Bao Nguyen

Heart Failure (HF) is on the end stage of the disease spectrum with many confounders and thus no specific symptoms and signs. There is a need for a test that can effectively confirm the diagnosis of volume overload in HF at its earliest to guide the initial approach and subsequent management. This study aimed to evaluate the effectiveness of a new test noted as the Size and Expansion of Femoral Vein (SEFV) in the diagnosis and management of patients with HF. This test was used specifically on asymptomatic patients or those who presented with severe comorbidities. The patients who arrived at the emergency room with a diagnosis of HF or suspected HF were enrolled. Ten patients without HF formed the control group. All patients received a standard physical examination (PE). The patients with the obvious diagnosis of HF by PE formed the HF control group. All patients with tentative diagnoses formed the HF study group. All patients underwent the ultrasound test to measure the size of the common femoral vein (CFV) and artery (CFA). The study enlisted 167 patients with HF or suspected HF. The results showed that the SEFV test was more accurate (98%) than the PE (54%). The SEFV test accurately differentiated between severely sick patients with intravascular overload and moderately sick patients with extravascular overflow. The test was accurate in patients with severe comorbidities (93%) or hypotension (100%). The SEFV test was more accurate in confirming the presence of fluid overload in patients with severe comorbidities or hypotension.

Background. The differential diagnosis of chest pain in women is complex, ranging from atypical angina to chest pain in the absence of coronary artery disease (i.e., Syndrome X). The mechanism of these conditions remains unexplained. The purpose of this study was to examine coronary blood flow based on a new angiographic technique. Methods. Patients with chest pain were enrolled. In the new technique, as the contrast injection stopped, the blood in white color moved in and displaced the black contrast. Characteristics of blood flow could be observed and classified by type and time. The duration of the arterial phase was calculated and compared with the control. Results. Sixty patients were enrolled. Ten patients with normal coronary arteries and ventricular function; without chest pain served as controls. In the control group, the duration of the arterial phase in the RCA was 1.76 sec, while it was 3.76 sec for the syndrome X group (p<0.05). From the mMID segment to the distal segment, syndrome X patients had a much longer delay compared to control subjects (0.81 vs. 0.26 sec) (p<0.05). From the distal segment (bDIS) to the origin of the PDA, syndrome X patients had an average duration of 0.81 sec compared to 0.40 sec in controls (p<0.05). The largest difference was the period of time when the contrast left the PDA until flushed from the distal vasculature, which was 1.66 sec and 0.40 sec in syndrome X vs. control. Syndrome X patients with prolonged myocardial phase (1.89 sec) had dense and prolonged contrast retention at the myocardium. Conclusions. In patients with syndrome X, the prolonged arterial phase deprived the myocardium of highly oxygenated blood and triggered ischemia. This new imaging method allows for a better understanding of the mechanism of ischemia in Syndrome X patients.