High total leukocyte count and heart failure after myocardial infarction

Background: Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI

Methods: A cross sectional study carried out from June-August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure

Results: Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [

Conclusion: This study shows that high TLC count appears to be associated with development of CHF and mortality after acute STEMI

High total leukocyte count and heart failure after myocardial infarction

Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI. A cross sectional study carried out from June -August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure. Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [

impact of age and sex in the pattern of coronary artery disease

Coronary Artery Disease [CAD] is the primary cause of death in the world. Over the last three decades, invasive procedures such as coronary artery bypass grafting [CABG] and percutaneous coronary interventions [PCI] have resulted in significant improvements in survival and quality of life for patients. Besides traditional modifiable risk factors, it has been proved that some fixed, nonmodifiable factors contribute in the behaviour of coronary involvement. To see whether the age and sex as a coronary risk factor contribute this differential coronary involvement, we conducted this study. To determine the frequency of coronary artery disease [CAD] as it varies with age and gender. It is a descriptive study carried out at NICVD Karachi. All the subjects were adults with previous history of ischemic heart disease and recommended coronary angiography based on history and non-invasive tests. There were 79.6% male patients and the mean age was 52 years [ranged from 28 to 85 year]. In 80% of patient femoral artery access was used for performing the procedure. Right coronary artery was found dominant in 73% angiograms. Left anterior descending artery was the most frequently involved artery[73.6%] among major coronary arteries and obtuse marginal was most frequently involved [20.4%] branche artery. Ramus intermedius was found diseased in 4.2%.The frequency of involvement of Left Main artery and distal segments of major coronary arteries was increased with advancing age but there was no significant association between age and sex and involvement of other coronary arteries. In conclusion males have a higher recorded rate of coronary angiography and single vessel disease is the most common finding. Females and ages above 80 and below 40 had low incidence of angiographic events

Determinants of decrease in pulmonary hypertension following percutaneous mitral commissurotomy

To identify the determinants of decrease in pulmonary hypertension after percutaneous balloon mitral commissurotomy. Quasi experimental study. Place and Duration of Study: National Institute of Cardiovascular Diseases, Karachi, from March to October 2007. Adult patients with severe mitral stenosis and pliable valve having no significant mitral regurgitation, aortic valve disease, or left atrial thrombus were selected for Percutaneous Transvenous Mitral Commissurotomy [PTMC] by double balloon method. All patients underwent echocardiography of left and right heart catheterization before and after PTMC. Univariate and multivariate analysis was done to assess the relation of age, gender, left atrial size, right ventricular size, gradient across mitral valve, valve area, valve area per meter,2 body surface area, and presence of Tricuspid Regurgitation [TR] on the decrease in pulmonary arterial pressure. Of the 100 cases included in the final analysis, 60% were female, 84% were in sinus rhythm and had a mean age of 27 years. There was a 48% decrease in mean left atrial and 29% decrease in right ventricular systolic pressure immediately postprocedure. The mitral valve area increased from 0.883 +/- 0.1261 cm2, pre-ballooning to 1.7864 +/- 0.28445 cm2 post-PTMC, a percent change of 102.41%. In multivariate analysis, mean left atrial pressure [p=0.00: CI=0.317- 0.007], younger age [p=0.010: CI=-0.667 to -0.095] and right ventricular size [p=0.038: CI: 0.25-0.871] were independent predictors of decrease in systolic pulmonary arterial pressure post-PTMC. Younger age, mean and left atrial pressure and right ventricular size were independent predictors of decrease in pulmonary systolic pressure immediately post-PTMC

High degree atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement

To determine the influence of time on development of high degree Atrioventricular [AV] block in patients with inferior Myocardial Infarction [MI], its association with Right Ventricular [RV] infarction and its ultimate morbidity and mortality. A descriptive study. The Emergency Department [ED] and the units of adult cardiology at National Institute of Cardiovascular Diseases [NICVD], Karachi, from October 2006 to March 2007. Patients presented at ED with typical chest pain and subsequently diagnosed by standardized diagnostic criteria as having inferior MI were recruited prospectively. Patients were first analyzed on the basis of absence [Group A] or presence [Group B] of high degree AV block regardless of RV infarction Then after patients were divided into two groups, those without RV infarction [Group I] and with RV infarction [Group II]. Each group was further sub-divided as Ia, IIa and Ib, IIb depending on absence or presence of high degree AV block respectively. Each group was analyzed for comparisons with different variables for prediction of influence of time, proportion of RV infarction, association of AV block with RV infarction, complication profile and immortality. Of the 220 patients with inferior MI, 52 [23.6%] had high degree AV block and 83 [37.7%] had RV infarction. They were older in age [p < 0.003]. Patients who took more time to seek medical treatment from onset of symptoms were more prone to develop AV block [p < 0.001]. Among patients with block, 73% received thrombolytic therapy [p < 0.009] and temporary pacemaker [TPM] was implanted in 75% [p < 0.0001]. Mortality was significantly high in those patients [p < 0.0001]. In group II, 61.4% presented with sinus rhythm [p < 0.001]. TPM was implanted to 31.3% [p < 0.0001]. In the 4 days of hospital course, 8.4% of patients with RV infarction developed AV block [p < 0.005], whereas 10.8% of patients without RV infarction experienced post MI angina [p < 0.031]. Mortality was found significantly high when block was associated with RV infarction [p < 0.007]. No significant difference was found in response to atropine, volume replacement or streptokinase administration and reverting of block to sinus rhythm. Patients with inferior MI who took more time to seek medical treatment were found to be more prone to develop high degree AV block. RV infarction was found in about 38% of patients defined a high risk subgroup. High degree AV block significantly influenced the outcome when associated with RV infarction, leading to high mortality

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