ABSTRACT
Background: Prevalence of carotid artery stenosis is high in patients with coronary artery disease in the western countries as well as in some Asian nations and this increases the risk of stroke in the coronary artery disease patients while undergoing coronary artery bypass grafting [CABG]
Objective: The objective of this study was to determine the frequency of severe carotid artery stenosis in diabetic patients undergoing coronary artery bypass grafting
Patients and Methods: It was a cross-sectional study, conducted in Cardiology department, Punjab Institute of Cardiology, Lahore, from 15[th] December 2006 to 15[th] June 2007. One hundred consecutive diabetic patients undergoing CABG were included in the study. They were diagnosed diabetic on history [previously diagnosed and taking medicine for diabetes] and new diabetic patients diagnosed on laboratory investigations by using criteria; [fasting plasma glucose level 126 mg/dl or higher on more than one occasion]. Type of diabetes, physical examination [carotid bruit] and coronary angiogram findings were noted. Carotid Doppler scan was done in all study population and the severe carotid artery stenosis was diagnosed with the help of Doppler diagnostic criteria that was peak systolic velocity of > 2.3 ml sec of ICA or peak diastolic velocity of >0.75 m/sec of ICA or ICA/CCA systolic ratio of >3 and confirmed by two cardiologists. Data was entered on the proforma, and analyzed in SPSS version 11
Results: The mean age of study subjects was 59.5 +/- 8.4 years, total of 100 patients were included in study. Severe carotid artery stenosis i.e. > 70% stenosis in the carotid arteries was diagnosed in 7% of the study population which were at higher risk for the perioperative neurological complications. Out of these 7 patients, > 70% right carotid stenosis was seen in 2 patients while the remaining 5 patients showed > 70% stenosis of the left carotid artery. We also observed that 7 patients who were diagnosed with severe carotid artery stenosis also had significant associated LMS disease. Out of these, 4 patients [57.1 %] had severe LMS while 2 patients [28.6 %] had moderate LMS disease
Conclusion: A high incidence of severe carotid artery disease was found by using Doppler ultrasound in diabetic patients with TVD or LMCA disease. There was significant association of severe carotid artery stenosis in patients who had severe LMCA disease. Carotid doppler can be used as a screening test to rule out significant carotid artery disease
ABSTRACT
Objectives: To assess the role of vigorous physical exertion and anger as triggers of acute coronary syndromes [ACS]
Materials And Methods: This prospective observational study was conducted at the Punjab Institute of Cardiology, Lahore from April to September 2010. Two hundred patients admitted through emergency and out patient department were studied. Patients were questioned in detail about the circumstances surrounding the onset of acute symptoms. Anger was assessed according to the anger scale comprising of 7 points and physical activity was assessed according to activity scale also comprising of 7 points
Results: The mean age of the study population was 54.2 +/- 10.8 years. There were 149[74.5%] males and 51[25.5%] females. Diabetes mellitus occurred in 69[34.5%], hypertension 86[43%], smoking 71[35.5%] and dyslipidemia in 51[25.5%] patients. Majority of patients had low education status with primary education in 75[37.5%] and illiteracy in 74[37%] patients. Premonitory symptoms occurred in 92[46%] patients. Most patients 65[32.5%] presented to the hospital in 6-12 hours duration of onset of symptoms followed by 54[27%] patients presenting in 0-6 hours. Typical chest pain occurred in 166[83%] patients. Mostly patients 123[61.5%] had ST segment elevation myocardial infarction, followed by Non ST segment elevation myocardial infarction in 45[22.5%] and unstable angina in 31[15.5%] patients. The onset anger scale identified 25[12.5%] patients having associated anger at the time of onset of symptoms. According to anger scale, level 1 anger was observed in 5[2.5%], level 3 in 3[1.5%], level 4 in 4[2%], level 5 in 5[2.5%], level 6 in 6[3%] and level 7 in 2[1%] patients. The history of exertion at the time of onset of symptoms revealed that 95[47.5%] patients had level 1 exertion followed by level 2 exertion in 61[30.5%] and level 4 exertion in 14[7%] patients
Conclusion: This study confirms previous results and shows a graded exposure- response relationship between physical exertion intensity and triggering of AMI onset. The specific clinical and sociodemographic factors associated with physical exertion and anger suggest that different pathophysiological processes may be involved