Evaluation of patients with coronary artery disease for major modifiable risk factors for ischemic heart disease

Incidence of cardiovascular diseases is on the rise in developing countries. Deaths due to ischemic heart disease can be reduced by modifying the risk factors. The present study was conducted to evaluate the patients scheduled for Coronary Artery Bypass Surgery for the presence of major modifiable risk factors for ischemic heart disease [IHD]. It was a descriptive study. All patients who underwent elective Coronary Artery Bypass cardiac surgery between November 1, 2008 and February 28, 2009 at Rehman Medical Institute, Peshawar, were included in the study. Presence of Diabetes, Hypertension, Smoking, Dyslipidemia, Sedentary life style, and Obesity was looked for in these patients. A total of 104 patients were studied during this period. Majority [97.11%] of patients had at least one major modifiable risk factor for IHD. Sedentary life style [53.84%] was the most common risk factor present in these patients followed by hypertension and dyslipidemia [47.11% each], smoking [43.27%], diabetes [35.57%], and obesity [9.61%]. Multiple risk factors [two or more] were found in 78 [75.0%] of patients. Most of the patients with coronary artery disease, severe enough to warrant coronary artery bypass grafting, have at least one of the major modifiable risk factors for IHD. Modification of these factors may well reduce the disease burden of CAD and reduce the cardiovascular mortality.

Acute type a aortic dissection: a pathology under diagnosed

To compare the frequency of acute type A aortic dissection with chronic dissections, at two large cardiac surgery centers of the country. Acute type an aortic dissection: a pathology under diagnosed. This study was conducted at Rehman Medical Institute, Peshawar and National Institute of Cardiovascular diseases, Karachi, between January 2001 and January 2007. All patients with type A aortic dissection are studied retrospectively. Patients with aortic aneurysm, undergoing aortic root surgery, were not included in the study. Out of 13 patients who underwent aortic root surgery for various pathologies of the aorta, 9 cases had type A aortic dissection. Eight patients were diagnosed by trans-thoracic and trans-esophageal echocardiography and one patient was diagnosed on contrast enhanced computerized tomography [CT] scan. None of the patients had cardiac catheterization or MRI. Six of the nine dissections were chronic. One patient had Marfan Syndrome. Eight patients were hypertensive. One patient had aortic valve repair with supra coronary tube graft interposition for ascending aortic dissection; while eight patients had aortic root replacement with prosthetic composite grafts. There was one in-hospital death. Post operative echocardiogram of the patient with aortic valve repair, revealed mild aortic regurgitation. Seven of the eight surviving patients are in NYHA class I while one patient is in NYHA class two. Aortic root surgery can be safely performed with results comparable to the published data. Hypertension needs to be controlled to avoid its potentially lethal complications, like aortic dissection