An Israeli-developed, thimble-like device worn over a person's index finger has been proven by clinical studies to predict who is at high risk of developing endothelial dysfunction - a key precursor of atherosclerosis, a major component in cardiovascular disease. Called the Endo-PAT, the device is based on PAT technology that measures subtle but significant vaso-motion changes through the pneumatic probe on the finger. It is the only non-invasive device approved by the US Food and Drug Administration that reliably detects impairment of the endothelial layer (the inner lining of blood vessels). Developed and manufactured by Itamar Medical in Cesearea, the screening technology adds an important dimension to cardiac medicine by allowing physicians to reliably and non-invasively measure endothelial function and identify pathological cases of dysfunction, according to foreign researchers. Presentations by four research groups (including the Mayo Clinic and Harvard University) in scientific sessions at the recent American Heart Association meetings in Orlando, Florida AHA (including one from the famed Framingham Heart Study) support the emergence of the Endo-PAT as a "significant tool in the prevention and management of cardiovascular disease." Following scientific confirmation of PAT technology, Itamar Medical will now promote its clinical use for the prevention of cardiovascular disease. The medical community has long sought a cost-effective, reliable, non-invasive method to improve the detection of endothelial dysfunction in large segments of the population safely, as well as to improve follow-up for sufferers of cardiac disease. The portable device can be used in any setting, from bedside to outpatient clinic. Oral presentations at the conference by British and Swedish researchers showed the relevance of endothelial function assessment with the Endo-PAT in other conditions in children and adults. Officials at the Israeli company, founded in 1997, said early detection can reduce the cost of cardiovascular disease and does not require skilled technicians. A SHOCKING WAY TO SAVE LIVES Electronic defibrillators that can save the lives of people who go into cardiac arrest should be required in all public places, said Knesset Science and Technology Committee chairman MK Benny Alon at a special session on Tuesday to mark International Heart Day. Such devices, which deliver electric shocks to the heart to "restart" them, are increasingly available in public places in Europe and the US. Natan Kudinsky, Magen David Adom's director of training, presented an advanced defibrillator that has an algorithm to identify the heartbeat and automatically deliver the necessary shock. Lightweight and costing only $1,500, it can be operated by a layman. If treatment is given quickly, the successful resuscitation rate reaches 90%, said Kudinsky. The need for wide availability in public places was reiterated by Prof. Amos Katz, chief of cardiology at Barzilai Medical Center in Ashkelon. One man who told his personal story was Rabbi Yitzhak Ansbacher. His life was saved when he suffered a cardiac arrest at his daughter's wedding and a volunteer medic from the Hatzala organization arrived quickly with a debrillator. THE PRICE OF NEGLECT The life of an eight-year-old girl from the haredi community in Jerusalem's Mea Shearim quarter was saved recently at Hadassah University Medical Center after her mitral heart valve nearly closed from rheumatic fever - a complication of an inadequately treated Streptococcus tonsil infection. Prof. Chaim Lotan, head of Hadassah's cardiology service, says he and his colleagues had never seen a case in such a young child. "If a Streptococcus throat infection is not treated in time with penicillin, in some cases it can cause rheumatic fever and damage heart valves. But the heart damage usually occurs decades after the throat infection. The youngest case we have seen like this was in a 17-year-old pregnant Arab girl." The girl from Mea Shearim, who has 13 siblings, came to Hadassah before Rosh Hashana with severe respiratory distress due to the heart valve damage. The cardiology physicians were in a dilemma, as the parents opposed open-heart surgery "because it would hurt the marriage chances of the girl and her sisters. Someone with an operation or a scar," said Lotan, "is regarded in the extreme haredi community as 'damaged goods;' fit to marry only someone else with a defect." Due to the parents' opposition, the team ordered angioplasty (balloon therapy) equipment from abroad to insert into her heart and expand the damaged valve.The procedure was performed by Dr. Yoav Turgeman and Prof. Azaria Rein two days ago, and the girl is now doing well. "Rheumatic fever is very rare today, and is always in haredi Jewish or Arab families suffering from poverty and overcrowding. It is very sad to see," said Lotan. "In the extreme haredi community, there are often a dozen children. The father, who doesn't recognize the Zionist state, spends the day studying Talmud, earning a pittance, while the mother works a bit as a teacher and raises a large brood under poor living conditions. The children in such cases are neglected. Angioplasty is routine at older ages, but this is the first time we have seen such an immediate complication at this young age." Lotan said he thinks the parents learned their lesson, and will take precautions in future. There is a danger of restenosis (repeated narrowing of the valves), which would then require another angioplasty.