Increased plasma fibrinogen concentration as a risk factor for ischemic heart disease

Thirty-seven patients [30 males and 7 females, aged 45-65 years] with coronary heart disease as well as 20 age- and sex-matched apparently healthy individuals as a reference group were participated in this study. Every patient was subjected to clinical evaluation including history taking and clinical examination with special stress on the presence of risk factors [e.g. smoking and hypertension], coronary angiography, and determination of fasting and post-prandial serum glucose, total cholesterol, low-density lipoprotein-c, high-density lipoprotein-c, triglycerides and determination of plasma fibrinogen levels. The aim of the present work was to assess the level and to evaluate the role of fibrinogen as a risk factor for coronary heart disease. Patients with coronary heart disease showed a statistically significant increase in plasma fibrinogen level [P < 0.001] when compared with the reference group. Coronary heart disease patients also showed statistically significant increase in fasting [P < 0.01], post-prandial serum glucose levels [P < 0.001], Low-density lipoprotein-c, triglycerides level [P < 0.001] and a statistically significant decrease in the serum levels of high-density lipoprotein-c [P < 0.001] when compared with the reference group. From these results, we concluded that the increased level of plasma fibrinogen is considered as a risk factor for the development of ischemic heart disease

Non-invasive measurement of pulmonary to systemic flow ratio by doppler echocardiography in isolated ventricular septal defects

Echocardiography provides anatomic and pathophysiologic information with reliable quantification of Q p/Q s flow ratio in patients with ventricular septal defect. The aim of this study was to assess the accuracy and reliability of the four different echo color Doppler methods for determining Q p/Q s] ratio comparing the results with the standard oximetry shunt quantification obtained from catheterization laboratory.50 patients [23males, 27 females] were collected from National Heart Institute. Q p/Q s ratio was determined by several methods using Doppler echocardiography and correlated with that obtained from cardiac catheterization. It was found that there was no correlation between method I and cardiac catheterization in detection of Q p/Q s ratio [R = 0.29]. There was a moderate correlation between method II and cardiac catheterization [R = 0.52]. While the correlation decreased in large defects [R = 0.49], there was a well significant correlation in small defects [R = 0.72] and a moderate correlation in moderate defects [R = 0.59]. There was a weak correlation between method III and cardiac catheterization [R = 0.40], while there was no correlation in large defects [R = 0.13], there was a weak correlation in small defects [R = 0.40] and in moderate defects [R = 0.47]. Method IV [Teien] demonstrated the best correlation with catheterization [R = 0.64]. In small defects it was 0.98, moderate defects showed good correlation [R = 0.78] and a less significant correlation was present in large defects. [R = 0.45]. Right to left shunt calculated by Aorta flow + ventricular septal defect flow - Pulmonary Artery flow was found to correlate significantly with catheterization [R = 0.93]. Conclusion and Recoinrnendation. The Doppler Q p/Q s ratio shunt ratio calculated by Teien method correlated the best with oximetry estimates of Q p/Q s ratio and seemed sufficiently accurate for clinical decision making a serial evaluation in infants and children with ventricular septal defect. The new equation [Right - left shunt = Aorta flow + ventricular septal defect flow - Pulmonary Artery flow] is useful in detecting Right to left shunt

Value of posterior and right precordial leads in acute myocardial infarction

Evaluation of the diagnostic and prognostic value of posterior chest leads [PCL] [V7, V8 and V9] and right chest lead [RCL] [V3R, V4R and V5R] in acute myocardial infarction [AMI]. 44 consecutive patients with AMI were included in this work; serial PCL [V7, V8 and V9] and RCL [V3R, V4R and V5R [and standard 12 leads ECGs were recorded. Accordingly patients were grouped into two groups; Group I: with inferior AMI and. Group II: with anterior AMI. Each group was subgrouped into A and B according to the presence or absence of changes in PCL and RCL. In-hospital course was assessed and echocardiographic wall motion score index [WMSI] was estimated for every patients. In group I; there were 13 out of 18 patients had changes in RCL and PCL [5 and 8 respectively] and 4 out of 24 patients in group II had changes in RCL and PCL [2 in each]. True isolated posterior AMI was recorded in 2 patients. Patients having changes in RCL and PCL had more frequent in-hospital complications; post MI angina [P<0.05], heart failure [P<0.01], serious dysrrhythmias [P<0.01], mortality [P<0.05]. Also, they had a significant reduction in E.F. [P<0.05] and F.S [P<0.01] and higher WMSI [P<0.01] as compared to those patients without right and posterior precordial leads changes. There were a significant prevalence of right ventricular [RV] and/or posterior myocardial infarction in association with anterior and inferior AMI. The presence of RV and posterior infarction, in addition, had a more adverse outcome. We recommend the routine recording of RV and posterior precordial leads in every patients presented with chest pain. It may improve the identification of the high risk subset of patients and may have an important therapeutic and prognostic implications