Coronary artery disease; severity and its associated risk factors in causing heart failure in patients presented with stemi at Gulab devi chest hospital

Development of heart failure is always secondary to presence of risk factors like diabetes mellitus, hypertension, age, smoking and underlying coronary artery disease. The objective of this study was to find the frequency of risk factors and coronary artery involvement in patients of heart failure after myocardial infarction. A non-randomized cross sectional study. Gulab Devi Chest Hospital. Six months. 100 patients was done. Using non probability [purposive] sampling technique; all patients with ages between 20 to 80 years, irrespective of gender, diagnosed with heart failure [with ejection fraction

Prevalence of cardiac diseases; during pregnancy and its feto-maternal outcome

Objectives: The objective of this study was to find the prevalence of cardiac disease among pregnant females and its impact on feto-maternal outcome

Study Design: Descriptive case series

Setting: Cardiology department Gulab Devi Chest Hospital Lahore

Duration: April 2013 to April 2014

Patients and Methods: All pregnant females with cardiac disease at any gestation with booked or un-booked statutes were included in this study. Patients were admitted for thorough evaluation and investigations. Labor was monitored intensively. Data regarding maternal outcomes were noted down on pre-formed questionnaire. Intra partum and postpartum details were also noted down along with fetal outcome. The results were analyzed using SPSS version 16.0

Results: The total number of females presented with cardiac disease was 2650, out of which only 35 women were reported as pregnant. The duration of pregnancy at the time of presentation was as follows: 05 [14.2%] females presented in first trimester, 20 [57.1%] in second trimester, 08 [22.8%] in third trimester and 02 [5.7%] patients presented in postpartum period. There were 08 [22.8%] patients who had preterm labor. In terms of fetal outcome 04 babies had birth weight of less than 1.5 kg, 12 had 1.5-2.0 kg, 15 were in range of 2-2.5 kg and 04 were more than 2.5 kg. 27 [77.1%] were term and 08 [22.8%] were preterm babies. Cleft lip and atrial septal defect were the only two identified congenital anomalies

Conclusion: The overall prevalence of cardiac diseases during pregnancy was found to be 1.3% in this study. Most common affected age group was of 20-25 years. Most common cardiac disease found in our patient was mitral stenosis. 02 pregnancies ended in intrauterine fetal death. 08 babies were born preterm. Cleft lip and atrial septal defect were the only two identified congenital anomalies in newborn delivered by our pregnant patients. Every effort should made to create awareness regarding pre-pregnancy counseling, so that associated fetal and maternal morbidity can be reduced

TIMI risk scores; frequency of double vessel coronary artery disease in different TIMI scores in patients presenting with non ST-elevation acute coronary syndrome at Gulab Devi Chest Hospital

Background: thrombolysis In Myocardial Infarction [TIMI] risk score predicts adverse clinical outcomes in patients with non-ST-elevation acute coronary syndromes [NSTEACS]. Whether this score correlates with the coronary anatomy is unknown

Objective: to determine the frequency of low, moderate and high TIMI risk score in patients of NSTEACS and to compare the frequency of two vessel coronary artery disease on angiography with low, moderate and high TIMI risk scores in patients of NSTE-ACS

Study design: this was a cross sectional study

Setting: department of Cardiology, Gulab Devi Chest Hospital, Lahore

Duration: six months

Patients and Methods: total 170 patients were included in the study. Patients' selection was done with the help of a pre-defined inclusion and exclusion criteria. TIMI risk score was calculated for each patient and patients were categorized into low, moderate and high risk groups [as per operational definition]. Patients were further evaluated with coronary angiograms to assess the double vessel CAD. All angiographies were performed by a single physician. Data analysis was done on SPSS version 17

Results: mean age of our patients was 54.81 +/- 10.55 years. Gender distribution shows that there were 106[62%] male and 64[38%] female patients. TIMI score risk classification showed that among 50[29.4%] patients TIMI risk score was low, among 107[62.9%] patients it was moderate and in 13[7.6%] patients it was high. There were 105[62%] patients who had two vessel coronary artery disease. Among 105 patients who had two vessel coronary artery disease, 25[23.8%] had low TIMI score, 69[65.7%] had moderate and 11[10.5%] of the patients had high TIMI score

Conclusion: in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score is significantly associated with two vessel coronary artery disease. So it should be recommended that a routine invasive strategy be carried in patients with moderate or higher TIMI risk score

Myocardial damage; frequency of patients undergoing CABG receiving intermittent antegrade warm blood cardioplegia at extended interval

Intermittent antegrade warm blood cardioplegia is routinely used as a mean of myocardial protection since its introduction. There is a considerable debate on the longest time off cardioplegia interval during aortic cross clamping. To see the frequency and extent of myocardial damage in patients undergoing CABG receiving intermittent antegrade warm blood Cardioplegia at LTOC [longest time off cardioplegia] 11-15 minutes [Group I] and 16-20 minutes [Group II]. A randomized prospective study involving 94 patients was arranged to see the safe periods of intermittency. There were two groups of patients having LTOC of 11-15 minutes [Group I] and 16-20 minutes [Group II]. 20 minutes was the upper limit. The duration of study was from 1-09-2013 to 10-02-2014. Data was analyzed using SPSS Version 16. Independent sample t-test and chi-square were applied to see the significance. Mean age was 54.1 +/- 9.36 years. There were more males as compared to females. More than 50% of the patients had Hypertension and Diabetes. There was no urgent surgery. Triple vessel disease [TVD] was present in 48.9% patients and 40.4% had Double vessel disease [DVD]. Average blood flow during CPB was 2.4 +/- 0.14 [L/ min.m-2]. Average body temperatures were 31.7 +/- 2.30 C. Cardioplegia temperature was 36-370 C. According to Left Ventricular Function Classification, 43.6% of the patients were of LV grade II and 10.6% of LV grade III. There was no significant increase in the levels of CK-MB in two groups. 77.8% patient in Group I and 66.7% in Group II gained spontaneous rhythm [p-value 0.16]. IABP was inserted in 5.4% patients in group I and 5.6% in group II [p-value 0.97]. There was no failure to wean off from bypass and no peri-operative mortality. The levels of inotropes viz dopamine and epinephrine on weaning were also almost the same. Perioperative MI occurred only in 7 patients [ruled out by biochemical evidence]. A reasonable margin of safety exists with intermittent antegrade warm blood cardioplegia in these two groups. So the LTOC [longest time off cardioplegia] up to 20 minutes is unlikely to lead to adverse clinical outcomes and is clinically acceptable