Pregnancy in a woman with uncorrected tetralogy of fallot.

Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease after 1 year of age, with overall incidence approaching 10% of all congenital heart disease. Natural survival (i.e. without corrective procedure) into the fourth decade is extremely rare (only about 3%), but there is a tendency of increasing number of women with cyanotic congenital heart disease living 3 to 4 decades and are becoming pregnant. Because of significant physiology adaptation and changes, pregnancy and delivery process are troublesome for mostly unhealthy women, including those with uncorrected ToF. For ToF patients, it remains an important cause of maternal morbidity (62,5%), and even mortality (10%) and has significant effects on fetal outcome. Discussed below a case of pregnancy in a 28 year old woman with uncorrected ToF, was diagnosed to have pneumonia, ToF-class III-IV of New York Heart Association, secondary polycythemia caused by hypoxia, and uncompensated metabolic acidosis on 25th week pregnancy. Through delicate medical care, patient's condition improvement can be seen. Patient decided to continue the pregnancy. Without optimal either obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor.

The use of ACE inhibitor in cardiovascular disease.

Competitive inhibition of Angiotensin Converting Enzyme has an important role in cardiovascular diseases, which has been demonstrated by various extensive studies. Based on pharmacologic and mechanism of action, the pharmacodynamic of ACE-inhibitor involves some specific system, such as hemodynamic, neurohormonal, anti- proliferation and renal effect, etc. ACE-inhibitor has beneficial effect in various cardiovascular diseases such as heart failure, hypertension, systolic and dyastolic left ventricle dysfunction and acute myocardial infarction. This article will discuss advantages of its therapeutic use, the adverse effects that might occur as well as how to overcome this effect and also when it should be stopped. Extensive studies also demonstrate that therapeutic use of ACE-inhibitor will improve the quality of life and survival rate in conjunction with the decrease of morbidity and mortality.

The correlation between high sensitivity C-Reactive Protein level and the Extent of Coronary Lesion and Cardiac Systolic Function in Coronary Heart Disease.

To determine the mean value of high sensitivity C-Reactive Protein (hs-CRP), association between plasma level of hs-CRP with extent of disease and systolic function. A cross sectional study had been conducted to 106 coronary artery disease patients (90 stable angina pectoris, 11 unstable angina pectoris and 5 acute myocardial infarction). Plasma quantitative level of hs-CRP with cor angiography to determine extent of disease and ejection fraction were measured. The mean of hs-CRP levels in patients with SVD were 5,5 ± 7,6 mg/L, DVD were 6,6 ± 21,7 mg/L and TVD were 5,5 ± 8,0 mg/L and p=0,056, respectively. There were no significant association between hs- CRP levels with extent of disease. Systolic function had negative correlation with levels of hs-CRP (p=0,015, r=-0,235). This study showed that plasma level of hs-CRP cannot reflect the extent of disease, and it had negative correlation with systolic function.