Angiographically documented coronary artery disease in asymptomatic middle aged men suspected of silent ischaemic heart disease

One hundred and fourteen asymptomatic middle aged men, with a positive stress test, underwent coronary angiography at Armed Forces Institute of Cardiology/National Institute of Heart Diseases [AFIC/NIHD], Rawalpindi. Of these, 66 [58%] were found to have significant disease [>50% luminal narrowing in at least one of the major epicardial arteries] while 48 [42%] had normal coronary arteries. Of the former, 27[41%] had 1-vessel CAD, 18[27%] had 2-vessel CAD and 21 [32%] had 3-vessel CAD. There were significantly more hypertensives, hyperlipidaemics and diabetics in CAD group, while other risk factors were the same. The overall risk factor prevalence was low. The major reasons for performing coronary angiography were a positive stress test done as part of routine annual medical checkup and resting ECG changes of enough significance to warrant further investigations. It is concluded that the presence of significant coronary artery disease can be silent in a large number of asymptomatic middle aged men, especially those who have conventional risk factors

Initial experience with thallium scan in NMC/AFIP

Our experience with first 25 cases of Thallium Scintigraphy is presented. From this relatively small study it is concluded that Thallium Scan is of particular use in the cases with the resting EGG abnormalities like Bundle Branch Blocks or ST, T changes where interpretation of exercise test becomes difficult. It has also been found helpful when ETT is inconclusive/equivocal. It has been noted that thallium scan has a reasonably close correlation to the angiographic findings which is considered a gold standard conventionally for detection of coronary artery disease

Correlation of resting ECG, stress ECG and thallium scan in the evaluation of coronary artery disease

This study includes 70 cases who underwent Myocardial Perfusion Studies with Thallium 201 during the years 1984-1985. They were studied clinically, had their Resting ECGs, Stress ECGs and Coronary Angiograms. Majority of these patients were males [64 out of 70], their ages ranged between 34 - 70 years [average 51 years]. The patient population included those with typical/atypical chest pain, some with resting ECG abnormalities, some after coronary angiography and a few after coronary artery bypass graft surgery. The results of all the modalities were compared with the conventional gold standard for Ischaemic Heart Disease, i.e., coronary angiogram. It is concluded that the sensitivity of resting ECG in the diagnosis of ischaemic heart disease is very low. The exercise test alone was found conclusive in about 74% of patients while sensitivity of Thallium Scan was 36% in this particular group of patients

value and limitation of thallium scintigraphy in the detection of individual coronary artery disease

In this study we randomly selected 45 patients whose coronary angiograms were abnormal i.e. showing triple, double and single vessel disease out of a pool of 80 patients who had undergone stress thallium imaging and coronary angiography during the one year period from June 85 to 86. Majority of these patients Were males [43 out of 45], their ages ranged between 34-54 years [average = 48]. Resting ECG's were normal in 25 patients, 15 patients had suffered inferior myocardial infarction and 5 had sustained anterior myocardial infarction in the past. Coronary angiography revealed triple vessel disease in 20 patients, double vessel disease in 15, and single vessel coronary artery disease in 10. We analysed their coronary angiograms and compared them with the scintigraphic findings. It is concluded that although thallium scanning has high sensitivity for detection of coronary artery disease in general, it has only moderate sensitivity for detection of stenosis in individual coronary arteries. In this study thallium scan identified 75% of RCA lesions, 66% of LAD lesions and 38% of Circumflex lesions. our results are in close correlation to the previous reports, so far as LAD and Cx lesions are concerned but the sensitivity for RCA lesions is greater. The probable reason is inclusion of higher number of patients with inferior infarcts. Thallium Scan sometimes fails to identify the less severe lesions in the presence of more severe coronary lesions in the same patient. The sensitivity is much higher in single vessel coronary artery disease

Multiple myeloma: a case report

A case of multiple myeloma has been described who presented with repeated chest infections and anaemia. The possibility of plasma cell dyscrasia was kept in mind although he had no typical symptoms and signs like bone pains, bony tenderness etc. The diagnosis of multiple myeloma was established by serum electrophoresis, radiological and bone marrow studies

Smoldering acute myeloid leukemia

A case of Acute Myeloid Leukeamia is described who presented as a case of sideroblastic anaemia, later as aplastic anaemia and in the tenth month of illness showed changes of acute myeloid leukaemia

Hepatic tuberculosis

A case of tuberculosis of liver is described who presented with nonspecific features suggesting cirrhosis. However the diagnosis of hepatic tuberculosis was confirmed on liver biopsy. The patient responded well to the anti-tuberculous therapy and became symptom free