Left ventricular diastolic filling dynamics during isometric exertion in patients with microvascular angina assessed with transmitral doppler flow velocities

The patients in this study were divided into three groups. The first group included 34 patients [22males and 12 females with a mean age of 48 +/- 3.21 years] with documented microvascular angina [typical anginal pain, positive electrocardiography on exercise with ST-T segment depression >1 mm, abnormal perfusion scans, normal coronary angiography]. The second group included 27 patients [19 males and 8 females having a mean age of 50 +/- 4.1 years with documented coronary artery disease. The third group included 15 healthy subjects of the same age group as controls [8 males and 7 females, mean age was 47 +/- 6.26 years]. Moderate isometric exertion [one half-maximal effort in one minute] produced approximately one-third increase in the mean arterial pressure and 30% increase in heart rate in all studied groups. In conclusion, isometric exertion, in form of firm sustained hand grip, induced left ventricular diastolic filling indices abnormalities in patients with microvascular angina. Similar changes were observed in patients with established diagnosis of coronary artery disease. These changes are consistent with impaired ventricular relaxation and support a generalized left ventricular abnormality in patients with microvascular angina

Cardiovascular stability after epinephrine propranolol lidocaine infiltration in septoplasty operation in patients under nitrous oxide/02 opioid relaxant technique

Epinephrine infiltration is a common practice in ENT operations to produce haemostasis its concomittant administration with inhalational anaesthetics carries the risk to develop cardiac arrhythmias. This study was conducted to assess the cardiovascular stability after epinephrine propranolol-lidocaine infiltration in patients undergoing septoplasty operation under nitrous oxide nalbuphine relaxant technique. Forty ASA I adult patients of either sex were randomly allocated into two groups each of 20. Both groups received nitrous oxide [66%] in oxygen supplemented with nalbuphine 0.2 mg kg using atracurium 0.5 mg kg as the nuscle relaxant during maintenance of anaesthesia. First group received lidocaine 100 mg i.v. prior to infiltration of the nasal septum while the second group received nothing. infiltration of the nasal septum was done 10 minutes after intubation using 4 -5 ml of a solution containing epinephrine 1,00.000. lidocaine 1% plus propranolol 0.1 mg/ml. Patients were monitored as regards heart rate. systolic and diastolic blood pressures. Results showed insignificant changes in heart rate and blood pressure. No ventricular arrhythmias were seen. Lidocaine group showed more cardiovascular stability, in conclusion, epinephrine propranolol and lidocaine infiltration is almost safe during nitrous oxide opioid anaesthesia and lidocaine administration prior to infiltration confers upon more cardiovasculary stability