role of white blood cells in acute coronary syndrome

Inflammation has been shown to play a role in atherosclerosis and acute coronary syndromes. An elevated total WBC count has been associated with increased cardiovascular risk, but which leukocyte subtypes carry this risk, is uncertain. This study was designed to determine the effect of WBC count and other inflammatory markers on severity and outcome of patients with UA/NSTEMI. Seventy [70] patients with UA / NSTEMI admitted to CCU at the Iraqi Center for Heart Diseases were subjected to thorough history and physical examination and WBC indices to find their relation to clinical severity and outcome for both in-hospital and/month after discharge. The results were compared with other thirty [30] patients with chronic stable angina and thirty [30] healthy persons as two control groups. High total baseline total WBC was more prevalent in patient with UA/NSTEMI than in those with stable angina and normal persons [94.1%, 5.9%. and 0%] respectively. High baseline neutrophil was found only in those with UA/NSTEMI [100%, 0%, and 0%]. High baseline Neutrophil/lymphocyte [N/L ratio] and Positive CRP were more prevalent in patients with UA/NSTEMI than in other two groups [92.3%. 7.7%. 0%] and [98.5%, 1.5%. 0%] respectively. Higher total baseline WBC count was significantly found in more severe Braunwald's class of those with UA/NSTEMI 6.3%. 31.3%. and 50.5% for patients with class I, II, III respectively. The same was true for baseline high neutrophil count [6.7%, 33.3% to 60%], high Baseline N/L ratio [7.7%, 15%. and 21.6%]. Patient in the UA/NSTEMI group with higher baseline WBC count had higher risk for death as compared to those of low and intermediate WBC count [0.00%. 0.00%. and 100.00%]. The same was true for those with higher baseline neutrophil count [0.00%. 1.90%, 20.00%] and those with higher baseline N/L ratio [0.00%. 25.000%. 75.000%] respectively. Total baseline WBC and differential count is simple, cheap and widely available bedside test that predicted the severity of CAD and one month survival

Pulmonary lymphangioleiomyomatosis

A 38-year-old Iraqi female, presented with one-year history of exertional dyspnea and exercise intolerance, without systemic or constitutional symptoms. Clinical examination revealed bilateral basal crackles with signs suggestive of left side pleural effusion, chest x-ray showed left sided pleural effusion, and diffuse bilateral basal pulmonary shadowing. Her biochemical analysis, hematological tests, electrocardiogram and echocardiography were normal, aspiration of the fluid revealed a chylothorax, the radiological shadowing was proved by computed tomography scan of the chest to be diffuse cystic lesions involving mostly the lower lobes. Open lung biopsy showed dilated lymphatic vessels with surrounding inflammatory cells and smooth muscle fibers consistently with the diagnosis of pulmonary lymphangioleiomyomatosis LAM

Left ventricular hypertrophy in hypertensive patients electrocardiographic and echocardiographic correlations and geometrical patterns

Left ventricular hypertrophy is considered to be an important risk factor for cardiovascular morbidity and mortality. To study the frequency of occurrence of left ventricular hypertrophy in hypertensive patients using the standard ECG and echocardiographic methods, risk factors for its developments and different LVH geometrical echocardiographic patterns. Two hundred and three hypertensive patients [203] and fifty [50] normotensive healthy subjects underwent standard ECG and echocardiographic examinations using internationally accepted formula for the detection of left ventricular hypertrophy. Electrocardiographic detection of LVH was found in 10.3% of hypertensive patients, compared to 50.2% detected by echocardiography with sensitivity of 18.4% and specificity of 91.3%. Concentric hypertrophy was the most common geometrical echocardiographic pattern [23.7%] followed by eccentric hypertrophy [17.3%] and concentric remodeling [15.3%]. Independent predictors of getting LVH were Age, obesity, uremia. Echocardiography is a more sensitive tool than ECG for the detection of left ventricular hypertrophy; concentric geometry is the most prevalent echocardiographic LVH pattern. Age, obesity and chronic renal failure were independent predictors of getting L VH in hypertensive patients