Increased level of morning surge in blood pressure in normotensives: a cross-sectional study from Pakistan

Objective: To determine the mean morning surge [MS] in blood pressure, the frequency of increased morning surge in normotensive subjects, and to compare those with morning surge with those without MS. Study Design: A cross-sectional, comparative study. Place and Duration of Study: The Department of Medicine, The Aga Khan University Hospital. Karachi, from April 2011 to March 2012

Methodology: Adult normotensive healthy volunteers aged 35 to 65 years were inducted. Their ambulatory blood pressure [ABP] was measured over a 24-hour period, using digital ambulatory blood pressure monitors. Morning surge was calculated as the average of four readings after waking minus the lowest three nocturnal readings. Increased morning surge was defined as > 11 mm Hg in systolic [SBP] or > 12 mm Hg in diastolic [DBP]. Dipping was defined as > 10% dipping in blood pressure

Results: Eighty-two healthy volunteers were recruited. Their mean age was 36.9 +/-1.2 years: 74.4 [61%] were men, and 58.5 [48%] woke up for morning prayers. Mean overall SBP was 113 +/-1.6 mm Hg, overall DBP was 73.9 +/-0.7 mm Hg, and overall heart rate was 75 [10] beats/minute. Mean morning surge was 17.6 +/-1.0 mm Hg in SBP and 16.0 +/-0.8 mm Hg in DBP. The frequency of increased morning surge was 66 [80.5%] in SBP, and 57 [69%] in DBP. On comparison of participants with normal morning surge and increased morning surge in SBP, there was a significant difference in non- dipping status [13.4% in normal vs. 18.3% in increased morning surge, p=0.001]

Conclusion: Mean morning surge in SBP and DBP are relatively higher in this subset population in a tertiary care center in Pakistan. These values are higher than those reported in the literature

Cardiac myxomas clinical spectrum and outcome

To describe the characteristics and outcome of patients with cardiac myxomas. A case series. The Aga Khan University Hospital [AKUH], from 1999 to 2004. All patients diagnosed and managed as having cardiac myxomas at AKUH, during a period of six years [1999- 2004] were included. Data was collected by reviewing clinical records. Follow-up data was collected from the clinical records and by a telephone interview where required. Out of 15 patients who were diagnosed to have cardiac myxomas, complete information was available in 14 patients. There was a female predominance [64%] with a mean age of 47 years. About two-thirds [71%] had symptom of dyspnoea. Half of the patients [50%] had neurological symptoms at presentation. Constitutional symptoms were present in 36% of patients. About two-third of patients [71%] had positive findings on cardiac auscultation. None of the patients had any rhythm abnormalities on the ECG. Diagnosis was made by transthoracic echocardiography in all patients. All of the tumors were located in the left atrium, and majority [64%] were attached to the interatrial septum. All patients were advised surgical treatment, however, only 8 [57%] were operated upon. Outcome was good in those who were operated upon, with no peri and postoperative mortality. Cardiac myxomas are a rare, but potentially curable form of heart disease. They occur in a wide range of age groups with a female predominance. Dyspnea is the most common clinical feature followed by embolic complications. Left atrium is the most common site of location. Surgical excision is a safe and effective procedure

Late in-stent restenosis in a patient with drug-eluting stent

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Raoamycin drug eluting stent.

Left ventricular hypertrophy in patients with focal cerebral ischemia

The study was designed to identify the presence of Echocardiographic Left Ventricular hypertrophy [LVH] in incident cases of focal cerebral ischemia. A cohort of patients with diagnosis of stroke or TIA were included who were admitted at the Aga Khan University Hospital, a tertiary care hospital in Pakistan. All these patients had transthoracic echocardiogram [TTE] done during admission on the advice of the primary Neurologist. Data was collected for 12 months and analysis done on epi-info program, using level of significance as a statistical test. We correlated the presence of hypertension with Echo-LVH and ECG-LVH. Echo-LVH was reported in 77 patients [61%] as compared to ECG-LVH which was observed in only 5 patients [4%, according to Este's criteria]. A total of 23 patients had Echo-LVH without known hypertension and this figure is quiet alarming. Hypertension increases the risk of stroke and cardiovascular disease and LVH is a strong predictor of Cerebrovoscular event. The increased incidence of ECHO-LVH in known and unknown hypertensive patients identified the need towards health awareness program in general as well as in highly susceptible population