Medicine of the Future in America

Exercise Limitation in Patients with Polymyositis: Methods (2)

Exercise Limitation in Patients with Polymyositis: Methods (2)Cardiac evaluation included a routine 12-lead electrocardiogram and an echocardiogram with Doppler flow studies; M-mode and two dimensional echocardiography with Doppler were performed by the cardiologist (T.B.) using a General Electric Pass II echocar-diographic machine (General Electric, Inc., Rancho Cordova, CA). Particular attention was directed to the pulmonic valve for evidence of pulmonary hypertension. The diagnosis of pulmonary hypertension was determined via: (1) measurement of the depth of the a-dip, (2) the presence or absence of systolic notching of the pulmonic valve, and (3) measurement of the acceleration time by Doppler flow studies. Reduction of the a-dip (less than 2 mm) or systolic notching of the pulmonary valve were considered suggestive of pulmonary hypertension. Pulsed Doppler echocardiograms were obtained with either a 2.5 or 3.5 kHz transducer in the parasternal and four-chamber views. Pulsed Doppler was employed in the right ventricular outflow tract to record the flow signal just proximal to the pulmonic valve. ventolin inhaler

The acceleration time was determined as the duration from the onset of pulmonary flow to the peak flow. The acceleration times were not corrected for heart rate. Normal acceleration time in our laboratory is 144 (±15.3) ms. An acceleration time of less than 114 ms was considered diagnostic of pulmonary hypertension. Secondary criteria were abnormalities of pulmonic valve motion, ie, reduction of the a-dip or systolic notching of the pulmonic valve. All pulsed Doppler signals were recorded on videotape and analyzed off-line with the cardiac calculation package. Measurements were made using a parasternal long axis view. The left ventricular diastolic and systolic dimensions were measured using the M-mode. Vblumes were calculated from the formula of Teichholz et al at both end-diastole and end-systole:


The EF was calculated from the following equation:


This entry was posted in Polymyositis and tagged active disease, polymyositis, pulmonary hypertension.
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