Cardiac profile in primary hypothyroidism and effect of therapy

This study was undertaken to evaluate the cardiac function determined by echocardiography, heart and chest X-rays and electrocardiogram [ECG] in a group of 15 infants and children with congenital hypothyroidism prior to and after thyroxine therapy. Their ages varied from 1 to 30 months, 6 cases were males and 9 were females. Prior to therapy, the study revealed that 40% of these patients had murmurs, 80% had ECG abnormalities, 66% had radiological enlargement of the cardiac silhouette, 20% had evidence of myopathic changes, mainly of the obstructive type, and all the subjects had small to moderate pericardial effusion. After full replacement therapy, these abnormalities reversed to normal, except for one patient with a persistent mild posterior effusion and an associated pulmonary stenosis. No significant abnormality in cardiac chamber dimensions or indices of myocardial function was detected among the hypothyroid children, prior to therapy or after re-establishment of normal thyroxine concentrations with exogenous hormone. The study revealed that the cardiac abnormalities observed in this study did not compromise the cardiac function and reversed to normal after full replacement therapy

Comparative study of measurements of mitral valve area by cross-sectional and Doppler echocardiography versus intra operative measurements

Thirty patients with mitral valve disease were prepared for surgical treatment in the form of mitral valve replacement or open mitral commisurotomy were included in our study. Mitral valve area was measured for all patients by cross sectional echocardiography [Plainmetry] and Doppler echocardiography [pressure half time] and correlated with the results of intraoperative measurements [balloon technique]. Also, correlation between two dimensional and Doppler measurements was done. We divided our patients into 3 groups. Group A including 13 patients with mitral valve disease atrial fibrillation and without affection of subvalvular apparatus. Group B including 7 patients with mitral stenosis, mitral regurgitation, sinus rhythm and no subvalvular affection. Group C including 8 patients with mitral valve disease, atrial fibrillation and with subvalvular affection. The correlation for the entire group was strong between Doppler versus intraoperative, two dimensional versus intraoperative and two dimensional versus Doppler but correlation between doppler versus intraoperative was better than that between two dimensional versus intraoperative. Also we observed a significant correlation between Doppler versus intraoperative in patients with atrial fibrillation and those with mitral regurgitation. Again in patients with subvalvular affection there was significant correlation between Doppler and intraoperative measurements, but in contrast, the correlation was poor between two-dimensional versus intraoperative and Doppler. Also two dimensional measurements of mitral valve area were inaccurate in patients with calcification of the mitral leaflet. Generally, we found that Doppler echocardiography was a more accurate method in estimating mitral valve area than two-dimensional. However real time echocardiography provides us with a morphological and anatomical details about the whole mitral valve apparatus. Consequently, the marriage of Doppler and two-dimensional echocardiography allows to estimate the severity of mitral stenosis accurately and abolishes the role of cardiac catheterization in this subject except in a limited number of cases

value of technetium 99m stannous pyrophosphate myocardial scintiscan in detection of acute myocardial infarction

As electrocardiogrophic criteria of acute myocardial infarction is not specific in some situation as in the case of non Q wave infarction, left bundle branch block and patients with previous infarction. Also elevation of cardiac enzymes can occur with other circumstances rather than acute myocardial infarction. The previous reports have encouraged us to perform this work in which we utilized technetium 99m pyrophosphate myocardial scintiscan as additional diagnostic tool in the diagnosis of acute myocardial infarction both Q and non Q wave. This work was done on fifty patients with prolonged chest pain suspicions of coronary insufficiency and ECG changes wether Q or non Q admitted to CCU of Ain-Shams university hospital. All patients were injected intravenausly by 10mci of Technetium 99m pyrophosphate which was prepared in the hot lab of nuclear medicine department, then injected in the patients after 20 minutes. The patient were transfered to nuclear medicine department 90-120 minutes after injection for myocardial scanning. The scanning was done by using gamma camera the adjoined computer system transfer the image to the special films. Evaluation of resultant images were done as regards type, grading and wall location of technetium 99m Pyrophosphate uptake. The myocardium scintiscan by Technetium 99m Pyrophosphate was positive in 42 patients, 32 patients with Q wave infarction and 10 patients with non Q wave infarction among those 42 patients only one patient considered as false positive. On the other hand we have 8 patients with negative scan, 4 of them proved to be lost false negative. Three types of scan uptake were recognized. The discrete type, which was seen in 22 patients, 20 of them were found to have Q wave infarction the other two were non Q. The diffuse type was the commonest finding of non Q infarction [in 70% of positive cases]. And lastly the doughnut type present in only two patients, one with Q wave infarction while the other with non Q wave infarction. As regards the sensitivity and specificity of this test among those patients presented with Q - wave infarction. The sensitivity was 94.1% and the specificity was 100%. The diagnostic accuracy this test was 94.2%. Among those patients with non Q ware infarction the sensitivity was 81%, the specificity was 75%, the diagnostic acuracy of this test was 80%

Doppler versus angiographic quantitation of mitral regurgitation

30 patients with mitral valve disease were subjected to clinical examination, resting 12-lead electrocardiogram, chest X-Ray. echocardiographic examination including Doppler study and finally to cardiac catheterization and angiography. Three Doppler echocardiographic indices were measured. The first was the left atrial flow pattern. The second was mapping the extent of the regurgitant jet into the left atrium. And the last was calculating the regurgitant fraction. The method that correlated mostly with left ventriculography was mapping of the extent of the regurgitant jet into the left atrium with a correlation coefficient of 0.88. The regurgitant fraction correlated less with left ventriculography with a coefficient of correlation of 0.88. Studying the left atrial flow pattern could not separate various grades of mitral regurgitation. It only succeeded in separating mild from other degrees

Analysis of QT interval in patients with mitral valve prolapse

20 patients with mitral valve prolapse were subjected to full clinical examination, 12 lead electrocardiogram [speed 25 mm/sec] followed by a rhythm strip on lead II or V4-V6, echocardiographic examination including doppler study and 24-hours ambulatory Holler monitoring. Twenty normal age and sex matched to the individuals with no cardiac complaints were subjected to the above mentioned investigations except echocardiographic examination which was not done in all the patients. In both groups both the mean and maximum QT intervals were measured and corrected using the formula derived from Bazelt by dividing the measured QT interval by the square root of the corresponding R-R interval. The aim of this study was to determine the relation between the abnormalities of the QT interval and the occurrence of arrhythmias. In this study it was found that the incidence of QT prolongation in patients with MVP varied between 20% by using the mean QT interval and 70% with the maximum QT interval. Higher incidence of arrhythmias were found in patients with MVP in whom the maximum QT interval were prolonged compared with those with normal maximum QT interval. Also we found a trend toward longer QT intervals and higher heart rates in patients with MVP