Outcome of ST segment elevated versus non-elevated acute myocardial infarction

To determine the outcome of patients with acute ST segment elevated myocardial infarction [STEMI] versus non -ST elevated myocardial infarction [NSTEMI] in our setup. A descriptive study. Cardiology department, Liaquat University Hospital, Hyderabad - Sindh from 1st May 2005 to 31st July 2005. Out of 580 patients hospitalized for acute coronary syndrome, 428 patients of acute myocardial infarction were selected for the study. The patients were selected on the basis of raised biomarkers [CPK, CKMB, SGOT, and LDH/Trop-T] and one of the two i.e. electrocardiography [ECG] changes or history of chest pain. They were grouped into STEMI and NSTEMI. Mean age of the patients was 52 years [range 35-75 years]. Majority of patients [73%] was male and 27% were females. Out of 428 patients selected for study, 288[67.28%] had STEMI while 140 [32.72%] patients had NSTEMI. Recurrent chest pain was present in 85 [29.51%] patients of STEMI; 45 [52.94%] with ECG changes and 40 [47.05%] without ECG changes. In STEMI group, complications were common, more in patients with recurrent chest pain and evidence of ECG changes as compared to those without ECG changes i.e. 16% and 10% respectively. Mortality was also higher [10.5%] in patients of recurrent chest pain and ECG changes compared to those without ECG changes [6.8%]. Among 140 patients of NSTEMI, 48 [34.28%] had recurrent chest pain; 30[62.5%] with ECG changes and remaining 18[37.5%] without ECG changes. In NSTEMI and STEMI patients, recurrent chest pain and ECG changes are bad prognostic markers as compared to recurrent chest pain without ECG changes. These patients are more likely to suffer complications and can benefit from aggressive/invasive strategy than patients with recurrent chest pain without ECG changes. In NSTEMI group, complications and mortality are more frequent in patients with recurrent chest pain and ECG changes compared to those without ECG changes

Risk factors associated with peripartum cardiomyopathy

To determine risk factors associated with peripartum cardiomyopathy in our set up. Coronary care unit, cardiology department Liaquat University Hospital, Hyderabad- Sindh from February to April 2005. Thirty patients with signs and symptoms of heart failure including chest x-ray showing cardiomegally were included in the study. Detailed clinical review of the patients was undertaken. Diagnosis of cardiomyopathy was confirmed on M-Mode / 2D / Colour Doppler Echocardiography. All [30] patients belonged to poor socioeconomic class. Mean age was 29.1 years [range 21-42 years]. Mean parity was 4 [range 1-8] and included primipara 1[3%], multipara 25 [83.3%] and grand multipara were 4[13.3%] patients. Five [16%] patients had gestational hypertension. Twenty-five[83.3%] patients presented with shortness of breath and orthopnea [NYHA Class-IV], 5[16%] with shifted apex beat and 3rd heart sound. All [100%] patients had sinus tachycardia, raised JVP and oedema feet. All patients also showed cardiomegally on x-ray chest. Echocardiograpically, 21 [70%] were having dilated left ventricle [LVIDD>57mm] ranging from 55-75 and reduced ejection fraction i.e, [<40%] ranging from 18-40%. Nine [30%] cases had normal size left ventricle and generalized left ventricular hypokinesia with reduced EF [<40%]. Eighteen [60%] patients were having moderate MR on Colour Doppler Echocardiography. This preliminary study shows that peripartum cardiomyopathy is associated with multiple risk factors in our set up. The most common risk factor is poor socioeconomic status followed by pregnancy with increasing age [>29 years] and multiparity [para >4]

Trial of I/V amiodarone in paroxysmal atrial fibrillation

Amiodarone in I/V form can be a very useful tool for the control of tachyarrhythmia, in doses of 20 mg/kg/body wt. about 1/3 -1/4 of which may be given as bolus, and the rest continued as infusion till either the arrhythmia is aborted, or a good control achieved, following which a maintenance oral does may me given if required. Pre-treatment with enzyme inducers may be helpful in bringing about arrhythmic control earlier than Amiodarone alone. The number of patients in this series was however very small and further studies are required to confirm these results. However, the conversion of 14/15 from atrial fibrillation to sinus rythm is very encouraging