Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Right ventricular myxoma with heart failure

Cardiac myxomas are histologically benign tumors but they may be lethal because of their strategic position. These are mostly located in the left atrium and uncommonly in the right atrium. We report a case of a large right ventricular myxoma presenting with heart failure

High altitude illness: experience of one year

Objectives of this study was to analyze symptoms of altitude illness commonly necessitating evacuation of patients from high altitude to the base hospitals in Siachin area by simple clinical screening. This was a prospective observational. Place and duration of study was Northern areas of Pakistan. This study was carried out at altitudes of 3633 meters [GOMA] and 2833 meters [Siksa] from Oct 2003 till Oct 2004. One hundred and thirty eight patients of altitude illness were studied, who were evacuated from altitude above 4000 meters. Out of 138 cases, 103 [74.6%] patients suffered from acute mountain sickness [AMS], while 21[15.2%] patients developed high altitude pulmonary edema [HAPE] and 14 [10.1%] patients developed high altitude cerebral edema [HACE], of which 3 patients were having concomitant HAPE. The most common symptom combination was headache and vomiting which was the presenting feature in 53[38.4%] patients, followed by headache, loss of appetite and insomnia, in 41[29.7] patients. Headache was the most common single symptom present in about 120[86.96%] patients that required evacuation. The next common symptom was vomiting that was found in 51[36.96%] patients while shortness of breath was present in 33[23.91%] patients. We conclude that headache is the most common presenting symptom in all the patients of AMS. Therefore, headache at high altitude should be taken seriously, if does not respond to common medication, then patient should be evacuated to a lower altitude. The incidence of AMS, HAPE, and HACE may be reduced by improving the physical fitness of mountaineers and observing the protocol of acclimatization

Pattern on risk factors and angiographic findings in serving armed forces personnel investigated for IHD at AFIC/NIHD, Rawalpindi

Incidence of ischaemic heart disease has been rising since 947. The reasons for this increase remain partly obscure. This is a study amongst serving armed forces personnel including officers and other ranks. Risk factors, pattern of coronary artery involvement, mode of presentation and status of left ventricular function etc were recorded. Total number of patients was five hundred. Equal number of officers and other ranks was included i.e two hundred fifty each. Most of the patients were under fifty years of age. Smoking and family history were the most common risk factors. Large number of patients had only one or two risk factors. Left anterior descending artery was the most frequently involved artery followed by right coronary artery. Single vessel disease was the most common pattern. Left ventricular function was normal in most of the patients. Acute myocardial infarction was the commonest mode of initial presentation. No significant difference [p value NS] was noted in pattern of risk factors, arteriographic findings and mode of presentation between officers and other ranks