randomised trial of recombinant tissue plasminogen activator combined with heparin versus heparin in acute pulonary embolism: assessing pulmonary perfusion and right ventricular function

26 patients with PE were enrolled in this study. PE was confirmed by high probability ventilation-perfusion lung scans. All patients were hemodynamically stable at presentation. They were randomly allocated to treatment with either rt-PA followed by heparin [group A] or heparin alone [group B]. In group A [12 patients], patients received 100 mg rt-PA over 2 hours [50 mg/h] with heparin subsequently infused at a rate of 1000 U/h. Patients in group B [14 patients] received an initial bolus dose of 5000 U heparin followed by a continuous peripheral intravenous infusion of heparin [1000 U/h]. Echocardiography and ventilation-perfusion lung scans were done at baseline and at 24 hours. Within 24 hours of treatment, right- ventricular wall motion improved in 42% of the rt-PA/heparin patients and worsened in 8%, while an improvement was observed in only 21% of the heparin alone patients and worsened in another 29% [P <0.001]. Moreover, the right-ventricular end-diastolic area decreased in the rt-PA/heparin patients and remained unchanged in the heparin alone patients. Also, the rt-PA/heparin patients showed absolute improvement in pulmonary perfusion of 16.3% compared with 1.9% improvement among the heparin alone patients. The findings of this randomized study suggested that thrombolysis with rt-PA followed by heparin is superior to heparin alone in producing rapid improvement of right-ventricular function and pulmonary perfusion in patients with acute PE

Nausea and vomiting as predictors of presence, location and size of acute myocardial infarction

In a trial to assess the value of nausea and/or vomiting in prediction presence, location and/or size of acute myocardial infarction [AMI] in patients presenting with acute chest pain and electrocardiographic [ECG], changes suggestive of coronary heart disease [CHD], 220 patients were included in the present work. They classified into AMI group [G1], [which was further classified into anterior Q-wave infarction [G[1a]], inferior Q-wave infarction [G[1b]] and non-Q-wave infarction [G[1c]] and noninfarction group [G[11]]. Nausea and/or vomiting were good predictors of AMI [85% positive predictive value]. They had no relation to infract site [67% in anterior infarction group VS. 65% in inferior infarction group with insignificant difference between them]. Using peak serum creatine kinase [CK] level, as an index of infect size, nausea and/or vomiting were good predictors of larger infarction [nausea and/or vomiting were present in 54%, 70%, 79% and 86% in patients with peak serum CK level < 1.000 IU/liter, > 1000 IU/liter, > 1.500 IU/liter, and > 2.000 IU/liter, respectively]. Thus, nausea and/or vomiting are important predictors in diagnosing AMI and are associated with larger myocardial infarctions but do not suggest infarctions in a particular location

Echocardiographic evaluation of cardiac dimensions and functions in elderly population

Seventy four subjects [33 females, 41 males] were the material of the study. Amongthem there were 57 elderly [60-69 years] and 23 control subjects. History and physical examinations were performed for all of them with empohasis on the cardio vascular system to ensure that the subjects were healthy achive and free from disease which night affect the cardiovaseular system. The resting cardiogram and echocardiography examination and 2.D and Doppler] were done for all subjects. Echocardiographic derived cardiac dimensions, systolic and diastolic indices were obtained and compared in both elderly and control subjects. Concerning cardiac dimensions, all parameters studied showed no significant difference, except for, right ventricular dimension [increased in males and females elderly] aortic diameter [increased in elderly over 70 years in males and females] the left atrial dimension [increased in male elderly between 40 and 70 years old] and posterior wall dimension [increased in male elderly]. As regards the systolic function, there was no significant difference between elderly and young subjects. However, all parameters studied for diastolic function showed highly significant difference between elderly and young age groups. Left ventricular diastolic waveform is substantially altered with aging. Early and late diastolic filling velocity and the ratio of maximal early to late diastolic filling velocities as assessed by Doppler echocardiography are importantly and indepentently affected by aging. This study revealed that echocardiogram is particularly suited to study the effect of age on the heart. It provides anatomic information which is unobtainable by any other technique in living individuals. Also the effect of age should be taken into account when the. normal, limits for Doppler indices of LV diastolic function are defined