Normalization of ventricular late potentials by captopril in survivors of myocardial infraction with reduced left ventricular ejection fraction

This study included 32 MI [myocardial infarction] survivors aged 37-67 years [52 +/- 1.5] [mean +/- SEM] with EF <45% [echocardiographic, biplane area length method] whose signal-averaged electrocardiogram [SAEKG] [standard criteria, time domain analysis] was abnormal 33 +/- 3.3 D after MI. Eighteen patients received captopril [35 mg tid for eight weeks] [active group] while 13 received no ACEI [control]. No patients had bundle branch block, syncope, antiarrhythmic drugs or underwent revascularization procedure. Active and control groups were comparable regarding age, gender, thrombolytic therapy, prevalence of hypertension, time after MI, percentage of anterior MR, FF and prevalence of angina. SAEKG was repeated after eight weeks for both groups. Data of 1st and 2nd recordings showed favorable alteration of all parameters. Out of 13 patients without captopril, only one normalized his SAEKG, whereas 17 of 19 patients on captopril normalized at the same period. Shortening of QRS correlated to EF rise

Serum prostacyclin levels in unstable coronary heart disease

To examine the diagnostic value of abnormal serum Prostacyclin [PG12] level as a marker of instability of coronary heart disease, 30 patients [[12 with unstable angina [UA], 8 with acute myocardial infarction [AMI], and 10 with stable effort angina [EA]], and 10 normal adults were studied. Clinical evaluation, as well as estimation of plasma 6-keto-prostaglandin F1 alpha have been carried out for all subjects. Statistical analysis of the results showed the wide dispersion of the prostacyclin values. Median, 25th, and 75th percentiles were adopted for measuring central and dispersion tendencies. The median together with the 25th and 75th percentiles of the 3 ischemic groups were clearly lower than those of the control group. No significant differences in prostacyclin values were present between different subsets of patients with coronary heart disease [CHD]. In spite of the limited number of patients, this study points to a limited diagnostic value for this test in patients with CHD

Clinical correlates of coronary collaterals in Egyptians with isolated lesions of LAD coronary artery

We analysed the clinical and angiography features of 40 males with isolated significant lesions of the anterior descending coronary artery [LAD]. Collaterals [C] graded according to their caliber diameter and the rate of retrograde filling of the LAD into poor. 25 patients had moderate or rich C [Group A] and 15 patients had into or poor C [Group B]. Both groups were compared in relation to age, smoking, hypercholesterolaemia, family history of coronary disease, diabetes, BP, pulse pressure, presence of angina pectoris [AP], incidence of myocardial infarction [M.I.], severity of LAI lesion and left ventricular ejection fraction. Group A patients had a significantly wider pulse pressure [48.4 +/- 11.7 versus 34.6 +/- 10.7 P< 0.01], lower incidence of AP [60% versus 87%, P< 0.01] and M.I. [64% versus 80%, P< 0.05]. There was no significant difference in relation to the other variables analysed. These features conform with previously reported obervations except for the observed wider pulse pressure in patients with significant inficant C to the LAD

Variants of tetralogy of Fallot and associated anomalies, a study of 125 patients

Associated cardiac anomalies and variants of tetralogy of Fallot are common findings. They may be identified by echocardigraphy or during cardiac catheterization and angiography. In 125 patients [ps] studied, associated anomalies were present in 70. Right sided aortic arch was the most common anomaly [34 pts], left to right atrial communication in 64 pts [58 pts had a patent foramen ovale, 5 pts a secondum defect and I had a primum defect]. Miscellaneous anomalies like patent ductus arteriosus, persistent left superior vena cava, anomalies of big arteries and abnormal coronary arteries were present in 16 pts. Variation of the tetralogy were present in the form of associated valvular pulmonary stenosis and or pulmonary supravalvular narrowing or obstruction. Selective pulmonary arteriography or right ventricular outflao tract injection was performed in 98 patients [group A], and only apical right ventriculogram in 27 patients [group B] with this anomaly. Forty seven patients [48%] of the first group [group A] had other obstructions more than infundibular narrowing, of these 42 pts had Valvular stenosls, 38 pts had a hypoplastic pulmonary artery, l9pts had right or left branch stenosis and 2 had an absent pulmonary artery branch. Valvular pulmonary stenosis was only seen on left lateral right ventricular angiogram in group-B, while other pulmonary supravalvular narrowings were not well visualized. In conclusion, associated anomalies are common with tetralogy of Fallot and they can be discovered by echocardiography. Their presence and extent should be confirmed by cardiac catheterization. Multiple levels of right ventricular outflow obstruction can not be asssessed except by the outlow right ventriculogram or by pulmonary arteriography which was safe and important for the correct diagnosis of pulmonary arterial anatomy. The correct diagnosis of tetralogy of Fallot with its variants and associated anomalies is of help in planning surgical approach

Dilated cardiomyopathy in Egyptian children: prevalence, clinical, echocardiographic and doppler profile

The prevalence and clinical profile of dilated cardiomyopathy [DC] in children seen at 2 large medical centers in Cairo were studied. Incidence was estimated from a retrospective analysis of 1 year data. A 4-year prospective study included 71 children with DC and aimed at defining the clinical profile, echocardiographic and hemodynamic characteristics, and prognosis. Doppler studies were done in 12 patients and cardiac catheterization in 14. An incidence of 33 per 100,000 children per year was obtained. From follow-up and mean age at presentation, a poor prognosis could be confirmed. Four-year mortaility was 82%. Left-sided failure was present in all children, while right-sided failure was seen in one half. Echocardiographic features included severe left ventricular [LV] dilatation, and decreased ejection fraction [mostly moderate-to-severe] in all children. Right ventricular [RV] dilatation was detected in 39.4%. Doppler evaluation in 12 cases showed mitral regurgitation in 66.6% and pulmonary hypertension in 75%. Cardiac catheterisation in 14 cases revealed elevated LV end-diastolic pressure in all children studied. Pulmonary artery and RV pressure were elevated in 93%