Percutaneous transvenous mitral commissurotomy; outcome of in patients of mitral stenosis

To compare the clinical, echocardiographic and angiographic variables after PTMC in patients of mitral stenosis having echo score < 8 and >/= 8. Cardiology ward and echocardiography department of the Punjab Institute of Cardiology, Lahore. The study was conducted from 15[th] of January 2006 till 30[th] of July 2006. It was a comparative study. Two hundred consecutive patients of mitral stenosis undergoing PTMC were studied. Patients were divided in to two groups. Group I consisted of patient having echo score <8, while Group II contained patients having echo score >=8. The immediate clinical follow-up of 200 patients who underwent PTMC procedure was studied. Patients were divided into 2 groups, Echo-Sc <8 [n=136] and Echo-Sc >/= 8 [n=64]. PTMC resulted in an increase in mitral valve area from 1.0 +/- 0.3 to 2.0 +/- 0.6 cm[2] in patients with Echo-Sc<8 and from 0.8 +/- 0.3 to 1.6 +/- 0.6 cm[2] in patients with Echo-Sc >/= 8 [P<0.0001]. Procedural success was 83.5% for the overall group, with patients with Echo-Sc <8 having a higher procedural success [93.4% versus 62.5%; P<0.0001]. Thirty three [16.5%] patients had unsuccessful procedures. There was 1 [0.5%] in-hospital death. Severe post- PTMC MR [>/= 3 grade] occurred in 19 [9.4%] patients, with grade III in 12 [6%] and grade IV in 7 [3.5%]. Emergent MVR was required in 3 [1.5%] of 200 patients. Pericardial tamponade occurred in 2 [1%] patients. Thromboembolic events [stroke] occurred in 2 [1%] patients in the overall population. Finally 1 [0.5%] patient developed complete atrioventricular block. Patients with echo score less than 8 have a favourable outcome in terms of procedural success and post procedure complications as compared to patients with echo score >/= 8

Role of exercise stress testing in evaluation of patients presenting with chest pain

To evaluate and assess the accuracy of the clinical diagnosis of ischemic heart disease [IHD] with exercise stress testing in patients presenting with chest pain. All patients referred from outdoor and emergency department were sent to exercise tolerance test [ETT] room, after undergoing full clinical assessment including history, examination and resting ECG. The patients underwent exercise testing according to Bruce Protocol. One hundred and twenty patients underwent exercise stress testing between December 2002 and June 2003. Among these 86 [71.7%] were males and 34 [28.3%] were females. The mean age of males was 45.19+9.49 years and females 44+10.9 years. Out of 120 patients, 50[41.6%] and 70 [58.3%] patients had positive and negative stress testing results respectively. Out of 50 positive cases, 33 [66%] were males and 17 [44%] were females. The mean age of patients with positive test was 51.3+8.3 years and negative test was 40.4+8.5 years. Hypertension was the most prevalent risk factor 42[35%] followed by family history 36[30%]. Out of total diabetics [18/120] twelve [66%] had positive test. A significant number of patients [n=30/38, [79%] with no risk factors were negative on stress testing. This study concludes that exercise stress test is a cost effective tool to evaluate patients presenting with chest pain in out-patients department suggestive of ischemic heart disease, both typical / definite angina as well as atypical / probable angina. This also helps to stratify those with increased likelihood of IHD into high-risk group needing referral for invasive tests and low risk group that can be observed

In hospital outcome of acute inferior wall Myocardial Infarction with or without right ventricular infarction

Patients of acute inferior wall MI with concomitant right ventricular infarction is considered as high risk patients because of associated high morbidity and mortality. Total of 50 patients were enrolled for seven days of hospital stay. They were divided into two groups; one with only acute inferior wall MI and the other with acute inferior wall MI associated right ventricular involvemen. The fatality rate was 33.3% with right ventricle involvement compared with 2.6% without right ventricle involvement. [p=0.003].The major cause of death was cardiogenic shock. Complications were as follow; cardiogenic shock [p=0.012], Tricuspid regurgitation [p=0.04], AV Block [p=0.04], tachyarrhythmia [p=0.077] and VSD in both groups. The conclusion was that right ventricle involvement was an independent predictor of prognosis in patients with acute inferior wall myocardial infarction