Relation of smoking and elevated homocysteine in patients presenting with acute coronary syndrome

Elevated plasma homocysteine levels. homocysteine levels are risk factor for coronary artery disease. Smoking is known to be Other risk factors like diabetes mellitus, associated with an increased plasmafamily history, obesity and dyslipidemia were homocysteine level and both with increased riskalso studied. of cardiovascular disease. To investigate the relation ship between smoking, plasma homocysteine and other conventional risk factors with coronary artery disease in relatively younger population of patients presenting with acute coronary syndrome in emergency room of Cardiology Department, Allied Hospital Faisalabad. Among 586 patients of ACS under 50 years, 221[38%] patients were found to be smokers. Smoking habit showed significant difference between male and female patients as 177 [80%] male and 44 [20%] female. Homocysteine level of 22.4% patients among all was high and was found associated [63.5% of smokers] with smoking habit Out of 1852 consecutive patients[P<0.01]. Hypertension was not among admitted in emergency room of Cardiologysignificant factors for smokers as 421 [65%] Department, Allied Hospital Faisalabad overwere not suffering from hypertension. There one year, 1375 [74%] presented with acute chestwere 93 obese among smokers and these two pain, 586 were under 50 year. 384 [66%] wererisk factors collectively posed insignificant males 202 [34%]. 200 [34%] were under 40effect [P<0.05]. years. 386 [66%] patients were in age range 41 - 50 years. The demographic details, history and clinical examination of patients were recorded and their blood was collected in fasting state for estimation of serum total cholesterol, plasma glucose and serum total It was concluded that smokers were more prone to have coronary heart disease due to increased levels of homocysteine, its association with abnormal lipid profile and especially when some other risk factor combines with smoking greatly increases the risk of cardiovascular disease and should therefore be offered intensive advice to help them cease smoking also have reduced levels of homocysteine

Exertional dyspnea in patients with diabetes mellitus: evaluation by myocardial perfusion scintigraphy

Coronary Artery disease is a major cause of morbidity and mortality in patients with diabetes mellitus. They have high incidence of silent ischemia as pain perception is blunt in such patients. As a result many of them present with atypical symptoms like exertional dyspnea, instead of classical chest pain as their chief presenting complaint. We evaluated incidence of myocardial perfusion scintigraphic [MPS] evidence of coronary artery disease [CAD] in patients with type II diabetes mellitus without known CAD presenting with exertional dyspnea as chief presenting complaint. We conducted stress-redistribution SPECT MPS with intravenous injection of 93-130 MBq [2.5-3.5 mCi] 201T1-thallous chloride in 290 subjects with type II diabetes mellitus having exertional dyspnea [SOB] as study group [151 male and 139 female, age range 20 to 76 years]. 138 asymptomatic subjects with type II diabetes mellitus also underwent same procedure as control group [56 male and 82 female, age range 29 to 65 years]. Upon the bases of clinical history, study groups were further divided into three categories, Esob=exertional SOB [n=54], AcpD= atypical chest pain with dyspnea [n=114] and TcpD=typical chest pain with dyspnea [n=122]. We conducted visual analysis on reconstructed tomographic slices. CAD was present in 34.78% control [ischemia 23.91%, myocardial infarction 10.87%] and in 66.9% study group subjects [ischemia 49.31%, myocardial infarction 17.87%]. Incidence of CAD was high in Esob group than control [48.15% vs. 34.78%], AcpD group than Esob [64.91% vs. 48.15%] and TcpD group than AcpD [77.05% vs. 64.91%]. Stress induced ischemia [SII] was more frequent in Esob group than control [37.04% vs. 23.91%] and AcpD group than Esob [50% vs. 37.04%]. However, its occurrence was almost similar in TcpD and AcpD groups [54.1% vs. 50%]. Observed frequency of myocardial infarction was almost same in control [10.87%] and Esob [11.11%] group. Incidence of myocardial infarction was higher in AcpD group than control [14.91% vs. 10.87%] and TcpD group than AcpD [22.95% vs. 14.91%]. Our study concludes that incidence of myocardial ischemia and infarction is quite high in patients with type-II diabetes mellitus presenting with exertional dyspnea. Presence of chest pain further increases the likelihood of CAD in these patients. We should perform MPS in all patients with type II diabetes mellitus who present with exertional dyspnea, even if they have no chest pain

Outcome of cardiopulmonary resuscitation in hospital patients following heart attack

Background: The aim of this study was to evaluate in hospital survival of the patients admitted or presenting in cardiac emergency room with cardiac arrest as well as to look into the factors associated with success rate of CPR

Methods: Prospective study of consecutive 404 patients admitted in cardiac emergency room who received advance cardiac life support protocol after in-hospital cardiac arrest. Short term survival [Return of spontaneous respiration and circulation] and hospital survival at the time of discharge were measured. In addition, factors affecting the outcome of CPR age, gender, duration of CPR, associated arrhythmias, defibrillation and TPM implantation were also taken in account. Main outcome: Immediate survival after CPR, at 24 hours and at the time of discharge

Results: Overall 134 out of 404 patients [33%] who received advanced cardiopulmonary life support, survived to hospital discharge. Survival was better in male i.e. 37% versus 26% in female. Younger age group showed better survival i.e. 40.4% in age range of 30 to Department of Cardiology, Punjab Medical College, Allied Hospital Faisalabad. 49 years, 33% in 50 to 69 years and 28% in 70 years or older. Survival rate was 86% when CPR duration was less than 10 minutes, at 15 minutes 48% and at 20 minutes CPR time, 25% patients survived. Only 13.9% patients survived at CPR time of 30 minutes. Survival was 42% for patients with VF and 68% in those presenting with VT, 61% in fast AF with hemodynamic instability. 29% patients having TPM implantation survived of cardiac arrest. Poor survival in patients of cardiac arrest presenting with new development of LBBB i.e. 18%, best in inferior wall STEMI [32%], intermediate in anterior wall STEMI [28%]. Total of 40 patients in cardiogenic shock had cardiac arrest and 17.5% resuscitated successfully

Conclusion: Survival was highest for patients with primary cardiac arrest, with short CPR duration, young age, male gender and with tachyarrhythmia. Patients who experienced cardiac arrest at cardiac emergency room have better survival. Survival was poor in patients with cardiogenic shocks, CPR duration more than 20 minutes