Door to needle time of streptokinase and ST segment resolution assessing the efficacy of reperfusion therapy at Karachi Institute of Heart Diseases

Early start of treatment including coronary revascularisation has been recognised as crucial variable in the outcome of acute ST-segment Elevation Myocardial Infarction [STEMI]. Objectives of the study were to determine the magnitude of ST-segment resolution after thrombolytic therapy predicts short- and long-term outcomes in patients with an Acute Myocardial Infarction [AMI]. The duration of quasi experimental study was 3 years, from July 2006 to June 2009, conducted at Karachi Institute of Heart Diseases. Total 1,023 patients of STEMI treated with streptokinase [SK] were enrolled in the study. Of the total 1023, 689 [67.3%] patients were males and 334 [32.6%] were females. Six hundred and twenty-nine [61.5%] were successfully resolved after thrombolytic therapy while in 395 [38.5%] patients ST-segment could not resolve into 3 conventional ST-segment resolution categories at 60 minute and 90 minute after thrombolysis. Three hundred and twelve [30%] and 444 [43.4%] with complete resolution, 344 [33.62%] and 325 [31.76%] with partial resolution, 367 [35.8%] and 491 [19.29%] were with no resolution at 60 and 90 minutes respectively. Shock, congestive heart failure, and recurrent angina and ischemia occurred more often in patients with partial or no ST resolution as compare to complete resolution

Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension

Hypertensive left ventricular hypertrophy [LVH] is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 [31.2%] men and 344 [69%] women >30 years of age in the study. Among them 177 [35.4%] were diabetic, 224 [45%] were dyslipidemia, 188 [37.6%] were smokers, and 14 [3%] had homocysteinemia. Duration of hypertension [HTN] was >/= 2 years]. Mean systolic BP [SBP] was 180 +/- 20 mm Hg and diastolic BP [DBP] was 95 +/- 12 in male and female patients. Left ventricular mass index [LVMI] was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 [25%] male and 299 [59.8%] female patients. Atrial fibrillation was noted in 108 [21.6%] male and 125 [25%] female patients, 30 [6%] male and 82 [16.4%] female patients had atrial flutter. Ventricular tachycardia was noted in 37 [7.4%] male and 59 [11.8%] female patients. Holter monitoring showed significant premature ventricular contractions [PVC'S] in 109 [21.8%] male and 128 [25.69%] female patients while Holter showed atrial arrhythmias [APC'S] in 89 [17.8%] males and 119 [23.8%] females. Angiography findings diagnosed coronary artery disease in 119 [23.8%] with CAD male and 225 [45%] without CAD while 47 [9.4%] females presented with CAD and 109 [21.8%] without CAD. A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH