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

value of plain X-ray film in diagnosis of septal defects

This study was carried out on 46 patients with septal defects. They were 21 females and 25 males, their ages ranged from 5 months to 14 years. Patients were referred with provisional diagnosis based on clinical data. Chest X-ray in postro-anterior and lateral views was performed. All patients were subjected to echocardiaography [M-mode, 2D, doppler, and contrast echo]. There were 17 patients with atrial septal defect [ASD], 19 patients with ventricular septal defect [VSD] and 10 patients with atrio-ventricular canal defects [A-V canal]. In the management of congenital heart disease [CHD], much more information is required than can be obtained from chest radiograph. Nevertheles, useful information may be present which may have an important bearing on planning of subsequent investigation vascular pattern faithfully reflects the underlying patho-physiology of the heart it would seem advantageous for the observer to start with. The roentgen appearance of the great vessele often provides valuable information for the diagnosis of heart disease. Echocardiopaphy of the heart offers a wealth of anatomical and physiological information without radiation or known risk. Echocardiography proved great efficiency in diagnosing all cases of atrial and ventricular septal defects. It clearly demonstrated the exact sites, of septal defects but it could not exactly demonstrated the magnitude of shunt. Finally, this study can conclude that any patient suspected of having CHD, septal defect, should be carefully examined clinically. A good chest film should be performed. Echocardiography should come next as a routine non invasive diagnostic tool

value of QT interval analysis in mitral valve prolapse patients

The aim of this study was to investigate the value of QT interval in 20 patients with mitral valve prolapse [MVP] and 20 controls. Patients had significantly longer QT-corrected values than the normal control subjects. The incidence of QT prolongation in patients with MVP varied from 20% by using the mean QTc interval to 70% by using the maximum QTc interval. Electrocardiographic repolarization abnormalities in patients with MVP had no significant relation to the QTc interval prolongation. An analysis of data was done and a longer QT and shorter R-R intervals were found, therefore higher heart rates were detected in MVP patients. It was concluded that QT interval prolongation was more common in patients with MVP than in normal subjects and that there was a higher incidence of arrhythmias in patients with prolonged maximum QTc interval

Comparison of the amount of ischemic myocardium in patients experiencing angina during treadmill testing versus those who had no angina during stress test

Previous studies that used thallium 201 scintigraphy to compare the amount of ischaemic myocardium in patients who had no anginal pain versus those who experienced angina during treadmill testing used either planar or SPECT imaging, the disparity in results was explained by the fact that different modalities of imaging were used seventy consecutive patients with at least one unequivocal reversible defect were included in our study, we used combined planar and SPECT imaging. Of the 70 patients 67 were males. 68% were known to have coronary artery disease, 54% had previous MI, and 62% had typical chest pain at rest. Twenty-five patient had no chest pain [Group 1], while 45 patients had chest pain during treadmill testing [group 2]. Both groups were identical regarding most clinical finding, except for the incidence of typical chest pain at rest, which was 30% in group 1 and 78% in group 2 P<0.01. Peak heart rate was 154 +/- 17 in group 1 versus 137+17 group 2 P < 0.0001, double product 45 + 5 [10_] versus 21 +/- 4 [10_] P <0.01, duration of exercise 8 +/- 3 min in group 1 versus 5.4 +/- 2.4 min in group 2 P< 0.0001. Stress test was positive in 3/25 patient's in-group 1 versus 18/45 patients in-group 2 P <0.02. The number of reversible defect on planar images was 3.5 +/- 2.3 group 1 versus 4.9 +/- 2.3 group 2 P<0.007 and 4 +/- 2.1 group 1 versus 5.4 +/- 2.3 P<0.009 in group 2 on SPECT images. The grade of worst reversible defect on planar images was 1.08 +/- 0.71 in-group 1 versus 0.77 +/- 0.67 in-group 2. P <0.04 and was 1.2 +/- 0.67 group 1 versus 0.74 +/- 0.62 P < 0.002 group 2 on SPECT images. The ischaemic index on planar images was 1.1 +/- 0.9 group 1 versus 1.61 +/- 1 group 2 P < 0.02 and 0.8 +/- 0.6 group 1 versus 1.3 +/- 0.8 group 2 P <0.008 on SPECT images. Thus both exercise ECG and T1-201 scintigraphy findings show lesser ischaemia in patients with no chest pain versus those with chest pain on treadmill testing. The results of this study were similar for both planar and SPECT imaging

value of plain X-ray film in diagnosis of septal defects

This study was carried out on 46 patients with septal defects. They were 21 females and 25 males, their ages ranged from 5 months to 37 years. Patients were referred with provisional diagnosis based on clinical data. Chest x-ray in postro-anterior and lateral views was performed. All patients were subjected to echocardiography [M-mode, 2D, Doppler, and contrast echo]. There were 17 patients with atrial septal defect [ASD], 19 patients with ventricular septal defect [VSD] and 10 patients with atrio-ventricular canal defect [A-V canal]. In the management of congenital heart disease [CHD], much more information is required than can be obtained from chest radiograph. Nevertheless, useful information may be present which may have an important bearing on planning of subsequent investigations. Vascular pattern faithfully reflects the underlying pathophysiology of the heart it would seem advantageous for the observer to start with. The roentgen appearance of the great vessels often provides valuable information for the diagnosis of heart disease. Echocardiography of the heart offers a wealth of anatomical and physiological information without radiation or known risk. Echocardiography proved great efficiency in diagnosing all cases of atrial and ventricular septal defects. It clearly demonstrated the exact sites of septal effects, but it could not exactly determine the magnitude of the shunts. Finally, this study can conclude that any patient suspected of having CHD, septal defect, should be carefully examined clinically. A good chest film should be performed. Echocardiography should come next as a routine noninvasive diagnostic tool