ABSTRACT
Abnormal dispersion of QT interval [QTd] measured as the interlead variability of QT, reflects an in homogeneity of ventricular action potential. This is increased in coronary artery disease [CAD] due to ischemia of myocardium
Aims and Objectives: To determine / investigate the values of QT dispersion in our population. To investigate whether there is any short term influence of coronary artery bypass grafting [CABG] on QT dispersion, evaluated early [7 days] after surgery
Design of study: Single center observational study
Site of study: Department of Cardiology and Cardiothoracic Surgery, Shaikh Zayed Hospital, Lahore
Patients and Methods: A total of 50 consecutive patients, who underwent CABG in Shaikh Zayed Hospital, were included in the study. All the patients were given the standard therapeutic treatment for the management of ischemic heart disease [IHD]. Biochemical lab data including complete blood count, blood sugar level, serum electrolytes, urea and creatinine was collected and assessed for any abnormality before the operation. A twelve lead electrocardiogram [ECG] was recorded during a resting period in all patients planned for CABG 24 hours before surgery. ECG was repeated 48 hours after operation and at the time of discharge from the hospital. QT interval was calculated from the onset of QRS complex to the point of return of 'T' wave to isoelectric line or to the nadir between 'T' wave and 'U' wave, in cases where a 'U' wave was present. QT dispersion was measured as the difference between maximum and minimum QT from the 12 lead ECG
Results: The mean QTd in healthy individuals was [53.60+/-19.56 ms] [p=0.000]. There was significant reduction in QTd from 24 hours before CABG to 48 hours and seven days after CABG [74.80+/-28.59 ms] [p=0.000] vs. [46.40+/-17.82 ms] [p=0.000] and [33.20+/-15.44 ms] [p=0.000] respectively
Conclusion: There is a significant reduction of QTd early after CABG. It seems that QTd is a simple non-invasive and a reliable mode for detecting coronary ischemia and also for evaluating the effects of revascularization
ABSTRACT
The objective was to assess the frequency of ACE inhibitor induced cough in our patients. The study was prospective open labeled one centre, in and out patients of cardiology department Sheikh Zayed Hospital, Lahore 2011. 200 patients using six different types of ACEI were used. Preference was given to patients to whom ACEI were prescribed for the first time. Patients with chronic respiratory diseases were excluded. Patients were follwed up on fortnightly basis for three months. On each visit besides recording their blood pressure, they were not specifically inquired about occurrence of any cough. Patients themselves came with the complaint of cough. The dry cough frequency with different ACEI was 17%, ranging from almost 20% with Enalopril, 16.6% with Captopril, 10% with Lissinopril and Ramipril, 15% with Qurinapril and Perindopril. The dry cough was moderate in the majority of our patients and they were not willing to continue their ACEI, although their blood pressure was well controlled with it. They were switched over to other group of anti hypertensive drugs. Incidence was almost same in males and females. ACEI have a relatively high frequency of dry cough and our patients don't want to take it if cough occurs
ABSTRACT
To determine the frequency of clot in left atrium [LA] in patients suffering from tight mitral stenosis [MS] with atrial fibrillation. A cross-sectional descriptive type study at two centers was performed. A total of 50 adult patients with tight MS and AF were included. A 12 leads electrocardiography was performed once for each patients to look for AF after transthoracic echocardiography [TTE] and clinical examination features revealed tight MS. Patients with AF were selected and TTE was done to detect clot in LA. Tran esophageal echocardiography [TEE] was performed whenever clot could not be detected with TTE. Among 50 patients studied. There were 20 males and 30 females, TTE was done of all patients and LA clot were detected in 10 patients [20% of total] and TEE were performed in remaining 40 patients [80% of total] and additional 12 patients [24% of total] with clot in LA were detected. Therefore total of 44% of patients had LA clot. Among them 4% had clot in LA body and 40% had in LA appendage. LA dimension was found to be relevant [P value = 0.004] with the presence of clot in patients of severe MS with AF. LA spontaneous echo contrast [LASEC] was found in all patients. LA clot was present in 44% patients with tight MS and AF. Larger LA diameters is a strong predictor- of presence of LA clot in severe MS with AF
ABSTRACT
Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy is a low-cost, noninvasive imaging technique, with limited radiation exposure that allows the correct evaluation of opening and closing angles and can add diagnostic value to echocardiography. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician's experience are important determinants for the management of prosthetic valve thrombosis
ABSTRACT
Introduction: Red Raisins [Monaka] are dried large sized red grapes. They contain some constituents common with red wines, which may play a crucial role in modulating lipoprotein metabolism, eicosanoid synthesis, oxidation and coagulation
Objective: Our objective was to assess the lipid altering efficacy and tolerability of MONAKA. Centre of Study: Department of Cardiology, Shaikh Zayed Hospital, Lahore. Duration of Study: Monaka was given to patients for 04 months. Design of Study: Interventional quasi experimental study
Methods: A total of 33 patients, aged 24 - 72 years, maintained on lipid lowering diet and having baseline total cholesterol > 240mg/d1 or LDL-C > 150mg/d1 or IML-C < 35mg/d1 were included in the study. Seven pieces of 'Monaka' twice a [lay as a monotherapy was given for 16 weeks and subjects reassessed thereafter. 26 patients completed the trial
Results: There was a ineaii reduction of total cholesterol of 11.39%, LDL-C of 16.33% and HDL-C of 7.58%, which were highly significant with p <0.002, < 0.001 and <0.031 respectively. 'Monaka' was well tolerated with one subject each having expistaxis, bleeding piles and diarrhea. One subject had difficulty controlling blood sugar and 03 were noncompliant
Conclusions: Monaka may be used as a lipid lowering agent but it needs more long term studies with larger number of patients and longer follow up
ABSTRACT
This study was done to evaluate the degree of change in autonomic activity, manifested as heart rate variability [HRV], from acute phase of MI to convalescent period of AMI. Design: Single center, observational prospective study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital, Lahore. The study was completed in one year from June 2000 to July 2001. Subjects and Thirty consecutive patients presenting within 24 hours of an ST segment elevation AMI with or without thrombolysis were included. First 24 hour Holter recording was done within 24-36 hours after AMI and the second was done before discharge. The mean hospital stay was 7.07 +/- 2.56 days. Mean duration between the two recordings was 5.47 +/- 2.36 days. The mean standard deviation of normal sinus interval [SDNN] was 65.07 +/- 25.11msec and 63-97 +/- 23.38msec; mean standard deviation of averaged sinus beats for 5 minutes segments of entire recording [SDANN] was 51.27 +/- 18.57msec and 55.83 +/- 19.65msec and mean SDDN index was 34.57 +/- 17.15msec and 30.57 +/- 14.89msec during early phase of acute MI and pre-discharge recordings respectively. There was no statistically significant difference in HRV between early phase of acute myocardial infarction and of pre-discharge recordings. HRV may be monitored for risk stratification at any time post AMI prior to discharge