Variation in admission rates of acute coronary syndrome patients in coronary care unit according to different seasons

Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Descriptive study. Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. The study group comprised consecutive patients with acute coronary syndrome [unstable angina, Non STElevation Myocardial Infarction [NSTEMI], ST-Elevation Myocardial Infarction [STEMI] admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, [winter, spring, summer and autumn]. The mean age of the 428 cases was 48.5 +/- 10.4 years [range 27 to 73 years]. Among the study group, 261 [61%] and 167 [39%] cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 [48%], 128 [30%] and 94 [22%] respectively. Among the 428 patients, 184 [43%] cases had hypertension, 133 [31%] cases were smokers, 103 [24%] cases had dyslipidemia and diabetes mellitus and 08 [2%] cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 [36.9%] and Summer 130 [30.3%] in comparison to Spring 80 [18.69%] and Autumn 60 [14.02%] season. It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season [winter] but also in hot season [summer] with sudden changes in temperature

Frequency of comorbidities and risk factors among ischaemic heart disease patients in Karachi-perspective from three tertiary care hospitals

To evaluate comorbidities and risk factors among ischaemic heart disease patients. The descriptive study was conducted at the cardiology wards of three hospitals in Karachi, and comprised and comprised data related to patients from September 5, 2013 to January 15, 2014. Data was analysed using SPSS 20. Out of 377 individuals, 238[63.1%] were males and 139[36.9%] were females. Depression outnumbered all other comorbids 137[58%] in males and 103[74%] in females. It was followed by anxiety in 129[54%] males and 90[65%] females. In risk factors, high-cholesterol diet outnumbered all other risk factors 137[58%] followed by stressful life 123[52%]in males, while in females physical inactivity 91[65%]and stressful life 91[65%] both were leading risk factors. A variety of risk factors existed in ischaemic heart disease patients. Special attention should be paid to stressful lifestyle and high cholesterol, two of the most common risk factors in both genders

Endovascular treatment of renal artery stenoses

To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. An experimental study. A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Hypertension [systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications] with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. There were 25 patients, 14 [56%] male and 11 [44%] female, with mean age of 49 +/- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 [44%], 10 [40%] and 4 [16%] patients respectively. Renal insufficiency [serum creatinine > 1.5 mg/dl] was seen in one [04%] patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 [20%], 9 [36%] and 11[44%] patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 [80%] patients. A significant decrease in systolic [168.20 +/- 9.987 vs. 140.60 +/- 5.649 mmHg, p < 0.001] and diastolic blood pressure [88.60 +/- 5.50 vs. 77.20 +/- 5.017 mmHg, p < 0.001] and reduction of medication [2.72 +/- 0.458 vs. 1.5 +/- 0.510, p < 0.01] were noted without a change in renal function [p= 0.061] after renal artery stenting. Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment

Efficacy of intracoronary bolus administration of tiroflban in acute coronary syndrome patients with no-reflow phenomenon during percutaneous coronary intervention [PCI]

Currently in acute coronary syndrome, PCI is most common strategy. No-reflow phenomenon [NR] is one of serious complication. Aim of this study was to evaluate role of intracoronary bolus administration of tiroflban in acute coronary syndrome patients with no-reflow during PCI. It is prospective and observational study. It is multicenter study, conducted in Karachi, Pakistan from August 2011 to July 2013. Total of 62 patients of acute coronary syndrome underwent for PCI and developed no-reflow, received intracoronary bolus tiroflban were included. The angiographic definition of successful reperfusion should include both TIMI 3 flow as well as MBG 2 or 3. No-reflow, assesed by thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade [MBG] during treatment. Data were entered and analyzed using SPSS-16 software. Statistical significance was defined as p-value <0.05. Out of 62 patients, 43 were males .The mean age was 51 +/- 13, range from 37 to 70 years. TIMI flow 1 and 11 seen in 17, 37 patients while MBG 1 and 11 seen in 20 and 33 patients before intracoronary bolus administration of tiroflban. After bolus administration of tiroflban, TIMI flow 111 was seen in 61[98.387 %] out of 62 patients while MBG 11 and 111 was also noted in 61[98.387 %] out of 62 patients. It showed better Thrombolysis In Myocardial Infarction flow grades and TIMI myocardial perfusion grades [OR 0. 22, 95% CI 0 .12 -0 .39, p-value <0.001] immediately after intracoronary bolus administration of tiroflban in-reflow phenomenon patients during PCI. In patients with ACS, Intracoronary bolus adminstration of tiroflban is effective drug to improve no-reflow during percutaneous coronary intervention especially when patient blood pressure is at lower-side

Frequency of culture positive tuberculosis in exudative pericardial effusion

To evaluate the frequency of culture positive tuberculosis and to determine the sensitivity of drugs in exudative pericardial fluid. Descriptive observational study. This study was conducted on patients admitted in cardiology and Medical wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 50 patients of pericardial effusion diagnosed on the basis of history, physical examination, electrocardiography, chest x-ray PA view and echocardiography underwent pericardiocentesis under fluoroscopy. Pericardial fluid D/R was done and all the patients having exudative pericardial fluid [protein] 3 gm% and LDH > 200 IU were selected. All the exudative pericardial effusion were sent for AFB culture and sensitivity on L.J. medium. Inclusion criteria were all patients with the diagnosis of exudative pericardial effusion above 12 years of age of either sex. Exclusion criteria were all patients with transudative pericardial effusion and below 12 years of age. 3 [6%] patients had culture positive for mycobacterium tuberculosis on L.J medium. 5 [10%] had culture positive of other bacteria of which 2 [4%] had culture positive for resistant Staphylococcus aureus, 2 [4%] had culture positive for Streptococcus pneumonia and 1 [2%] had culture positive for Streptococcus viridans and 42 [84%] patients had culture negative for AFB and other bacteria. Out of 50 patients, 16 [32%] were in age group between 20-40 years, 22 [44%] were in age group between 41-60 years and 12 [24%] were in age group> 60 years. Out of 16 patients having age between 20-40 years, 1 [6.25%] had culture positive for AFB, 3 [18.75%] had culture positive for other bacteria and 12 [75%] had culture -ve for all organism. Out of 22 patient having age between 41-60 years, 2 [9.09%] had culture +ve for AFB, 2 [9.09%] had culture for other bacteria and 18 [81.81%] had culture negative for all organisms. Out of 12 patients having age >60 years, none [0%] had culture +ve for AFB, none [0%] had culture +ve for other bacteria and all 12 [100%] had culture negative for all organisms. All 3 patients having culture positive for AFB were found to be sensitive to all antituberculous drugs. The concluded that frequency of culture positivity is only 6% for Mycobacterium Tuberculosis, so this should not be the investigation of choice to confirm tuberculous pericardial effusion. However, other parameters should also be looked for in establishing the diagnosis of pericardial effusion like clinical parameters, the prevalence of tuberculosis in relative area, ESR, MT, Mycobacterium tuberculosis DNA PCR and Mycobacterium tuberculosis culture on BACTEC

To know the frequency of right ventricular infarction in patients with inferior wall myocardial infarction

To know the frequency of right ventricular infarction in patients with acute inferior wall myocardial infarction. Retrospective study. This study was carried out in Department of Medicine at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. In this study 65 adult patients of either sex with ECG evidence of inferior wall infarction were enrolled who were admitted in medical department at Civil Hospital Karachi. The duration of the study was 6 months. Inclusion criteria were age > 12 years of either sex or acute inferior wall myocardial infarction on electrocardiography [ST- segment elevation of more than or equal to 1 mm in at least two or three leads i.e. II, III, and aVF]. Exclusions criteria were age less than 12 years and evidence of either right or left bundle branch block on ECG. Data was analyzed through SPSS software. Out of these 65 patients, 45 [69%] were male and 20 [31 %] were female. All patients with acute inferior wall myocardial infarction were divided into three age groups i.e. 3[4%]cases were < 40 years, 44[58.66%] cases between 40-60years , and 18[24%] cases in > 60 years. From a total of 65 patients presented with acute inferior wall myocardial infarction, 40 [62%] were not associated with right ventricular infarction [Group-I], whereas 25 [38%] were associated with right ventricular infarction [Group-II], On ECG, ST-segment elevation in leads V 3R and V 4R was present in 1 out of 40 [2.5%] patients in Group-I, and 23 out of 25 [92%] in Group-II [p=<0.001]. The sensitivity, specificity, positive and negative predictive value of raised JVP was 72%, 82.5%, 78.2% and 82.5% respectively. The sensitivity, specificity, positive and negative predictive value of clear lung fields in the presence of raised JVP was 84%, 87.5%, 80.7% and 89.7% respectively. ST-segment elevation in leads V3R and V4R was 92% sensitive, 97.5% specific, having 95.8% positive and 95.12% negative predictive value. On echocardiography right ventricular dilatation was 96% sensitive, 97.5% specific, having 96% positive and 97.5% negative predictive value. In conclusion, frequency of right ventricular infarction is 38.46% in association with inferior infarction in our clinical settings

High risk coronary artery anomalies in 5131 adult patients undergoing coronary arteriography at Nicvd Karachi

To evaluate the frequency, origin, course and clinical significance of coronary anomalies. Single centre, descriptive study. The study was carried out at National Institute of Cardiovascular Diseases, [NICVD] Karachi, from January 2003 to July 2004. All adult patients [n=5131] undergone during study period for coronary arteriography included. Coronary arteriograms were evaluated for coronary anomalies by author. Patients with low risk coronary anomalies were excluded from study. Seventy two percent were males and 28% females; the mean age of patients was 54 years with a range of 26 years to 70 years. Fifty five percent were present with chestpain,33.3% with shortness of breath and 11.1% with palpitation. Total frequency was seen in 0.35%; out of them 88.8% have anomalous origin and distribution while 11.11% have coronary artery fistula. Left circumflex, LAD, left main coronary artery arise from right sinus of valsalva with frequency of 0.155, 0.058 and 0.058% respectively. In 0.058% of patients RCA arise from left sinus while 0.038% patients LAD arise from non coronary sinus. Coronary fistula noted in 0.038% patients. Clinicians, cardiologists and cardiac surgeons may consider coronary anomalies to be interesting rarities. The proper recognition determine the proper course of action for their management