Study of the pathophysiological mechanism in patients with typical chest pain and normal coronary arteries

Endothehelial dysfunction. thrombogenesis and inflammation were studied as possible mechanisms in pathogertesis of cardic syndrome-X through monitoring plasma endothelin-1 fibrinogen, vWF and CRP in patients with typical chest pain, positive stress ECG[clinical and ECG evidence of ischemia] and normal coronary angiography. The aim of this study is to evaluate plasma concentration of enclothelin-1 and other factors in patients with typical angina pectoris and angiographically normal coronary arteries. This study included 50 patients complained of typical chest pain [group A], Another group of 20 healthy subjects were studied as control group [group B]. Exercise test and coronary angiography were performed for all patients. Patients showing positive exercise ECG and having normal coronary arteries were selected. Blood samples were collected and examined for endothelin-1, fibrinogen, CRP and vWF. Endotheline-l fibrinogen, CRP and vWF were found to be significantly raised in that group of patients with syndrome-X in comparison with the control group, so they could predict and confirm diagnosis in patients with syndrome-X. CRP, vWF fibrinogen and ET-1 in that order were significantly high in patients with syndrome-X. Thus assessment of their levels in serum may be highly needed to fulfill the diagnosis of cardiac syndrome-X

Evaluation of some new diagnostic modalities for deep venous thrombosis

The aim of this work is to evaluate some new diagnostic modalities; D-dimer test, Duplex imaging and MR venography; for Deep Venous Thrombosis [DVT]. Thirty patients were included in this study with clinically suspected Dm. Full history taking and thorough clinical examination together with routine, Laboratory investigation, resting ECG, Trans- thoracic Echo-Doppler Murex D-dimer test and Duplex imaging were done for all patients. MR venography was done only for the 16 cases with the clinical pretest intermediate probability for DVT. The results of the present study showed that 20 cases showed positive duplex, 7 with popliteal, 7 fern oral and 6 cases with femoral and popliteal DVT. 19 cases showed positive D-dimer test Vs 11 with negative test. The 16 cases subjected to MR venography showed results coincide with same findings as Duplex apart from 3 cases in which soleal and ilia1 DVT not detected by Duplex study. Conclusion: From the results, it was found that: Duplex ultrasonography is now considered the diagnostic modality of choice in evaluation of the venous system of lower limbs. Because of its safety, accuracy, high specificity, sensitivity, and its availability, all these makes it a modality of choice. D-dimer test is specific degradation product of fibrin, in our study and other studies have shown its high sensitivity moderate specificity and high negative predictive value for suspected deep vein thrombosis. Its value varies from, one study to another according to the type of D-dimer assay used in the study. When D-dimer test combined with clinical pretest probability, its negative predictive value is markedly increased up to 100%. MR venography and Duplex sonography have been found to be identical for evaluation 01 DVT in venous system as regard of popliteal and femoral veins, but it is superior to Duplex study in evaluating venous system of the pelvis and iliac veins. Its availability, lack of operator experience and its cost limit its application. Recommendation: Duplex ultrasound is the diagnostic modality of choice for DVT of lower limbs and MR venography is preferable only in selected cases. D-dimer test when combined with clinical probability is a good negative test which can reduced the need for Duplex imaging

Role of Ambulatory Blood Pressure monitoring in evaluating hypertensive patients with and without left ventricular hypertrophy

This study included 60 patients with essential hypertension [32 females and 28 males], their age ranged from 43 to 59 years [mean 52 +/- 4 Twenty normal, age and sex matched, healthy subjects were also studied as a control group. All subjects were subjected to 24 hours Ambulatory Blood Pressure Monitoring [ABPM], EGG and Echocardiography. According to echocardiographic parameters, hypertensive patients were classified into two groups. hypertensives with left ventricular hypertrophy [LVH] and hypertensives without LVH. This study revealed: Significant increase in left ventricular mass and LVH in hypertensive versus normotensive group. LVH is more closely related to ambulatory blood pressure than to casual blood pressure. Closer relation of systolic over diastolic BP to the degree of hypertrophy, another evidence that wall stress which is mostly related to systolic blood pressure [SBP] is a key factor influencing LVH development. Significant increase in left ventricular mass and LVH in hypertensives with marked fluctuation in BP throughout 24 hours versus hypertensives without marked fluctuations. Significant increase in LVM in hypertensive non-dippers versus hypertensive dippers. The propensity for LVH among patients with hypertension is increased with age and with the duration of hypertension. The results of this study shows a significant relationship between cir-cadian blood pressure changes and left ventricular hypertrophy which underlines the importance of ambulatory blood pressure monitoring in evaluating the effects of hypertension in relation to left ventricular hypertrophy

Study of the effect of left ventricular hypertrophy on Q-T dispersion in patients with essential hypertension

There is increasing interest in Q-T dispersion as a marker of inhomogenicity of ventricular repolarization and hence ventricular arrhythmia due to re-entery. This study was performed to assess QT- dispersion in hypertensive patients with and without left ventricular hypertrophy. The study included 50 hypertensive patients: 25 patients with left ventricular hypertrophy [LVH] [Echo-diagnosed] as group I and 25 without LVH as group II. Every patient was subjected to full history taking and thorough clinical examination, analysis of serum sodium and potassium, EGG for measurernent of QT- dispersion and echocardiography for detection of left ventricular hypertrophy. The study showed that: QT dispersion was significantly increased in presence of left ventricular hypertrophy in hypertensive patients compared with that in hypertensives without left ventricular hypertrophy. So, early detection of LVH is of important valve in detecting the hypertensives who are at higher risk for arrhythmia and sudden death- Those patients must be investigated by arrhythmogenic marke