Non - traumatic emergencies - Experience from a tertiary care centre In Karachi

To review the incidence, clinical presentation and outcome of Non traumatic Aortic emergencies in a tertiary care hospital and its evaluation in the Emergency department [ED]. We conducted a retrospective review of cases presented to the ED at Aga Khan University Hospital during 15 year period [1988 - 2002] who had final diagnosis of Aortic Dissection or Ruptured Aortic Aneurysm. Patients without confirmatory investigations were excluded. We aimed at looking for the incidence, clinical presentation, evaluation in the ED and final outcome. Of the 12 cases, 7 had aortic dissection while the remaining 5 had ruptured aortic aneurysm. For Aortic dissection, mean age of presentation was 53 years with male predominance. Most of these patients had chest pain. Most common comorbid condition was hypertension. Pulse deficit was found in 2 cases, murmur in 4 cases, and focal neurologic deficit in 2 cases. Electrocardiogram revealed ischemic changes in 3 cases. Widened mediastinum on chest x-ray was present in all cases. The only initial misdiagnosis was cardiac ischemia. One patient survived to discharge. For patients presenting with ruptured aortic aneurysm, mean age of presentation was 52 yrs with a male predominance. The associated comorbid condition was hypertension. Almost all patients presented classically with abdominal pain, hypotension and palpable mass. No patient survived to discharge. Aortic emergencies although rare, are associated with significant mortality. High index of suspicion and prompt recognition by the emergency physician is of key importance

echocardiographic evaluation of left ventricular systolic functions in hypertensive patients

A total of 30, consecutive, hypertensive patients, equally divided between the two sexes, were evaluated by M mode and 2-D echocardiography. They were divided into four groups; Group A - Left ventricular [L.V.] mass < 100 g/m2. Group B LV mass = 101 - 125 g/m2. Group C - LV mass = 126 - 150 g/m2. Group D - LV mass> 150 g/m2. All patients [n=7] in group A had normal LV Systolic function as determined by E-point-to-septal separation [E.P.S.S.], Ejection Fraction [E.F.] and Fractional Shortening [F.S.] excepting one patient with a minimally increased E.P.S.S. Of 11 patients in group B, eight [72.5%] showed increased E.P.S.S. whereas only one of these eight patients had reduction in E.F. and F.S. as well. The other three patients had normal E.P.S.S. E.F. and F.S. Group C consisted of six patients. All [100%] of these had increased E.P.S.S. but normal E.F. and F.S. Group D also had six patients, Of these four [66%] had prolonged E.P.S.S. whereas three of these four patients had reduced E.F. or F.S. as well. The other two patients had normal E.P.S.S. and F.S. In Conclusion, this study suggests a direct correlation of increasing LV mass with progressive LV systolic dysfunction in hypertensive patients. Also, increased E.P.S.S. appears as the first abnormality of LV systolic function before reduction in E.F. or F.S