Can computerized tomographic angiography be used to triage patients with chest pain presenting to the emergency department?

To confirm the findings of Computerized Tomography Angiography by invasive angiography. This comparative study on 50 patients fulfilling the inclusion criteria were admitted in cardiology ward. Then they were shifted to catheterization lab of Lady Reading Hospital Peshawar for invasive angiography and segmental analysis of all four vessels i.e. right coronary, left coronary circumflex and left anterior descending artery was done. A total of 50 patients were studied both with CT angio and invasive angio and 750 segments were analyzed for the 4 main arteries that is LMS, LAD, RCA and Circumflex. The sensitivity of CT angiography for the LMS was 87.5%, Specificity 100%, PPV 100% and NPV 97.6%, PPV was 100% and NPV was also 100%. Similarly the diagnostic accuracy of CT angiography for the circumflex was sensitivity 100%, PPV 100% and NPV 97.91 to 100%. For RCA the sensitivity was from 60 to 100%, specificity 100%, PPV 100% and NPV 95 to 100%. Coronary CT angio with the highest resolution scanners could be a suitable means for rapid triage of patients presenting to emergency departments with chest pain and for evaluation of patients with equivocal stress test results who might otherwise need invasive angiography

An audit of the complications of dual and single chamber pacemaker in adult patients followed over a period of one year

To determine the frequency of dual and single chamber pacemaker complications in adults. This study was conducted in 151 pacemaker implanted patients and they were followed every month for 1 year, for evaluation /programming of pacemaker function and examining for device related complications. Out of 151 patients with pacemaker, 111[73.5%] patients received single chamber pacemaker and 40[26.5%] patients were implanted with dual chamber pacemakers. In one year follow up 21[13.9%] patients developed different complications while 130 patients had uneventful follow up. The different complications seen were infection 9[6%] patients, lead displacement 4[2.6%] patients, heart failure 3[2.0%] patients, Pacemaker syndrome, lead fracture, diaphragmatic twitching, pocket hematoma and keloid formation at scar site was noted in 1[0.7%] patient each. As a whole complications in single chamber was 73.5% compared to patient with dual chamber pacemaker which was 26.5%.The rate of complications associated with PPM is not significant, but the rate of complications were more in single chamber pacemaker compared to dual chamber pacemaker. Infection was the major complication seen