Early detection of coronary artery disease in asymptomatic type 2 diabetes mellitus patients.

Type II Diabetes Mellitus (DM) is a major risk factor for Coronary Artery Disease (CAD). Patients remain mostly asymptomatic and thus diagnosed at an advance stage of the disease. Our aim of study was to detect the CAD at an early stage in asymptomatic diabetic patients. Methods: 136 asymptomatic type II diabetes mellitus patients were enrolled prospectively for treadmill test (TMT) and subsequent coronary angiography (CAG) was performed on 96 (70.87%) TMT positive patients. Diabetic status, clinical parameters including risk factors, TMT and angiographic findings were analyzed. Results: The patients were divided into two groups, high rich group A (risk factor >2) and low risk group B (risk factor >1). 34 patients of group A (36.95%) were CAD positive out of 92 patients of high risk group and 4 patients group B (9.09%) out of 44 patients of low rich group. Duration of diabetes mellitus and multiple risk factors were correlated with coronary artery disease (CAD) as well as multiple coronary artery involvement. Conclusions: A routine TMT of all long standing asymptomatic type 2 diabetic patients (>10 years) with family history of CAD and subsequent CAG should be done on all TMT positive patients for early detection of CAD to take early appropriate revascularization measure.

Assessment of right ventricular diastolic function: does it predict post-operative course in tetralogy of Fallot.

BACKGROUND: In some cases of tetralogy of Fallot the post-operative course is characterized by episodes of low cardiac output, elevated central filling pressures and prolonged ventilation and inotropic support. This may be due to impaired diastolic function of the right ventricle despite preservation of biventricular systolic function. METHODS AND RESULTS: Sixty-four consecutive patients (mean age 7.06+/-4.9 years) undergoing repair of tetralogy of Fallot were prospectively studied to assess right ventricular diastolic function. 'Restrictive physiology' was defined as presence of laminar antegrade diastolic pulmonary artery flow (A wave) throughout the respiratory cycle, which was coincident with atrial systole. Right ventricle restriction was present in 45/64 (70%, Group 1) patients and absent in 19/64 (30%, Group 2) patients. There was a marked inspiratory augmentation of the pulmonary artery A wave velocity, flow integral and duration. Transtricuspid flow revealed significantly lower peak E velocity, lower E/A ratio, shorter E deceleration time and higher A velocity time integral in those with right ventricular restriction. Biventricular systolic function and transmitral flow were normal in all patients. Those with restrictive physiology had significantly longer mean inotrope support duration, longer ventilation and chest drainage times. Correspondingly, the mean intensive care unit stay (56.7+/-9.3 v. 34.7+/-5.38 hours, p<0.01) and mean hospital discharge time (9.3+/-2.3 v. 6.2+/-0.5 days, p <0.001) was also significantly longer in group 1. CONCLUSIONS: Right ventricular restriction (as seen by laminar antegrade diastolic pulmonary artery flow throughout the respiratory cycle) exists in a significant subset of patients with tetralogy of Fallot following operative repair. Following surgery, such patients have higher inotropic requirement, longer ventilation times and longer hospital stay.

Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm.

The formation of pseudoaneurysm in the femoral artery after cardiac catheterization is a well-recognized complication occurring in 1%-4% of cases. It is traditionally managed surgically and has a high morbidity. Prolonged ultrasound-guided compression of the neck of the pseudoaneurysm, and ultrasound-guided injection of thrombin into the aneurysm are newer modalities of treatment especially for small aneurysms. We describe the case of a giant pseudoaneurysm of the right femoral artery, post-arteriography, which was successfully managed with ultrasonographically guided percutaneous thrombin injection.