Frequency of coronary artery anomalies in adult cardiology practice; an angiographic study

The aim of this paper was to measure the frequency of various coronary artery anomalies in our patient population who underwent coronary angiography for various indications. The data was collected retrospectively by analyzing the angiographic data of 13,615 consecutive patients undergoing coronary angiography between January 2008 and June 2012. Coronary artery anomalies were found in 305 patients [prevalence of 2.2%]. Among these patients, 186 [61.12%] were male and 119[39%] were female. Two hundred and ninety two [95.7%]anomalies were benign and 13[4.2%] were potentially of dangerous nature. Anomalies of the right coronary artery [RCA] in decreasing order of frequency included ectopic RCA from right sinus of valsalva [RSV] 54 [17.7%], coronary ectasia /aneurysm 24[7.8%], fistula 13[4.2%], RCA from left sinus of valsalva[LSV] with anomalous course 11[3.6%] and split RCA 3 [0.98%]. Anomalies of the left coronary artery[LAD] in decreasing order of frequency included myocardial bridge 71[23.3%], separate origin of LAD and circumflex from LSV [absent left main trunck] 58[19.02%], circumflex arising from RSV with anomalous course 28[9.18%], coronary ectasia/ aneurysm 23[7.54%], fistula 14[4.5%], LAD arising from RSV withanomalous course 3[0.98%], LCA arising from RSV with anomalous course[retroaortic] 1[0.32%] and single coronary artery 2[0.66%]. The prevalence and the pattern of coronary artery anomalies in our patient population were almost identical to previous studies. Cardiologists should be aware of the coronary anomalies because of its potential for serious cardiac events and its importance in interventional cardiology and cardiac surgery practice

Comparison of risk factors profile in patients below and above forty years of age presenting with acute myocardial infarction

To compare the frequency of conventional risk factors in patients below and above forty years of age presenting with acute myocardial infarction. It was a three years retrospective comparative descriptive study conducted in Cardiology Department, PGMI, Lady Reading Hospital, Peshawar. Computerized data of patients admitted with acute myocardial infarction [AMI] from 1st September 2006 to 31st August 2009 was reviewed. Patients with age <40 years were assigned Group-I while those with >/= 40 years as Group-II. Conventional risk factors were age, sex, pertinent family history, smoking, hypercholesterolemia, hypertriglyceridemia, hypertension and diabetes mellitus. Using SPSS version 16, data was analyzed. A total of 4935 patients were admitted with AMI over the study period. Mean age was 58.4 +/- 12.37 [20 to 99] years. Group-I had 252 patients [79.4% males], while Group-II had 4683[65.9% males].Positive family history in Group-I vs. Group-II was 43[17.1%] vs. 426[9.1%], [p<0.001], respectively. Hypertension in Group-I vs. Group-II was 57[22.6%] vs. 1666[35.6%], [p<0.001], respectively. Diabetes mellitus in Group-I vs. Group-II was 29/252[1.5%] vs. 1059[22.6%], [p<0.001], respectively. Hypercholesterolemia in Group-I vs. Group-II was 63[25%] and 583[12.4%], [p<0.001], respectively. Hypertriglyceridemia in Group-I vs. Group-II was 68[27%] vs.1188 [25.4%], [p<0.001], respectively. Smokers in Group-I vs. Group-II were reported in 24[9.5%] vs. 76[1.6%], [p<0.001], respectively. Positive family history, hypercholesterolemia, hypertriglyceridemia and smoking were more frequent in younger age group while hypertension and diabetes mellitus were the predominant risk factors in older age group

Effect of cholesterol level on platelet aggregability in normal individuals

The aim of present study was to find the effect of cholesterol level on platelet aggregability in normal individuals. This study was conducted in Cardiology department, Lady Reading Hospital, Peshawar in September-October 2007. Normal individuals aged 18 years or above were randomly included. Patients who were suffering from any cardiovascular or other diseases were excluded. Those who were taking ante-platelets, anti coagulants and lipid lowering drugs were also excluded. Thus a total of 101 individuals were examined, after taking informed written consent. Fasting blood samples were taken from each patient. Total cholesterol was measured in hospital laboratory, while platelet aggregation was measured with chronolog whole-blood platelet aggregometer [WBA]. A total of 101 patients were examined. Their mean age was 51.24 +/- 8.23 years. Male were 60[59.41%] and female were 41[40.59%]. Mean platelet aggregability of these individuals was 7.87 +/- 4.40 ohms. Mean cholesterol was 163.47 +/- 20.75 mg/dl. When age was correlated with aggregability, both had a weak negative correlation. Pearson correlation coefficient was -.018 [p=0.855]. When age was correlated with cholesterol, again both have a weak negative correlation. Pearson correlation coefficient was -.152 [p=0.129]. When aggregability was correlated with cholesterol, both have a significant positive correlation. Pearson correlation coefficient was +0.269 [p=0.006]. Platelet aggregability is increased in patients with high cholesterol. These patients may need higher doses of anti platelets and more aggressive treatment of lipids to avoid vascular events

In-hospital complications of acute right ventricular myocardial infarction

To determine the in-hospital complications of acute right ventricular myocardial infarction[RVMI]. This study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from May to October 2009. A total of 100 patients with acute RVMI were evaluated for in-hospital complications. Male patients were 77 [77%] and females 23 [23%]. Patient's mean age was 59.96+12.3 years with age range 28-82 years. Total in-hospital complication events were 174. In-hospital complications were present in 77% patients. Cardiogenic shock was the commonest complication with frequency of 25.8%followed by acute left ventricular failure [LVF] in 17.8% and atrioventricular blocks [AV Blocks] in 14.3% respectively. Re-infarction occurred in 5.7% [10] patients. Thirty eight patients died in our study [21.8%]. Among RVMI patients, 65% stayed in-hospital for more than 4 days. Frequency of complications is higher and cardiogenic shock is the most common complication in acute RVMI patients

Frequency of aspirin resistance in patients with cardiovascular diseases

To find out the frequency of aspirin resistance, as measured by the inhibition of platelet aggregation, using Whole Blood Aggregometery, in patients with cardiovascular diseases presenting to out patient department of a tertiary care hospital. This study was conducted in the outpatient department of Cardiology, Lady Reading Hospital Peshawar, from October 2007 to January 2008. A total of 105 normal individuals not taking aspirin and 136 patients taking aspirin for cardiovascular diseases were randomly included. Blood was taken for measuring platelet aggregation using whole blood aggregometer. Result of each individual was noted on a proforma. Patients who were on any other ante-platelet like clopidogrel; or on warfarin and heparin were excluded from the study. Chi -square and independent t-test were used to find significant differences between different groups and variables. Platelet aggregability in 105 normal subjects, not taking aspirin was 9.28 +/- 3.23ohms. So cutoff for aspirin non responsiveness was taken as 9.28-3.23=6.0 ohms. Mean aggregability of 136 cardiovascular patient, taking aspirin was 5.81 +/- 5.47 ohms. Mean age was 52.66 +/- 10 years.Male were 80[58.8%]. Patients having aggregability >/= 6 ohms were 47.1%[n=64]. Mean aggregability of male patients was 5.66 +/- 5.45 ohms. Mean aggregability of female patients was 6.03 +/- 5.54 ohms[p=0.69]. When age was correlated with aggregability, both have a weak negative correlation [Pearson correlation coefficient= - .109 [p=0.205]. Mean age of patients having aggregability /= 6 was 51.46 +/- 10.36 [p=0.19]. Aspirin resistance as defined by inhibition of platelet aggregation measured with Whole Blood Aggregometry, is a common problem. Gender and age has no significant affect on platelet aggregability

Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus

This study compared the efficacy and safety of streptokinase as thrombolytic agent for ST-elevation myocardial infarction [STEMI] in patients with and without diabetes mellitus. This prospective interventional study was carried out in the department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients admitted to coronary care unit with STEMI and eligible for thrombolytic therapy [no contraindications per AHA/ACC guidelines] were studied from December 2009 to December 2010. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution [reduction] of elevated ST segment was evaluated after 90 min of streptokinase administration. Comlications of streptokinase infusion including hypotension, shock and hemorrhage was noted. Failed reperfusion [<30% ST resolution] was significantly higher in diabetic as compared to non-diabetic patients [21.6% vs. 9.5%; p<0.0003] while successful reperfusion [>/= 70% ST-resolution] was significantly higher in non-diabetic than diabetic patients [66.7% vs. 49.1%; p<0.0001]. Complication rates between the two groups were statistically similar. Hypotension occurred in 45 [20.3%] and 51 [23%]; p=0.458 patients in non-diabetic and diabetic group respectively while shock occurred in 10 [4.5%] and 13 [5.9%]; p= 0.506 and hemorrhagic manifestations in 13 [5.9%] and 10 [4.5%]; p=0.294 patients respectively. The outcome of thrombolytic therapy is adversely affected by Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly the risk of hazards associated with thrombolytic therapy is same in both diabetic and non-diabetic patients

Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia

To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >/= 144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences [SPSS Ver. 15.0]. A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +/- 9.748 [95% CI 57.39 - 55.31]. Male were 58.1% [n=198]. The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation [AF] 15.8%, ventricular tachycardia [VT] 11.7%, ventricular fibrillation [VF] 10.9% and complete heart block [CHB] 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema [CPE] 7.9% and cardiogenic shock [CS] 11.7%. Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively

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

Post extraction bleeding associated with long term maintenance dose of aspirin 75-150mg

The objective of this study was to see post extraction bleeding associated with long term maintenance dose of aspirin 75mg-150mg without discontinuation. This study was conducted at Lady Reading Hospital Peshawar from January 2009 to June 2010. Patients for simple single tooth extraction and on aspirin [75-150 mg] were included. Patients with systemic disease like hematologic, renal, or liver disease, bone marrow disorders, alcoholism, or any concurrent medication affecting hemostasis such as anticogulants or anti-inflammatory drugs and patients who needed extractions of deciduous teeth, surgical extractions, extractions in different quadrants, or multiple extractions [>1 tooth] were excluded. Patients were evaluated for immediate and late post extraction bleeding. A total of 254 patients were studied. Patients were categorized into two groups with equal number of patients in each group i.e. 127 each. Group 1 [study] on maintenance dose of Aspirin 75-150mg while group 2 [control] were not taking aspirin. In aspirin group 05 [03.93%] patients had post extraction prolonged immediate bleeding while 03 [02.36%] were in control group. This difference was not statistically significant [p=0.722]. In aspirin group 02 [01.57%] patients had late bleeding at 12 hour post extraction while one [0.78%] patient suffered in control group [p=1.00]. The bleeding was successfully controlled with pressure on gauze and no patient required suturing or re-hospital visit. There was no bleeding in post extraction period at 24 and at 48 hours. It was concluded that simple tooth extraction in patients on long term maintenance dose of 75-150mg aspirin without discontinuation is safe as far as post extraction bleeding is concerned

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

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