Myocardial damage in successful single vessel coronary angioplasty as assessed by creatinine kinase and its myocardium band lsoenzyme levels

To determine the frequency of myocardial damage in elective, successful, single vessel percutaneous coronary angioplasty by assessing myocardial band [MB], creatinine kinase levels and to find out the association of common modifiable risk factors with myocardial damage in patients undergoing single vessel coronary angioplasty. Descriptive. Armed Forces Institute of Cardiology / National Institute of Heart Disease, Rawalpindi, from September 2006 to September 2007. Fifty patients undergoing elective and successful single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before and after 8 hours and 1[st] day following coronary angioplasty. Studied variables included the length of stent deployed, maximum deployment pressure and total balloon inflation time, apart from hypertension, cholesterol level, smoking and diabetes mellitus. Out of 50 patients, 9 had raised creatinine kinase at 8 hours [18%] and 10 had raised creatinine kinase [20%] on 1[st] day following coronary angioplasty, 7 [14%] patients and 8 [16%] patients had raised creatinine kinase MB levels at 8 hours and 1st day following coronary angioplasty respectively. The rise of either was equal to or more than 3 times the normal limits. Modifiable risk factors, significantly associated with myocardial damage, were diabetes mellitus [p=0.006] and LDL levels [p=0.009] in patients undergoing single vessel coronary angioplasty. Successful elective, uncomplicated, single vessel coronary angioplasty resulted in some myocardial damage evident by mild rise in cardiac enzymes but rise of creatinine kinase MB above 3 times of normal, which signifies percutaneous coronary angioplasty-related myocardial infarction, was not seen. There was a significant association between diabetes mellitus, LDL levels and myocardial damage in patients undergoing coronary angioplasty but no significant association was found between hypertension, smoking and myocardial damage

Morphological changes in coronary arteries in cases of sudden cardiac death at high altitude

To determine the changes in coronary arteries in patients dying at high altitude. Observational descriptive study was carried out at Armed Forces Institute of Pathology and Army Medical College Pathology Laboratory, Rawalpindi form 2002 to 2004 on autopsy of 58 cases dying at high altitude. In 53 out of 58 cases, death was attributed to coronary atherosclerosis. The majority of cases were less than 40 years as also observed in people dying below high altitude. However triple vessel coronary atherosclerosis was seen in 67% cases and left anterior descending coronary artery was involved in almost 100% cases. Coronary atherosclerosis remains the major cause of death at high altitude in acclimatized individuals. Accelerated coronary atherosclerosis with triple vessel involvement in patients without prior history of ischemic heart disease points to specific indicators. Dietary modifications with high carbohydrate diet are recommended at high altitudes