ABSTRACT
Background: Patients with elevated Troponin T levels had more complex lesion characteristics in baseline coronary angiogram. Cardiac troponin T positive patients had predominantly multi vessel disease, greater coronary narrowing and frequently complex lesion morphology
Objective: To determine the association between quantitative Troponin T levels and angiographic findings in unstable angina/non ST elevation MI
Patient and Methods: The study population was composed of 210 consecutive patients with clinical diagnosis of unstable angina, admitted at Punjab Institute of Cardiology, Lahore. Samples for troponin T levels were obtained 6-12 hours after the onset of chest pain. Patients were grouped into quartiles according to the level of troponin T measured. Coronary angiography was performed in every patients before discharge. All coronary angiograms were evaluated without knowledge of clinical or Troponin T status
Results: The mean age was 53.3 +/- 10.49. 165[76%] were males. Left main disease [LMD] was present in 13.3% [n=28]. Three vessels, two vessels and single vessel disease was present as 41.4%, 27.1% and 26.7% respectively. Normal coronary angiogram was noted in 4.8%. More than 70% luminal narrowing at least in 1 vessel was present in 95.2% of the patients, 3.3% has calcification, 67.6% has occlusion and 6.2% had visible thrombus as well
Conclusion: Our study has demonstrated that there was a significant association between elevated quantitative Troponin T levels and number of diseased vessels. Therefore, Troponin T positive patients should be evaluated by coronary angiography to know the severity of the disease
ABSTRACT
Long QT syndrome is considered a fatal disease because of its association with ventricular arrhythmias and sudden cardiac death. Objectives of study were to determine the prevalence of long QT syndrome and other heart diseases, in deaf-mute children. A Cross-sectional descriptive study was conducted at Cholistan special education centre and Cardiology department, Sheikh Zayed hospital Rahim Yar Khan, Pakistan in September 2006. A total of 104 congenitally deaf-mute children were assessed. Height, weight and blood pressure measured, 12-lead electrocardiogram done and QTc calculated using Bazette's formula. Children with prolonged QTc underwent 24-hour ambulatory ECG recording. All were auscultated following complete protocol. A child with murmur was further evaluated with colour Doppler echocardiography. Audiometry was performed on all the children and the result interpreted according to WHO recommendations. Diagnosis of LQTS was based on Revised Schwartz criteria. Out of 104 children, 62 were male with mean age 11.89 yrs. The average systolic and diastolic BP was 97/67 mmHg. Average height was 126 Cm. All children had moderate to severe bilateral sensorineural hearing loss [40-80 dB]. One child had associated Patent Ductus Arteriosis. Fifteen had an innocent murmur. Prevalence of congenital heart disease was found to be 0.1/1000. Four children had QT interval more than 440 mSec, [range 0.46-0.47 mSec.]. Both genders were equally affected. Three children had high probability of LQTS and one had intermediate probability. Screening of family of these 4 patients showed prolonged QT interval in the sibling of one patient. Our study highlights the significant prevalence of Jervell Lange-Nielsen Syndrome in Pakistani deaf-mute children, which may be associated to the high level of consanguinity in this region. Awareness of this syndrome among health care providers is needed as timely diagnosis and subsequent treatment may prevent fatal complications.
Subject(s)
Humans , Male , Female , Deafness , Persons With Hearing Impairments , Child , Jervell-Lange Nielsen Syndrome , Death, Sudden, Cardiac , Echocardiography , Cross-Sectional StudiesABSTRACT
Stress echocardiography has emerged as an important tool for non-invasive assessment of coronary artery disease [CAD]. Exercise and dobutamine stress echocardiography [DSE] are frequently used modalities with distinct clinical indications and procedural variations. We report our findings on these two tests comparing various aspects and outcomes. Four hundred seventy one consecutive patients underwent SE at Sheikh Zayed Hospital Rahim Yar Khan. Exercise Echo [Ex.E] was performed on treadmill using Bruce's protocol. DSE performed in standard method. SE was considered as positive with the appearance of new or worsening wall motion abnormality. Ex.E performed by 300 patients and DSE 171 with mean age of 48.09 and 54.92 respectively. Males were dominant in both groups. The risk factors were almost same in both groups. Ex.E was more performed for diagnosis of CAD than DSE [59% vs 25%]. Viability testing was exclusively done by DSE. Post revascularization status was assessed in 10% and pre-operative assessment for non cardiac surgery in only 2%. Incidence of side effects was 26% in DSE and none in Ex.E. The double product was greater in Ex.E. Positive tests were reported in 43% and 33% in DSE and Ex.E respectively. Stress induced LV dysfunction was more common in DSE. Comparing available coronary angiograms, single vessel disease was better detected by DSE [60% vs 46%]. Double vessel disease was relatively higher in Ex.E [35% vs 28%]. Ex.E is safer and better non invasive diagnostic imaging modality in patients who can perform physical exercise, however DSE is more useful for viability, pre-operative evaluation and patients physically disabled for treadmill or ergometer exercise test
ABSTRACT
Background: Magnesium, the second most abundant intracellular cation has several clinically important roles in the human ++ body. In addition to energy production and maintenance of electrolyte balance, Magnesium [Mg] is essential for normal ++ neuromuscular functions, excitation contraction coupling, maintenance of vascular tone, blood coagulation, as well as Ca and +++ K transport across the plasma membrane. Mg has also important role to play in cardiovascular homeostasis
Objectives: To ++ find out serum Mg levels in Acute Myocardial Infarction [AMI] patients at presentation to emergency departments and its comparison with normal subjects
Patients and Methods: This was a comparative study, conducted at Punjab Institute of Cardiology, Lahore from June to December 2000. A total of 125 subjects were enrolled for this study, with 88 patients having their first episode of AMI. These patients were divided into three groups A, B and C depending on age. 37 normal subjects were taken as comparative group
Results: There was hypomagnesemia [p< 0.001] in all the sub groups. Our results show that hypomagnesemia is present in all groups and as it is an important risk factor for post AMI complications. The corrective dose should not be empirical but be based on individual patient requirements, as mortality rate due to AMI and its complications is high
Conclusion: Hypomagnesemia was observed in all the sub groups A, B and C. Therefore, it is suggested that serum Magnesium ++ should be estimated in each case of AMI patient and emphasis given to Mg supplementation when needed
ABSTRACT
Background: acute myocardial infarction [MI] is a major health problem with a substantial mortality and morbidity. Numerous guidelines have been established that should be followed in the management of acute MI
Objective: to determine whether the current practice in managing patients admitted with acute MI in a tertiary care hospital is evidence based compliant
Patients and Methods: this retrospective study was based on the record of the patients with diagnosis ofMI admittedbetween January to June 2007, at Sheikh Zayed Hospital, Rahim Yar Khan, who fulfilled the predefined criteria
Results: Total number of cases were 58, mean age of the study subjects was 47+ 8.65 years, with age range of 16 to 95 years. It was observed that 81% of study subjects were male. Half of the patients belonged to lower income group; Laborer and house wives were 3 1 % and 19% respectively. Sixteen percent of patients were hypertensive and diabetic. 19 % were smoker and 5% had family history of coronary artery disease. Anterior and inferior wall MI were reported in 64% and 32% of the patients, respectively. Injection Streptokinase [SK] was given to 52% of the patients. Aspirin, clopidogril and nitrates were given to all patients, whereas 34 % and 36% were prescribed Beta blocker [BB] and statins, respectively. Angiotensin converting enzyme inhibitor [ACEI] was given in 43% patients
Conclusion: SK, the only means of acute revascularization was given in only 52% patients mainly due to delayed presentation. Use ofAspirin is an unbeatable target and given to all patients. Use of BB and statins in < 40% and ACEI in<50% is not optimal. However, these trends of cardiac medication in a tertiary care hospital with limited provision, reflects the diffusion of light of evidence based medicine into darkness of periphery
ABSTRACT
Dobutamine Stress Echocardiography [DSE] is a relative and recent development with promising results in evaluation of CAD, viable myocardium and pre-operative assessment for non-cardiac surgery. We performed DSE on 100 consecutive patients with mean age of 51.83 years [range 30-90 years], male: female ratio of 2:1. Two third patients were unable to perform exercise due to various medical reasons, remaining had orthopedic limitation or debility. 76 percent were evaluated for coronary artery disease [CAD], 16 percent for viabilty study, 8 percent for post CABG evaluation. New regional wall motion abnormality or worsening of existing abnormality at rest was considered positive for test. Biphasic response [improvement at low dose and worsening at peak dose] was the most specific indicator for viability. Test stopped due to positive ischemic response in 5.1 percent patients. 49 percent were negative. One third had minor side effects. Most patients for viability study showed biphasic response, only few revealed persistent improvement with peak dose. In CABG, all grafts were patent, however native disease was detected. Excellent correlation observed with few available coronary angiograms. In conclusion DSE is safe, feasible, cost effective, comparable modality -for evaluation of suspect or known CAD and viable myocardium
Subject(s)
Humans , Male , Female , Exercise Test , Echocardiography , DobutamineABSTRACT
Mitral stenosis [MS] is the leading cause of morbidity and mortality among rheumatic valvular heart disease. Its incidence and clinical pattern has been described in hospital/school based data. We present the full spectrum of rheumatic MS in rural population sample of all ages and various ethnic groups from southern Punjab, Rahim Yar Khan. Study was conducted in 11 villages, randomly selected using scientific sampling technique for prevalence and pattern of RHD. Among 54 cases with RHD more than half were suffering from MS [total 30, isolated 13, and mixed 17] giving an overall prevalence of 3.15/1000. Females had significant preponderance over males. Juvenile MS occurred in 25 percent. Dyspnoea was the commonest symptom. Among abnormal ECG's, 25 percent had AF, 48 percent LAE, 25 percent RVH. Echo/Doppler studies revealed mild MS [53 percent], moderate 30 percent and severe 17 percent. Subvalvular disease and calcification in 16 percent, thrombus 3 percent and vegetation in 2 percent. This study concludes MS being the commonest rheumatic valvular disease, affecting majority of female patients in milder/asymptomatic form that can only be detected through cross-sectional survey