Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre

Rheumatic Heart Disease [RHD] continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. A total of 13, 414 patients [7, 219 Males [53.8%], 6, 195 Females[46.2%]] ranging from 11 to 90 years with a mean age of 42.33 +/- 18.976 were studied. On echocardiography, 7, 500 [56%] had mitral regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4%] had aortic regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4$] had aortic regurgitation [4.8% severe AR]. MS was detected in 2, 729 [20.3%] patients [15.3% severe MS], AS in 102 [0.8%] and TS in 31 [0.2%] patients. Mixed mitral valve disease was seen in 3, 185 [23.7%], mixed aortic valve disease in 222 [1.7%] and mixed tricuspid valve disease in 47 [0.4%] patients. All three valves were involved in 2, 826 [21.06%] patients, combination of mitral and aortic valves in 3, 103 [23.13%], mitral and tricuspid in 3, 784 [28.2%], and mitral only in 3, 701 [27.59%] patients. There was some mitral valve abnormality in all patients. Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in

In hospital outcome of acute myocardial infarction in patients receiving Streptokinase

To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic [streptokinase] therapy versus those who were not thrombolysed. This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 10 of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase [SK] group and patients not receiving streptokinase [Non-SK] group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58+11.02 years and Non-SK group was 55.78+10 years. In SK group 170[83.3%] patients were males and 34[16.7%] were females. Only 54[26.5%] diabetics and 150[73.5%] non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group [p<0.0001]; left ventricular failure occurred more frequently in Non-SK group and was the most common cause of death in both the groups [p<0.0001]. Only 4.3% patients in the SK group and 19.6% patients in the Non-SK group died in first 24 hours of hospital admission [p<0.0001]. Mechanical complications occurred more frequently in Non-SK group [p<0.008]. There was a statistically non significant difference [p<0.436] noted in comparison of electrical complications between the two groups. Streptokinase infusion given in the early hours of acute myocardial infarction leads to a significant reduction in in-hospital mortality and mechanical complications like left ventricular failure

Prophylactic role of epidural saline injection for post dural puncture headache: a pilot study

This pilot study was designed to judge the prophylactic role of epidural saline injection for prevention of post dural puncture headache [PDPH] in patients with accidental dural puncture during the setting up of epidural anaesthesia. Ten patients who sustained accidental dural puncture during the setting up of epidural anaesthesia. Ten patients who sustained accidental dural puncture during routine epidural anaesthesia for various gynaecological and obstetrical surgical procedures carried out in Gynae Block of Services Hospital Lahore between 16-03-05 to 15-04-06 were included in the study. All patients had ASA I to ASA III status. The age range was 25 to 50 years and weight range was 45 to 70. Kg. A 16 gauge Touhy needle was used for epidural anaesthesia. In case of dural puncture, epidural anaesthesia was given one space above or below the site of puncture. The study was approved by hospital ethical committee. After completion of surgery, 30 ml of normal saline [0.9%] was injected in the epidural space. All patients were observed for three days for occurrence of post dural puncture headache. Two out of ten patients [20%] complained of post dural puncture headache. One patient had to undergo repeat surgery under general anaesthesia for a surgical complication but did not complain of post dural puncture headache. Prophylactic epidural saline injection is associated with low frequency of post dural puncture headache in patients with accidental dural puncture during setting up of epidural anaesthesia

Carotid endarterectomy at Punjab institute of cardiology, Lahore: Mid term postoperative results

This study was designed to review postoperative results of the carotid endarterectomy [CABG/CEA] performed at the Punjab Institute of Cardiology, Lahore. Cconsecutive 10 patients with coexisting severe ischemic cardiac and carotid artery disease were operated on during 1-year period ending December 2003 at Punjab Institute of Cardiology, Lahore. The mean age of the study population was 60.20 +/- 7.56 years, among theses 9 were male and 1 female patient. Four [40%] patients with carotid artery stenosis were asymptomatic. Previous stroke occurred in 2 [20%] patients: two [20%] patients presented with a history of blackouts and two [20%] with a transient ischemic attack. The mid term results with regard to 30-day postoperative mortality, stroke and major postoperative complications were significantly low in terms of post operative infection as only one [10%] patient had chest infection and there was no in-hospital mortality. Combined interventions of CE and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. The introduction of routine preoperative carotid duplex scanning resulted in higher diagnostic rate for asymptomatic carotid artery disease among the patients scheduled for combined CABG/CE procedure