Prognostic significance of transient myocardial ischaemia in patients with stable chronic angina pectoris

Data on the prognostic value of transient myocardial ischemia in stable patients with coronary artery disease are as yet, very scarce. This study was designed to assess the prognostic significance of transient ischemic episodes [silent and symptomatic] during daily activities in patients with chronic stable angina. Seventy eight patients attending the cardiac out patient clinic were studied by exercise treadmill testing and 24-hours of ambulatory Holter monitoring and followed for prognostic purposes for up to 24 months [mean of 17 months]. Patients inclusion depend on the clinical diagnosis of stable coronary artery disease which necessitated out patient review and it was not dependent on objective evidence of reversible ischemia. Events recorded during the follow-up period included death, non-fatal myocardial infarction, unstable angina and requirements for revascularization. Twenty four patients [31%] had transient ischemic episodes during their daily activities and 45 [58%] patients had a positive exercise test for ischemia with 19 patients [24%] had evidence of ischemia on both investigations and 21 patients [27%] had no documented evidence of ischemia on either investigation. Thee were 16 patient events [20.5%] recorded over a mean of 17 months follow-up including one cardiac death [1.3, 4 non-fetal MI [5.1%], 4 admissions with unstable angina [5.1%] and 7 patients were referred for revascularisation because of symptoms. Of the 5 cases of cardiac death and non-fatal Ml only 2 had evidence of ischemia in both investigations and 2 had no ischemia on either Investigation. As a whole 6 of recorded events occurred in 19 patients [31%] with both investigations positive for ischemia, 6 in 21 patients [29%] with both in investigations negative and 4 in patients who had one test positive for ischemia. We could conclude that in an unselected group of patients with stable angina, 17 months outcome was favorable and over this time the results of ambulatory ST segment monitoring seemed to contribute little to the identification of patients liable to have non-fatal myocardial infarction or cardiac death

Study of C-reactive protein in some Egyptian heart diseases

CRP was measured in 93 subjects and patients. All subjects and patients were subjected to clinical examination, chest X-ray and ECG. CPK was measured in patients with AMI only. Results showed significant elevation of CRP in patients with AMI compared with either control group or other subgroups of IHD patients. There was highly significant positive correlation between peak CRP and peak CPK in patients with AMI. CRP in severe hypertensive patients was significantly elevated compared with either the control group or mild or moderate hypertensive patients. CRP in patients with acute or chronic cardiac failure was significantly elevated compared with that of control group. It was no significantly changed in patients with rheumatic heart disease compared with that of control group. So, it could be concluded that, although CRP elevation is non specific, it is very useful in diagnosing and evaluating these cardiac problems provided that it is interpreted in light of clinical information

Echocardiographic assessment of systolic and diastolic functions in athletic hearts

To evaluate the effects of relatively long term, minimum 3 years physical training on left ventricular [LV] systolic and diastolic functions, a total of 80 subjects [S] with age ranging between 18-40 years, were classified into 4 groups [G] and studied. GI, isometric exercise [20] S, GII, isotonic exercise [20] S, GIII, subjects retired for 3 years from endurance sporting program for at least 33 years. GIIIa, retired from isometric exercise [10] S, GIIIb, retired from isotonic exercise [10] Ss, IV, control [20] S. Clinical, ECG and Echo-Doppler examinations were done. Compared to the control G, GI and GII has significantly decreased heart rates, GI had significant increase in LV posterior wall thickness, while GII and IIb had significant increase in end diastolic dimensions or EDD. Left atrial size, LV mass, pulmonary peak velocity [PFV] and average acceleration were significantly increased in GI, II and III. Ejection fraction [EF] and mitral deceleration half-time were significantly increased in GII. Compared to GIIIa, PFV, mitral peak velocity; time velocity integral; deceleration time and deceleration half time as well as aortic time velocity itegral and average acceleration were significantly increased in GI. Compared to GIIIb, only tricuspid peak E. velocity was significantly increased in GII. In conclusion, the changes in systolic function in athletes in practice, GI and II are minimal except for EF which was increased in GII secondary to an increase in FDD. The changes in diastolic function are due probably to the increase in LV mass. Both of them did not return to the pre-exercise levels especially in GIIIb