Acute coronary syndrome in young adult and old age [comparative study]

Clinical characteristics as well as biochemical profile and angiographic findings in patients with acute coronary syndrome may differ in young compared to old patients. We compared clinical, laboratory and angiographic characteristics in forty four patients with acute coronary syndrome at age 50 years [group II]. All patients presented by acute coronary syndrome and admitted to the coronary care unit at Bab-Elsharia University Hospital. The two patients groups were compared in coronary risk factors and angiographic features. STEMI were [43.2% vs 28.6%], NSTEMI [9.1% vs 7.l%] and UA [47.7% vs 643%] with no statistical significance. Smokers were high in GI [47.7% vs 35.7%] and non smokers were high in GII[45.5% vs 62.5%] with no statistical significance and the smoking index is more in Gil [1262.1 + 618.9] than GI [946.67 +/- 514.3] mostly due to longer duration of smoking. No statistical significance as regard hypertension [27.3 vs 42.9%] and DM [25% vs 32.1%] but the duration of DM has great trend in GII [7.94 +/- 6.08 II vs 5.91 +/- 4.39] [p value 0.06]. Among the diabetic patients; five [8.9%] in GII had retinopathy [p value < 0.05]. No statistical significance as regard past history of ischemic events or family history of premature coronary artery disease. There is significant correlation between LDL level and age of the patients [56.8% vs 76.8%] [p value = 0.05]. Serum TG was [59% vs 44.6%] with no statistical significant difference were detected [p value > 0.05]. The mean number of risk factors was 2.068 +/- 1.265 vs 2.143 +/- 1.368 with no statistical significance. In coronary angiography ectatic vessels with no significant stenotic lesions were [13.6% vs 5.4%] while myocardial bridge were [11.4% vs 7.1%]. Ostial and/or proximal lesions present in [31.8% vs 51.7%] while twenty six mid and/or distal lesions in [59.l% vs 78.6%] with no statistical significance. One vessel disease in [34.1% vs 30.3%], 2 vessels [11.4% vs 25%], three vessels [13.6% vs 12.5%] and more than three diseased vessels [6.8% vs 12.5%] p value > 0.05. Mean% narrowing of significant stenosis was in GI 82.915 +/- 15.821 vs 1181.114 +/- 16.286 with [p value > 0.05] but the number of segments was more in GI with p value 0.049. We still have much to learn about the pathophysiology of the acute coronary syndrome especially among thee young Egyptian patients. Age difference in acute coronary syndrome of Egyptian patients has no influence on other traditional risk factors although high prevalence of other risk factors in old age group especially serum level of low density lipoprotein [LDL-c], duration of diabetes mellitus and its micro-vascular complications may be related to long duration of these factors

Electro-cardiographic detection of the site of totally occluded left anterior descending coronary artery

The goal of this study was to undertake the assessment of the value of ST-segment changes in various ECG leads during evolving acute anterior wall myocardial infarction in predicting the location of left anterior descending coronary artery obstruction by coronary angiography. A total number of 40 patients were enrolled between October 2000 and June 2001. All patients subjected to full history taken, clinical assessment, twelve leads resting ECG serial cardiac enzymes, laboratory tests, echocardiography and coronary angiography. According to angiographic results, patients were classified into: Group A having proximal LAD and group B having mid and/or distal LAD lesion. In this study, the presence of the ST-segment elevation in lead land aVL were greater and more frequent when lesion was in the proximal LAD than when it was in the mid or distal segment. On the other hand, the presence of ST-segment depression in leads II, III and aVF also were greater and more frequent when the lesion was in the proximal LAD than it was in the mid or distal segment. Also, this work demonstrated that STsegment depression in inferior leads II, III and aVF was strongly correlated with ST-segment elevation in leads I and aVL. Also, group A had a significantly higher incidence family history of ischaemic heart disease than group B. This work concluded that patients with proximal LAD lesion had a worsen prognosis than patients with mid or distal LAD lesion

Duplex ultra-sonographic assessment of carotid arterial wall abnormalities in normotensive post-menopausal women

The aim of this research was to assess both structural and functional carotid arterial wall abnormalities in normotensive post-menopausal women by duplex Ultra sonography. Sixthy eight female patients [age 56 +/- 6.3] were attending gynaecology and obstetrics out patient clinic for non cardiac causes at Bab El Sha‘aria University Hospital, were chosen for the study [from October 2002 to April 2003], twenty five premenopausal womenlwere taken as controls [age 36 +/- 4.32]. Exclusion criteria were ischaemic and myopathic heart diseases, aortic valve diseases, diabetes mellitus, renal diseases, and peripheral vascular or systemic diseases. They were subjected to the following investigations, blood sugar level, uric acid, female hormonal assay level in the blood [oestradiol E2, progesterone FSH, LH], and blood lipid profiles [cholesterol, Triglycerides. LDL, HDL]. Duplex data of the carotid arterial wall was obtained to measure the intimal-medial thickness and to estimate elasticity and distensibility indices of the compliance.Carotid artery elastic properties wgre determined by relating changes in arterial diameter to changes in pressure generated with each heart beat, carotid artery distensibility was less and young modulus of elasticity was greater in post menopausal women than premenopausal women. Carotid artery wall thickness increased in post menopausal women and carotid vascular changes in normoncnsivc post menopause were associated with higher level of FSH, LH with lower level oestradiol [E2]. progesterone than controls. Also, these changes were associated with higher level of cholesterol, trighlycerides, LDH with lower level of HDL than controls

Conclusion: Carotid compliance is reduced in normotensive post-menopausal women. Carotid intimal medial thickness increases. Carotid arterial wall abnormalities are associated with low ocstradiol and progesterone with high blood lipid profile

Role of glycoprotein receptor IIB/IIIA antagonists in acute coronary syndromes, comparative study between Eptifibatide and Tirofiban

The aim of this study was to determine the difference between eptifibatide and tirofiban as glycoprotein IIb/IIIa receptor antagonists in acute coronary syndromes, as regards the efficacy in reducing morbidity and mortality and also as regards safety. A total of 60 patients was enrolled between November 2000 and October 2001. All eligible patients were those who had ischemic chest pain, either ECG changes indicative of ischemia or high serum concentration of CK- MB troponin I or both. They were randomly assigned to receive either eptifibatide or tirofiban, in addition to standard therapy. Drugs were infused for 48 hours. The endpoint was a composite of death, myocardial infarction and refractory ischemia within seven days after randomization. There were no significant differences between both groups [eptifibatide and tirofiban] as regards the frequency of the composite end point [at 48 hours, 26% in the eptifibatide group vs. 20% in tirofiban group and at 7 days, 20% versus 24%]. Similarly, the frequency of bleeding events was not significantly different between both groups [14% in the eptifibatide group versus 6% in the tirofiban group]. The study concluded that there were no significant differences between eptifibatide and tirofiban in acute coronary syndromes, as regards efficacy and safety

Left ventricular diastolic filling dynamics during isometric exertion in patients with microvascular angina assessed with transmitral doppler flow velocities

The patients in this study were divided into three groups. The first group included 34 patients [22males and 12 females with a mean age of 48 +/- 3.21 years] with documented microvascular angina [typical anginal pain, positive electrocardiography on exercise with ST-T segment depression >1 mm, abnormal perfusion scans, normal coronary angiography]. The second group included 27 patients [19 males and 8 females having a mean age of 50 +/- 4.1 years with documented coronary artery disease. The third group included 15 healthy subjects of the same age group as controls [8 males and 7 females, mean age was 47 +/- 6.26 years]. Moderate isometric exertion [one half-maximal effort in one minute] produced approximately one-third increase in the mean arterial pressure and 30% increase in heart rate in all studied groups. In conclusion, isometric exertion, in form of firm sustained hand grip, induced left ventricular diastolic filling indices abnormalities in patients with microvascular angina. Similar changes were observed in patients with established diagnosis of coronary artery disease. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular abnormality in patients with microvascular angina

Evaluation of cardiovascular changes in adolescents with mild essential hypertension by echocardiography and duplex ultrasonography

The aim of this research was to assess the cardiac as well as the vascular changes in adolescents with mild essential hypertension by echocardiography and duplex ultrasonographic technique of both carotid arteries. Forty-seven male patients with mild essential hypertension were chosen for the study. Sixteen male normotensive subjects in the same age group were taken as controls. The echocardiographic data showed that isovolumic relaxation time, posterior wall thickness at diastole, muscle mass and muscle mass index were significantly increased in hypertensive group; while, Ef%, Fs%, MVCF, stroke volume, stroke volume index, cardiac output, cardiac output index, E- F-slope, interventricular septal thickness at diastole, aortic root and left atrium dimensions insignificantly changed. Duplex data of both carotid arteries showed that intimal-medical thickness significantly increased, while pulsatility index insignificantly increased in hypertensive group

Early and late haemodynamic effects of successful coronary angioplasty with coronary stenting on the mitral and aortic flow filling patterns assessed by pulsed doppler-echocardiography

Forty patients [31 males, 9 females], mean age [49.33 +/- 8.166 years] were selected for this study. Their clinical presentations were different: 5 cases with highly positive stress test, 21 cases non-infarct and 14 cases infarct with clinical manifestations of instability. For all selected patients in this study, the coronary arteries lesions fulfilled the criteria for intervention with different anatomical site lesions. Successful angioplasty with coronary stenting was defined as 50% increase in luminal diameter with residual narrowing <40%. Doppler echocardiographic measurements were obtained before, within 24 hours, after three months of the procedure. Twenty healthy persons were taken as controls [15 males and 5 females with mean age 51.1 +/- 8.172 years]. Early effects of successful PTCA with coronary stenting on the mitral and aortic flow filling patterns were the diminution of isovolumic relaxation time [IVRT]. Peak aortic flow significantly increased and other variables insignificantly changed. However, after three months, the value of EF slope increased. Also, E/A integral ratio increased, and while A% integral decreased, E/A ratio increased. Acceleration and deceleration times significantly increased and aortic flow integral increased. The mean value of EF%, FS%, MVCF, SV, SVI, COPI insignificantly changed either early or late after revascularization

Immediate and late effect of mitral balloon valvuloplasty on pulmonary function tests and arterial blood tensions gases

This work was carried out to evaluate the effect of mitral valvuloplasty on pulmonary function tests and on the arterial blood gases tensions. Twenty-two patients with rheumatic mitral stenosis were presented with symptoms, and signs sufficient to warrant intervention. Every subject in this study was assessed as followed: Complete history taking, clinical evaluation, ECC, x-ray chest, pulmonary function tests, echo-Doppler examinations, percutaneous balloon mitral valvuloplasty and arterial blood O2, CO2 tensions. All patients had immediate post procedural considerable clinical and hemodynamic improvements

Assessment of percutaneous transluminal balloon pulmonary valvuloplasty for the relief of pulmonary valve stenosis

Percutaneous Transluminal Balloon Valvoloplasty was performed in 30 patients with isolated pulmonary valve stenosis in the National Heart Institute, patients ranged in age between 23 months and 28 years [mean 11.24 +/- 7.8]. Before dilatation, all patients with severe pulmonary stenosis had variable degrees of right axis deviation and right ventricular hypertrophy on the ECG. Moderate and severe pulmonary valve stenosis [right ventricular pulmonary artery systolic pressure gradient [50-80] and > 80 mmHg respectively] was confirmed both baemodynamically and echocardiographically. Balloon size was selected to be approximately 30 - 40% larger than the pulmonary valve annulus. Balloons were inflated to approximately 5 atmospheres of pressure. Predilatation peak systolic pressure gradients ranged from 45 to 215 mmHg [mean 114 +/- 44.7 mmHg] and decreased significantly immediately after dilatation to a range of zero to 100 mmHg with mean of 31.31 [ +/- 21.17 mmHg] and remained low during follow up period of 6 months where they ranged from 15 mmHg to 100 mmHg, with a mean 37.48 +/- 27.78 mmHg. There were no deaths nor major complications. Four patients showed mild degrees of pulmonary regurgitation in the follow up period