O coelho e a tartaruga nos sintomas da estenose Mitral.

Early Hemodynamic Changes Versus Peak Values: What Is More Useful to Predict Occurrence of Dyspnea During Stress Echocardiography in Patients with Asymptomatic Mitral Stenosis?
Journal of the American Society of Echocardiography
Issue: Volume 24(4), April 2011, p 392–398
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.DISCUSSION

The results of the present study can be summarized as follows: 1) In a group of asymptomatic patients with moderate to severe MS, occurrence of dyspnea during exercise was frequent, occurring in 46% of patients. 2) Analyses of hemodynamic pattern during exercise showed that increases in MG and relative SPAP were significantly higher and more rapid in patients who developed dyspnea than in patients who remained asymptomatic. 3) This contrasts with the lack of significant difference observed in peak SPAP values between groups. Peak SPAP >=60 mm Hg was reached in three of four cases and was not significantly associated with occurrence of dyspnea during exercise.
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Estudo com Eco de esforço demonstrou sintomas não correlacionados com pressões sistólicas mais elevadas no leito pulmonar. Parece que a adaptação ao esforço depende de elevações mais tardias no pico da pressão pulmonar e não do valor máximo atingido.
Mais uma demonstração da adaptação ao defeito cardíaco como determinante para o surgimento dos sintomas, fato que vemos repetidas vezes na insuficiência aórtica.