Arrhythmias in the first twenty four hours after acute myocardial infarction

Twenty patients with acute myocardial infarction were studied within the first 24 hours of onset of symptoms. They were 70% males and 30% females, their mean age was 55.3 +/- 10.5 years. The 24-hour Holter electrocardiographic monitoring revealed a high incidence of arrhythmia. Sinus tachycardia in 70%, bradycardia in 10%, supraventricular tachycardria in 5% and atrial premature beats in 70%. Ventricular arrhythmias occurred in 95% of cases and all of them had premature ventricular contractions. Ventricular tachycardia occurred in 40% of cases. The relationship between incidence of arrhythmias and duration of pain showed that the highest incidence occurred after one hour from the onset of symptoms, except bradycardia which occurred after 4 hours. Smokers showed significantly high incidence of complex PVCs and VT. There was no significant correlation between resting ECG and the occurence of arrhythmias. As regards the site of infarction all types of arrhythmias occurred with inferior infarction, while bradycardia was associated with anterior and combined infarctions. Presence of VT does not carry poor prognosis

Exercise tolerance pulmonary functions and haemodynamics in mitral stenois before and after mitral commissurotomy

Fifteen patients with isolated mitral stenosis recommended for mitral commissurotomy were studied. The aim was to evaluate them by standardized exercise tolerance test in relation to pulmonary functions and hemodymanic studies. They were assessed two months after mitral commissurotomy. There was significant correlation between NYHA classes and hemodynamics, VC% MVV%, maximum workload, duration of exercise and VO2 max preoperatively, but not with CO, MVA or DS/TV% and the left atrial size postoperatively. Echocardiographic study showed that EF slope, DE amplitude, left atrial size, stroke volume and cardiac output were markedly improved two months postoperatively. Pulmonary function tests revealed a picture of restrictive- obstructive derangement, which did not return to preoperative values two months after surgery. The maximum workload at the end of exercise tolerance was variable; 60% of patients were improved by effort test, while 30% did not improve and one patient showed deterioration in his effort tolerance. Observed VO2 max and FAI% showed significant improvement

Left ventricular functions before and after mitral commissurotomy by echocardiography

Fifteen patients with isolated rheumatic mitral stenosis were included in the study. All were subjected to full clinical evaluation, 12 leads electrocardiogram, roentgenography of chest and heart and M-mode echocardiography then mitral valvotomy was carried out. Two weeks postoperatively a repeat echocardiogram was done. Two months later a follow up study was done. The echocardiographic data postoperatively showed a significant increase of the E-F slope of the anterior mitral valve leaflet and D-E amplitude of the mitral valve, reduction in left atrial size, reduction in right ventricular end diastolic dimension, increase in LVIDd LVIDs, significant increase of stroke volume, cardiac output, ejection fraction and fractional shortening, significant increase of left ventricular posterior wall excursion and posterior wall velocities [maximum systolic and diastolic endocardial velocities]

Clinical review of unstable angina pectoris

This study included 62 patients [42 males and 20 females] with the diagnosis of unstable angina. Acute myocardial infarction occurred in 15% of patients and acute mortality rate was 3%. Advanced age and a previous myocardial infarction favored a complicated in-hospital course [myocardial infarction and/or sudden death]. Patients with persistent and recurrent chest pain after admission and those with frequent arrhythmias were more prone to complications. Multiplicity of risk factors were more evident in the group of patients with a worse short-term prognosis

Asymptomatic ischemic heart disease in diabetics with clinically manifest angiopathy

Twenty patients with maturity onset diabetes mellitus and detectable vascular complications were studied. All were free from symptoms and/or clinical signs of ischemic heart disease, as well as being normotensive. They were 15 males and 5 females with a mean age of 57 and 55 years, respectively. Diabetic retinopathy was detected in 25% and cerebral vascular complications in 15%. The age, long duration of the disease and the poorly controlled diabetic state were the precipitating factors for the vascular complications. The incidence of occult ischemic heart disease in the studied group was 35%. This was discovered from either a resting electrocardiogram or exercise stress test

Stress testing in the diagnosis of latent ischaemic heart disease in high risk patients

Thirty patients with more than two high risk factors were studied. They were 13 asymptomatic and 17 symptomatic patients, also 15 normal controls were included. All patients and controls were above 40 years. The bicycle ergometer was used to perform the graded exercise stress test. With taking all the parameters of positivity, 7 out of 13 asymptomatic patients showed positive stress test [53.84%]. In the symptomatic group 14 patients showed positive results [82.35%]. Comparison of the results in asymptomatic group with the controls revealed the significance of discovering latent IHD by means of exercise stress testing

Echocardiographic and skeletal features of mitral valve prolapse

Study of the various modes of presentation of mitral valve prolapse [MVP] syndrome in the patients was carried out with special stress on echocardiographic and skeletal features. Review of the records of 30 patients with established diagnosis besides the study of new 12 cases was done. Skeletal abnormalities were frequent in the studied material and echocardiography proved to be a precise noninvasive mean for the diagnosis of MVP syndrome. Also, a correlation was found between the auscultatory and echocardiographic signs