Relation of smoking and elevated homocysteine in patients presenting with acute coronary syndrome

Elevated plasma homocysteine levels. homocysteine levels are risk factor for coronary artery disease. Smoking is known to be Other risk factors like diabetes mellitus, associated with an increased plasmafamily history, obesity and dyslipidemia were homocysteine level and both with increased riskalso studied. of cardiovascular disease. To investigate the relation ship between smoking, plasma homocysteine and other conventional risk factors with coronary artery disease in relatively younger population of patients presenting with acute coronary syndrome in emergency room of Cardiology Department, Allied Hospital Faisalabad. Among 586 patients of ACS under 50 years, 221[38%] patients were found to be smokers. Smoking habit showed significant difference between male and female patients as 177 [80%] male and 44 [20%] female. Homocysteine level of 22.4% patients among all was high and was found associated [63.5% of smokers] with smoking habit Out of 1852 consecutive patients[P<0.01]. Hypertension was not among admitted in emergency room of Cardiologysignificant factors for smokers as 421 [65%] Department, Allied Hospital Faisalabad overwere not suffering from hypertension. There one year, 1375 [74%] presented with acute chestwere 93 obese among smokers and these two pain, 586 were under 50 year. 384 [66%] wererisk factors collectively posed insignificant males 202 [34%]. 200 [34%] were under 40effect [P<0.05]. years. 386 [66%] patients were in age range 41 - 50 years. The demographic details, history and clinical examination of patients were recorded and their blood was collected in fasting state for estimation of serum total cholesterol, plasma glucose and serum total It was concluded that smokers were more prone to have coronary heart disease due to increased levels of homocysteine, its association with abnormal lipid profile and especially when some other risk factor combines with smoking greatly increases the risk of cardiovascular disease and should therefore be offered intensive advice to help them cease smoking also have reduced levels of homocysteine

Exertional dyspnea in patients with diabetes mellitus: evaluation by myocardial perfusion scintigraphy

Coronary Artery disease is a major cause of morbidity and mortality in patients with diabetes mellitus. They have high incidence of silent ischemia as pain perception is blunt in such patients. As a result many of them present with atypical symptoms like exertional dyspnea, instead of classical chest pain as their chief presenting complaint. We evaluated incidence of myocardial perfusion scintigraphic [MPS] evidence of coronary artery disease [CAD] in patients with type II diabetes mellitus without known CAD presenting with exertional dyspnea as chief presenting complaint. We conducted stress-redistribution SPECT MPS with intravenous injection of 93-130 MBq [2.5-3.5 mCi] 201T1-thallous chloride in 290 subjects with type II diabetes mellitus having exertional dyspnea [SOB] as study group [151 male and 139 female, age range 20 to 76 years]. 138 asymptomatic subjects with type II diabetes mellitus also underwent same procedure as control group [56 male and 82 female, age range 29 to 65 years]. Upon the bases of clinical history, study groups were further divided into three categories, Esob=exertional SOB [n=54], AcpD= atypical chest pain with dyspnea [n=114] and TcpD=typical chest pain with dyspnea [n=122]. We conducted visual analysis on reconstructed tomographic slices. CAD was present in 34.78% control [ischemia 23.91%, myocardial infarction 10.87%] and in 66.9% study group subjects [ischemia 49.31%, myocardial infarction 17.87%]. Incidence of CAD was high in Esob group than control [48.15% vs. 34.78%], AcpD group than Esob [64.91% vs. 48.15%] and TcpD group than AcpD [77.05% vs. 64.91%]. Stress induced ischemia [SII] was more frequent in Esob group than control [37.04% vs. 23.91%] and AcpD group than Esob [50% vs. 37.04%]. However, its occurrence was almost similar in TcpD and AcpD groups [54.1% vs. 50%]. Observed frequency of myocardial infarction was almost same in control [10.87%] and Esob [11.11%] group. Incidence of myocardial infarction was higher in AcpD group than control [14.91% vs. 10.87%] and TcpD group than AcpD [22.95% vs. 14.91%]. Our study concludes that incidence of myocardial ischemia and infarction is quite high in patients with type-II diabetes mellitus presenting with exertional dyspnea. Presence of chest pain further increases the likelihood of CAD in these patients. We should perform MPS in all patients with type II diabetes mellitus who present with exertional dyspnea, even if they have no chest pain

Diagnosis of coronary artery disease by stress Echocardiography and perfusion scintigraphy

This meta-analysis was performed to compare the diagnostic efficacy of stress echocardiography [SE] and Stress perfusion studies [SPS] in detecting coronary artery disease [CAD]. A meta-analysis of peer reviewed articles, published in English language, reporting head-to-head comparison of vasodilator stress echocardiography [VSE] and SPS for the diagnosis of CAD, was performed. Data of 13 studies comprising of 860 patients from 13 different institutions were analyzed. Algorithms were developed to generate raw data from published papers to calculate statistical parameters with confidence intervals and then compare them at specified significance levels. The overall diagnostic accuracy of the two tests was almost similar, 0.77 for VSE vs 0.8 for SPS [p=ns]. SPS gave higher sensitivity, 0.88 vs 0.70 in cumulative data [p<0.0001] while VSE gave higher specificity, 0.90 vs 0.67 [p<0.0001]. Accuracy of VSE with state-of-the-art protocols became even better than SPS [p<0.05]. In hypertensive patients specificity of SPS was markedly deteriorated. Contrary to this, VSE gave higher specificity [0.90 vs 0.40] in this subgroup of patients as well. VSE might become an effective alternative of SPS where scintigraphy techniques are not available or affordable