The haemodynamic cascade

Excerpt

In this issue of the Netherlands Heart Journal, Jansen et al. describe the influence stress echocardiography has on clinical decision-making in patients with mitral valve disease [1]. In 1935, Tenant and Wiggers described the sequelae of coronary occlusion [2]. From their description the ischaemic cascade has been derived. In this cascade, symptoms are a relatively late phenomenon and are preceded by electrocardiographic changes. This has led to the routine application of stress electrocardiography in the evaluation of patients with suspected coronary artery disease. In patients with valvular heart disease one could assume the existence of a haemodynamic cascade. In the haemodynamic cascade, which starts with seemly insignificant valve defects, the second phase would be haemodynamic changes, followed by cardiac adaptation and as the last phase, symptoms. Analogous to stress electrocardiography, stress echocardiography can then be applied to relate symptoms with echocardiographic findings. …