Right sided restrictive cardiomyopathy in Egyptian peasants with hepatosplenic schistosomiasis: a Retrospective 5- year study

Endomyocardial Fibrosis [EMF] is a common disease in the humid zones of tropical Africa- Recognition of cases outside the tropical zone has been reported with increasing Interest. We report our experience with 30 Egyptian peasants who all had infection with schistosoma. Laboratory investigations, 12-lead electrocardiography and pericardiocentesis were performed in all patients. Pericardial biopsy was performed in some patients. All patients had evidence of infection with schistosoma mansoni, schistosomal hepatic fibrosis. splenomegaly and ascites. All patients had markedly congested neck veins with positive kussmaul's sign in some patients. All patients had no eosinophilia. Atrial fibrillation was detected in 24 patients. Detailed echocardiographic study showed obliteration of the right ventricle [RV], apical RV firbrosis, varying degrees of exudative pericardial effusion in all patients. No extension of fibrosis into RV outflow tract. No fibrosis in left side of heart. Hugely dilated right atrium [RA] with RA spontaneous echo contrast detected in all patients and FM thrombi in only 10 patients. Normal size pulmonary artery without pulmonary hypertension. Minimal to mild tricuspid regurgitation was detected in all patients by Doppler echocardiography. In conclusion, right-sided restrictive card iomyopathy is a special form of EMF detected only in Egyptian peasants without eosinophilia. It always, involved the right side of the heart. Calcification extended to the RV outflow tract in some cases

Duplex carotid ultrasonography in patients with ischemic heart disease

This study was designed to assess the the extracranial carotid arteries by a simple non invasive inexpensive repititlve tool to search for atherosclerotic changes and their correlation with similar ischemic coronary artery disease in similar age groups. The material of the study comprised 68 subjects: 53 patients with various types of ischemic heart disease and 15 subjects as a control group. Our results showed the following: Significant positive correlation between all lipogram parameters including total cholesterol/HDL cholesterol ratio hyperuriceamia and carotid atherosclerosis. Significant positive correlation between echocardiographic left atrial diameter, left ventricular hypertrophy and carotid atherosclerosis. Significant increase in carotid atherosclerosis in patients with transmural MI and non-Q wave MI when compared to those with stable and unstable angina. Carotid atherosclerosis is more in patients with stable angina than in those with unstable angina. The overall conclusion of the study is that, there is a close relationship between coronary and carotid atherosclerosis, both sharing more or less the same risk factors. The degree of carotid atherosclerosis can be used as a mirror for coronary atherosclerosis so it can be used as a non invasive procedure for assessment of patients prepared for coronary angiogram. Carotid atherosclerosis goes hand in hand with coronary atherosclerosis so, the incidence of carotid plaques or increase intima media thickness with subsequent transient ischemic attacks or other neurological events are more in patients with transmural MI than those with non Q-wave MI, and in the later than those with stable or unstable angina