ABSTRACT
Background@#Cardiac disease increases morbidity and mortality in pregnant patients. This is found in both developing countries and underdeveloped countries. Cardiovascular demand increases with pregnancy, causing additional stress on a diseased heart. This then poses a greater risk of complications; thus, specialized care involving an Obstetric-Gynecologist and a Cardiologist is warranted. The Modified WHO Classification of Maternal Cardiovascular Risk, CARPREG, and CARPREG II predict risk among gravidocardiac patients and corresponding needed medical attention perinatally. Little data has been known on the clinical outcomes of pregnancy among gravidocardiac patients in the Philippines. This study aims to gauge the clinical outcomes of gravidocardiac patients admitted to a tertiary hospital in Dumaguete City.@*Methods@#A retrospective, cross-sectional descriptive study was carried out among all gravidocardiac patients admitted for labor and delivery between January 2015 and December 2019. A chart review of the cases satisfying the inclusion criteria was done. Data gathered were tabulated, and a Chi-Square was used to assess if there was a significant relationship between the cardiac condition and the mode of delivery, duration of pregnancy, maternal outcomes, and fetal outcomes.@*Results@#Cardiac lesions noted among gravidocardiac patients include mitral valve prolapse, which comprised the majority of cases, patent ductus arteriosus, ventricular septal defect, mitral valve regurgitation, aortic valve regurgitation, atrial septal defect, and peripartum cardiomyopathy. Pregnancies were mainly carried to term with vaginal delivery as the primary mode of birth. Maternal outcomes were generally favorable, with no deaths recorded. Fetal outcomes were variable among cases, and fetal mortality was recorded at 3.92%. A significant relationship was seen between maternal cardiac condition and maternal outcomes of the pregnancies.@*Conclusion@#Among pregnant patients with cardiac conditions, maternal outcomes of pregnancy can be predicted in association with the cardiac condition. There is a great need to educate the public on the need for proper perinatal care when a cardiac condition in pregnancy is detected.
ABSTRACT
Introduction@#Erectile dysfunction (ED) has numerous links to cardiovascular disease. Numerous studies show the severity of ED is strongly associated with atherosclerosis and endothelial dysfunction implicated in the pathogenesis of coronary artery disease (CAD). These common vascular pathways have led to evidence that ED onset may be used as a marker of the severity of CAD as well as a preclinical marker of early onset-CAD. The researchers aim to determine the association of ED and CAD in terms of prevalence, clinical presentation and severity and extent of vessel involvement by SYNTAX score among CAD patients undergoing coronary angiography.@*Methods@#This is a prospective, cross sectional, analytical study design set at Perpetual Succour Hospital – Cebu Heart Institute, a private, tertiary hospital with cardiac specialty units located in Cebu City. This study includes all Filipino patients admitted at Perpetual Succour Hospital suspected to have coronary artery disease based on symptoms of angina, dyspnea or other anginal equivalent with indications to undergo coronary angiography during the period of October 1, 2014 to September 30, 2015 were included.@*Results@#A total of 160 patients were included in the study. The mean age is 57.23 years with most of the patients admitted for stable ischemic heart disease (SIHD) of 54.7%, non-ST elevation acute coronary syndromes (NSTEACS) 33.5% and ST-elevation myocardial infarction (STEMI) 11.8% with multiple cardiovascular risk factors like hypertension, diabetes mellitus, smoking and dyslipidemia. Eighty-two percent complained of ED symptoms with a mean International Index of Erectile Function (IIEF) score of 15.15. Most ED patients identified had mild to moderate ED (31.7%), mild ED (21.7%), moderate ED (17.4%) and severe ED (11.8%). There were only 17.4% of patients who had undergone coronary angiography for CAD complaints that had no ED symptoms on admission. Per clinical presentation, there was a significant association between patients presenting with severe ED, moderate ED and mild to moderate ED with those presenting with SIHD and ACS-NSTEMI on admission, moderate ED and mild to moderate ED. ED was significantly associated with obstructive CAD (p=0.001) and correlated directly with the number of vessels involved (p<0.01) and inversely related to SYNTAX scores (p<0.001). ED symptoms were noted to precede CAD diagnosis by 4.9 to 5.9 years.@*Conclusion@#In conclusion, there is a high prevalence of ED among CAD patients and its existence is significantly associated with obstructive CAD varying directly with extent and number of vessel involvement. There is a significant inverse relationship with severity of ED and SYNTAX scores. The existence of ED was present in all subsets of CAD patients, regardless of presentation of admission and preceded CAD symptoms and diagnosis by four to five years.