Frequency of left main artery/three vessel disease predicted through ECG changes in patients presenting with non-ST segment acute coronary syndrome

Background: Electrocardiography [ECG] is simple, quick and economic investigation for diagnosis of acute coronary syndrome. Its applicability in prediction of left main coronary artery/ 3 vessel coronary disease can be of very useful in saving precious time in the critical care of coronary patients

Objective: Electrocardiography changes as a predictor of left main coronary artery / 3 vesselcoronary disease in patients presenting with Non-ST segment elevation acute coronary syndrome

Methodology: This cross sectional study was executed from July 2014 to June 2015 at Isra University hospital Hyderabad taking 114 consecutive patients of age >/=20, of either gender, presenting with symptoms of Non-ST segment elevation MI or that showed ECG changes in lead aVR. Informed written consent for the study was taken from the immediate family members of patients. Approval from ethics review committee of Isra University was taken. Data analysis was done through SPSS. Descriptive statistics [Mean +/-standard deviation for continuous and frequencies and percentages for categorical variables] were expressed

Results: Patients' mean +/-SD age was 56.65 +/-15.44 years [Range: 20-89 years]. Male to female ratio was 3.4:1. More than a half [52%] of these patients had Left main [LM] / 3 vessels disease. About a quarter other [25%] had 2 vessels while [22%] had single vessel disease [P value <0.0001]. Patients having ST elevation in lead aVR, were associated with increased risk of developing LM / three vessels disease [P value <0.0001]

Conclusion: ST elevation in lead aVR and ST depression in leads II, III, and aVF can be practically used for evaluation left main / 3 vessel disease among NSTE-ACS patients

Outcome of native valve endocarditis

OBJECTIVE: To determine the in-hospital outcome of Native Valve Endocarditis patients and associated complications

STUDY DESIGN, PLACE AND DURATION: Hospital based prospective study, Department of Cardiology, Liaquat University Hospital Hyderabad from July 2005 to December 2007

PATIENTS AND METHODS: 56 consecutive patients, who presented with fever, joint pain, dyspnoea, history of Rheumatic fever, previous history of IE, history of I/V drug abusiveness were studied by history, physical examination, 3 blood samples were taken and sent to the laboratory for culture and sensitivity. All patients were evaluated by Doppler echocardiography on day 1, at 14 day, at one month and on 6th week of treatment. Empiric treatment was started on admission and later adjusted according to culture and sensitivity. Descriptive and inferential statistical analysis was performed using SPSS version 16.0

RESULTS: Males out numbered females with ratio 37[66.1%] / 19[33.9%]. Definite vegetation was found in 40/56 [71.4%]; but definite culture positive cases were 30/56 [53.6%]. Complete improvement was seen in 32[57.1%], 08[14.3%] patients died during the course of treatment in hospital, 10[17.9%] were referred for surgery and 06[10.7%] patients developed recurrent episode of infective endocarditis. 13/56[23.2%] patients developed congestive heart failure, recurrent episodes of fever in 8[14.3%] and valvular regurgitation 6[10.7%] cases

CONCLUSION: Our study showed that native valve infective endocarditis is not un common

Early diagnosis and treatment can help in improving morbidity and mortality, overall outcome and can reduce devastating complications associated with infective endocarditis. Patients who require surgical intervention like large vegetations or abscess should be referred for surgery as early as possible to avoid further complications

Left ventricular thrombus in acute Myocardial infarction

To determine Left ventricular thrombus [LVT] in acute Myocardial infarction [MI] and to find out the correlation of risk factors with development of LVT. Hospital based observational study. Department of Cardiology, Liquate University Hospital Hyderabad between November 2005 to November 2006. 280 consecutive patients presented with first episode of acute Myocardial infarction were included. Patients with previous history of Myocardial infarction, rheumatic heart disease, dilated cardiomyopathy and mural thrombus were excluded. Baseline characteristics were recorded on the proforma. Two dimensional echocardiography was performed on day 3, at the time of discharge, 3 and 6 months after infarction. Two echo cardiographers blinded to clinical details separately reviewed the echo images. Descriptive and inferential statistical analysis was performed using SPSS version 16.0. Two hundred and eighty patients with first episode of acute MI were studied; 214[76.4%] were male and 66[23.6%] were female. Mean age of patients was 54.08 +/- 11.9 SD. Left Ventricular Thrombi [LVT] was found in 50,280 [17.86%] patients detected by 2-D echo method. 3[6%] patients died while in the coronary care unit and 7 [14%] with LVT failed to follow up. In remaining 14140 [35%] patients' thrombus once detected, was present during the entire echocardiographic follow up and became organized. However in 36/40 [65%] patient's thrombus disappearance was noted on follow up echocardiographic studies. Only 3/50 [6%] patients had complication of systemic embolization, all in the CNS. Among risk factors only smoking and Diabetes Mellitus were found to be statistically significant. LVT was seen in patients with decreased left ventricular wall motion especially anterioapical wall akinesia. LVT is important complication of acute myocardial infarction. If diagnosed and anticoagulated earlier, further risk of complications and its potential to embolize can be minimized

Ovarian Tumours along with pregnancy

Pregnancy complicated by ovarian tumours is rare. 18 women having ovarian tumours associated with pregnancy were admitted at Liaquat Medical College Hospital, Hyderabad from January 1991 to October 1994. All cases of ovarian tumours were more than 6 cms in diameter and were confirmed at Laparotomy. 65 percent of the ovarian tumours were diagnosed during 1st and 2nd trimester, therefore, the role of the clinical examination and ultrasound in early pregnancy is emphasized as a diagnostic aid. 25 percent were diagnosed during Caesarean section and puerperium. This underlines the importance of examining the ovaries at the time of Caesarean sections and careful abdominal examination during puerperium

Obstructed labour, a series of 305 cases in Liaquat Medical College Hospital, Hyderabad

During a two year period, 305 women with obstructed labour were admitted; they formed 3.32% of 9200 deliveries. A total of 280 [91.8%] cases presented with prolonged labour and ruptured membranes, the duration of labour lasting, upto 70 hours. The causes of obstructed labour included 135 [44.26%] cases due to cephalopelvic disproportion, 68 [22.3%] due to malpositions of foetal head, 67 [21.96%] due to malpresentations, 12 [3.94%] due to other causes, and in 23 [7.54%], the cause was not known. The mode of delivery of the women was Caesarean section in 241 [79.02%], Caesarean hysterectomy in 24 [7.87%], destructive operations in 16 [5.15%]: in 4 women [1.31%], repair of uterine rupture was carried out. There were 12 maternal deaths, one woman, admitted moribund, died undelivered shortly after admission; 10 died due to sepsis, and 1 with ruptured uterus died due to pulmonary embolism. As regards foetal outcome, 106 [34.87%] babies were stillborn; 198 [65.13%] were liveborn; of the latter, 15 died neonatally, thus the perinatal loss was 121 i.e. 398.03/1000