Gender distribution of coronary artery lesions in patients aged 50 years and below

Objective: this study was designed to compare the gender differences in the pattern of coronary artery lesions in young Pakistani population

Material and Methods: a series of 120 consecutive patients [60 females/60 males], 50 years or less of age, with significant coronary artery lesions, were analyzed and compared for distribution of significant lesions in coronary arteries at National Institute of Cardiovascular Diseases, [NICVD] Karachi

Results: the mean age of female patients was 45 + 5.8 years and male patients 44 + 5.9 years. Single vessel disease [SVD], mid-LAD [left anterior descending artery] lesion and ejection fraction were significantly higher in females. In males, a higher trend for triple vessel disease was observed. In both genders with single vessel disease, the predominant vessel involved was left anterior descending artery. Almost equal incidence of double vessel disease [DVD] was noted in both genders

Congenital giant aneurysm of the left atrial appendage: diagnosis and management

Left atrial [LA] aneurysm is a rare congenital abnormality [1] and associated with life-threatening complications. We report the natural history of Left atrial aneurysm which was complicated by supraventricular tachycardia [SVT] and stroke in early childhood and her condition deteriorate rapidly after development of progressive mitral regurgitation [MR] and heart failure and expired despite successful surgery

Our purpose of this case report is to give the natural history of LA aneurysm and review it along its current literature, surgical strategy, and patient outcome. In literature there is a very limited description of such cases and their management

Gender comparison of coronary risk factors and clinical presentation in young pakistani patients with coronary artery lesions

This cross-sectional study was designed to compare the gender prevalence of coronary risk factors and clinical presentation in young Pakistani patients with coronary artery lesions for defining high risk groups. A series of 120 consecutive patients [60 females/60 males] 50 years or less of age, with significant coronary artery lesions, were compared in different clinical subsets and coronary risk factors at National Institute of Cardiovascular Diseases, Karachi. The mean age of female patients was 45 +/- 5.8 years and male patients 44 +/- 5.9 years. On gender comparison: Significantly higher percentage of females presented with unstable angina and functional class III while males presented with post myocardial infarction angina, stable angina and functional class II. Diabetes mellitus was more common in females while smoking and dyslipidemia in males. Females with unstable angina had higher percentage of single vessel disease and isolated left circumflex disease while males presented with post myocardial infarction angina and greater percentage of right coronary artery lesion. Single and double vessel disease was significantly high in diabetic females compared to diabetic males. In males high serum cholesterol were associated with single vessel disease. Triple vessel disease was more common in hypertensive females and in males with family history of coronary artery disease. Within diabetics, multi-vessel disease was more common than single vessel disease. Single vessel disease was higher in non-diabetics. However, non-diabetic males had higher percentage of both single and double vessel disease has a trend for proximal lesions. Diabetes mellitus increases possibility of multi-vessel disease in both genders. Hypertension in females while high serum cholesterol and family history of coronary artery disease in males had significantly higher percentage of multi-vessel disease compared with their gender counterpart. Smoking was not a risk factor in females in the study population

Case report of halofantrine induced QT interval prolongation with subsequent ventricular arrhythmias

A 45 years old lady, presented in emergency department of NICVD with 2 days history of high grade fever with rigors followed by severe vertigo. There was no previous history of any cardiac ailment nor she was hospitalized for any major illness. No family history of cardiac disease. No past history of palpitations or vertigo. She was prescribed antimalarial "halofantrine" in a dose of 500 mg 6 hourly [3 doses], a day prior to admission in NICVD. On examination, middle-aged lady appeared anxious and tachypnic. Apart from irregularly irregular pulse and relative hypotention rest of the examination was unremarkable. ECG:Initial ECG showed prolongation of QT interval, i.e., 0.48 seconds. QTc, 0.6 seconds. She developed unstable Torsade De pointes and then subsequent ECGs showed recurrent intermittent ventricular tachycardia. Management : Patient was cardioverted initially at 200 Joules, followed by i/v bolus of lignocaine; as she failed to respond, i/v magnesium sulphate was tried, as intermittent VT continued, temporary pacemaker was implanted and overdrive pacing successfully maintained normal sinus rhythm. Patient`s intrinsic heart rate was 80b/m, QT 0.48 sec. QTc, 0.6 see, while overdrive pacing was done at 120b/m, with QT 0.36 see, QTc 0.46 sec Investigations: All routine hemotological and biochemical investigations were found normal including [CBC, ESR, RBS, Urea. Creatinene, Electrolytes, Cholesterol, UrineD/R, LFTs], Chest XRay and echocardiagraphy reports were also normal. Course in the Hospital:Subsequently, temporary Pacemaker was switched off after few days. Serial ECGs showed normalization of QT interval. Last ECG showed QT of 0.4 seconds, QTc, 0.5 seconds. She was discharged after a week without any medication