Myocardial protection with glucose-insulin-potassiuminfusion during adult cardiac surgery

Background and Objective: Recent meta-analysis reports have called for more randomized trials to evaluate the effectiveness of GIK solution in patients of cardiac surgery. So this study was conducted to evaluate the effectiveness of Glucose-insulin-potassium [GIK] solutions in non-diabetic patients undergoing coronary artery bypass grafting

Methods: A total number of one hundred and sixty [160] patients were randomized into two equal groups; GIK Group and non-GIK group. In GIK group, 5% dextrose containing 70 IU/L regular insulin and 70 meq/L of potassium was administered. The infusion was started at a rate of 30 ml/hour after induction of anesthesia and before the start of cardiopulmonary bypass. The infusion was started again after removal of aortic cross clamp and was continued for six hours after the operation

Results: In early post-operative period, peak CKMB levels were high in non-GIK group 48.50+/-19.79 IU/L versus 33.40+/-14.69 IU/L in GIK group [p-value <0.001]. There was no statistically significant difference in requirements of inotropic support between the groups. The mean duration of inotropic support in GIK group was only 5.50+/-6.88 hours in GIK group and 8.64+/-7.74 hours in non-GIK group [p-value 0.008]. Mean ventilation time in GIK group was 5.06+/-2.39 hours versus 6.55+/-3.58 hours in non-GIK group [p-value 0.002]. Similarly, ICU stay period was also shorter in GIK group [p-value 0.01]. We did not found any detrimental effect of GIK infusion on non-cardiac complications e.g. renal, pulmonary and neurologic complications

Conclusion: Glucose-insulin-potassium [GIK] infusion has a beneficial role in myocardial protection and is associated with better post-operative outcomes without increasing the risk of non-cardiac complications

Comparison of complications in patients of inferior wall myocardial infarction with and without right ventricular infarction

To compare in-hospital complications in terms of complete heart block and mortality in patients of inferior wall myocardial infarction with or without right ventricular infarction and to see the frequency of right ventricle infarction in patients of inferior wall myocardial infarction. Cross-sectional comparative study. The study was conducted at Chaudary Pervez Elahi Institute of Cardiology, Multan from 7th August 2009 to 6th February 2010. 73 patients with inferior ST-segment elevation myocardial infarction were distributed into two groups; one with IWMI only and second with IWMI with RV infarction. Patients with prior MI, pre-exiting heart failure, valvular heart disease, pericardial disease, acute pulmonary embolism, significant pulmonary diseases were excluded from the study. The data was analyzed by using software SPSS. The difference in frequencies of complications in two groups was compared using chi square test and a p value of <0.05 was considered significant. Mean age was 51.95 +/- 11.8 years in group 1 and 54.17 +/- 12.0 years in group 2. Patients in group 2 had more complications as compared to group 1. The incidence of Complete AV block was 7 [38%] in group 2 vs. 3 [5%] in group 1 [p=<0.001]. The incidence of right ventricular infarction in patients of inferior wall myocardial infarction was noted to be 26%. RVI results in increase in the frequency of complete heart block and mortality in patients of inferior wall myocardial infarction with right ventricular infarction and the incidence of right ventricular infarction in inferior wall MI was 26%

Complications of streptokinase during infusion in acute myocardial infarction

To find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction [Ml] in Multan institute of cardiology emergency department. Multan Institute of Cardiology. Multan. January 2008 to June 2008. This is a descriptive study of 200 patients presenting within 12 hours of acute myocardial infarction in Multan Institute of Cardiology emergency, diagnosed on the basis of typical ischemic chest pain, ECG changes of acute MI and raised cardiac enzymes. Out of 200 patients, 135 [67.5%] were male and 65 [32.5%] were female. In SK and control group male to female ratio was 71:29 and 64:36 respectively. Out of 200 patients 139 [69.5%] present with chest pain, 41 patients [20.5%] presented with dyspnea and 20 [10%] with chest pain and dyspnea. Early administration of SK lowers in hospital mortality

comparative study of complications in patients of myocardial infarction managed with and without streptokinase

Background - Numerous meta-analysis have been published and on the basis of the results of the some or all of the more than 33 trials evaluating intravenous streptokinase for acute myocardial infarction. All of these reviews demonstrated a consistent, statistically significant reduction in mortality for patients with acute myocardial infarction who were treated with intravenous streptokinase. Objectives - Intravenous streptokinase clearly confers a protective effect against early mortality in patients with acute myocardial infarction, with this initial hope that the administration of thrombolytics to patients with evolving acute myocardial infarction will prevent infarct complications. We conducted prospective study to observe the rate of complications as a whole in patients who could not get the thrombolytic therapy. Setting - This study was conducted in the coronary care unit and out patient Department of Cardiology Bahawal Victoria hospital Bahawalpur affiliated with Quaid-e-Azam Medical College Bahawalpur. Methods - This observational study was carried out in 960 patients fulfilling the diagnostic criteria for acute myocardial infarction. These patients were prospectively followed for clinical end points during the hospitalization and 90 days follow up period. Streptokinase 1.5 million units was used as a thrombolytic agent in the patients fulfilling the eligibility criteria. Results - A total of 960[21.22%] patients with acute myocardial infarction were assessed for the complications of myocardial infarction with or without thrombolytic therapy. Male and female patients were 664 [69.16%] and 296[30.83%] respectively. Mean age of patients with myocardial infarction was 57.30 years. Anterior myocardial infarction was diagnosed in 680[70.83%] patients and inferior wall myocardial infarction was diagnosed in 280[29.16%] patients. Streptokinase was given in 500[52.08%] patients while 460[47.9%] did not get it. There was statistical significant difference of complications as a whole with p value of < 0.001. Conclusion - Thrombolysis is the first line between life and death and now it has become the established fact beyond doubt in the treatment of acute myocardial infarction. The advent of streptokinase has led to substantial changes in clinical practice of managing acute myocardial infarction especially evolving one. The magnitude of the treatment effect lowers the risk of mortality and hospital stay

Comparative study of frequency of cough with angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertension

Background-Hypertension is an important factor in premature death and contributes to several of the leading causes of the death including heart diseases, stroke and renal diseases. The effect of ACEIs' and ARBs' was studied for the development of cough beyond blood pressure control. Setting - Outpatient Department of Cardiology and Medicine Bahawal Victoria Hospital, Bahawalpur attached with Quaid-eAzam Medical College Bahawalpur. Method - Two hundred male patients with uncomplicated mild to moderate essential hypertension were randomized to the treatment with ACEIs' and ARBs' for a mean period of twelve weeks. During each treatment period, the incidence of cough which necessitated the withdrawl of drug, was studied after fulfilling the inclusion and exclusion criteria. Results - Two hundred male patients who were randomized to receive the drugs having mean age of 51.9 years, mean systolic blood pressure 164.55 mmHg and mean diastolic blood pressure 99.55 mmHg. The mean dose of enalapril was 13 mg and the mean dose of losartan potassium was 65 mg. After treatment of 12 weeks, mean systolic blood pressure was 124.55 mmHg and mean diastolic blood pressure was 92.55 mmHg. 25 patients [25%] with ACEIs' developed cough while 4 patients [4%] developed cough with ARBs' with significant difference of incidence of cough with <0.001. Conclusion - Now that numerous agents are available to manage hypertension, more research should be directed towards improving the compliance of patients with anti hypertensive therapy with less side effect profile. ARBs' may be preferred over ACEIs' in certain cases