RESUMO
Background: Ischemic Heart Disease which encompasses Acute Coronary Syndrome and Chronic Stable Angina is the most common cause of worldwide mortality and morbidity. Carotid intima media thickness (CIMT) is a non-invasive ultrasonographic technique to image the carotid arteries which measures the thickness of the intima and media of these vessels. It is a marker of atherosclerotic process. Flow mediated dilatation (FMD) is a marker of endothelial function of arteries. Ischemic heart disease can be predicted long before its actual occurrence by observing these two phenomenons. Methods: This cross sectional study done in the Department of Cardiology, Dhaka Medical College Hospital during the period of Oct 2010- Sept 2011.We enrolled 102 patients admitted with IHD by purposive sampling. We assessed FMD of brachial artery, CIMT by vascular duplex. Coronary artery disease severity was assessed by vessel score, stenosis score and extent score from angiography. Results:The mean (±SD) age of the patients was 50.9(±11.3) years. The male- female ratio was 5:1. CIMT has significant negative correlation with FMD (r=-.407, p=<.001). Flow mediated dilatation of brachial artery has weak but significant negative co-relation with vessel score(r=-.609, p=<.001), stenosis score(r=- .493, p=<.001) and extent score (r=-.477, p=<.001). However, carotid intima media thickness has weak but positive correlation with vessel score (r=.447, p=<.001), stenosis score (r=.417, p=<.001) and extent score(r=.412, p=<.001). Conclusion: The present study concludes CIMT has significant negative correlation with flow mediated dilatation of brachial artery. FMD has weak but significant negative co-relation and CIMT has weak but positive correlation with vessel score, stenosis score and extent score of coronary arteries.
RESUMO
Background: The ECG diagnosis of acute posterior infarction has traditionally been based on the presence of ST segment depression on the pericardial chest leads. However, such ST segment depression is neither specific nor sensitive for the diagnosis of a posterior infarction. Detection of ST segment elevation in V7- V9 in 15 lead ECG can help in early diagnosis of acute Posterior myocardial infarction. Method: Total of 100 patients Inferior myocardial infarction was evaluated by Electrocardiography in standard 12 lead and 15 lead. The patients were categorized into group I having posterior/ and or associated changes and group II having without posterior changes in ECG. Echocardiography and LVgraphy was done to evaluate the posterior wall movement. Result: For diagnosis of posterior myocardial infarction, 43.3% sensitivity and 95.1% specificity was found in 12 lead ECG, whereas in 15 lead ECG it was 80.0% sensitivity and 95.1% specificity. Conclusion: 15 Lead ECGs (including V7-V9) more sensitive than 12 lead ECGs in diagnosis of acute posterior myocardial infarction. Patient with inferior myocardial infarction or anterior ischemia developed more complications if associated with acute posterior myocardial infarction. 15 lead ECGs can routinely be used in patients with ischaemic type of chest pain.