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Category Archives: Cardiopulmonary Disease

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Discission (Part 3)

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Discission (Part 3)It is also possible that the differences observed in the principal study end point (length of hospitalization) might have achieved greater statistical significance in a larger population.
Given the wide variability in hospital stay among dyspneic patients, to prove at a significance level of p<.05 that echocardiography was responsible for shortening this stay by the observed mean of 2.3 days (with a 90 percent likelihood of detecting such a difference), would require testing of well over 900 patients. Thus, while some benefit from echo cannot be entirely excluded by this study, it can be concluded that the overall impact of echo in the patients tested was small. buy levaquin online Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Discission (Part 2)

Limitations
Echo-Doppler is being increasingly used to evaluate valvular heart disease and cialis professional 20 mg of cardiac diastolic function. Our laboratory had not as yet acquired Doppler technology at the time of this study. However, even with this limitation, echo frequently identified the presence of valvular disease and abnormalities compatible with volume overload (chamber enlargement) or diastolic dysfunction (hypertrophic cardiomyopathy). Report of such findings had little apparent impact on patient treatment. Thus, while the addition of Doppler may have proved to be more sensitive in defining the cause of dyspnea in some patients, whether such findings would have swayed patient treatment to a greater degree than the anatomic abnormalities that were reported by echocardiography is uncertain. Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Discission (Part 1)

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Discission (Part 1)This study demonstrates that echocardiography can be expeditiously performed among patients suffering from acute respiratory distress. However, indiscriminate (random) echo among clinically comparable patients was not shown to significantly alter their clinical diagnosis, diagnostic or therapeutic management, hospital stay, or mortality. buy antibiotics online Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 5)

Duration of Hospitalization
The mean (± SD) length of hospital stay among the entire group of 196 patients was 7.9 ± 10.9 days (range, one to 106 days). There was no significant difference in the mean duration of stay among patients receiving vs those not receiving echocardiograms during the first 24 hours of hospitalization (6.8 ±5.4 days vs 9.1 ± 14.9 days, respectively, p>.14). Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 4)

Overall, when diagnoses were categorized as cardiac, pulmonary, both, or neither, these w ere observed to change as infrequently in patients w’ho received echocardiography (9.6 percent of patients) as in control patients (8.6 percent; p>.9). Likewise, medications prescribed during hospitalization changed categories from cardiac, pulmonary, both, or neither in 21 percent of echo patients and 25 percent of controls (p>.6). buy prednisone Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 3)

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 3)Correlation between Clinical and Echocardiographic Findings
Prior to echocardiography, dyspnea was attributed, clinically, to cardiac dysfunction in 66 patients (27 [41 percent] of w hom were randomized to receive echocardiography), to pulmonary causes in 97 patients (59 [61 percent] of w hom received echocardiograms), and to both cardiac and pulmonary causes in 31 patients (18 [58 percent] of w hom received echo studies). Two patients were not believed to have either a cardiac or a pulmonary basis for dyspnea; neither was randomized to receive an echocardiogram. Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 2)

Echoca rdiograim
Echocardiograms could be performed in 93 (89 percent) of 104 patients randomized to receive such studies; 11 patients either declined testing or were believed to be too ill for study. Of 93 echo studies, three (3 percent) were of poor quality and inadequate for diagnosis; 90 studies (97 percent) were technically satisfactory for diagnosis. Figure 1 summarizes echo findings in the 90 interpretable studies, nearly 70 percent of w hich had definite cardiac abnormalities. Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Results (Part 1)

Patients
Most patients presenting with acute dyspnea were observed to have a history of cardiac or pulmonary disease (89 percent). The clinical features of these patients are summarized in Table 1. Among the 196 patients evaluated, 104 (53 percent) were randomized to receive echocardiograms, and 92 patients (47 percent) were randomized to control. Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Methods (Part 3)

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Methods (Part 3)Definitions
Diagnoses ascribed to patients during their hospitalization were categorized as cardiac, pulmonary, both, or neither. Cardiacascribed diagnoses included coronary artery disease, acute myocardial infarction, congestive heart failure, congenital heart disease, valvular heart disease, cardiomyopathy (dilated or hypertrophic), pericarditis, tamponade, arrhythmia, or hypertension. Pulmonary-ascribed diagnoses included acute upper airway obstruction, asthma, chronic obstructive lung disease, pulmonary embolism, pneumonia, pneumothorax, pleural effusion, restrictive lung disease, or lung tumor. Diagnoses ascribed to neither cardiac nor pulmonary systems included anemia, morbid obesity, renal failure, and psychogenic dyspnea. Continue reading

Immediate Echocardiography in the Management of Acute Respiratory Exacerbations of Cardiopulmonary Disease: Methods (Part 2)

Echocardiography
Images were acquired by a cardiac ultrasound unit (Hewlett-Packard 77020A) with a 2.5- or 3.5-MHz phased array transducer. Cardiac chamber dimensions and wall thickness were determined quantitatively from two-dimensional directed M-mode echocardiograms and qualitatively from standard parasternal, apical, and subcostal two-dimensional images, and they were described as normal or increased. Left and right ventricular systolic function were estimated visually and described as normal, mildly depressed, or moderately to severely depressed. Continue reading

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