Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease

A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute inferior wall myocardial infarction [MI] cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermore, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery [RCA] in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross-sectional study carried out at the department of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 to September 2008. A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. Out of 60 patients, 29 [48.4%] had the culprit lesion in proximal, 23 [38.5%] in mid and 8 [13.4%] in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion

prevalence of renal artery stenosis in ischemic heart disease patients undergoing coronary angiogram

Objective: To understand the presence of renal artery stenosis [RAS] in patients with coronary artery disease [CAD] and the correlations among coronary artery disease, renal artery stenosis, hypertension and renal insufficiency

Methods: A prospective observational study carried out at Punjab Institute of Cardiology from January 2003 to July 2003. Convenience based abdominal aortograms was performed to assess the anatomy of renal arteries in 155 patients who were scheduled for coronary angiography

Results: Of the total patient cohort 25 [16. 1 %] had significant [>or=50%] RAS. Out of these 4 [2.6%] patients had bilateral RAS. 6 [3.9%] patients had left sided RAS and 15 [9.7%] patients had right sided RAS. All 25 [100%] patients suffering from RAS had significant CAD. 19 [76%] had triple vessel disease, 5 [20%] had two vessel disease and 1 [4%] had single vessel disease. 64% patients suffering from RAS had hypertension. 3 [12%] patients had elevated serum creatinine

Conclusion: RAS is a frequent finding in patients with CAD, especially in triple vessel disease patients. Hypertension is closely related to RAS. Abdominal/ renal angiogram may be recommended in patients of triple vessel disease

Transcatheter occlusion of secundum atrial septal defects with the self centering amplatzer septal occluder-Initial experience

Between September 1999 to April 2001, 14 children and adults with age ranging between 343 years and weight ranging from 10-82 Kg were selected to undergo transcatheter occlusion of secundum atrial septal defect with self centering Amplatzer septal occluder. Echocardiographic criteria for exclusion were a defect >26mm or an insufficient septal tissue rim <4mm from either AV valve, coronary sinus or the right pulmonary veins. 11 of the 14 patients were successfully treated with the device. The defect diameter ranged from 621mm on T E.E and balloon stretched diameter varied from 16-30mm.11 devices ranging from 16-34mm were placed within the ASD and implanted. The procedural time ranged from 55165 minutes. 3 of the 14 patients could not be treated due to technical problems. 10 out of 11 treated patients demonstrated complete defect closure immediately after implantation of device as witnessed on colorflow Doppler examination while complete closure of defect was observed in all the patients after 24 hours. During follow up period of 8-737 days closure with no residual shunt has been demonstrated in all patients. Thus the Amplatzer septal occluder has proved to be effective and safe device for closing secundum atrial septal defects

Risk factor analysis of ischemic heart disease in patients presenting for coronary angiography at punjab institute of cardiology, Lahore initial results of ongoing prospective study

Between September 1998 to June 1999 risk factor analysis of 2495 patients of established coronary artery disease presenting for coronary angiography was done. Patient population included 1963 males and 532 females. Majority 88.01% of patients was above age group 40. Dyslipidemia was most common identifiable major risk factor in our patient population. Lipoprotein abnormalities included raised total serum cholesterol [level>160 mg%] and LDL cholesterol [level>100mg%] in 86.65% and 85.25% cases respectively. This was followed by reduced serum HDL cholesterol [level <35 mg%] in 29.54% and raised triglyceride [levels >200mg%] in 42.28% of cases. Smoking was the second most important major risk factor in our male study group accounting for 45.4% of cases. History of hypertension and diabetes as a risk factor was present in 37.55% and 26.37% cases respectively. Compared to the west minor risk factors constituted very significantly to coronary risk as sedentary life style and obesity was present in 48.66% and 21.20% of our patient group while positive family history of HID was present in 38.19% of cases. Although lipoprotein abnormalities was the most significant risk factor in our patient population only 980 cases [39.27%] had their serum lipids checked previously out of which 803 cases had history of hyperlipidemia and only 30.37% of these cases were receiving drug therapy for hyperlipidemia. The findings of the study suggest that major as well as minor risk factors contribute to the incidence of coronary heart disease in our patient population. As lipoprotein abnormalities is the most significant major risk factor therefore screening of serum lipids should be a part of investigative workup of our CHD patients and lipid lowering therapy should become a routine part of secondary prevention programme. Avoidance of smoking, good diabetic and hypertensive control along with active lifestyle should also be aimed for prevention of recurrent coronary events thus reducing mortality