Are BP readings taken after a patient-physician encounter in a real-world clinic scenario the lowest of all the readings in a clinic visit

To determine the difference in Blood Pressure [BP] readings taken before, during and after the clinic encounter. Descriptive study. Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013. Hypertensive and normotensive participants aged >/= 18 years were recruited. Pre-clinic BP was measured by a nurse and in-clinic BP by a physician. After 15 minutes, two post-clinic BP readings were taken at 1 minute interval. All readings were taken using Omron HEM7221-E. Out of 180 participants, males were 57% and 130 [71%] were hypertensive. Mean SBP [Systolic BP] taken preclinic, in-clinic, post-clinic 1 and post-clinic 2 were: 126 +/- 20 mmHg, 131 +/- 23 mmHg, 126 +/- 20 mmHg and 121 +/- 21 mmHg respectively [p < 0.001]. Mean DBP [Diastolic BP] taken pre-clinic, in-clinic, post-clinic 1 and post-clinic 2 were 77 +/- 12 mmHg, 81 +/- 13 mmHg, 79 +/- 12 mmHg and 79 +/- 11 mmHg respectively [p < 0.001]. BP taken in the post-clinic setting may significantly be the lowest reading in a clinic encounter, making in-clinic BP unreliable to diagnose or manage hypertension

QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction

To determine the association between left ventricular [LV] dyssynchrony assessed by tissue Doppler imaging [TDI] in patients with left ventricular ejection fraction [LVEF] < 35% and prolonged ventricular depolarization on electrocardiography. A cross-sectional study. The Aga Khan University, Karachi, from June to September 2007. All patients with LVEF <35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony. A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients [28.6%] had evidence of dyssynchrony on TDI. Five patients [23.8%] had dyssynchrony on the basis of basal septal and basal lateral velocity difference [p=0.045] and 6 patients [28.6%] had evidence of dyssynchrony based on basal anterior and basal inferior velocity difference [p=0.018]. Out of the remaining 39 patients with narrow QRS complex, only 2 patients [5.1%] had dyssynchrony on TDI. The study demonstrates a significant association between prolonged QRS duration and left ventricular dyssynchrony on TDI. Therefore, such patients should be screened for prolonged QRS duration on ECG before cardiac resynchronization therapy [CRT]

Extra pulmonary uptake of Tc 99m MAA perfusion lung scan as a result of right to left intra cardiac shunt

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin [MAA] is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients1. It occurs when the agent bypasses the lungs due to a right to left [R-L] cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size.2 When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a clinically unsuspected shunt was diagnosed from the lung perfusion scintigraphy