Comparison of clinical outcome of fixed-dose subcutaneous low molecular weight heparin (tinzaparin) with conventional heparin in unstable angina: a pilot study.

Forty patients who were hospitalized for unstable angina were randomized to receive treatment with either regular heparin (Group I) in conventional dose as continuous infusion for 5 days or fixed-dose low molecular weight heparin (LMWH) (Group II), 3500 units subcutaneous twice daily for a period of 5 days. Both the groups were evenly matched with regard to age, sex presence of risk factors and adjunctive drug therapy. The clinical endpoints at the end of 5 day therapy were: recurrence of angina, occurrence of myocardial infarction and need for urgent revascularization. In Group I, 6 out of 20 patients had recurrence of angina, of whom 3 required urgent coronary angiography and revascularization. In Group II, 4 out of 20 patients had recurrence of angina, of whom one patient required urgent angiography and angioplasty. There were no bleeding complications in either of the groups. The recurrent anginal episodes in the conventional heparin group correlated with low aPTT values at the time of angina. Thus, this pilot study suggests that LMWH is equally effective in the treatment of unstable angina, the advantage of LMWH being the ease of administration and no need for monitoring aPTT levels during therapy.

Apolipoproteins A-1 and B as predictors of angiographically assessed coronary artery disease.

Serum lipids, lipoproteins, apolipoproteins (A-1 and B) were determined in 225 patients with angiographic evidence of coronary artery disease (having abnormal coronary angiogram and positive exercise stress test), and 112 patients without any clinical and/or angiographic evidence of coronary artery disease. The variable with the strongest association with coronary artery disease was the ratio of apo B/A-1. Thus, the determination of apolipoproteins yielded complementary information in this case control study and warrants further study in a prospective setting.

Malignant hypertension due to reflux nephropathy in an adolescent (a case report).

Malignant hypertension in an adolescent due to reflux nephropathy (RN) is rare. Here we are presenting such a case unassociated with the usual symptoms of hypertension. The problems of diagnosis, management, prognosis and prevention of RN are discussed with a review of relevant literature.

Coronary arteriographic findings soon after non Q wave myocardial infarction.

We performed early coronary arteriography in 27 patients (23 males, 4 females) having non Q wave MI. Infarct related vessel (IRV) was totally blocked in 25.9%, whereas 66.7% had severe residual stenosis (greater than or equal to 70%). Left main was involved in 7.5%, and at least 2 major coronary arteries were involved in 51.8%. Visible collaterals were seen in 11%. We feel, as compared to transmural MI, where total occlusion of IRV is common, the higher incidence of subtotal occlusion of IRV with severe residual stenosis, poor collaterals and significant involvement of at least one other major coronary artery may be responsible for observation of early recurrent ischemic episodes in non Q wave MI.

Coronary artery disease pattern in the young.

Ninety-two patients aged 40 years or less with documented coronary artery disease were studied with special emphasis on risk factors, coronary angiographic patterns and left ventricular function. Tobacco consumption was the most common risk factor (54%) followed by family history of coronary artery disease (40%). Hyperlipidaemia was not a frequent risk factor. Significant single vessel disease was present in 29% of patients. The incidence of double vessel and triple vessel disease was much higher. The left anterior descending artery was the most commonly involved vessel followed by right and circumflex coronary arteries. Left ventricular function as determined by ejection fraction was abnormal in 51% of patients; left ventricular end diastolic pressure was abnormal in 28% of patients. Sixty-eight percent of patients with no risk factors had either zero vessel or single vessel disease indicating a positive relationship between occurrence of risk factors and significant coronary artery disease in the young.

Pulsed Doppler derived indices in predicting noninvasively, pulmonary arterial pressures.

The pulsed doppler (P.D.) signals obtained in RVOT just below the pulmonary leaflets were used to calculate acceleration time (AcT), pre-ejection period (PEP) and their ratios. These indices were correlated in 31 patients (2 1/2-49 yrs. age) having varying cardiac lesions to Pulmonary arterial pressure (P.A.P) measured during cardiac catheterisation. The mean values of AcT for those with normal PAP was 137 +/- 19.9ms, as compared to 105 +/- 37 ms in those in whom PAP greater than 20mm of Hg. (t = 3.0.p less than .01). The P value was less than 0.001 when comparison was between normal PAP and severe PH. The ratios of PEP upon AcT was 0.87 +/- 0.18 for normal PAP, as compared to 1.39 +/- 0.74 in those with PH (t = 0.31, p less than 0.01). The PEP/AcT predicted systolic PAP 35.49 PEP/AcT + 3.22 (r = 0.77, p less than 0.001). The mean PAP was best predicted by 23.94 PEP/AcT + 2.44 (r = 0.75, p less than 0.001). The quantitative assessment showed presence of presystolic 'a' wave in all with normal PAP; this was absent in all the 9 patients with severe PH (MAPA greater than 40mm of Hg.). We conclude that noninvasively obtained P.D. derived indices can help accurately to predict PAP.

Left main coronary block in a nineteen-year-old woman.

A 19-year-old woman had angina on exertion, which had existed for 4 years. An exercise test was strongly positive, and selective coronary angiography showed 95% block of the left main coronary artery at its ostium. The patient underwent a successful aortocoronary bypass to the left anterior descending coronary artery. After 1 year and 10 months, she continues to be asymptomatic.

Anomalous origin of right pulmonary artery from ascending aorta with right ventricular endocardial fibroelastosis.

A case of aortic origin of the right pulmonary artery with right ventricular endocardial fibroelastosis is reported. Its diagnostic features, surgical aspects, and postmortem findings are discussed. This is a rare combination. The relevant literature is reviewed.