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1.
PAFMJ-Pakistan Armed Forces Medical Journal. 2016; 66 (1): 44-46
in English | IMEMR | ID: emr-178736

ABSTRACT

Objective: To assess the relationship between psychological illnesses and atypical chest pain in reported cases of soldiers serving in hard areas


Study Design: A cross-sectional study


Place and Duration of Study: Armed Forces Institute of Cardiology [AFIC] and National Institute of Heart Diseases [NIHD] Rawalpindi from Nov 2012 to Oct 2013


Patients and Methods: Forty patients through non-probability convenience sampling were studied with complaints of chest pain besides no evidence of heart disease once assessed by ECHO, computerized tomography [CT] Angio, Thallium Scan and echocardiography [ECG], they were subjected to psychometric assessment


Results: Out of 40 patients 72.5% [n=29] were found to have psychiatric illnesses including, depressive disorder [n=26], adjustment disorder [n=2], and malingering [n=1]. Of these 29 patients, 42.5% [n=17] appeared with mild [acute] symptoms of depression and 15% [n=6.6] with moderate and severe depression respectively


Conclusion: Psychiatric illnesses mostly go unrecognized and in order to over come the current stressor generally an individual tries to display it in socially acceptable organic disorders to avoid stigmatization

2.
PAFMJ-Pakistan Armed Forces Medical Journal. 2016; 66 (6): 841-844
in English | IMEMR | ID: emr-184929

ABSTRACT

Objective: To determine the association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hypertension


Study Design: Cohort retrospective study


Place and Duration of Study: Department of Cardiac Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi from 11[th] Nov, 2014 to 10[th] Nov, 2015


Material and Methods: Sixty four patients with systemic arterial hypertension were divided into two equal groups on the basis of left ventricular hypertrophy. Patients with acute or old myocardial infarction, diabetes mellitus, cerebrovascular accident, heart failure, structural heart disease, bundle branch block and cardiomyopathies were excluded from the study. DMS 300 4L Holter monitors were used to obtain 3 channel signal averaged ECG recording. CardioScan premium luxury software was used for analysis of ventricular late potentials


Results: There were 49 [76.6%] males and 15 females [23.4%] with the mean age of 60 +/- 11.83 years. Ventricular late potentials were revealed in 10 [31.3%] out of 32 patients with left ventricular hypertrophy whereas in patients without hypertrophy only 1 [3.1%] patient showed it. Ventricular late potentials were strongly associated with left ventricular hypertrophy [p-value=0.03] and the relative risk of developing ventricular late potentials was 10 times higher in patients with left ventricular hypertrophy as compared to those without left ventricular hypertrophy


Conclusion: Ventricular late potentials were strongly associated with left ventricular hypertrophy

3.
Professional Medical Journal-Quarterly [The]. 2015; 22 (2): 227-234
in English | IMEMR | ID: emr-178209

ABSTRACT

Mitral valve prolapse is generally considered a benign condition, however, a subset of patients remains at high risk of arrhythmogenesis which may lead to sudden cardiac death. To stratify risk of arrhythmogenesis in patients with mitral valve prolapse on the basis of high resolution ECG, Holter monitoring, resting heart rate and mitral leaflet geometry. Cross sectional comparative study. Armed Forces Institute of Cardiology [AFIC]/National Institute of Heart Diseases, Rawalpindi and Army Medical College, Rawalpindi, Pakistan Mitral leaflet displacement and thickness were measured on echocardiography in 37 patients with mitral valve prolapse. Resting heart rate and time domain indices of heart rate variability of each patient were recorded from 24 hours Holter monitoring. High resolution ECG of all the patients was carried out to record ventricular late potentials. Statistical analysis was performed using SPSS and the alpha value was set at <0.05 for significance. The mean values for resting heart rate, leaflet displacement and leaflet thickness were 77.19 +/- 6.29 per minute, 3.64 +/- 0.92 mm and 4.96 +/- 0.79 mm respectively. Ventricular late potentials were present in 8 [21.62%] whereas heart rate variability was reduced in 5 [13.51%] patients. Leaflet thickness was significantly greater in patients with ventricular late potentials as compared to those without [p-value 0.004]. Patients with reduced heart rate variability had significantly higher resting heart rate as compared to those with normal variability [p-value 0.02]. One patient [2.7%] had ventricular late potentials, reduced heart rate variability, resting heat rate of 88 beats per minute and leaflet thickness over 5 mm. Combined effects of high resolution ECG, holter monitoring and leaflet geometry identified the high risk subset, comprising of 2.7% of the study population


Subject(s)
Humans , Male , Female , Arrhythmias, Cardiac , Electrocardiography , Electrocardiography, Ambulatory , Heart Rate , Cross-Sectional Studies
4.
PAFMJ-Pakistan Armed Forces Medical Journal. 2015; 65 (1): 125-129
in English | IMEMR | ID: emr-168296

ABSTRACT

To determine association of ventricular late potentials with mitral valve regurgitation in patients with mitral valve prolapse. Descriptive cross sectional study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2006 to February 2007. Thirty Seven Patients with confirmed diagnosis of mitral valve prolapse on 2 dimensional echo echocardiography were selected for the study. Patients having myocardial infarction, ischemic heart disease, hypertension and diabetes mellitus were excluded. Signal Averaged ECG of every patient was recorded using 1200 EPX High Resolution Electrocardiograph and was analyzed for the presence or otherwise of ventricular late potentials. Male to female ratio of study patients was 23:14 with mean age of 26.27 +/- 6.18 years. Twelve patients out of 37 had mitral valve regurgitation. Out of these, 8 [67%] patients had ventricular late potentials on signal averaged ECG. Only 1 [4%] patient without mitral valve regurgitation showed ventricular late potentials. Association between ventricular late potentials and mitral regurgtation was found statistically significant [p = 0.001]. Ventricular late potentials are hghly associated with mitral valve regurgitation in patients with mitral valve prolapse. These can act as noninvasive predictors of ventricular tachyarrhythmias and sudden cardiac death in these patients


Subject(s)
Humans , Male , Female , Heart Ventricles , Mitral Valve Prolapse , Cross-Sectional Studies , Electrocardiography
5.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 64 (2): 328-332
in English | IMEMR | ID: emr-154718

ABSTRACT

To determine the association of QTc interval prolongation with ventricular arrhythmias in patients with chronic heart failure. Descriptive study. This study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan from April 2013 to August 2013. Fifty three heart failure patients were monitored for 48 hours using ambulatory holter electrocardiography recorders. Digital ECG data was analyzed for QTc interval along with frequency and severity of arrhythmias. Association of prolonged QTc interval with ventricular arrhythmias and severity of arrhythmias was analyzed. Cardiac arrhythmias were observed in 79.2% patients. QT analysis revealed that 69.8% patients had prolonged QTc interval, 86.4% patients with prolonged QTc had ventricular arrhythmias. Of these 66% patients were found to have severe ventricular arrhythmias. Comparison of mean QTc interval of our study population with a reference value showed significantly higher QTc interval of our study group than the test value. Arrhythmia frequency and severity significantly increases with an increase in QTc interval in heart failure demonstrating association of prolonged QTc interval with high risk of severe ventricular arrhythmias and sudden cardiac death in chronic heart failure

6.
JIIMC-Journal of Islamic International Medical College [The]. 2014; 9 (3): 59-62
in English | IMEMR | ID: emr-177894

ABSTRACT

To screen out patients with Mitral Valve Prolapse at high risk of ventricular arrhythmogenesis, based upon Heart Rate Variability. Department of Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. This cross sectional study included 37 patients with mitral valve prolapse. Patients with acute or old myocardial infarction, diabetes mellitus, ischemic heart disease and systemic hypertension were excluded. Patients were holtered for 24 hours and time domain analysis of heart rate variability was carried out. Statistical time domain measures of heart rate variability i.e. SDNN, SDANN and RMSSD were calculated. Descriptive statistics were used to calculate frequencies and percentages of categorical variables using SPSS version 22. Mean values of SDNN, SDANN and RMSSD were 141.62 +/- 30.80, 125.16 +/- 25.58 and 28.40 +/- 8.06 milliseconds respectively. Two patients [5.40%] had reduced HRV in all the three indices. In one patient [2.70%] values of SDNN and SDANN were reduced whereas in another one patient [2.70%] the values of SDNN and RMSSD were reduced. In remaining one patient only SDNN was found to be reduced. There is a subset of patients with mitral valve prolapse with reduced heart rate variability which may be at risk of ventricular arrhythmogenesis

7.
JIIMC-Journal of Islamic International Medical College [The]. 2014; 9 (2): 11-16
in English | IMEMR | ID: emr-177910

ABSTRACT

To study the impact offunctional class of heart failure [NYHA] on the severity of ventricular arrhythmias in patients with heart failurebased upon 48 hours ambulatory ECG [Holter] recordings. Descriptive cross sectional study. Study was conducted at Armed Forces Institute of Cardiology/Nationallnstitute of Heart Diseases, from April2013 to August 2013. A descriptive cross sectional study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from April 2013 to August 2013. In 53 heart failure patients' detailed history and 2 dimensional echocardiography were recordedto assess the functional class and left ventricular ejection fraction. Patients were then subjected to 48-hour Holter monitoring using ambulatory [Holter] electrocardiography recorders. Digital ECG data was acquired and manually edited. Arrhythmias were analyzed for frequency, type and severity. Statistical analysis was done to determine associations between arrhythmia severity and NYHA class of heart failure. Male: female ratio was 3.4: 1with mean age of 60 years. Mean ejection fraction was 21.69% and 86% patients had NYHAclass Ill and IV. 57% of these patients also had severe cardiac arrhythmias. Prevalence and severity of arrhythmias in heart failure is dependent upon degree of ventricular dysfunction and presenting NYHA functional class.There is a significantly higher prevalence of severe ventriculararrhythmias amongst patients with reduced ejection fraction and advanced NYHA functional class

8.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S19-S21
in English | IMEMR | ID: emr-157507

ABSTRACT

To determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with NSTE-ACS undergoing cardiac catheterization. We conducted a cross sectional descriptive study in 154 patients with NSTE-ACS admitted at AFIC-NIHD from 1[st] April to 30[th] September 2011. For each patient the GRACE risk score was calculated by using specific variables collected at admission. The extent and severity of coronary artery disease was evaluated on angiography for each patient. A total of 154 patients were included in the study. The average age of the patients was 55.81years. Majority [75%] of the patients was male and 25% were females. The mean GRACE score was 132.85. Overall 40 patients had low, 54 had intermediate, and 60 had high GRACE risk score. Among patients with low score 28 had SVCAD, 4 patients had DVCAD and none of the patients had TVCAD. In the intermediate group 24 patients had SVCAD, 18 had DVCAD and 6 had TVCAD whereas among the high GRACE risk score 4 patients had SVCAD, 24 had DVCAD and 32 had TVCAD. Regarding the severity of coronary artery disease; among the low GRACE risk score patients; 8 had subcritical and 32 had critical CAD. In the intermediate GRACE risk score subset of patients, 6 had subcritical and 48 had critical CAD and none of the patients of high GRACE risk score had subcritical CAD and all 60 patients had critical CAD. GRACE risk score is a valuable noninvasive tool in predicting the extent and severity of CAD


Subject(s)
Humans , Male , Female , Coronary Angiography , Predictive Value of Tests , Risk Assessment/methods , Myocardial Infarction/mortality , Cross-Sectional Studies
9.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S22-S26
in English | IMEMR | ID: emr-157508

ABSTRACT

The purpose of study was to characterize culprit artery characteristics in terms of presence of thrombus burden in patients with acute myocardial infarction using prevalent parameters of thrombus estimation. Descriptive study. Adult cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] October 2011 to 31[st] September 2012. We studied 119 patients treated with primary percutaneous coronary intervention for ST- segment myocardial infarction. Bare metal stents were used in all patients as per hospital protocol. Thrombus burden [TB] was graded [G] as GO = no thrombus, G1= possible thrombus, G2 = small [greatest dimension <, 1/2 vessel diameter [VD]], G3 = moderate [>1/2 but <2 VD], G4 large [>2 VD], G5 = unable to assess TB due to vessel occlusion. Patients with G5 were reassessed after passage of guide wire or small balloon for thrombus burden. Frequency of major adverse cardiac events [MACE]-defined as death, myocardial infarction and infarct- related artery revascularization was recorded for the pen-procedural period which was defined in our study up to 72 hours. Overall, in hospital MACE was 8.4%. Large thrombus burden is a significant predictor for mortality and MACE


Subject(s)
Humans , Male , Female , Percutaneous Coronary Intervention/adverse effects , Coronary Angiography , Coronary Thrombosis/prevention & control , Myocardial Infarction/surgery , Angioplasty, Balloon, Coronary , Thrombolytic Therapy
10.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S27-S30
in English | IMEMR | ID: emr-157509

ABSTRACT

To determine the efficacy and safety of transradial approach in primary percutanous intervention in acute ST segment elevation myocardial infarction. Descriptive study Emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases [AFIC/NIHD] from Dec 2011 to Dec 2013 Retrospective data of 354 patients had been collected through records. All the patients presented with acute myocardial infarction to emergency reporting [ER] department of Armed Forces Institute of Cardiology National Institute of Heart Diseases were included in the study. All the patients underwent primary coronary intervention through transradial route. All patients received IIB IIIA inhibitors bolus and infusion. The primary end points were procedure success and local access site hematoma and secondary end points were major bleeding requiring blood transfusion and door to balloon time. The mean age of the patient was 64 +/- 18 years, there were 251 [70.9%] males and female were 103 [29.1%]. Radial access site cannulation time was 194 +/- 22 sec and door to balloon time was 78 +/- 14 min. Procedural success was 349 [98.6%]. Forearm hematoma was noted in 4 [1.12%]. No major bleeding requiring transfusion was noted. Primary percutanous intervention [PPCI] via transradial [TRI] route in acute STEMI patients can be achieved with high success and low complications in our population. The clinical outcome is matching with local and international data


Subject(s)
Humans , Male , Female , Percutaneous Coronary Intervention , Radial Artery , Treatment Outcome
11.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S31-S34
in English | IMEMR | ID: emr-157510

ABSTRACT

To determine the frequency and angiographic characteristics of coronary artery ectasia in the patient population of AFIC and NIHD. Descriptive Study Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jan 2007 to Dec 2011. All coronary angiograms done during the period were included in the study. The reports of coronary angiograms of those patients who were diagnosed to have coronary artery ectasia were left circumflex artery reviewed to assess the distribution of ectasia in different coronary arteries. Concomitant significant coronary artery stenosis left ventricular [LV] systolic function and history of revascularization were also documented. Over the study period, a total of 41,459 patients underwent coronary angiograms. 548 [1.32%] patients were diagnosed to have coronary artery ectasia. Out of these 467 [85.21%] patients were males and 81 [14.78%] were females. Their mean age was 53.7 years. Left anterior descending [LAD] was the coronary artery, most commonly affected by ectasia followed by left circumflex artery [LCx] and Right coronary artery [RCA]. Twenty three patients also had ectasia of left main stem. Four Hundred and three [73.54%] patients also had concomitant occlusive coronary artery disease and 19.52% patients had history of coronary revascularization either by percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]. Coronary artery ectasia is not a benign disorder as it could present as acute coronary syndrome having its own morbidity and mortality


Subject(s)
Humans , Male , Female , Dilatation, Pathologic/epidemiology , Dilatation, Pathologic/mortality , Coronary Angiography , Constriction, Pathologic , Coronary Stenosis/epidemiology , Coronary Artery Bypass/methods
12.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S35-S38
in English | IMEMR | ID: emr-157511

ABSTRACT

To determine the frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty. Descriptive study. Armed forces Institute of Cardiology / National institute of Heart Disease Rawalpindi from June 2012 to Nov 2013. Hundred patients undergoing elective single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before, after 8 hours and 24 hours following coronary angioplasty. The detailed performa was filled from each patient covering the necessary variables. Out of 100 patients 22% had raised creatinine kinase at 8 hours and 43% had raised creatinirie kinase after 24 hours following coronary angioplasty. Whereas 19% patients and 38% patients had raised creatinine kinase MB levels at 8 hours and 24 hours following the procedure respectively. No patient had rise of creatinine kinase or creatinine kinase MB more than 3 times of normal limits in the study. Among patients with raised CK-MB highest frequency was of diabetes mellitus, raised LDL levels, smoking and hypertension. Patients with raised CK-MB levels after 1[st] day of coronary angiography had diabetes mellitus [84%], raised LDL levels [79%], smoking [68%] and hypertension [58%]


Subject(s)
Humans , Male , Female , Risk Factors , Creatine Kinase, MB Form/analysis , Biomarkers , Angioplasty, Balloon, Coronary/adverse effects , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Myocardium/enzymology , Stents/adverse effects
13.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S44-S48
in English | IMEMR | ID: emr-157513

ABSTRACT

To compare recorded heart rate variability from 24 hours with that recorded from 72 hours holter monitoring in patients with mitral valve prolapse. Cross sectional study. Department of Clinical Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. Patients from 15 to 38 years of age with confirmed diagnosis of mitral valve prolapse on 2 dimensional echocardiography were included. Patients with acute myocardial infarction [MI], Ischemic heart disease, diabetes mellitus or hypertension were excluded. Total 37 patients were included in the study through non-probability consecutive sampling. All these patients underwent 72 hours holter monitoring using Reynolds medical holter monitors 'life card CF'. Statistical time domain measures of heart rate variability i.e. standard deviation of all NN intervals [SDNN], standard deviation of the averages of NN intervals [SDANN] and square root of the mean of the squares of differences between adjacent NN intervals [RMSSD]. Mean values of SDNN, SDANN and RMSSD from 24 hours holter monitoring were 141.62 ms, 125.16 ms and 28.40 ms whereas those recorded from 48 hours of holter monitoring were 136.94 ms, 122.37 ms and 26.46 ms respectively. Difference between none of the variables from the two recordings was significant. Heart rate variability remains the same irrespectively of the length of holter monitoring


Subject(s)
Humans , Male , Female , Heart Rate , Arrhythmias, Cardiac/diagnosis , Electrocardiography, Ambulatory , Echocardiography , Cardiac Electrophysiology , Myocardial Infarction , Cross-Sectional Studies
14.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S59-S62
in English | IMEMR | ID: emr-157516

ABSTRACT

The aim of this study was to report management; peri-procedural and short term results of patients hospitalized with acute myocardial infarction [MI]complicated by ventricular septal rupture [VSR] considered high risk or unfit for surgical repair at AFIC-NIHD. Quasi experimental study Adult and paediatric cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] January 2012 to 31[st] August 2013. We included 12 patients with post myocardial infarction VSR with mean age of 59 years [41-85 years], who underwent elective transcatheter closure. The entry criteria for trans-catheter closure after initial medical stabilization was 1] patients with ventricular septal rupture up to 20 mm size with significant left to right shunting [Qp/Qs >1.5] 2] defect anatomy and location thought to be suitable for device closure or otherwise considered high risk or unfit for surgical closure. The time from the onset of infarction to the index procedure ranged between 4 to 20 days [mean 10.83 days]. There were ten patients in acute phase [2 weeks or less] and two presented in sub-acute phase [> 2 weeks]. Ten patients were in NYHA class III and one each in class II and IV. A successful device implantation occurred in all patients except in one in whom second attempt failed. The defect size ranged 4-18 mm [mean 9.25 mm] and the devices ranging from 8-22 mm [mean 13.3 mm] were implanted. The procedure time ranged from 90-140 min [mean 105 min]. In all patients Qp/Qs was more than 2 and decreased to less than two after the procedure. Six surviving patients are in NYHA class II and doing well. One patient died one hour after the procedure whereas one patient died twelve hour after the closure because of re-infarction. One patient developed another VSR leak 3 days after the procedure and device closure was attempted again but the device could not be deployed. He subsequently died awaiting surgery. Primary trans-catheter closure of post-infarction ventricular septal rupture may be an alternative to surgery in patients with suitable anatomy and high risk or unfit for surgery


Subject(s)
Humans , Myocardial Infarction/complications , Ventricular Septal Rupture/pathology , Treatment Outcome , Risk Factors
15.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S63-S66
in English | IMEMR | ID: emr-157517

ABSTRACT

The objective of the study was to determine the microbiological spectrum of cardiac implantable electronic device [CIED] infections. Case series Armed Forces Institute of Cardiology / National Institute of Heart Diseases AFIC/NIHD from January 2011 to Nov 2013. A total of 15 pus samples from patients with possible CIED infection out of 814 patients with implantable CIEDs were processed. Thirteen patients with positive cultures out of fifteen were included in the study. Clinical evidence of CIED infection included signs of inflammation and purulent drainage. A CIED infection was microbiologically confirmed based on culture yield. Blood cultures were carried out in all patients with suspected CIED infection along with trans-oesophageal echocardiography [TOE], wherever clinically indicated to exclude bacteremia and lead endocarditis. Sixty nine percent of patients with culture proven CIED infection were females and 31% were males. The mean age of patients was 61 years [range 53-70 years]. Devices included 11 PPMs, 1 ICD and 1 CRT. The most frequent organisms were gram-positive [77% of isolates]; with Coagulase-negative Staphylococci [CoNS] predominating in particular Methicillin Resistant Staphylococcus epidermidis [MRSE] in 46.4% cases followed by Methicillin Sensitive Staphylococcus epidermidis [MSSE] in 15%. Non tuberculous Mycobacterium fortuitium was isolated from pus in two patients; with PPM and ICD implants respectively. MRSA was isolated in only 01 PPM infection with evidence of lead endocarditis on TOE. Pseudomonas species was isolated from pus in one patient with CRT implant. CIED infections are more often caused by Staphylococci predominantly CoNS, although atypical Mycobacteria can be implicated


Subject(s)
Humans , Male , Female , Pacemaker, Artificial/adverse effects , Pacemaker, Artificial/microbiology , Nontuberculous Mycobacteria , Methicillin-Resistant Staphylococcus aureus , Echocardiography , Defibrillators, Implantable/adverse effects , Antibiotic Prophylaxis
16.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S80-S85
in English | IMEMR | ID: emr-157520

ABSTRACT

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results


Subject(s)
Humans , Male , Female , Myocardial Infarction/surgery , Myocardial Infarction/physiopathology , Myocardial Infarction/diagnostic imaging , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Hospital Mortality , Treatment Outcome
17.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S94-S99
in English | IMEMR | ID: emr-157523

ABSTRACT

The objective of the study was to determine the outcome of thrombus aspiration in Primary coronary intervention [PCI] for ST elevation myocardial infarction [STEMI]. Case Series The study was carried out in Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD] over a period of twelve months from January 2013 to December 2013. Data of 30 patients who underwent aspiration thrombectomy during primary PCI for STEMI by the transradial approach was collected. Inclusion criteria were chest pain suggestive of myocardial ischemia lasting longer than 30 min accompanied by ST- segment elevation or new left bundle branch block on the ECG within 12 h of symptom onset. Patients with previous CABG, cardiogenic shock or requiring TPM placement were excluded from this study. A 6F sheath was placed inside the radial artery, and cardiac catheterization was performed. Angiographic and electrocardiographic signs of myocardial reperfusion were assessed. Study endpoints included TIMI III flow and ST-segment resolution at the end of the procedure. Mean age of the patients was 52 years [range 37-77 yrs] and 63% [n= 19] were males and 37% [n=11] were females. The right radial artery was used in 90% of cases. Thrombus aspiration catheter used was 6 F Thrombuster II [70%] and Hunter [30%].There was significant improvement in markers of myocardial reperfusion with achievement of ST-segment resolution and TIMI 3 flow in 28 patients [93%]. No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Thrombus aspiration [TA] is applicable in the majority of patients undergoing primary PCI for myocardial infarction with ST-segment elevation, and it improves early markers of myocardial reperfusion


Subject(s)
Humans , Male , Female , Suction/instrumentation , Thrombectomy/methods , Myocardial Infarction/therapy , Myocardial Reperfusion , Electrocardiography , Cardiac Catheterization , Shock, Cardiogenic
18.
PAFMJ-Pakistan Armed Forces Medical Journal. 2014; 1 (1): S109-S113
in English | IMEMR | ID: emr-157526

ABSTRACT

To determine the types and frequency of cardiac arrhythmias in patients with heart failure based on 48 hours ambulatory ECG recordings. Cross sectional descriptive study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from April 2013 to August 2013. Fifty three heart failure patients with ejection fraction of

Subject(s)
Humans , Male , Female , Ventricular Dysfunction/epidemiology , Electrocardiography , Heart Failure/etiology , Cross-Sectional Studies
19.
PAFMJ-Pakistan Armed Forces Medical Journal. 2013; 63 (2): 184-188
in English | IMEMR | ID: emr-141820

ABSTRACT

The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Validation study. This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology [AFIC] Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. There were 207 [90.4%] true negative cases, 15 [6.6%] true positive, 2 [0.9%] false positive and 6 [2.2%] false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus


Subject(s)
Humans , Echocardiography , Fetus , Sensitivity and Specificity
20.
JAMC-Journal of Ayub Medical College-Abbotabad-Pakistan. 2012; 24 (2): 50-53
in English | IMEMR | ID: emr-150147

ABSTRACT

Diabetes is a well-known cause of sudden mortality. Due to autonomic imbalance, those patients who are suffering from ischemic heart disease and diabetes concurrently are at a greater risk of manifesting arrhythmias. Heart rate variability [HRV] can be utilised for assessment of autonomic nervous system. The purpose of this study was to identify the values of HRV in diabetic and non-diabetic patients with acute myocardial infarction [AMI]. This noninterventional descriptive study was carried out at Armed Forces Institute of Cardiology over a period of 6 months. A total of 50 healthy volunteers and 50 patients with myocardial infarction [MI] were Holter monitored for 24 hours and HRV was analysed in time and frequency domains. The time domain indices; SDNN [non diabetics=78 +/- 30 ms vs diabetics=58 +/- 20 ms; p=0.01], SDANN [non diabetics=68 +/- 28 ms vs diabetics=49 +/- 19 ms; p=0.23], SDNNi [non diabetics=36 +/- 13 ms vs diabetics=26 +/- 14 ms; p=0.02], RMSSD [non diabetics=29 +/- 11 ms vs diabetics=23 +/- 15 ms; p=0.16] and pNN50 [non diabetics=7 +/- 10 ms vs diabetics=4 +/- 12 ms; p=0.43] were declined in diabetic patients with acute myocardial infarction when compared with non diabetic patients inflicted with infarction. Frequency domain indices, Total power [non diabetics=1479 +/- 12 ms[2] vs diabetics=759 +/- 6 ms[2], p=0.01], VLF [non diabetics=997 +/- 9 ms[2] vs diabetics=495 +/- 5 ms[2], p=0.04], LF [non diabetics=292 +/- 2 ms[2] vs diabetics=123 +/- 1 ms[2], p=0.01] and HF [non diabetics=121 +/- 1 ms[2] vs diabetics=54 +/- 5 ms[2], p=0.01] showed attenuated HRV in diabetic patients with acute myocardial infarction. Comparison of diabetic and non diabetic infracted patients with healthy volunteers revealed decreased HRV in patients with myocardial infarction but gets even worse in diabetic patients with myocardial infarction. Heart rate variability is attenuated in diabetic patients with acute myocardial infarction. It reflects sympatho-vagal imbalance in coronary patients with co-existent diabetes mellitus

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