Pulmonary function profile in chronic congestive heart failure and the effect of ipratropium bromide.

Twenty-five symptomatic patients of chronic heart failure were subjected to spirometry to detect abnormalities of pulmonary function and to assess the effect of ipratropium bromide in reversing or minimising these abnormalities. All the patients exhibited abnormal pulmonary function manifesting as obstructive (15/25) or restrictive (10/25) ventilatory defect. There was overall improvement in lung functions with ipratropium bromide especially in those with obstructive ventilatory defects and mostly comprised of smokers. Forced expiratory volume in one second increased by 47.7 percent (p < 0.02), forced expiratory volume in one second/forced vital capacity ratio by 14.1 percent (p < 0.001) and maximal voluntary ventilation by 40.6 percent (p < 0.05) in these patients. It is concluded that ipratropium bromide can prove as a promising adjunctive therapeutic intervention in improving quality of life in patients of chronic congestive heart failure who are incapacitated by dyspnoea and have clearly documented ventilatory defects.

Silent myocardial ischemia and cardiac autonomic neuropathy in diabetics.

OBJECTIVE: To evaluate the association of silent myocardial ischemia (SMI) with cardiac autonomic neuropathy in asymptomatic diabetic patients. MATERIAL AND METHODS: Two hundred asymptomatic patients of diabetes mellitus were assessed for evidence of cardiac autonomic neuropathy. Of these, 30 (15 males, 15 females; mean age 44.7 +/- 8.8 years) were found to have cardiac autonomic neuropathy. Thirty (30) age and sex matched diabetic patients (mean age 42.4 +/- 7.6 years) who had no evidence autonomic neuropathy were included in the study as control group. Both the groups of patients were evaluated for SMI by 24 hour ambulatory electrocardiographic (ECG) monitoring. RESULTS: Incidence of SMI was significantly higher in patients with autonomic neuropathy 12/30 (40%) compared to those without 3/30 (10%) p < 0.001. Duration of diabetes was more (13 +/- 1.59 years) in patients with autonomic neuropathy compared to the control group (8.66 +/- 1.55 years) p < 0.001. Serum cholesterol and triglyceride levels were significantly higher in patients with autonomic neuropathy in comparison to control group < 0.05 and < 0.01, respectively. There was no difference in the pattern of SMI in the two groups (p = N.S). CONCLUSION: Cardiac autonomic neuropathy predisposes patients with diabetes mellitus to SMI. Twenty four hour ambulatory ECG monitoring provides useful diagnostic information in early detection and evaluation of SMI in asymptomatic diabetic patients.