S Cosson, J-P Kevorkian, M-L Virally, P Henry, M Laloi-Michelin, T Meas, P Beaufils, P-J Guillausseau
OBJECTIVE: We sought to determine whether abnormalities of left ventricular structure and function could be detected in asymptomatic type 2 diabetic patients free of cardiovascular complications. RESEARCH DESIGN AND METHODS: We compared 48 subjects with type 2 diabetes (34 men, 50+/-6 years) without hypertension, coronary artery disease and microangiopathic complications with 30 age-matched healthy controls. Left ventricular diastolic function was assessed by conventional Doppler echocardiography and new echocardiographic techniques (tissue Doppler imaging, color M-mode propagation velocity)...
February 2007: Diabetes & Metabolism
Stefano De Castro, Maurizia Rasura, Emanuele Di Angelantonio, Mario Beccia, Ilaria Passaseo, Filomena Di Lisi, Cesare Fieschi, Natesa Pandian, Francesco Fedele
BACKGROUND: Transesophageal echocardiography (TEE) has improved the diagnostic evaluation of ischemic stroke patients, permitting detection of potential cardiac sources of embolism. The present study aimed to evaluate the distribution of potential cardioembolic sources in young versus older stroke patients and their clinical implication for recurrent vascular events. Two hundred and twenty-eight patients with undetermined ischemic stroke were enrolled in the study. METHODS: All patients were submitted to transthoracic and to TEE examination...
March 2006: Journal of Cardiovascular Medicine
Pedro Paulo S Soares, Adalgiza M Moreno, Sérgio L D Cravo, Antonio Claudio L Nóbrega
INTRODUCTION: Imbalance in autonomic cardiovascular function increases the risk for sudden death in patients with coronary artery disease (CAD), but the time course of the impact of coronary artery bypass grafting (CABG) on autonomic function has been little studied. Thus, the purpose of the present study was to determine the effects of the CABG on the cardiovascular autonomic function. METHODS: Patients undergoing CABG (n = 13) and two matched control groups (patients with CAD who refused surgical treatment [n = 9], and healthy volunteers [n = 9]) underwent a prospective longitudinal study consisting of autonomic evaluation before and after (3, 6, 15, 30, 60, and 90 days) surgery, including measurement of heart rate variability (HRV), respiratory sinus arrhythmia (RSA), and Valsalva maneuver...
April 2005: Critical Care: the Official Journal of the Critical Care Forum
John K Boyer, Srihari Thanigaraj, Kenneth B Schechtman, Julio E Pérez
To determine the prevalence of left ventricular diastolic dysfunction in asymptomatic, normotensive patients with type 2 diabetes mellitus, we studied 61 consecutive normotensive patients with type 2 diabetes using conventional Doppler echocardiography at rest (deceleration time, isovolumic relaxation time, early diastolic velocity [E]/peak atrial systolic velocity [A] ratio), and during the Valsalva maneuver. In addition, mitral annular velocity and velocity of flow propagation were assessed in all patients using tissue Doppler imaging (TDI) and color M-mode echocardiography...
April 1, 2004: American Journal of Cardiology
G V R K Sharma, Patricia A Woods, Costas T Lambrew, Claire M Berg, Daniel A Pietro, Thomas P Rocco, Frederick W Welt, Peter Sacchetti, Kevin M McIntyre
BACKGROUND: Measurement of left ventricular filling pressure (LVFP) provides an accurate assessment of left ventricular failure. Clinical and radiographic methods of estimating LVFP are unreliable. The noninvasive method of analyzing the decline in the arterial pressure during the strain phase of the Valsalva maneuver may be used to directly measure LVFP. OBJECTIVE: To examine the relationship and the level of accuracy of a noninvasive system (VeriCor) in directly determining left ventricular end diastolic pressure (LVEDP) using simultaneously recorded VeriCor and LVEDP measurements obtained during left heart catheterization...
October 14, 2002: Archives of Internal Medicine
Paul E Valensi, Nicolas B Johnson, Pierre Maison-Blanche, Fabrice Extramania, Gilbert Motte, Philippe Coumel
OBJECTIVE: Prolongation of the QT interval and increased QT dispersion are associated with a poor cardiac prognosis. The goal of this study was to assess the long-term influence of the autonomic nervous system on the heart rate dependence of ventricular repolarization in patients with diabetic autonomic neuropathy (DAN). RESEARCH DESIGN AND METHODS: We studied 27 subjects (mean age 51.8 years) divided into three age- and sex-matched groups: nine control subjects, nine diabetic subjects with DAN (mostly at a mild stage; DAN+), and nine diabetic subjects without DAN (DAN-)...
May 2002: Diabetes Care
Gouri Chaudhuri, Cynthia D Hildner, Susan Brady, Brad Hutchins, Norman Aliga, Eileen Abadilla
The prolonged voluntary closure of the glottis during the supraglottic and super-supraglottic swallowing techniques may create the Valsalva maneuver. The Valsalva maneuver has been associated with sudden cardiac death and cardiac arrhythmias. This study describes the effects of the supraglottic and super-supraglottic swallowing techniques on the cardiovascular system. Subjects included 23 patients from an acute inpatient rehabilitation hospital. Subject groups included recent stroke, dysphagia. and a history of coronary artery disease (Group 1, N = 11)...
2002: Dysphagia
Y Balbay, A Cosgun, R Jean-Baptiste, A D Demir, H Tikiz, S Korkmaz, E Kutuk
Previous studies showed that increased QT dispersion (QTd) has been observed during episodes of myocardial ischemia or infarction and identify the patients at risk of arrhythmia or sudden death. The objective of this study is to investigate the relationship between coronary artery disease and QTd during the Valsalva maneuver. The study population included 85 subjects (21 with normal coronary arteries, 35 with stable angina pectoris, and 29 with unstable angina pectoris). Twelve-lead surface ECGs were recorded at 50-mm/sec paper speeds and were obtained before the Valsalva maneuver and during the strain phase...
November 2001: Angiology
D Ural, E Ural, G Kahraman, O Caymaz, C Aktolun, B Komsuolu
In some hypertensive patients, echocardiographic examination does not reveal any pathologic finding in spite of a documented blood pressure elevation. In our study, we investigated the effect of preload reduction with Valsalva manoeuver on transmitral flow velocities in hypertensive patients with normal mitral flow pattern and compared the results with a healthy control group. Sixty-eight patients without evidence of coronary artery disease or heart failure (28 female, 40 male, age 50 +/- 7) were divided in two groups according to their E/A ratio as those with diastolic dysfunction (n = 36) and without diastolic dysfunction (DD(-): n = 32)...
September 2001: Journal of Human Hypertension
P Poirier, P Bogaty, C Garneau, L Marois, J G Dumesnil
OBJECTIVE: Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes. RESEARCH DESIGN AND METHODS: We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia...
January 2001: Diabetes Care
Hans-Peter Brunner-La Rocca, Christine Helena Attenhofer, Rolf Jenni
BACKGROUND: The objective of this study was to determine whether analysis of changes in the transmitral filling pattern during the Valsalva maneuver improves the diagnostic accuracy to noninvasively detect an elevated left ventricular end-diastolic pressure (LVEDP). METHODS: We prospectively compared the diagnostic accuracy of the mitral flow velocity indexes at baseline with those obtained during the Valsalva maneuver to detect an elevated LVEDP in 50 patients with coronary artery disease. RESULTS: Moderate correlations were found between LVEDP (mean, 11...
April 1998: Echocardiography
D S Goldstein, C Holmes, S T Li, S Bruce, L V Metman, R O Cannon
BACKGROUND: In Parkinson disease, orthostatic hypotension can result from L-dopa treatment or from sympathetic neurocirculatory failure. The latter is detected by abnormal blood pressure responses to the Valsalva maneuver and can be associated with loss of functional cardiac sympathetic nerve terminals. OBJECTIVE: To determine the frequency of cardiac sympathetic denervation in Parkinson disease, with or without sympathetic neurocirculatory failure, and its association with disease duration, severity, and L-dopa treatment DESIGN: Intergroup comparisons in resting patients...
September 5, 2000: Annals of Internal Medicine
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