simple index to predict myocardial infarction size and adverse clinical outcome in patients with acute stemi undergoing primary pci

Background: Early improvement of perfusion after acute MI will improve left ventricle function and decrease the infarction area, thus decreasing mortality

Methodology: 52 patients presented with acute ST segment elevation MI Who underwent primary PCI within 24 hours of presentation. All patients were subjected to full history taking, physical examination, serial ECG, cardiac enzymes, calculation of relative importance index [RII] by dividing culprit segment diameter by left anterior descending , circumflex and right coronary arteries at their proximal segments and myocardial perfusion image to detect infarction size

Results: There is significant correlation between RII and left ventricular dysfunction [p: 0.028]. Significant correlation between RII and mortality are present

Conclusion: RII is significantly correlated with adverse clinical outcome in patients with acute STEMI

Aortic root distensibility in patients with coronary artery disease

An important determinant of myocardial performance, namely cardiac afterload is largely dependent upon aortic root distensibility [AD], peripheral arterial resistance and end systolic wall stress. The latter can be reliably measured by using m-mode and 2-D echo whereas AD used to be a neglected parameter. In patients with ischaemic heart disease, the question always arises whether AD could in a way or another predict coronary arterial pathology /= 200 and /or LDL >130mg/dl in 21pts and HTN in 17pts. Following clinical evaluation including 12 lead ECG, m-mode and 2-D echocardiography, all pts underwent diagnostic CA and were subjected to transoesophageal echocardiography [TEE] using phased array multiplane 32 elements transducer [5MHz] mounted on the tip of 100cm gastroscope with Acuson Sequoia C256 system. Transoesophageal [TEE] was done while the pts in the left lateral position. The studies were recorded on videotapes for off-lines analysis. Images of the aortic root were obtained in an angle of about 120 degrees. Aortic root was measured in systole [maximal diameter] and diastole [electrocardiographic Q-wave] 3cm from cusps insertion using the trailing edge-to-leading edge method. Measurements were taken in 3 cycles and the mean value was taken, with the difference in diameter delta d as a measurement of aortic root excursion, delta p as the pulse pressure, and d=diastolic aortic root diameter. AD was expressed as =2xdelta d / delta pxd. According to CA, pts were divided into those with diseased coronary arteries 74.4% and those with a normal CA 25.6%. Compared to the normal CA group, AD was insignificantly different from that into pts with diseased CA 23.9 vs 21.4, p value = 0.573. Patients were then stratified into two groups with an age of 50yrs, SBP of 130mmHg, DBF of 80mmHg, serum cholesterol >200 and /or LDL >/= 130mg/dl and presence of DM serving as arbitrary dividing limits

Respiratory mechanics and arterial blood gases in relation to survival

This study was performed on 37 patients presenting with acute respiratory failure, who were classified as 26 COPD patients with a mean age of 60.3 [range 31-76 years] and 11 patients with restrictive lung disease with a mean age of 42.2 [range 18-72 years]. Airway pressure [peak, plateau and mean airway pressures], lung mechanics and arterial blood gases were measured and compared in survivors [29 patients] and non-survivors [8 patients] as regards the initial measurements taken immediately after mechanical ventilation, final measurements and the pattern of changes throughout the course of mechanical ventilation. Comparing both groups, data showed that in the initial measurements, there was a highly significant difference in static compliance [cstat] and airway pressures [peak, plateau and mean airway pressure], but an insignificant difference was found in airway resistance, AutoPEEP, work rate and ABG. While, in the final measurements, with an improvement of the lung mechanics in survivors, there was a significant difference between the two groups in all the above-mentioned measurements, except ABG which still showed an insignificant difference

Cardiac arrest in the critically ill patients

The purpose of the present work is to highlight the main causes of cardiac arrest in a major referral Center. It retrospectively reviewed the files of 5099 critically ill patients admitted over ten years to the Critical Care Center of Cairo University. Of the latter 480 patients had sustained cardiac arrest. Their ages ranged from 2 to 90 years [mean of 53.2 +/- 18 years]. Underling diseases in those who sustained cardiac arrest encompassed heart disease in 172 patients, non coronary HD in 107, respiratory failure in 63, surgery and trauma in 54 CVA in 40, systemic sepsis and multiple organ failure in 31, hepatic and renal failure in 13 patients. Mode of arrest was primarily progressive hemodynamic deterioration in 252 patients, hypoxic arrest in 234 and arrhythmic death in 133 patients. Cardiopulmonary resuscitation [CPR] was successful in 55 and unsuccessful in 195 patients. Compared to survivors, those who died, had more frequently cardiac disease [76.4% vs 23.5%], multiple organ failure and systemic sepsis [6.1% vs 1.8%], respectively. Survivors belonged mostly to those with HD [34.5%], non coronary HD [23.6%], and hypoxia [16.4%]. Recurrence of CPR was met with in 111 patients and of the latter, only seven patients survived

Hemodynamic evaluation of right ventricular function in chronic obstructive airway disease before and after beta 2 mimetics

This study assessed the effects of IV terbutaline [Bricanyl] as a prototype of beta 2 mimetics on cardiorespiratory function in 20 patients with COPD [16 males, 4 females]. Arterial blood gases on admission showed a mean PO2 of 124 mmHg and a mean PCO2 of 59 mmHg. 14 out of 20 patients were on assisted ventilation. All patients were subjected to cardiac catheterization using flow directed Swan Ganz catheter. Baseline evaluation was followed by hemodynamic measurements. Beta mimetic therapy increased HR by 23%, BP by 11% and PCWP by 27%, while there was almost no effect on CVP. Intravenous Bricanyl significantly augmented CI, SVI and increased LVSWI and RVSWI. IV Bricanyl substantially increased SaO2, SVO2, O2 transport and O2 uptake without significantly changing O2 extraction ratio. The increase in the SVSWI was highly significant compared with the modest increase in LVSWI

Hemodynamic effects of different modes of positive pressure mechanical ventilation

Many patients admitted to the ICU are in need for mechanical ventilation. Ventilators directly affect cardiovascular performance by changing either lung volume or intrathoracic pressure. As oxygen delivery to various organs is the product of regional blood flow and oxygen content, the effect of different modes of positive pressure ventilation on circulatory dynamics and oxygen transport are to be compared. From the results obtained it was concluded that positive pressure ventilation had adverse effects on circulatory dynamics. Choosing the optimal ventilatory mode as well as the best weaning policy should be guided by the underlying clinical state and followed up hemodynamically by noninvasive, and if necessary, invasive means

Catecholamine induced myocardial necrosis modulation by verapamil [part II]

Calcium channel blockers are one of the corner-stones in management of patients suffering from coronary artery disease. Protective action of verapamil [Ver] against myocardial necrosis induced by isoprenaline [Iso] infusion was studied in adult albino rats weighing 100 - 150 g [both sexes]. Animals were divided into 3 groups: Control group [10 rats], Iso group [44 rats] and verapamil treated rats [56 rats]. Animals were injected with verapamil according to the following schedule: Acute treatment with [Ver] SC, 15 minutes before Iso in 3 doses [0.9, 25 and 50 g/kg], acute post-treatment with [Ver] in a dose of 50 mg/kg after 15 and 30 minutes of Iso injection, and subacute treatment with Ver in a dose of 15 mg/kg, SC for 7 days. 15 minutes after the last dose, Iso was injected in a dose of 300 mg/kg. ECG, serum CPK level and microscopic examination were used for assessment of protective action of Ver. From the results it obtained it was concluded that, verapamil could protect against the development of isoprenaline-induced myocardial necrosis in rats in a dose as well as time dependent manner