Color M-mode for the assessment of left ventricular diastolic function

During the last two decades, Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular [LV] diastolic function. Trans-mitral and pulmonary venous Doppler flow indices have been used to evaluate different parameters of diastolic function, but it is difficult to use these modalities in differentiation between a normal filling pattern and a pseudo-normal filling pattern. Recently, color M-mode [CMM] of LV inflow and tissue Doppler imaging [TDI] of mitral annulus have provided additional insights in the assessment of diastolic function. Aim of the work: was to correlate the new parameter CMM of LV inflow with trans-mitral flow [TMF] in different patterns of diastolic performance to evaluate its clinical utility. 70 patients [46 males, and 24 females] who are having diseases known to affect diastolic function and 10 normal individuals as a control group were included in the study. The 70 patients were divided into 3 groups according to their LV diastolic filling pattern based on the conventional TMF pattern and included, group I [impaired relaxation pattern, IR], group 2 [pseudo-normal pattern, PN] and group 3 [restrictive filling pattern. RFP]. All of them were subjected to trans-thoracic Doppler echocardiography [TTE] with TMF and CMM examinations. In group I [IR], flow propagation velocity [VP] was lower than that in PN and control groups but higher than that in RFP group. Time delay [TD] and E/VP ratio were lower than those in PN and RFP groups but higher than those in control group. In group 2 [PN], VP and TD were higher than those in IR and RFP groups but lower than those in control group. E/VP was higher than that in IR and control groups but lower than that in RFP. In group 3 [REP], VP was lower than that in all other groups. TD and E/VP were higher than those in all other groups. Tei index was significantly higher in group 2 and 3 as compared to the control group but did not show significant change between group 1 and the control group. Also there was statistically significant correlation between E/VP ratio with, E, TD and Tei index. While statistically significant negative correlation was recorded between E/VP ratio with EDT, IVRT and VP. The new modality CMM is helpful in differentiation of PN pattern from normal pattern and can be complementary to TMF to give an idea non-invasively about diastolic parameters

Value of fetal echocardiographic screening for cardiac malformations

With advancing technology in ultrasound machines, examination of the fetal heart became available even at 14 weeks gestation. There are many reasons for referral for complete fetal echocardiographic assessment; the most common one is family history of congenital heart disease, while the most productive one is abnormal four chamber view. This study describes the value and accuracy of fetal echocardiographic screening for cardiac malformations in high-risk pregnancies. We studied 270 pregnant ladies who were referred for fetal echocardiography for several reasons e. g. family history of CHD, diabetes mellitus, inadequate or abnormal view of the heart [four chamber or great vessels], the presence of fetal abnormality on obstetric scanning and increased nuchal translucency thickness particularly in the first trimester. Antenatal fetal echocardiographic scanning of the heart was performed and compared with the postnatal one or compared with the histopathological finding of the specimen if termination of pregnancy took place. In cases where chromosomal abnormalities were detected, a chromosomal study was carried out. Our results showed a spectrum, of multiple cardiac abnormalities, both major and minor such as atrioventricular septal defect, hypoplastic left heart, aortic coarctation, large VSD, transposition of great vessels, cardiomyopathy and cardiac tumours. The most productive group of patients were those referred due to abnormal or inadequate four chamber view, the percentage of CHD in this group was 66.6% extended examination of the fetal heart [four chamber view and great vessel view] could detect about 75% of CHD. The percentage of chromosomal abnormalities in case with CHD was 20%. The accuracy of fetal echo is affected by the time during gestation when scanning is performed especially for valvular stenosis, coarctation of the aorta. Scanning in the first trimester is confined to the high risk patient

anticholinergic effects of the commonly used antidepressants

This study included 120 patients with major depressive disorder, divided into three groups: Group I: 60 patients received tricyclic antidepressants [half of them were put on amitriptyline and the other half on imipramine]. Group II: 30 patients received tetracyclic antidepressant maprotiline. Group III: 30 patients received monoamine oxidase inhibitor tranylcypromine. To evaluate the anticholinergic effects, all patients were submitted to the following [before and after 6 days of using antidepressants]: A] Estimation of volume of salivary secretion. B] Estimation of concentration of salivary secretion: 1. Concentrotion and autput of amylase enayme in salivary secretion 2. Concentration and output of bicarbonate in salivary secretion. C] Estimation of serum cholinesterase enzyme. The results revealed the following: - The four drugs have decreasing effect on salivary juice volume which could be used as indicator for severity of anticholinergic activity. Tricyclics have more significant lowering of salivary volume than the other two. The anticholinergic effects of antidepressants are not only due to the relative affinity of these drugs for muscarine receptors [it interferes with the action of acetylcholine] as it was believed before, but it could be also attributed to the increase in serum cholinesterase enzyme which leads to more destruction of acetylcholine. The increased concentrations of salivary amylase and bicarbonate could be ascribed to the increase in norepinephrine which accompanies using these drugs

Comparative study of the effects of the commonly used antidepressants on the cardiovascular system

This study included 120 patients with major depressive disorder, divided into three groups. Group I: 60 patients received tricyclic antidepressants [half of them were put on amitriptyline and the other half on imipramine]. Group II: 30 patients received tetracyclic antidepressant maprotiline. Group III: 30 patients received mononamine oxidase inhibitor tranylcypromine. Before and after 6 weeks of treatment, all patients were submitted to [a] Measurement of blood pressure [both supine and standing] and [b] EGG. The results revealed: 1-Tricyclic antidepressants [amitriptyline and imipramine] have significant effects on ECG [increase in heart rate, prolongation of P-R interval and QTc time]. 2-Imipramine has significant increasing effect on the degree of orthostatic hypotension while the other 3 drugs have non-significant increase. 3- The only significant cardiovascular effect of maprotiline was decreased amplitude of T-wave. 4- Tranylcypromine was the least cardiotoxic [except significant lowering of supine blood pressure]