Prevalence of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy

Abnormalities in left ventricular relaxation are indicators of left ventricular [LV] diastolic dysfunction. LV diastolic dysfunction may occur in patients with LV hypertrophy in the absence of systolic dysfunction. The purpose of this study is to assess the prevalence of LV diastolic dysfunction in patients with left ventricular hypertrophy in Pakistani population. 200 consecutive patients age 20 years and above and of either sex with left ventricular hypertrophy were included in this study. LV diastolic function was assessed by pulsed wave Doppler studies measuring transmitted E and A-wave velocities, E/A ratio, deceleration time and Isovolumic relaxation time intervals. LV diastolic dysfunction was diagnosed. Out of 200 patients, 106 [53%] were male and 94 [47%] were female. The average age was 53.66 +11.07 years. The average body surface area of male patients was 1.79 + 0.19 and female patients was 1.59 + 0.16 m2. The average LV mass of male patients was 290.09 + 68.29 and of female patients was 242.23 + 54.34 grams. 92 [46%] patients had LV diastolic dysfunction. 58 [61.70%] of female patients and 50 [47.17%] of male patients had LV diastolic dysfunction [P=0.04]. The average age of patients with LVDD was 55.55 + 10.86 years as compared to 50.27 + 10.38 years in patients without LVDD [P=0.001]. The mean body surface area of patients with LVDD was 1.667+0.202 as compared to 1.738+0.199 of patients without LVDD [P=0.014]. Ejection fraction and LV mass were not different statistically in patients with or without LVDD. LVDD is a frequent finding in patients with left ventricular hypertrophy. It is more frequent ir female patients with advancing age and smaller body surface area

Percutaneous coronary intervention of osteal lesions in newly established tertiary care cardiac hospital

To assess the outcome of percutanious Angioplasty in patients with osteal lesions in Coronary artery Diseases. This is a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases [KIHD], a tertiary referral center in Karachi, Pakistan, between the periods August 2006 to August 2008. Fifty patients were enrolled which included thirty-five men and fifteen women and all were >40 years of age. Each patient had a single target osteal lesion: twenty nine patients underwent PCI for ostial LAD lesion [among them twenty males and nine females], six had ostial LCX [five males and one female], and fifteen patients had osteal RCA stenosis [10-male patients and 5- female patients]. After high-pressure balloon dilatation residual stenosis was reduced. Twelve patients were treated with bare metal stents [BMS] while thirty eight with drug eluting stents [DES]. In all cases the procedure was successful without any pre and post procedural complications. A key issue in the treatment of an osteal lesion is to assure that the stent is inserted proximal enough to fully cover the osteal junction. Improvements in technique, equipment, adjunctive drug therapy and better understanding of the procedure have remarkably changed the practice of interventional cardiology

Echocardiographic profile of patients with mitral stenosis

Rheumatic heart disease is a common cardiovascular disease in our country. These patients are referred to echocardiography laboratory for the evaluation of valvular lesions. In this study we are presenting the echo-cardiographic data of patients with mitral stenosis referred to our lab during 2006. We have retrospectively analyzed the data of patients with mitral stenosis [MS]. A total of 3393 echo studies were performed during this year. Out of these 70 patients had significant MS. Of these 42[60%] were female and 28[40%] were male patients. The mean age of these patients was 41.13 +/- 12.64 years [Range 17-70 years] and the median age of 40 years. The mean age of patients with mild MS was 48.63 +/- 12.38 years, with moderate MS was 40.33 +/- 12.52 and with severe MS was 34.67 +/- 9.12 years. All patients had dilated left atrium and normal sized left ventricle. The mean diameter of left atrium was 45.65mm. The mean of MVA by planimetry was 1.28 +/- 0.39 cm2 and by pressure half time method was 1.25 +/- 0.35 cm2 [P=0.366]. The mean MVA in female patients was 1.33 +/- 0.31cm2 and 1.21 +/- 0.49 cm2 and in male patients was 1.21 _0.31 cm2 and 1.28 +/- 0.39 cm2 by planimetry and PHT methods respectively. The mean of mean pulmonary artery pressure was 49.26 +/- 26.82 mmHg. In female patients it was 44.49 +/- 22.33 mmHg and in male patients 57.35 +/- 32.0 mmHg [P=0.024]. 19[27.1%] patients had mild MS, 33[47.1%] moderate and severe in 18[25.1%] patients. Mitral regurgitation was present in 36[51.4%] patients, tricuspid regurgitation in 33[49.1%] patients and 13[18.6%] patients had calcification on leaflets or commissures

Non-invasive assessment of cardiovascular autonomic activity induced by brief exposure to 50 % nitrous oxide in children

Nitrous Oxide is used for relief of pain in children undergoing minor surgical procedures, however its effects on autonomic nervous system have not been studied. The objective of this study was to assess the cardiovascular autonomic activity induced by brief exposure of 50% nitrous oxide in children. Sixteen non- premedicated pre-pubertal children under going middle - ear surgery were studied. Our results show that brief exposure to 50% nitrous oxide in children results in: [a] Absence of effect on mean arterial pressure and systolic arterial pressure variability; [b] Attenuation of the low frequency component of heart rate variability with a shift of the sympathetic - parasympathetic cardiac balance towards a parasympathetic predominance; and [c] Absence of alteration of spontaneous baroreflex sensibility. We conclude, nitrous oxide has relatively few effects on cardiovascular sysem and has a depressent effect in children as opposed to that in adults

Effect of statins on triglycerides in the management of hypercholesterolemia in patients with coronary heart disease

Coronary heart disease [CHD] is the leading cause of death worldwide. Effective treatment of hyperlipidemia can prevent development of CHD and significantly reduce the risk for cardiovascular events and mortality. The association between LDL cholesterol and CHD risk is well estalished. Low levels of HDL cholesterol and high levels of triglycerides are also strong risk factors of CHD. Statins are the drug of choice for lowering LDL-cholesterol. In this study we have assessed the effect of various statins on triglycerides levels in the management of hypercholesterolemia in patients with CHD. The data of 179 patients were assessed retrospectively. 131[73.18%] were male and 48 [26.82%] were female patients. The mean age of these patients was 52.07 +/- 9.2 years. The mean trigyceride levels were 202.35 +/- 154.32 mg/dl before and 172.39 +/- 38.45 mg/dl after statins therapy showing a reduction of 29.96 mg/dl [14.81%]. This difference is significant statistically [p=0.007]. Atorvastatin was given to only 2 [1.12%] patients. The mean triglyceride levels were 210.00 +/- 37.59 mg/dl and 154.00 +/- 9.89 mg/dl before and after atorvastatin therapy. Cerivastatin was used in 14 [7.82%] patients which reduces triglycerides by 19.93 mg/dl [9.85%] [p=0.157]. Fluvastatin was used in 37 [20.67%] patients which lowers triglycerides by 23.87 mg/dl [12.43%] [p=0.050]. In 25 [13.97%] patients lovastatin was given and this reduces triglycerides levels by 18.54 mg/dl [10.21%] [p=0.106]. Simvastatin was used in 101 [56.42%]. It results in reduction of 16.09 mg/dl [8.35%] in triglycerides level which is highly significant statistically [p=0.0001]. We conclude all statins lower triglycerides levels in patients with hypercholesterolemia. This effect is more marked with simvastatin and fluvastatin than other statins