Comparison of left coronary artery diameter among diabetics and non-diabetics

To compare the left coronary artery diameter between diabetic and non-diabetic patients undergoing coronary angiography. This was a hospital based cross sectional comparative study. After obtaining an informed consent, 139 patients each in diabetic and non-diabetic groups were selected by non-probability purposive sampling method. Coronary angiography was done through femoral approach using Seldeinger technique and standard views were taken. Quantitative analysis of digital angiograms was performed. Data analyzed using SPSS version 11.0. Independent t test was applied to calculate mean coronary artery size between diabetic and non-diabetic patients. A p-value of less than 0.05 was considered significant. Out of 278 patients included in the study, 139 [50%] were diabetics and 139 [50%] were non-diabetics. Males were 168 [60.4%] as compared to females 110[39.6%]. Mean age was 52.82 + 7.115, and mean body surface area was 1.8004 +.11094. There was significant difference in coronary diameters of LAD [p value 0.000], LMS [p value 0.008], and distal Cx coronary arteries [p value 0.000] between the two groups. In this study, left coronary arteries and its branches were found to be narrower in diabetic patients than in non-diabetics

Frequency of coronary heart disease risk factors among nurses

To find out frequency of various risk factors for coronary heart diseases in nurses. This was a cross-sectional study. Nurses working in three shifts at Lady Reading Hospital, Khyber Teaching Hospital, Nursing school of Lady Reading Hospital Peshawar, were included in the study. All participants were interviewed in detail including their family history, past medical history, smoking and dietary history. Pulse, blood pressure, body mass index [BMI] and waist: hip ratio was determined. Their random blood sugar and total cholesterol was checked. Data was analyzed for cardiovascular risk factors using SPSS version 16. A total of 165 nurses were screened and interviewed. Mean age was 40.75 +/- 8.577 years. Mean BMI was 28.80 +/- 4.77. Mean systolic BP was 124.82 +/- 20.91 mm Hg, while mean diastolic BP was 82.45 +/- 13.07 mm Hg. Mean random blood sugar was 128.39 +/- 52.74 mg /dl. Diabetic nurses were 18[10.9%],hypertensive nurses were 31[18.8%], nurses having high cholesterol were 4[2.4%], nurses having documented CAD were2[1.2%], other than above risk factors or conditions were present in 34[20.6%] of the nurses, not having any of the mentioned risk factors or diseases were present in 76[46.1%]. Nurses not having any regular exercise schedule were 104 [63%]. We noticed that among modifiable risk factors hypercholesterolemia, diabetes and hypertension were less frequent in nurses while obesity, physical inactivity and sedentary life style with more duty hours and smoking were more prevalent

Effect of heart rate on hemodynamics in mitral stenosis

To assess the effect of heart rate [HR] on haemodynamic parameters in patients with Mitral Stenosis [MS]. The study was conducted at Cardiology department, Lady Reading Hospital, Peshawar from November 2010 to April 2011. Patients with MS, regardless of severity, were included. Patients with severe heart failure, other valvular or structural heart disease were excluded. Echocardiographic parameters were recorded at slow and fast HR. Patients with tachycardia were given beta-blockers and patients with bradycardia were given parenteral Atropine. A total of 60 patients were included, females were 57 [78%]. Mean age was 31 +/- 9 years. Mean slow and fast HR was 77 +/- 12bpm and110 +/- 13 bpm, respectively. Peak mitral valve gradient [PMVG] slow vs. fast HR was 12.8 +/- 4.80 and 14.93 +/- 7.18 mm Hg [p=0.000]. Mean mitral valve gradient [MMVG] at slow vs. fast HR was 6.62 +/- 3.29 and 8.15 +/- 4.88 mm of Hg [p=0.000]. E pulse Doppler [E] at slow vs. fast HR was 168 +/- 35 and 181 +/- 40 cm/s [p=0.013], while E tissue Doppler [E] velocity was 10.47 +/- 2.81 and 10.97 +/- 2.38 cm/s / [P=0.098], respectively. E/E ratio for slow and fast HR was 17 +/- 5.63 vs. 17 +/- 5.41 [P=0.792]. Right ventricular systolic pressure [RVSP] at slow vs. fast HR was44 +/- 16 vs.49 +/- 17.05mm of Hg [P=0.001]. The above parameters had insignificant change with the HR when there was accompanying more than mild MR. Slowing HR in patients with MS significantly decreased PMVG, MMVG and RVSP. LV function did not change significantly with HR. Rate control drugs may be used in preference to improve symptoms in moderate and severe MS

Radial artery approach for coronary intervention - early experience

To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52 +/- 7years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1 +/- 0.3 and 11.5 +/- 1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, readmission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization

Short term effects of rosuvastatin on plasma concentration of high sensitivity c-reactive protein in patients with chronic stable angina

To determine the short term effects of rosuvastatin on elevated base line high-sensitivity C-reactive protein [hs-CRP] in patients with chronic stable angina. This Quasi-experimental comparative study was conducted in Cardiology department, Lady Reading Hospital Peshawar, between March 2010 and February, 2011. We selected 44 consecutive patients age 40 years or above, of any gender having hs-CRP levels >/= 1.2mg/l with chronic stable angina. Base line levels of hs-CRP, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and creatine phosphokinase [CPK] were measured in fasting status. These patients were treated with rosuvastatin 20 mg once daily at night and followed up for one month. Using SPSS version 16 data was analyzed. Mean age was 53 +/- 7.2 and 50% were females. Following treatment with rosuvastatin 20mg for one month the mean hs-CRP levels reduced from 4.08 +/- 2.56 to 2.72 +/- 2.40 [95%CI, 0.41 to 2.29, p=0.006]. Similarly mean total cholesterol levels decreased from 185.88 +/- 37.62 to 147.45 +/- 38.35, [p=0.0001]. LDL cholesterol decreased from 118.34 +/- 31.31 to 86.63 +/- 35.72 [p= 0.0001]. But mean HDL cholesterol had no significant increase from baseline levels i.e. from 32.18 +/- 9.93 to 33.95 +/- 7.65 [p=0.174]. TGs levels reduced from 240.11 +/- 123.66 to 197.43 +/- 88.24 [p=0.008]. Mean CPK levels did not differ significantly from base line at follow up, from 101.43 +/- 58.63 to 96.22 +/- 55.10 [p=0.646]. Short term treatment with rosuvastatin significantly decreases elevated hs-CRP levels in patients with chronic stable angina

comparative analysis of in-hospital left ventricular function in patients with successful or unsuccessful streptokinase thrombolysis following acute myocardial infarction

To compare in-hospital left ventricular function in patients with unsuccessful and successful thrombolysis presenting with acute myocardial infarction treated with streptokinase. This comparative study was conducted at department of Cardiology, Lady Reading Hospital Peshawar, from October 2006 to October 2007. Two hundred patients with first acute myocardial infarction were divided into two groups: group A [successful thrombolysis] and group B [unsuccessful thrombolysis], using ECG criteria. To determine Left Ventricular Function, 2-D Echo was used. Group A included 136 [68%] patients and group B included 64 [32%] patients. Impaired left ventricular function was found in 41 [30.1%] patients in group A and 41 [64.1%] patients in group B [p< 0.001]. Left ventricular failure was present in 31 [22.8%] patients of group A and 30 [46.9%] patients of group B [p=0.001]. Cardiogenic shock was diagnosed in 2 [1.5%] patients in group A and 6 [9.4%] patients in group B [p-0.008]. Presence of LVF is strongly associated with unsuccessful thrombolytic therapy in this group of patients

Utility of transradial coronary angioplasty in patients with chronic stable angina discharged on same day

To study the utility of Transradial Coronary Angioplasty in Patients with Chronic stable Angina discharged on same day. This was a single center observational study with prospective data collection of 228 patients underwent transradial coronary angioplasty from January to December 20JO, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina and were discharged on same day were included in the study, using purposive non-probability sampling technique. Patients with unstable angina and acute coronary syndrome who had to stay for more than one day, were excluded from the study. Patients were followed at one month of hospital discharge in out patients department and clinical outcome data was recorded. A total of 228 patients were included in the study. Male were 64.9% and 35.1% were female with mean age of 56 +/- 9years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; diabetic 46.4%, hypertensive 45.6%, smokers 32.8%, dyslipidemic were 47.8% and mean values of serum creatinin and Hemoglobin were 1.2 +/- 0.5 and 12.8_2.4, respectively. The frequency of various complications were as follow; mild hem atom a 1.7%, nausea and vomiting 1.3%, pain in hand 10.5%, readmission to hospital for chest pain 7.4%, need for revascularization 3%, hand ischemia 2.5%, minor bleeding 0.8%, and mortality was 1.3%. There was no access site major bleeding or hematoma. The radial artery approach for coronary angiopalsty is found to be very useful with low degree of access site vascular complications and an early patient mobilization

Diagnostic yield of stress echocardiography in coronary artery disease patients

To find out the sensitivity and specificity of dobutamine stress echocardiography in comparison to the anaiographic findings. This Cross-Sectional study was conducted at cardiology department, Lady Reading Hospital Peshawar, from January to December 2007. Data was collected by non probability purposive sampling technique. Study patients underwent both dobutamine stress echo and coronary angiography, after taking an informed consent. Dobutamine stress echo was performed according to standard protocol. Total of 50 patients, whose mean age was 51.6 +/- 9.7, were studied. Men were 35 [70%] and women were 15 [30%]. Dobutamine was infused [10 to 40 micrograms/kg/min] in 3 minutes intervals. The inducible ischemia was detected in total 33[66%] patients. Seven patients [14%] had only resting wall motion abnormalities with no change by dobutamine stress. These patients were also taken as positive for ischemia. Coronary angiography showed 43/50 [86%] patients had > 50% stenosis in at least one coronary artery. Compared with coronary angiography, the sensitivity, specificity, positive and negative predictive values and accuracy of dobutamine stress echo for detection of coronary artery disease were 91%, 86%, 97%, 60%and 90% respectively. The sensitivities for SVD, DVD and TVD were 76%, 89% and 100% respectively. Dobutamine stress echo is a sensitive and specific method in non invasive diagnosis of suspected CAD. It is highly sensitive for multivessel disease as compared to single vessel disease

Comparision of in-hospital complications between diabetic hypertensive and diabetic normotensive patients with acute myocardial infarction

To compare the frequency of in-hospital complications between diabetic hypertensive and diabetic normotensive patients presenting with acute myocardial infarction [MI]. This observational cohort study was carried out in the department of Cardiology, Lady Reading Hospital, Peshawar. A total of 444 diabetic patients with acute MI were studied from December 2009 to September 2011. Among these half of patients were hypertensive while rests were normotensive. After enrolment in the study, patients were monitored for in- hospital complications of acute MI. Most of the baseline characteristics were similar between the two groups of patients. However patients in diabetic hyper tensive group had a long history of diabetes, high heart rate and blood pressure on presentation. Complication rates were not different statistically between the two groups. Complication rates between diabetic hypertensive and diabetic normotensive groups were; atrial fibrillation [AF] 15.3% vs. 12.12% p=0.204 respectively while ventricular tachycardia [VT] 14% vs. 12.6% p=0.390, ventricular fibrillation [VF] 4.5% vs. 3.8% p=0.405, type 1 second degree heart block 8.6% vs. 6.8% p=0.296, type 2 second degree heart block 2.3% vs. 1.4% p=0.362, complete heart block[CHB] 11.7% vs. 9.9% p=0.323, acute congestive heart failure [CHF] 13.1% vs. 9.5% p=0.269, left ventricular failure [LVF] 19.9% Vs 16.7% p=0.147, cardiogenic shock[CS] 14% vs. 10.4% p=0.080, recurrent MI [Re-MI] 14% vs. 10.8% p=0.194 and death rate 14% vs. 12.2% p=0.336 respectively. Hypertension in diabetic patients is not associated with an increase risk of in-hospital complications after acute MI

Frequency of cardiovascular risk factors among prisoners

To find out frequency of various risk factors for cardiovascular diseases in prisoners. This was an cross-sectional study involving prisoners recruited in Peshawar Heart Study [PHs]. All participants were interviewed in detail including family history, past medical history, smoking history and drug history. All participants pulse, blood pressure, body mass index [BMI] and waist hip ratio was determined. Their random blood sugar and total cholesterol was checked. ECG was carried out. Data was analyzed for cardiovascular risk factors. Total of 166 prisoners were screened and interviewed. Mean age was 62 years. Mean BMI was 26.52 +/- 4.59. Mean systolic BP was 136.8 +/- 22.91 mm Hg and mean diastolic BP was 87.77 +/- 11.93 mm Hg. Mean random blood cholesterol was 178.91 +/- 29.12mg/dl. Mean random blood sugar was 135 +/- 4.93 mg /dl. Out of 166 prisoners, 20 [2%] had random blood sugar more than 180 mg /dl. Active smokers were 36 [21.7%]. Most prisoners were not exercising 119 [71.7%]. We found that risk factors for cardiovascular diseases like lack of exercise, smoking, obesity and hypertension are quite frequent in this group

Prevalence of risk factors for cardiovascular diseases among journalists in Peshawar - the Peshawar heart study

To assess the prevalence of risk factors for cardiovascular diseases in journalists working in Peshawar. This was a descriptive study involving journalists working in Peshawar recruited in Peshawar Heart Study [PHS]. All participants were interviewed in detail including family history, past medical history, smoking history and medications history. Dietary habits were explored. All participants' pulse, blood pressure, BMI and waist hip ratio was determined. Their random blood sugar and total cholesterol was checked. Twelve lead ECG was recorded. Data was analyzed for cardiovascular disease risk factors. Total of 150 Journalists were interviewed at press club Peshawar. Mean age was 32 +/- 7.7 years. Current smokers were 36% [n=54]. Naswar was consumed by 6% [n=10]. Family history of cardiovascular disease was present in 30% [n=46]. Only 26% [n=40] took regular exercise. Mean Body Mass Index was 25.68 +/- 4.78. Mean W/H ratio was 0.91 +/- 0.03. Mean systolic blood pressure was 115. 31 +/- 14.63 mmHg while 20% [n=31] had systolic of > 140 mmHg. Mean diastolic blood pressure was 75.30 +/- 9.92 mmHg. Mean cholesterol was 158 .53 +/- 20.31 mg%. Mean random blood sugar was 98. 28 +/- 32.12 mg% with five journalists having more than 180mg%.Risks factors for cardiovascular disease like obesity, smoking, sedentary life style, hypercholesterolemia and hypertension were found prevalent among the journalists working in district Peshawar

hospital-based study on causes peculiar to heart failure

We sought to determine the frequency of the risk factors for congestive cardiac failure [CCF] in a tertiary care hospital in Peshawar, Pakistan. This retrospective, observational study was conducted in the department of cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2005 to September 2007. Relevant information regarding the risk factors of CCF was recorded on questionnaires, devised in accordance with the objectives of the study. This study recruited 1019 patients with an established diagnosis of CCF on the basis of clinical findings and pertinent investigations. The study population comprised 583 [57.12%] men and 436 [42.78%] women. The patients' age ranged from 6 years to 82 years with a mean age of 48.5 years and a mode of age of 45 years. The distribution of the causative factors of CCF was as follows: ischemic heart disease in 38.56%; hypertension in 26.30%; dilated cardiomyopathies in 10.10%; obstructive and restrictive cardiomyopathies in 5.39%; valvular heart diseases in 9.32%; congenital heart diseases like ventricular septal defects and atrial septal defects in 4.41% and 0.58%, respectively; constrictive pericarditis in 1.07%; pericardial effusion in 0.68%; chronic obstructive pulmonary disease and pulmonary hypertension in 1.47%; thyrotoxicosis in 0.68%; complete heart block in 0.29%; and Paget's disease in 0.09% of the cases. Ischemic heart disease, hypertension, cardiomyopathy, valvular heart disease, and congenital heart disease were the major contributors to CCF in our patients

new technique for treatment of permanent pacemaker [PPM] erosion

To evaluate the safety and efficacy of a new technique for treatment of late erosion and infection of permanent pacemaker [PPM] system pocket. Material and This retrospective observational study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from 1994 to 2005 on patients presenting with eroded or near erosion PPM. The operative procedure entailed formation of a new pocket medial and inferior to the old pocket through a 3cm fresh incision. The old pocket was approached from below and pacemaker and lead were mobilized. The pacemaker was then transported to the new pocket without exposure. The wound of newly formed pocket was stitched. The exposed area of old pocket was left open with separate dressing. Trans-esophageal echocardiography was done to exclude lead infection and endocarditis. All patients had culture sensitivity of blood and material obtained from wound. Study included 26 patients, 12 females [46%] and 14 males [54%] with mean age 64 years +/- 12 years. The mean duration of PPM implant was 36 months +/- 18 months. The procedure was successful in all patients. All were followed for minimum two years with no recurrence of infection. The procedure was complicated in one patient who had transient asystole due to disconnection of lead. Local redness, tenderness and ooze at old PPM site subsided rapidly. This technique is clinically safe and effective and may be considered as an alternative to complete removal of PPM system in selected patients

Pattern of valvular lesions in rheumatic heart disease

To evaluate relative frequency of cardiac lesions in Rheumatic heart disease [RHD] in patients presenting to cardiology department, Lady Reading Hospital, Peshawar. This retrospective study was conducted at Cardiology Department Lady Reading Hospital Peshawar. The data on patients undergoing transthoracic two-dimensional echo and Doppler studies were retrieved from the computerized database from July 2003 to July 2006. The data was analysed with SPSS 11 window. Out of 3060 patients of RHD [1278 male and 1782 female], 1723 [56.3%] had mixed valvular lesions. Mean age was 22 + 6 years. Mitral stenosis [MS] was the predominant valvular lesion affecting 2141 [70%] patients [1040 pure MS and 1101 in combination]. Of those, 525 [24.5%] patients had severe MS, and 811 [37.9%] had moderate MS. Mitral regurgitation [MR] affected 1793 [58.59%] patients [245 pure MR, 1548 mixed] while 404 [22.5%] patients had severe MR and 497 [27.1%] had moderate MR. Aortic regurgitation [AR] was present in 1438 [47%] patients and almost always [98 85%] in combination. One hundred and eight [7.5%] patients had severe AR. Aortic stenosis [AS] was noted in 48 [1.56%] patients, of which 30 [62.5%] were in isolation and 18 [37.5%] in combination. Out of 1723 mixed lesions, MS+MR+AR were found in 826 [47.94%] cases and MR+AR in 428 [24.84%] cases. Most of the patients had mixed Valvular lesions. The predominant lesion was mitral stenosis followed by mitral regurgitation, aortic regurgitation and aortic stenosis respectively

Long term echocardiographic follow-up of percutaneous transvenous mitral commissurotomy [PTMC]

This study was conducted to report the local experience of long-term echocardiographic follow up of Percutaneous Transvenous Mitral Commissurotomy in symptomatic severe mitral stenosis [MS] patients. Material and We conducted this retrospective computer data base echocardiographic study of symptomatic severe MS patients [who underwent PTMC from 1992 to 1995 in our cardiology unit] to evaluate the immediate and long term echocardiographic of PTMC in 269 patients. We did transthorasic and Transoesophageal echocardiographic study of all symptomatic severe Mitral stenosis patients. Those patients who were found eligible and underwent PTMC were selected for the study. Total of 269 patients were evaluated. Female constituted 67.7% and Male were 32.3% of total patient population. The mean age of patients was 27.51 +/- 7.82 years. Mean Mitral valve area on day one increased from<1.0 cm[2] to >1.5 cm[2] in 72.9% of patients. At four years the mean area was 1.4 cm[2] +/- 0.10 [p=NS]. Peak and mean Mitral valve gradients increased from 10.07 mmHg +/- 4.59 at day one to 14.57 mmHg +/- 6.66 at four year [p=NS]. Mean MVG was 6.31+/ -3.50 mmHg on day one and 10.29 +/- 5.62 at four years [p=NS]. Mean right ventricular systolic pressure post PTMC was 46.35 +/- 14.35 mmHg and decreased to 13.50 +/- 30.37 mmHg [p=0.120] at four years. The RV size was found to decrease from 2.16 +/- 0.48 cm to 1.7 +/- 0.45 cm at four years [p=NS]. The LA size did not change much [from 4.15 +/- 0.59 cm to 4.24+/ -0.43, p=NS] Very few patients [2.2%] developed significant restenosis [MVA < 1.0 cm[2]]. The study shows that PTMC is an effective and safe method to relieve MS and it improves the haemodynamics and the are sustained over prolonged period