Frequency of high degree AV blocks in acute inferior myocardial infarction and their impact on clinical outcomes

Objective: To evaluate the frequency of high degree AV block in acute inferior wall myocardial infarction and to compare in hospital clinical outcomes in patients with inferior wall MI with and without AV Block

Study Design: Cross sectional descriptive study

Place and Duration of Study: Study was carried out at Armed Forces Institute of Cardiology, National Institute of Heart Diseases [AFIC-NIHD] Rawalpindi from Nov 2011 to June 2012, on patients admitted with acute inferior ML

Patients and Methods: Standard 12 lead ECG was recorded immediately after admission. Diagnosis of acute inferior wall MI was made in the presence of ST elevation >0.1 mv [1mm] in two or more of leads II, III and aVF. Continuous bed side cardiac monitoring was carried out. Two groups were made out of 193 patients. GROUPA [AVB+]=Patients having acute inferior wall infarction with AV block, GROUPB [AVB-jPatients having acute inferior wall infarction without AV block. Each group was compared for different variables. Data analysis was done by SPSS 17 statistical software

Results: AVB was found in 54 of 193 patients with inferior wall MI [28%]. Five patients [9.25%] of group A and 2 patients [1.43%] of group B died during hospital stay showing significantly higher mortality in patients with AVB [p=0.009]

Conclusion: Heart blocks are frequent among patients with inferior wall MI and are accompanied with a variety of in hospital complications. These complications can be minimized by early recognition and timely management including interventions like temporary cardiac pacing

Pattern of severe acute maternal morbidity at CMH Quetta

To determine the pattern of severe acute maternal morbidity [SAMM] at Combined Military Hospital Quetta. Descriptive Study. Department of Gynae Obs, Combined Military Hospital Quetta from March 07 to Sept 08. One hundred admitted patients of severe acute maternal morbidity [SAMM] were identified through random sampling procedure. Thorough history, examination and laboratory investigation were considered to identify the pattern of SAMM that is; severe hemorrhage, hypertension, sepsis, pulmonary embolism, uterine rupture, inversion, ruptured ectopic pregnancy etc and to recognize patient features common in cases of SAMM like maternal age, parity, socio-economic/ educational status and level of antenatal care. Out of 100 patients of SAMM, 52% had severe obstetrical hemorrhage, 32% had hypertension, 10% had both severe pre-eclampsia and massive obstetrical hemorrhage, 4% had ruptured Ectopic pregnancies, 1% had septic induced abortion and 1[1%] had puerperal sepsis. These complications were greater in booked multi-gravidas of 20 to 40 years, para 3 to 5, under matric and with less than Rs.10,000/month income. Massive Hemorrhage and uncontrolled hypertension are the major contributors of severe acute maternal morbidity. SAMM is more prevalent in women of 20 to 30 years [reproductive age], parity 3-5, under metric and with monthly income of less than Rs.10,000.