Objective: To review our studies of the ease and importance of parasympathetic and sympathetic (P&S) measures in managing cardiovascular patients. Background: The autonomic nervous system is responsible for the development or progression of hypertension (HTN), orthostasis, coronary disease (CAD), heart failure (CHF), and arrhythmias. Finally, new technology provides us with rapid, accurate P and S measures critically needed to manage these patients much more successfully. Methods: Using the ANX 3.0 autonomic monitor, P&S activity was recorded in 4 studies: 163 heart failure patients in total, mean follow-up (f/u) 12-24.5 months; 109 orthostasis patients, f/u 2.28 years (yr), and 483 patients with risk factors or known HTN, CAD, or CHF, f/u 4.92 yrs. All were on guideline-driven therapy. Results: Fifty-nine percent (59%) of CHF patients had dangerously high sympathovagal balance(SB) or cardiac autonomic neuropathy (CAN), and Ranolazine markedly improved 90% of these, improved left ventricular ejection fraction in 70% of patients on average 11.3 units, and reduced MACE (acute coronary syndromes, death, acute CHF, ventricular tachycardia/fibrillation[VT/VF]) 40%. Sixty-six-percent (66%) of orthostatic patients corrected with (r) alpha lipoic acid ([r]ALA); non-responders had the lowest S-tone. In the 483 patient study, SB>2.5 best predicted MACE when compared to nuclear stress and echocardiography (sensitivity 0.59, OR 7.03 [CI 4.59-10.78], specificity 0.83, positive predictive value 0.64, and negative predictive value 0.80).

The pulmonary vascular reactivity test (PVRT) is essential to define patients with pulmonary hypertension(PH) responders to calcium antagonist treatment, this is possible evaluating the changes registered in the 3 hemodynamic variables: pulmonary vascular resistance (PVR), mean pulmonary arterial pressure(MPAP) and cardiac output(CO). Cardiac catheterization is unquestionably the gold standard for performing the test, but its application implies high costs, technical boarding limitations, risks, and complications minor to serious inherent to the procedure. On the other hand, Doppler echocardiography is harmless and economical, offering in the last 15 years a considerable advance in techniques and practical methods for estimating these variables, being the most analyzed and documented to date, the PVR. In this study we will review the different echocardiographic equations proposed by different authors to calculate the PVR and MPAP, in all cases, comparing the results obtained with the measurements made by the right heart catheterization (RHC). The results obtained in them will be briefly mentioned and will give an important reference to the reader of a study done in our research center, where we grant a new user to the non-invasive measurement of MPAP applied in the PVRT.

OBJECTIVES This study correlated the multi - detector computed tomography (MDCT) calcium scores with the results of coronary angiography in diabatic and/or hypertensive patients with atypical angina pectoris in order to assess its value to predict or exclude significant coronary artery disease (CAD). BACKGROUND Muti-detector computed tomography is a sensitive method to detect coronary calcium. However, it is unclear whether it may play a role as a filter before invasive procedures in patients with atypical angina pectoris. METHODS A total of 150 patients (116 men and 34 women) with diabetic and/or hypertension for at least 5 years and atypical angina pectoris from a single center were included in our study. patients underwent calcium screening with MDCT and have calcium score more than 100 , then all patient underwent invasive coronary angiography. RESULTS The Mean age was 62±5.7 and 77.3% were male, 78% of men and 88.2 % of women revealed significant coronary stenoses (> 50% lumen narrowing of left main trunk stenosis and > 70% stenosis of any epicardial coronary artery). Significant correlation between calcium scoring and significant coronary artery stenosis was seen (P: 0001). A 70% were DM, 90% were hypertensive and 61.3% were HTN and DM. The LAD artery was the most stenotic artery by 53.3% followed by RCA (37.3%) and finally LCX (30.7%). one significant coronary artery was 42% followed by two significant CAD (26.7%), while 9.3% included three-vessel disease. The significant coronary artery diseases was increased with age ( P: 0003). CONCLUSIONS Coronary calcium proved to have good diagnostic performance for significant coronary artery stenosis in patient with atypical angina pectoris.

Junctional ectopic tachycardia (JET) is a rare supraventricular tachycardia more frequently seen in pediatric patients which is associated with high morbidity and mortality without an adequate treatment. Its treatment often requires multiple drugs for arrhythmia control and, in some cases, a cryoablation is indicated. Some patients may revert to sinus rhythm spontaneously after long periods on antiarrhythmic drug. Currently, the arrhythmia prognosis has improved significantly since cryoablation development and the implementation of a more aggressive pharmacological treatment strategy. The purpose of this review is to describe the natural history of idiopathic JET and treatment advances.

Background A primary percutaneous coronary intervention (PCI) Primary PCI continues to be the optimal reperfusion therapy in patients with ST elevation myocardial infarction however, in areas where PCI centers are not readily available, a pharmacoinvasive strategy has been proposed. This study investigated the safety and efficacy of a pharmacoinvasive strategy compared with primary (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in Gaza. Methods: We randomized 145 patients presenting within 2 hours of symptom onset of acute ST elevation myocardial infarction to primary CPI (PCI) or for pharmaco-invasive PCI 2-24 hours after streptokinase, except in the event of failed reperfusion, in which case, emergency angiography was recommended. The primary endpoint a composite of death, shock and congestive heart failure at 30 days. Results: Total 145 patients with mean age 56.5+10.48 years. (The mean age of patients is) The primary endpoint in primary PCI (17%) and in pharmaco-invasive PCI (16.1%) p = 0.24.???? There was no difference in 30-day mortality (4.7 % in primary PCI and 4.9% in pharmacoinvasive strategy (P=0.94). Secondary endpoints:Emergency angiography was required in 39.5% of the patients in the pharmaco-invasive strategy and the median time for underwent angiography was 6 hours after randomization. TIMI major bleeding occurred among 4 patients ( 4.9 % ) in the pharmacoinvasive group and in 2 patients (3.1%) of the primary PCI group (P = 0.59).The pharmacoinvasive group had 1.9 times the odds of having TIMI major bleed compared with the primary PCI group Conclusions In this randomized trial, early-presenting STEMI patients unable to undergo primary PCI within 1 hour (median, 75±20 minutes) were randomized to primary PCI or a pharmaco-invasive strategy with streptokinase followed by PCI. At 1 month follow-up, there was no statistical difference in all-cause mortality, heart failure or shock. This study suggests that, if primary PCI cannot be performed within 1 hour of presentation, a pharmaco-invasive strategy may be as good as primary PCI.