Combined spinal epidural anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body

Dilated cardiomyopathy [DCM] is characterized by ventricular dilatation and impaired systolic cardiac Junction. Anesthetic management, of patients with cardiomyopathy with reduced systolic Junction, is challenging and may be associated with high mortality. The purpose of this study was to evaluate the hemodynamic effects of combined spinal epidural anesthesia [CSEA] in patients with dilated cardiomyopathy, underwent vascular surgery in the lower half of the body, in addition to assess the safety of this anesthetic technique in the early postoperative period. After approval by local research ethics committee of the Faculty of Medicine, and informed written consent obtained from all patients, 24 patients having dilated cardiomyopathy, subjected to vascular surgery in the lower half of the body under CSEA. The effects of CSEA on hemodynamics; IBP, HR and CVP [measured at base line and then every 10 min], in addition to cardiac complications during the hospital stay period were studied. patients had significant decrease in MAP in all readings after the base line one with maximal decrease at 70 min [-14.7%], while HR increased significantly in all readings after the base line one except the last reading with maximal increase at 50 min [13.1%]. CVP showed insignificant changes in all readings except at 90 and 100 min which showed significant increase [p< 0.05]. Four patients developed ECG changes in the postoperative period, while no significant changes in EF. combined spinal epidural anesthesia [CSEA] may be an alternative to general anesthesia in patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body, as our patients had a largely im eventful postoperative recovery with good pain control

pulse pressure as a predictor of increased cardiac risk in middle-aged hypertensive patients

This work aimed to study the pulse pressure [PP] as a predictor of increased risk of cardiovascular diseases [CVD] in middle-aged hypertensive patients. This study included 100 middle-aged patients with newly diagnosed essential hypertension and had not received any anti-hypertensive medications previously. PP was calculated for all patients who were classified into 2 groups; hypertensives with PP 50 mmHg. All the included patients have been studied by electrocardiography and echocardiography. The number and percentage of patients with left ventricular hypertrophy [LVH] were significantly higher in the group of hypertensive patients with PP>50 mmHg than those with PP 50 mmHg than those with pp 50 mmHg in middle-aged hypertensive patients is a predictor of LVH and increased risk of CVD independent of SBP so, the width of PP must be considered in the risk assessment of hypertensive patients and antihypertensive medications reducing the PP should be evaluated in the future

Soluble as an apoptotic marker in myocardial infarction, the outcome and its relation to high risk, clinical features

This study was designed to detect the impact of apoptosis on prognosis and clinical outcome in patients with myocardial infarction [MI] and its relation to the other risk factors for coronary artery disease. Forty patients [22 males, 18 females] with mean age 53.88 +/- 1.39 years diagnosed as MI on the basis of electrocardiographic and enzymatic changes in addition to the clinical symptoms and signs. Twenty-two patients were smokers. Fifteen healthy volunteers were chosen as a control group. Patients group was classified according to infarct size [expensive MI 62.5%, localized MI 37.5%], presence or absence of heart failure [MI with HF 67.5%, MI without HF 32.5%], presence or absence of diabetes mellitus [DM] [MI with DM 46.5%, MI without DM 52.5%], presence or absence of hypertension [HTN] [MI with HTN 47.5%, MI without HTN 52.5%]. For every participant, history and clinical examination paying special attention to vital signs and cardiopulmonary examination, as well as resting electrocardiogram [ECG] looking for the changes of MI were done. In addition, the following laboratory investigations: Serum sugar, total cholesterol, triglycerides, soluble Apo-1/Fas, homocysteine and nitric oxide [NO] concentrations in serum were assessed. It was concluded that soluble Fas as a marker of myocardial apoptosis is strongly associated with and may be a major determinant of unfavorable early symptomatic post- infarction HF and is related to the size of MI. Homocysteine acts as an independent risk factor for atherosclerotic cardiovascular events and the decreased level of NO is associated with increased risk for development of atherosclerosis, HTN and symptomatic left ventricular [LV] dysfunction

Soluble fas as an apoptotic marker in myocardial infarction: the outcome and its relation to high risk clinical features

In myocardial infarction [MI], activation of soluble fas which is a widely expressed cell surface receptor can induce apoptosis in cardiac myocytes. Apoptosis contributes to myocardiocyte loss in cardiac disease and may be a major determinant for the development of early symptomatic heart failure [HF] but the precise role of apoptosis in the development of cardiac dysfunction need to be established. To detect the impact of apoptosis on prognosis and clinical outcome in patients with myocardial infarction and its relation to the other risk factors for coronary artery disease. Forty patients [22males, 18 females] with mean age 53.88"1.39 years diagnosed as MI on the bases of electrocardiographic and enzymatic changes in addition to the clinical symptoms and signs.Twenty two out of them were smoker. Fifteen healthy volunteers, age and sex matched with the patients as control group has been enrolled in this study. Patient group were classified according to: A- Infarct size [extensive MI 62.5%, localized MT 37.5%]. B- Presence or absence of heart failure [Ml with HF 67.5%, MI without HF 32.5%]. C- Presence or absence of DM [Ml with DM 47.5%, MI without DM 52.5%]. D- Presence or absence of hypertension [Ml with hypertension 47.5%, Ml without hypertension 52.5%]. For every participant, history and clinical examination paying especial attention to vital signs and cardiopulmonary examination, resting electrocardiogram [ECG] looking for the changes of MI and the following laboratory investigation: blood sugar, total choleserol, triglycerides, nitric oxide [NO], Apo-l/fas, and homocysteine concentrations in serum were measured. The serum levels of fas, nitric oxide [NO] and homocysteine are significantly higher in the patients than in the controls [p<0.001]. As regard serum levels of soluble fas in patients with MI, there were significantly higher values in patients with extensive lesion and in those associated with HF when compared to patients with localized lesion and patients not associated with HF respectively [p<0.001]. Serum level of NO was significantly higher in normotensive patients with MI than in hypertensive patients with MI [p<0.001]. Also the serum level of NO was significantly higher in patients with extensive MI than in patients with localizes MI [p<0.001] and significantly higher in patients with compensated heart than in patients with symptomatic HF [p<0.001]. Serum level of homocysteine is significantly higher in normotensive patients with MI and in non diabetic patients with MI when compared to MI patients associated with hypertension or diabetes mellitus [p<0.05, <0.001 respectively]

Are patients with polycystic ovary syndrome at risk for cardiovascular disease?

Polycystic Ovary Syndrome [PCOS] is considered not only a reproductive endocrinopathy but also a metabolic disorder associated with long term health risks, including diabetes mellitus and coronary artery disease and it shares some or all components of syndrome X. To assess and evaluate cardiovascular risk factors in patients with PCOS and to compare the various systolic and diastolic function indices hetween PCOS patients and regularly cycling control women. 45 patients with PCOS [mean age 26.16 +/- 6.47 years and mean BMI 28.18"5.47 kg/m[2]] were recruited for this study, in addition to 30 healthy volunteer women with regular menstrual cycles, their age and body mass index [BMI] matched with the patients group. A thorough history and clinical examination were performed. Transvaginal sonography was performed using a transvaginal probe 5 MHZ. Hormonal assay for [serum luteinizing hormone [LH], follicle stimulating hormone [FSH], prolactin and total testosteronel, lipid profile [high and low density lipoproteins [HDL and LDL], triglyceride [TG] and total cholesterol [T Chol]], uric acid, homocysteine and two hours post prandial serum glucose [PPSG] levels were determined for all studied participants. M-mode, two dimension and Doppler echocardiography were performed for evaluation of systolic and diastolic function parameters. We have studied indices of cardiac flow in women with PCOS in relation to BMI, blood levels of reproductive hormones [LH, FSH. testosterone and prolactin]. lipid profile, uric acid, PPSG and homocsteine levels. The mean serum levels of LH, total testosterone, T Chol, TG, homocysteine, uric acid, PPSG, LH/FSH ratio and T Chol./HDL ratio were significantly higher in patients with PCOS group [p <0.001] than control group. Patients with PCOS had significantly lower peak mitral flow velocity in early diastole [PEV], ratio between peak mitral flow velocity in early diastole [E] and late diastole [A] [B/A ratio], Ejection fraction [EF] and fraction of shortening [FS] [p < 0.001] and significantly longer isovolumic relaxation time [IVRT] and E-velocity deceleration time [EVDT] [p <0.001]. Patients with PPSG> 140 mg/dl had significantly lower B/A ratio [p < 0.05] and those with BMI > 25 kg/m[2] had significantly longer IVRT [p <0.01]. Moreover, we found significant negative correlation between E/A ratio and both PPSG [r = -0.349] and LDL [r = -0.382] and significant positive correlation between IVRT and BMI [r = 0.415]. We conclude that both diastolic and systolic dysfunction are common findings in population with PCOS and this dysfunction together with the increased serum homocysteine concentration, dyslipidemia and impaired glucose tolerance may contribute to increased risk of cardiovascular disease in these patients