Is left atrial size related to left ventricular hypertrophy in hypertensives?

The present study was specifically designed to identify the effects of systemic arterial hypertension on the left ventricular and left atrial function analyzed by 2D and M-mode echocardiographic images. The study included two groups: Patient group included 30 hypertensive patients with age ranging from 35-70 years [51.5 +/- 10.4]; 11 males [36.7%] and 19 females [63.3%], were subjected to echocardiographic study including 2-dimensional and M-mode. Control group included 15 healthy volunteers with age ranging 35-70 years [51.2 +/- 9.75]; 7 males [46.7%] and 8 females [53.3%]. Statistically, there was no significant difference as regard the age. All patients in the study were subjected to full history taking with special emphasis on valvular heart diseases, congenital heart diseases, ischemic heart disease, medical therapy; especially antiarrhythmic drugs, thorough clinical examination with special emphasis on pulse rate, rhythm, systolic and diastolic blood pressure excluding patients on congestive heart failure, standard 12-lead ECG and echocardiographic examination including 2D and M-mode imaging. The study showed systemic arterial hypertension lead to impairment of left ventricular diastolic function due to increased after load but also the changes of left ventricular geometry and structure producing left ventricular hypertrophy. Also, the left atrium involved in this process by structural abnormalities of the left atrial chamber as regarding by the echo imaging. Individual with systolic arterial hypertension had; 1-ECG finding of LVH. 2-Echoparameters showed increased LAD, LAV, IVS, PWT, RWT, LVM and diastolic dysfunction. 3-Hypertension patients may have LVH or not which may be due to recent incidence or lower level of blood pressure. Hypertension patients without LVH did not show increase in LAD and LAV. 4-Left ventricular hypertrophy could be divided into concentric or eccentric LVH according to present or absence of increase RWT. However LA size and volume were similar in patients with concentric and eccentric LVH. There were positive correlation between LAD and degree of LVH represented by LVM and RWT also LAD positively correlate with LV internal dimension and DT and negatively correlate with E/A ratio

Assessment of the site myocardial ischemia by exercise ECG and thallium scintigraphy versus coronary angiography

Different methods for detecting myocardial ischemia and risk assessment like exercise treadmill test and single photon emission computed tomography [SPECT]; however coronary angiography remains the golden standard for defining coronary anatomy. The study aims to compare between Exercise ECO and Thallium scintigraphy in diagnosing and locating coronary artery disease CAD in relation to the gold standard coronary angiography. This study included 40 patients with chronic stable angina with or without past history of acute coronary episodes[20 males and 20 females]. Patients with heart failure, left bundle branch block and/or left ventricular hypertrophy with strain pattern in ECG were excluded from the study. All patientso were submitted to [1] Full history taking and careful clinical examinations. [II] Resting standard 12 lead electrocardiograms [III] Exercise Electrocardiography according to standard Bruce protocol. [IV] Thallium- 201 SPECT study was done according to stress reinjection redistribution protocol. [V] Coronary arteriography was done within two months from stress. We found that exercise stress scintigraphy can detect ischemia or scar [defect] in the territory of LAD with 95% sensitivity, 78% specificity and 93% overall predictive accuracy, while the ability of exercise ECG in localizing anteroseptal ischemia [V2, V3, V4] reached a sensitivity of 32%, specificity of 55% and overall predictive accuracy of 37%. Exercise stress scintigraphy can detect ischemia or scar [defect] in the territory of left circumflex with 75% sensitivity, 78%specificity and 77%overall predictive accuracy. While the ability of exercise ECG in localizing lateral ischemia [LI, aVL, V5, V6], reached a sensitivity of 75%, specificity of 46% and overall predictive accuracy of 53%. Also we found that exercise stress scintigraphy can detect ischemia or scar [defect] in the territory of right coronary artery with 95% sensitivity, 100%speciflcity and 98% overall predictive accuracy. While the ability of exercise ECG in localizing inferior ischemia [LII, LIII, AVF] reached a sensitivity of 47%, specificity of 47% and overall predictive accuracy of 48%

6 Months follow-up study of patients treated by direct stenting versus those treated by conventional predilatation and stenting

Objectives: The aim of our study was to compare the long-term clinical outcomes of direct coronary stenting compared to balloon predilatation followed by stent placement

Methods: We studied the clinical outcomes after 6 months for 2 groups of patients. The 1[st] group included 40 patients who had direct stenting; the 2nd group included 40 patients who had a stern only if the post balloon residual restenosis was > 30%. The 2 groups were matching regarding risk factors as well as type and length of lesions

Results: Incidence of complications During the follow up period, in group I; no patient died, one patient developed MI [2.5%] and one patient developed angina [2.5%]. In group II one patient developed MI [2.5%] and 2 patients developed unstable angina [5%]; p value > 0.05 with no significant difference between the 2 groups. Incidence of restenosis: In this study 11 patients in GI had significant target artery restenosis [27.5%] versus 13 patients in GII [32.5%] with no significant statistical difference between the 2 groups

Conclusion: The long term clinical outcomes in patients undergoing coronary intervention are equivalent when comparing direct stenting with stenting after predilatation

Hazards of thrombolytic therapy in acute myocardial infarction

A variety of therapeutic strategies for management of acute myocardial infarction have become available. AMI management can range from home care to early hospital discharge to an invasive intervention with agents to salvage ischaemic myocardium and reduce infarct size Although many opinions were against thrombolytic therapy, it called achieve popularity in the last few years. In some centers and for different reasons thrombolytic therapy is going to be a routine. Here we review 5 groups of hazards which may result due to application of thrombolytic therapy [mainly streptokinasie STK] on AMI