The Experts below are selected from a list of 63 Experts worldwide ranked by ideXlab platform
P. Quigley - One of the best experts on this subject based on the ideXlab platform.
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Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.
The American journal of cardiology, 1993Co-Authors: James J. Crowley, Sinead M. Donnelly, Maire Tobin, Oliver Fitzgerald, Barry Bresnihan, Brian Maurer, P. QuigleyAbstract:Abstract Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 ± 10 years) underwent full clinical Examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 ± 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial Examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities ( E A ratio) were noted in 9 patients. In 3 patients there was an increased E A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations. It is concluded that LV diastolic dysfunction occurs frequently in patients with ankylosing spondylitis, even in the absence of clinical cardiac involvement.
Adam L. Gertz - One of the best experts on this subject based on the ideXlab platform.
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Present Role of the Precordial Examination in Patient Care
The American journal of cardiology, 2014Co-Authors: Barry Silverman, Adam L. GertzAbstract:Recent observations suggest that many physicians do not consider the bedside cardiac Examination as a valuable tool in patient care. Internists, hospitalists, emergency department physicians, cardiologists, physician assistants, and nurse practitioners were interviewed to ascertain their current practice in completing the cardiac Examination. In addition, we surveyed patients in a cardiology practice concerning their attitudes about the cardiac physical Examination. The study found that a significant number of practitioners failed to carry out a basic cardiac Examination. Most patients do not have their chest exposed. It is unusual for the patient to be examined in the lateral decubitus position or for maneuvers to be used to evaluate the significance of a murmur. Most patients were more confident in the physician when a bedside Examination was carried out, and they expect to undress for the Examination. Half of the patients were more secure when they were undressed if there was a attendant of the same gender in the room. Review of the medical literature suggests that when a skilled examiner completes the bedside cardiac Examination, it has an excellent sensitivity and specificity to recognize clinically significant cardiac disorders. A thorough cardiac bedside Examination can make an echocardiogram unnecessary in some patients and compliment the echo in every patient. In conclusion, the bedside cardiac Examination is a valuable diagnostic aid for diagnosing heart disease. If on the teaching wards and in the medical journals more emphasis is placed on the importance of physical findings for diagnosing heart disease, more physicians will make the effort to perform a thorough Examination.
G. R. Sutherland - One of the best experts on this subject based on the ideXlab platform.
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Transoesophageal echocardiographic evaluation of atrial morphology in children with congenital heart disease
European heart journal, 1992Co-Authors: B. Tuccillo, Oliver Stumper, J. Hess, R. J. Van Suijlen, Egbert Bos, Jos R.t.c. Roelandt, G. R. SutherlandAbstract:In a prospective study, atrial morphology was evaluated by both transoesophageal and Precordial echocardiography in 86 unoperated children with congenital heart disease (age range = 0.2 to 14.8 years, mean = 3.8 years) to determine what advantages, if any, might be inherent in the transoesophageal approach. The information derived from both ultrasound approaches was correlated and compared to information obtained during subsequent cardiac catheterization (78 patients) and, or, surgical inspection (53 patients). Atrial appendage morphology and hence atrial situs was determined by transoesophageal echocardiography in every case (82 solitus, two right atrial isomerism, two left atrial isomerism). In addition, the transoesophageal approach indicated left juxtaposition in four patients, compared to only one by Precordial Examination. Probe patency of the foramen ovale was correctly predicted in 21 patients by transoesophageal imaging, but in only 10 by Precordial imaging. In two children significant secundum defects, undetected by the Precordial route, were identified. Multiple atrial septal defects were correctly defined in four patients by transoesophageal study but in only one by Precordial study. Sinus venosus defects were documented in four by the transoesophageal approach, but in only one by the Precordial. Primum defects were equally well documented (nine patients) by either technique, but the associated valve leaflet morphology was better documented by transoesophageal study in 5/9. A subtotal cor triatriatum was diagnosed in one child only by transoesophageal investigation. Transoesophageal echocardiography allows a much more detailed evaluation of atrial morphology than Precordial imaging even in infants. It provides direct diagnosis of atrial situs, detection of juxtaposed atrial appendages and improved demonstration or definitive exclusion of atrial septal defects.
Gordon K. Danielson - One of the best experts on this subject based on the ideXlab platform.
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Partial Anomalous Pulmonary Venous Connection: Diagnosis by Transesophageal Echocardiography
Journal of the American College of Cardiology, 1997Co-Authors: Naser M. Ammash, James B. Seward, Carole A. Warnes, Heidi M. Connolly, Patrick W. O'leary, Gordon K. DanielsonAbstract:This study sought to demonstrate that with proper technique, identification of the normal and abnormal pulmonary venous connection can be made with confidence using transesophageal echocardiography (TEE). Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly whose diagnosis has classically been made using angiography. We performed a retrospective review of all patients of all ages with PAPVC diagnosed at the Mayo Clinic who had undergone TEE because of either right ventricular volume overload or suspected intracardiac shunting by transthoracic echocardiography or intraoperatively. A total of 66 PAPVCs were detected in 43 patients (1.5/patient); in 2 additional patients, TEE suggested, but did not diagnose, PAPVCs. Shortness of breath was the most common presenting symptom (42.2%), followed by heart murmur and supraventricular tachycardia. Right-sided anomalous veins were identified in 35 patients (81.4%), left-sided in 7 (16.3%) and bilateral in 1 (2.3%). There was a single anomalous connecting vein in 23 patients (53.5%), two in 18 (41.9%), three in 1 (2.3%) and four in 1 (2.3%). The connecting site was the superior vena cava (SVC) in 39 veins (59.1%), right atrial-SVC junction in 6 (9.1%), right atrium in 8 (12.1%), inferior vena cava in 1 (1.5%) and the coronary sinus in 2 (3.0%). Ten anomalous left pulmonary veins were connected by a vertical vein to the innominate vein (15.1%). Sinus venosus atrial septal defect (ASD) was the most common associated anomaly in 22 patients (49%), followed by ostium secundum ASD in 6 and patent foramen ovale in 4. Fifteen patients had an intact atrial septum. Thirty-one patients (68.8%) underwent surgical repair. PAPVC was confirmed in all patients, including the two whose TEE results were suggestive of PAPVC. All 49 PAPVCs detected by TEE preoperatively were confirmed at the time of operation. TEE is highly diagnostic for PAPVC and can obviate angiography. Accurate anatomic diagnosis may influence the need for medical and surgical management. TEE should be performed in patients with right ventricular volume overload when the Precordial Examination is inconclusive.
James J. Crowley - One of the best experts on this subject based on the ideXlab platform.
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Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.
The American journal of cardiology, 1993Co-Authors: James J. Crowley, Sinead M. Donnelly, Maire Tobin, Oliver Fitzgerald, Barry Bresnihan, Brian Maurer, P. QuigleyAbstract:Abstract Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 ± 10 years) underwent full clinical Examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 ± 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial Examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities ( E A ratio) were noted in 9 patients. In 3 patients there was an increased E A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations. It is concluded that LV diastolic dysfunction occurs frequently in patients with ankylosing spondylitis, even in the absence of clinical cardiac involvement.