multi slice computed tomography coronary angiographic study of coronary artery disease in soldiers with chest pain

The study is sought to highlight the role and results of MSCT angiography in scenario of acute chest pain to determine or exclude significant coronary artery disease in patients who do not have high risk features for significant coronary disease. Descriptive study. Computed topography department, Armed Forces Institute of Cardiology, National Institute of Heart Diseases Rawalpindi from September 2013 to December 2013. A total of 150 patients [soldiers] who were referred to this hospital with chest pain and who did not have high risk features were evaluated by multi slice computed coronary angiography. One hundred and fifty patients who reported to this hospital with chest pain were evaluated by multi slice computed tomography [MSCT] angiography. Their age ranged from 20 to 53 years. Cases studied were those having low probability of coronary artery disease. Patients having high probability of coronary disease, acute coronary syndrome or definite coronary artery disease were excluded from this study and were evaluated by conventional coronary angiography, 114 [76%] patients showed normal coronary arteries. 6 [4%] had subcritical coronary disease, 5 [3.33%] had only minor irregularity in coronary arteries, 4 [2.66%] had significant coronary artery disease that necessitated coronary angiogram. 16 [10.66%] cases had muscle bridge in left anterior descending artery. One [0.66%] patient had patent graft after coronary artery bypass graft surgery. Three [2%] patient's had patent stents in coronary arteries. While 1[0.66%] patient had aberrant origin of coronary artery. There were no side effects observed during study. Patients presenting with chest pain with low risk features can be studied conveniently with MSCT angiography. Prevalence of significant coronary artery disease is low. MSCT angiography is a very useful, convenient and safe tool to screen low risk patients to rule out presence of significant coronary artery disease

Culprit artery characteristics and severity of angiographic thrombus burden in primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction

The purpose of study was to characterize culprit artery characteristics in terms of presence of thrombus burden in patients with acute myocardial infarction using prevalent parameters of thrombus estimation. Descriptive study. Adult cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] October 2011 to 31[st] September 2012. We studied 119 patients treated with primary percutaneous coronary intervention for ST- segment myocardial infarction. Bare metal stents were used in all patients as per hospital protocol. Thrombus burden [TB] was graded [G] as GO = no thrombus, G1= possible thrombus, G2 = small [greatest dimension <, 1/2 vessel diameter [VD]], G3 = moderate [>1/2 but <2 VD], G4 large [>2 VD], G5 = unable to assess TB due to vessel occlusion. Patients with G5 were reassessed after passage of guide wire or small balloon for thrombus burden. Frequency of major adverse cardiac events [MACE]-defined as death, myocardial infarction and infarct- related artery revascularization was recorded for the pen-procedural period which was defined in our study up to 72 hours. Overall, in hospital MACE was 8.4%. Large thrombus burden is a significant predictor for mortality and MACE

Management of patients with acute myocardial infarction complicated by ventricular septal rupture - AFIC study

The aim of this study was to report management; peri-procedural and short term results of patients hospitalized with acute myocardial infarction [MI]complicated by ventricular septal rupture [VSR] considered high risk or unfit for surgical repair at AFIC-NIHD. Quasi experimental study Adult and paediatric cardiology departments of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from 1[st] January 2012 to 31[st] August 2013. We included 12 patients with post myocardial infarction VSR with mean age of 59 years [41-85 years], who underwent elective transcatheter closure. The entry criteria for trans-catheter closure after initial medical stabilization was 1] patients with ventricular septal rupture up to 20 mm size with significant left to right shunting [Qp/Qs >1.5] 2] defect anatomy and location thought to be suitable for device closure or otherwise considered high risk or unfit for surgical closure. The time from the onset of infarction to the index procedure ranged between 4 to 20 days [mean 10.83 days]. There were ten patients in acute phase [2 weeks or less] and two presented in sub-acute phase [> 2 weeks]. Ten patients were in NYHA class III and one each in class II and IV. A successful device implantation occurred in all patients except in one in whom second attempt failed. The defect size ranged 4-18 mm [mean 9.25 mm] and the devices ranging from 8-22 mm [mean 13.3 mm] were implanted. The procedure time ranged from 90-140 min [mean 105 min]. In all patients Qp/Qs was more than 2 and decreased to less than two after the procedure. Six surviving patients are in NYHA class II and doing well. One patient died one hour after the procedure whereas one patient died twelve hour after the closure because of re-infarction. One patient developed another VSR leak 3 days after the procedure and device closure was attempted again but the device could not be deployed. He subsequently died awaiting surgery. Primary trans-catheter closure of post-infarction ventricular septal rupture may be an alternative to surgery in patients with suitable anatomy and high risk or unfit for surgery

Procedural outcome of primary PCI inst-segment elevation myocardial infarction at Afic and Nihd Rawalpindi - Pakistan

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results

Coronary artery disease and T wave inversions in electrocardiogram at high altitude

To find out the role of coronary artery disease [CAD] as a cause of T wave inversions in electrocardiogram [ECG] in otherwise healthy soldiers who were evacuated from high altitude because of chest pain. A prospective observational study. The study was carried out at CMH Skardu from September 2003 to September 2004 fifty-four consecutive patients evacuated from height > 4000 meters [13123 feet] with symptoms of chest pain and electrocardiographic changes of T-wave inversions in a group of leads were included in the study. Echocardiography and Exercise tolerance test [ETT] was performed on all the patients. All of the patients with indeterminate or inconclusive results on ETT underwent coronary angiography at Armed Forces Institute of Cardiology, Rawalpindi. Out of 54 patients, 36 [66.7%] patients had normal exercise tolerance test. In the rest 18 [33.34%] patients coronary angiogram was done and in 04 patients it was reported abnormal. In 02 [3.70%] patients coronary angiogram confirmed coronary artery disease. In 02 patients coronary angiograms were abnormal but there was no evidence of coronary artery disease. T wave inversions at high altitude suggestive of IHD are not true indicators of underlying coronary artery disease

Hyperventilatory capacity - a predictor of altitude sickness

The aim of the study was to document link between hyperventilatory capacity and risk for developing acute mountain sickness [AMS]. This study was carried out at Karakorum Mountain ranges [Northern areas of Pakistan] from March till July 2004. 54 healthy male subjects were enrolled in this study. Arterial oxygen saturation [SpO[2]] of the subjects was measured by the pulse oximeter at rest and after 1 minute of voluntary hyperventilation at an altitude of 2833 meters. Symptoms of acute mountain sickness [AMS] were recorded on a questionnaire by using the Lake Louise consensus scoring system 24 hours after ascent to high altitude. Mean pre hyperventilation oxygen saturation [SpO[2]] was 94.07 + 0.26% whereas SpO2 after 01 minute of hyperventilation was 98.61 + 0.14% that was significantly increased [p<0.001]. The mean increase in percent oxygen saturation of hemoglobin after one minute of hyperventilation [hyperventilatory capacity] for the study group was 4.61 + 0.24% while the mean symptom score was 2.06 + 0.26. It was noted that 19 [35.2%] subjects did not develop AMS whereas 34[63.0%] subjects had mild AMS and only one subject developed moderate AMS. There was no case of severe AMS. The data reveals significant [P<0.01] association between hyperventilatory capacity and development of the symptoms of AMS [r= - 0.664]. It is evident that individuals with greater hyperventilatory capacity manifest less number of symptoms of mountain sickness. It is concluded that post hyperventilation increase in oxygen saturation at lower altitude may help to predict the susceptibility of subjects to develop high altitude sickness

Hypercholesterolemia and IHD two years experience at combined military hospital Multan

Hypercholesterolemia is a health risk, and a strong relationship between this and atherosclerosis has been established through epidemiological, experimental, and clinical trial data. We indented to reestablish this association in one of our local population. We followed 540 consecutive patients during two years period who were admitted to the medical units of combined military hospital Multan with ischemic heart disease [IHD]. Mean age of the patients was 48.39 +/- 0.61 years, mean cholesterol 214.61 +/- 1.69 mg/dl, mean high-density lipids [HDL] 50.13 +/- 1.05 mg/dl, mean low-density lipid [LDL] 154.53 +/- 2.27 mg/dl and mean triglycerides [TG] 172.81 +/- 3.63 mg/dl. Risk factors were recorded in 450 patients out of which hypertension was recorded in 120 [22.22%] patients, diabetes in 100 [18.51%] patients, family history of HID in 80[14.81%] patients while there were 150 smokers. There were 383[70.09%] male patients in whom the mean cholesterol was 213.32 +/- 2.26 mg/dl, mean LDL 151.39 +/- 2.79 mg/dl, mean HDL 49.16 +/- 1.00 mg/dl and mean triglycerides was 170.64 +/- 4.18 mg/dl. There were 157[29.10%] female patients in whom mean cholesterol was 222.94 +/- 5.07 mg/dl, mean LDL159.73 +/- 4.48 mg/dl, mean HDL 53.05 +/- 2.95 mg/dl and mean TG 178.81 +/- 8.33 mg/dl. 51[9.44%] patients [mean age 50.10 +/- 1.91] presented with acute myocardial infarction out which 43 were males and 8 females. Mean cholesterol in this group of patient was 221.36 +/- 3.70 mg/dl, mean LDL 155.17 +/- 3.28 mg/dl, mean HDL 52.09 +/- 1.22 mg/dl, mean TG 170.41 +/- 6.74 mg/dl. 22 [4.1%] patients [Mean age was 33.05 +/- 1.35] presented with unstable angina of which 13 were males and 9 females. In this group, mean cholesterol was 231.14 mg/dl, mean LDL 162.70 mg/dl, and mean HDL 42.86 mg/dl. It can be concluded from this study that hypercholesterolemia is associated with IHD and levels of cholesterol, low-density lipoproteins and triglycerides were higher than the desirable levels in our local population. Though the levels of the cardio protective HDL were also higher in our study group which was contrary to the common observation