Intraventricular dyssynchrony among patients with left bundle branch block

Objective: To determine the frequency of intraventricular dyssynchrony among patients with left bundle branch block

Methods: The study was conducted at Hayatabad Medical Complex, Peshawar, from January, 2017 to July, 2017. All patients aged 18 years and above with Left Bundle Branch Block [LBBB] on ECG with or without heart failure were included in the study. Patients with valvular heart disease, predominant diastolic heart failure, acute coronary syndromes or coronary revascularization in last three months and atrial fibrillation were excluded. Tissue Doppler Imaging [TDI] parameters were measured from 2-D images in apical 4-chamber and 2chamber views. Consecutive non-probability sampling technique was used for sample collection

Results: Our study included 159 patients. Mean age was 52 years with SD +/- 2.74. Ninety-nine [62%] patients were male and 60 [38%] patients were female. One hundred and three [65%] patients had heart failure while 56 [35%] patients didn't have heart failure. More over in our study 124 [78%] patients had Intraventricular dyssynchrony while 35[22%] patients didn't have Intraventricular dyssynchrony

Conclusion: The incidence of Intraventricular dyssynchrony is high among patients with heart failure and left bundle branch block

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

Comparative analysis of type of myocardial infarction in patients with successful or unsuccessful streptokinase thrombolysis following st elevation myocardial infarction

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A [successful thrombolysis] and group B [unsuccessful thrombolysis] using ECG criteria. Total number of patients were 200. Group A included 136 [68%] patients and group B included 64 [32%] patients. There were total 88 [44%] patients of anterior MI with 47 patients in group A and 41 patients in group B [34.6% vs 64.0%, p<0.001]. There were total 110 [55.0%] patients of inferior MI with 88 patients in group A and 22 patients in group B [64.7% vs 34.4%, p<0.001]. Lateral myocardial infarction was diagnosed in 2 [1%] patients with 1 patient each in group A and group B [0.7% vs 1.6%, p=0.583]. Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Trans catheter closure of post infarct ventricular septal defect by asd device

Post infarction ventricular septal defect carries high mortality and the management of these patients is challenging both for cardiologist and cardiovascular surgeon, because of the patient hemodynamic instability and tissue friability which make the intervention difficult. We report one of our patient who had anterior M I followed by apical ventricular septal defect with cardiogenic shock .The patient was subjected to PCI and the defect was closed successfully with ASD closure device. The patient was discharge successfully from hospital

comparative analysis of in-hospital left ventricular function in patients with successful or unsuccessful streptokinase thrombolysis following acute myocardial infarction

To compare in-hospital left ventricular function in patients with unsuccessful and successful thrombolysis presenting with acute myocardial infarction treated with streptokinase. This comparative study was conducted at department of Cardiology, Lady Reading Hospital Peshawar, from October 2006 to October 2007. Two hundred patients with first acute myocardial infarction were divided into two groups: group A [successful thrombolysis] and group B [unsuccessful thrombolysis], using ECG criteria. To determine Left Ventricular Function, 2-D Echo was used. Group A included 136 [68%] patients and group B included 64 [32%] patients. Impaired left ventricular function was found in 41 [30.1%] patients in group A and 41 [64.1%] patients in group B [p< 0.001]. Left ventricular failure was present in 31 [22.8%] patients of group A and 30 [46.9%] patients of group B [p=0.001]. Cardiogenic shock was diagnosed in 2 [1.5%] patients in group A and 6 [9.4%] patients in group B [p-0.008]. Presence of LVF is strongly associated with unsuccessful thrombolytic therapy in this group of patients

comparative analysis of frequency of in-hospital arrhythmias in patients with successful versus failed thrombolysis following acute myocardial infarction

To compare frequency of in-hospital arrhythmias in patients with successful and failed thrombolysis using streptokinase in patients presenting with acute myocardial infarction [AMI]. This was a comparative study conducted at department of Cardiology, Lady Reading Hospital,Peshawar from October 2006 to October 2007 .Two hundred patients with first AMI were divided into two groups: group A [successful thrombolysis] and group B [failed thrombolysis] using ECG criteria. A total of 200 patients were studied. Group A included 136 [68%] patients while group B included 64 [32%] patients. Among these 24 [12.0%] patients developed arrhythmias. Of these 8 patients were in group A and 16 patients were in group B [5.9% vs. 25.0%, p=0.003].Ventricular tachycardia was the most common arrhythmia. It was documented in 9 [4.5%] patients, with 2 patients in group A and 7 patients in group B [1.5% vs. 10.9%, p=0.003]. The other arrhythmias which included atrial fibrillation, ventricular fibrillation and supraventricular tachycardia were statistically insignificant between the two groups [p=0.174]. In hospital mortality was more common in patients with failed thrombolysis [6 [9.4%] vs. 3 [2.2%] [p=0.023]]. Failed thrombolysis is associated with complex arrhythmias and high in- hospital mortality

Doppler detected opening size and flow chart as predictors of early failure of arteriovenous fistula in hemodialysis patients

To determine whether Flow rate and the Size of the opening can predict early failure of arteriovenous fistulae in haemodialysis patients on Doppler ultrasonography. Prospective, quasi experimental study from March 2004 to January 2006. This study was conducted in Surgical "c" ward of the Khyber Teaching Hospital, Preshawar. A total of 92 patients with ESRD [End Stage Renal Disease] who were selected for haemodialysis. All the patients were subjected to Doppler study during the first week of AVF [arteriovenous fistula] construction, and the stomal size and blood flow rate detected. Both these parameters were used as predictors of AVF failure on follow-up visits during the next six months. Out of 92 patients, 13 [14.1%] had an initial stomal opening ranging from 2.3-3.5 mm and 44 [47.8%] from 3.5-5mm, while in 35 [385] patients the opening was > 5 mm. Twenty two [23.9%] patients had an initial flow rate of <400ml/min, 52 [56.5%] 400-700 ml/min and in 18 [19.5%] patients the flow rate was >700 ml/min. During the six months follow-up visits there were 14 [15.3%] AVF failures; all these patients had an initial flow rate of less than 400 ml/min, with a stomal opening of <3 mm in size. Initial stomal opening size and flow rate can be used as good predictors of early Arterio-venous failure in haemodialysis patients on Doppler ultrasonography

hospital based study on future approaches to combat cardiovascular diseases

To determine the opinions of the physicians posted in two tertiary care hospitals of Peshawar regarding future strategies to combat cardiovascular diseases [CVD]. Descriptive observational survey. Khyber teaching hospital [KHT], Hayatabad medical complex [HMC] and department of community medicine Khyber medical college Peshawar. From 20th June to 15 august 2006. A total of 60 clinical experts were selected, 48 from KHT/KMC and 12 from HMC. Medical specialists, general physicians and community experts were included. They were interviewed with a pre-designed questionnaire, prepared in accordance with the objectives of the study. According to the clinicians and general physician's opinion the national approaches to combat cardiovascular diseases should be aimed at: tobacco control legislation and its empowerment [60%], national physical activity policy [70%], check on food quality [21.66%], research promotion in the field of CVD [36.66%], conducting workshops and seminars to educate people about CVD [30%] etc. Community approaches should be more specific towards promotion of healthy activities [71.66%], discouraging smoking [96.66%], and conducting local workshops to increase awareness [26.66%]. Individual approaches to combat CVD is to screen their blood pressure, glucose and lipid profile regularly [85%], stop smoking [96.66%], decrease their weight with exercise [75%], take appropriate medicine in time if is patient or at risk [46.66%] and leadership and advocacy to increase awareness and decrease stigma [43.33%]. while establishing a strategy for combating CVD there is need to offer multiple approaches on national, community and individual levels

Bronchoscopic evaluation of 475 patients during 1982-89

A total of 475 patients were examined with fiberoptic Bronchoscope. Out of these 375 were male and 100 females, age from 10-89 years. 84 patients turned out to be carcinoma bronchus based on bronchoscopic findings. Majority of them were smokers. 237 cases were of inflammatory nature. Out of these 183 were male and 54 female. Majority of them were tuberculous in nature. Four patients were subsequently diagnosed as hydatid cysts, 3 female and one male. One female patient came with bronchospasm and bronchoscopic examination revealed foreign body [husk of sugar cane] impacting in the right main bronchus, it was removed bronchoscopically and patient got relief. The remaining 149 patients revealed no pathology