Association of GRACE Risk Score with Angiographic Severity of Coronary Artery Disease in patients with ST Elevation Myocardial Infarction.

Background: Clinical guidelines recommend that optimal management of acute coronary syndrome should include patient risk stratification. Predicting the anatomical extension of coronary artery disease is also potentially useful for clinical decision. The objective of our study is to determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with ST elevation myocardial infarction. Methodology: 50 patients diagnosed with Acute Myocardial Infarction were included as sample by purposive sampling method. GRACE risk score for each patient was calculated and the patients were divided into groups according to the GRACE risk score: low risk (<108); intermediate risk (109-140). The severity of the coronary artery disease was assessed by vessel score and Gensini score. Relation between Grace score and Gensini score was evaluated. Results: Mean GRACE score of study population was 128.3±22.7. Mean Gensini score was 23.88±17. Mean Gensini score were 15.47±10.4, 27.75±9.26 and 31.52±16.91 in low GRACE risk group, intermediate group and high risk group respectively and the difference of mean Gensini score was statistically significant (p=0.006). In our study correlation co-efficient between GRACE risk score and Gensini score was r=0.17 (p=0.04). Multiple regression analysis showed that age more than 50 years (p=0.02), ST segment deviation (p=0.01), smoking (p=0.02), hypertension (p=0.01) were able to independently predict patients with severe CAD. Conclusion: Our study demonstrates that the GRACE risk score carries a significant positive correlation with the coronary artery disease severity in patients with STEMI.

Relationship between P Wave Dispersion and Left Ventricular Diastolic Dysfunction in Hypertensive and Ischemic Heart Disease Patients.

Background: There is growing recognition that congestive heart failure caused by a predominant abnormality in left ventricular diastolic function is common and causes significant morbidity and mortality. Diastolic function usually declines before systolic function, and this precedes clinical signs. 12-lead electrocardiogram is a commonly used tool to assess left atrial enlargement, which is a marker of left ventricular diastolic dysfunction. We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and left ventricular diastolic function. Methods: There were 100 patients: 50 with diastolic dysfunction and 50 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and echocardiographic measurements of diastolic dysfunction were assessed. Results: Maximum P wave duration was observed significantly (p=0.001) in patients with left ventricular diastolic dysfunction (119.60±8.2 ms vs 114.0±6.4 ms). Minimum P wave duration was observed significantly (p=0.001) higher in patients without diastolic dysfunction (72.6±7.5 ms vs 62.70±7.4 ms). P wave dispersion was observed significantly (p=0.001) higher in patients with left ventricular diastolic dysfunction (56.6±6.3 ms vs 41.5±5.2 ms). When patients were grouped according to grades of diastolic dysfunction, P wave dispersion was observed sequentially increased among 3 grades of left ventricular diastolic dysfunction (55.8±5.2 ms vs 55.9±7.0 ms vs 61.4±4.7) but the differences were not statistically significant (p=0.09). Conclusion: We conclude that P wave dispersion increases in diastolic dysfunction of LV. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation between P wave dispersion and left ventricular ejection fraction.

Complications of streptokinase during infusion in acute myocardial infarction

To find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction [Ml] in Multan institute of cardiology emergency department. Multan Institute of Cardiology. Multan. January 2008 to June 2008. This is a descriptive study of 200 patients presenting within 12 hours of acute myocardial infarction in Multan Institute of Cardiology emergency, diagnosed on the basis of typical ischemic chest pain, ECG changes of acute MI and raised cardiac enzymes. Out of 200 patients, 135 [67.5%] were male and 65 [32.5%] were female. In SK and control group male to female ratio was 71:29 and 64:36 respectively. Out of 200 patients 139 [69.5%] present with chest pain, 41 patients [20.5%] presented with dyspnea and 20 [10%] with chest pain and dyspnea. Early administration of SK lowers in hospital mortality

Kindler, Weary or Kindler-Weary syndrome? a study based on clinical and pedigree analysis of three Egyptian families and review of the literature

Kindler syndrome [KS] is a rare genodermatosis, which presents with blisters, poikiloderma and atrophy. The exact clinical features of KS and its mode of inheritance are not settled yet. It bears some resemblance to a closely related syndrome. Weary syndrome [WS]. Both have been frequently described as one entity. In an attempt to solve this dilemma, we described the clinical manifestations and family pedigree of 10 patients from three unrelated Egyptian families originating from different geographic localities, presenting with classic manifestations of KS. We, in addition, reviewed the literature to establish the order of frequency of occurrence of each morphological component to delineate the clinical features of KS, its mode of inheritance and the possible relation between KS and WS. From our cases and from the literature, the most constant features of KS that were present in all cases are congenital regressive mechanical acral blisters, progressive poikiloderma and cigarette-paper-like atrophy. Photosensitivity, palmo-planter keratoderma and ginigival involvement were present in two thirds of the patients. Webbing of fingers and toes, loss of fingerprinting and strictures were present in half of the cases. KS is differentiated from WS by absence of severe atrophy, photosensitivity, mucosal involvement and the presence of hyperkeratotic acral papules on the dorsa of hands and feet in WS. Absent dermatoglyphics is characteristic for KS. KS shows an autosomal recessive mode of inheritance, while WS shows an autosomal dominant mode. Therefore, we consider KS a distinct entity from Weary syndrome until the molecular genetic basis of either syndrome is clarified