Frequency of left main artery/three vessel disease predicted through ECG changes in patients presenting with non-ST segment acute coronary syndrome

Background: Electrocardiography [ECG] is simple, quick and economic investigation for diagnosis of acute coronary syndrome. Its applicability in prediction of left main coronary artery/ 3 vessel coronary disease can be of very useful in saving precious time in the critical care of coronary patients

Objective: Electrocardiography changes as a predictor of left main coronary artery / 3 vesselcoronary disease in patients presenting with Non-ST segment elevation acute coronary syndrome

Methodology: This cross sectional study was executed from July 2014 to June 2015 at Isra University hospital Hyderabad taking 114 consecutive patients of age >/=20, of either gender, presenting with symptoms of Non-ST segment elevation MI or that showed ECG changes in lead aVR. Informed written consent for the study was taken from the immediate family members of patients. Approval from ethics review committee of Isra University was taken. Data analysis was done through SPSS. Descriptive statistics [Mean +/-standard deviation for continuous and frequencies and percentages for categorical variables] were expressed

Results: Patients' mean +/-SD age was 56.65 +/-15.44 years [Range: 20-89 years]. Male to female ratio was 3.4:1. More than a half [52%] of these patients had Left main [LM] / 3 vessels disease. About a quarter other [25%] had 2 vessels while [22%] had single vessel disease [P value <0.0001]. Patients having ST elevation in lead aVR, were associated with increased risk of developing LM / three vessels disease [P value <0.0001]

Conclusion: ST elevation in lead aVR and ST depression in leads II, III, and aVF can be practically used for evaluation left main / 3 vessel disease among NSTE-ACS patients

Acute myocardial infarction; a comparative study to assess the angiographic changes in diabetic and non diabetic patients

To compare the angiographic findings in patients with acute myocardial infarction [AMI] and compare it with diabetic and non-diabetic patients admitted in the cardiology department of LUHMS. Descriptive analytical study. Department of cardiology at Liaquat University of Medical and Health Sciences [LUMHS] Hospital, Hyderabad. Periods of 1[st] June 2012 to 31[st] July 2013. All patients with AMI and had diabetes mellitus and age eighteen or more than eighteen years both male and female were included after taking informed consent. Out of 297 patients diagnosed as AMI, 195 [65.65%] patients had acute ST elevation Myocardial Infarction and 102 [34.35%] patients had acute non ST elevation myocardial infarction. Among 297 patients, 190 [64%] patients were non-diabetic and 107 [36%] patients were diabetic. Diabetic patients were older, more often males, but prevalence of smoking was less marked. Coronary angiographic findings among patients with AMI and diabetics revealed three vessels disease. Older patients with male predominance presented with AMI and had diabetes mellitus were found to have three vessels disease in coronary angiography

Outcome of native valve endocarditis

OBJECTIVE: To determine the in-hospital outcome of Native Valve Endocarditis patients and associated complications

STUDY DESIGN, PLACE AND DURATION: Hospital based prospective study, Department of Cardiology, Liaquat University Hospital Hyderabad from July 2005 to December 2007

PATIENTS AND METHODS: 56 consecutive patients, who presented with fever, joint pain, dyspnoea, history of Rheumatic fever, previous history of IE, history of I/V drug abusiveness were studied by history, physical examination, 3 blood samples were taken and sent to the laboratory for culture and sensitivity. All patients were evaluated by Doppler echocardiography on day 1, at 14 day, at one month and on 6th week of treatment. Empiric treatment was started on admission and later adjusted according to culture and sensitivity. Descriptive and inferential statistical analysis was performed using SPSS version 16.0

RESULTS: Males out numbered females with ratio 37[66.1%] / 19[33.9%]. Definite vegetation was found in 40/56 [71.4%]; but definite culture positive cases were 30/56 [53.6%]. Complete improvement was seen in 32[57.1%], 08[14.3%] patients died during the course of treatment in hospital, 10[17.9%] were referred for surgery and 06[10.7%] patients developed recurrent episode of infective endocarditis. 13/56[23.2%] patients developed congestive heart failure, recurrent episodes of fever in 8[14.3%] and valvular regurgitation 6[10.7%] cases

CONCLUSION: Our study showed that native valve infective endocarditis is not un common

Early diagnosis and treatment can help in improving morbidity and mortality, overall outcome and can reduce devastating complications associated with infective endocarditis. Patients who require surgical intervention like large vegetations or abscess should be referred for surgery as early as possible to avoid further complications

Pattern of congenital heart disease at Liaquat university hospital Hyderabad

Objective: to find out the frequency of various congenital heart disease among affected children from birth to 12 years of age at Liaquat University Hospital Hyderabad

Setting: Study was conducted in pediatric Department of Liaquat University Hospital Hyderabad

Study design: This descriptive study was conducted over a period of one year from April 2006 to March 2007

Patients and Method: eighty Children up to 12 year of age with clinical suspicion of congenital heart disease were evaluated for type of lesion, gender and age at presentation. They were subjected to chest X-ray, ECG and detailed echocardiography which confirmed the final diagnosis .The results was analyzed on SPSS window version 10

Results: out of eighty cases fifty were male [62.5%] and thirty were female [37.5%].Fifty eight [72.5%] children were having cyanotic heart disease. Among A cyanotic lesion VSD was present in 42 patients [52.5%], ASD were 7 [8.75%] 6 have secondo types. PDA was present in 6 [7.50%] patients. A total of 7 [8.75%] patients had the TOF and 3 [3.75%] had TGA in association with VSD in one and ASD in 2 patients .Severe pulmonary stenosis was seen in 3 [3.75%] patients 2 were in association with ASD. Single ventricle and dextrocardia were seen in 3 [3.75%] patients each. Complex cardiac lesion was seen in 2 [2.5%] patients

Conclusion: majority of Congenital heart disease in children at Tertiary care Hospital are acidotic, VSD is the commonest acidotic lesion while TOF is the commonest cyanotic lesion. Early detection of this defect is important for proper management

Outcome of thrombolytic and no thrombolytic therapy in acute myocardial infarction

Objective: to compare morbidity, in hospital mortality and benefits of Streptokinase [SK] therapy and Non- Streptokinase [non-SK] therapy in acute myocardial infarction patients

Methods: retrospective review of the medical record of 300 patients with all types of acute MI admitted in our CCU between Nov. 2000-April 2001

Resutls: out of 300 patients, 210 [70%] were male and 90 [30%] were female. 150 [50%] were given SK therapy and 150 [50%] did not receive SK therapy because they did not qualify. Mean age was 55 years. The success of SK therapy was judged indirectly through non-invasive measures

Limitations: this data is from a hospital which does not have invasive or PCI facilities; hence it was totally dependent on non-invasive measures. However, this might help in patient management in our society where most hospitals/CCUs do not have invasive facilities

Conclusion: the overall survey shows that not only mortality was improved in SK group but also patients had less complications, early pain relief and shorter hospital stay. However, due to higher earlier event rate in SK group, these patients should preferably be referred to a facility having interventional support

Etiology of congestive cardiac failure in children from birth to 15 years

Objective: - To study the various causes of congestive cardiac failure in children. Study Design: - Prospective descriptive study. Period of Study: - 1[st] November 2004 to 31[st] March 2005. Setting: - Pediatric and cardiology Dept of LUH Hyderabad

Patient and Method: - During study period of 5 months all children between the age of 0-15 year presenting with symptom and sign suggestive of congestive cardiac failure were evaluated with relevant investigation for the underlying etiology. Those patients who expired during study before diagnosis was established were excluded

Results: - Out of total 55 patients 30 [54.54%] were male and 25 [45.45%] female and the commonest etiology of CCF was congenital heart disease. Seventeen patients [30.9%] were below one year of age and the commonest etiology was congenital heart disease of which eleven patients [64%] had VSD, seven [63%] of them had lower Respiratory tract infection. Other etiologies included myocarditis with pericardial effusion and gross Anemia. Eleven patients [64%] were between 1-5 years and the commonest cause of congestive heart failure was acute myocarditis other causes were congenital heart disease and Gross Anemia. Twenty seven [49%] patients were between 5-15 years and the commonest cause was Rheumatic carditis found in 12 patients [44%] other causes included congenital heart disease, myocarditis, dilated cardiomyopathy and Anemia, valvular vegetations was seen on preexisting Rheumatic value disease in 2 patients. Ten patients had noncardiac causes of congestive cardiac failure commonest one was Anemia seen in 8 patients

Conclusion: - The cardiac failure could occur at any age and the predominant etiology during infancy was VSD while myocarditis is common in age group 1-5year. Rheumatic carditis was the commonest cause of congestive heart failure beyond 5 yr. Among non-cardiac cause Anemia is on the top

Acute haemodynamic effects of intravenous ICI 153,110 in congestive heart failure

Despite recent advances in the pharmacological and mechanical means of supporting ventricular function, congestive heart failure continues to be major cause of morbidity and mortality. Impaired myocardial contractility remains to be a primary feature. Phosphodiesterase inhibition can lead to an increase in cyclic AMP and augment myocardial contractility. The results in this study suggest that the positive inotropic drug may be beneficial for the treatment of Congestive heart failure. Furthermore ICI 153, 110 proves to be effective positive inotropic drug with vasodilating effects and does improve left ventricular performance during acute administration in patients with congestive heart failure