Comparison of dobutamine stress and atropine exercise stress test myocardial perfusion spect in patients with poor exercise capacity

Exercise stress test [E] is the main diagnostic stress modality used with myocardial perfusion SPECT [MPS]. However, its usefulness and accuracy depends on patient's [pt] ability to achieve target heart rate [THR], limiting its utility in pt with poor exercise capacity. We sought to study the safety and feasibility of atropine administration during exercise myocardial perfusion study [EMPS] as compared to standard dobutamine MPS. Thirty patients aged 51.4 +/- 8.3 years; 80% males referred for a diagnostic MPS study and failed to achieve their THR on E. Patients were divided in to 2 groups [G]; G I 15 pts continued E and atropine was administered in doses of 0.5 mg /min until THR achieved or ischemic ECG changes or a maximum dose of 2 mg. GII 15 patients were subjected to dobutamine MPS from the start. There was no significant difference between the two groups regarding pretest likelihood of ischemia, resting heart rate, systolic and diastolic blood pressures. All pts in GI reached THR after atropine injection. GII experienced more side effects [40% vs 0%, p=0.017]; varying from chest pain 33%, headache 6.7%, nausea and vomiting 6.7%. No difference was found in the frequency of ECG changes [37% vs 47%] or frequency of positive MPS [87% vs 80%]. Use of atropine as an adjunct to standard EMPS in pts with poor exercise capacity allows them to achieve THR and can help decrease the number of inconclusive tests. Atropine EMPS is better tolerated by than dobutamine MPS

Non-invasive assessment of peripheral arterial disease in asymptomatic diabetic patients: Whom should we screen?

Diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. This condition increases the risk of developing coronary, cerebrovascular and peripheral arterial disease [PAD] up to 4 fold. It has been reported that more than half of those with PAD are asymptomatic or have atypical symptoms. Peripheral arterial disease [PAD] increases the risk of heart attack, stroke, amputation and death, hence early identification and treatment are crucial. The aim of this work was to assess the value of non invasive imaging using echo-doppler technique to detect peripheral arterial disease in diabetic and non-diabetic Egyptians. This study was conducted on forty patients admitted to Cardiology Department, Alexandria University suffering from anginal chest pain for evaluation of their chest pain, they were divided into two groups - Twenty diabetics suffering from type II diabetes, and twenty non diabetics. The two groups are matched as regard age and sex, there is significant increase in serum cholesterol, triglycerides, carotid intimal thickness in diabetic group there is marked increase in Carfem index in diabetic group but with no significant difference in ankle brachial index. As regards coronary angiography, most of diabetic patients [85%] are suffering from multi-vessels coronary artery disease. Non invasive measurements of atherosclerosis [Carotid and Carfem index] are of significant evidence in diabetic patients. Carfem index is a major predictor of coronary artery in diabetic patients. The ankle brachial pressure index was less sensistive than intimal and medial thickness of carotid and femoral arteries in the detection of early stages of atherosclerosis

Study of echocardiographic and haemodynamic features of the left ventricle in schistosomal cor pulmonale

Evaluation of the left ventricular functions at rest in schistosomal cor pulmonale was done in 15 male patients. They were assessed using echocardiography and cardiac catheter