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

Frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty

To determine the frequency of common modifiable risk factors in patients with myocardial damage undergoing single vessel coronary angioplasty. Descriptive study. Armed forces Institute of Cardiology / National institute of Heart Disease Rawalpindi from June 2012 to Nov 2013. Hundred patients undergoing elective single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before, after 8 hours and 24 hours following coronary angioplasty. The detailed performa was filled from each patient covering the necessary variables. Out of 100 patients 22% had raised creatinine kinase at 8 hours and 43% had raised creatinirie kinase after 24 hours following coronary angioplasty. Whereas 19% patients and 38% patients had raised creatinine kinase MB levels at 8 hours and 24 hours following the procedure respectively. No patient had rise of creatinine kinase or creatinine kinase MB more than 3 times of normal limits in the study. Among patients with raised CK-MB highest frequency was of diabetes mellitus, raised LDL levels, smoking and hypertension. Patients with raised CK-MB levels after 1[st] day of coronary angiography had diabetes mellitus [84%], raised LDL levels [79%], smoking [68%] and hypertension [58%]

Frequency of risk factors in male patients with acute coronary syndrome

To determine the frequency of risk factors in male patients presenting with acute coronary syndrome. Observational study. Armed Forces Institute of Cardiology and National Institution of Heart Diseases, Rawalpindi, from October 2007 to September 2008. Male patients with acute coronary syndrome were included in this study. Patients having angioplasty [PCI], coronary artery bypass surgery, chronic liver and kidney diseases were excluded. Presence of diabetes, smoking, hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease [CAD] and medication was hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease [CAD] and medication was documented. Blood pressure, ECG, cardiac enzymes, fasting blood glucose, lipid profile and echocardiography were done within 24 hours of admission. Body mass index and waist circumference were measured. Data was analysed using SPSS-15. a total of 135 male patients of ACS were studied having mean age of 54.26 +/- 11.60 years. Maximum number of patients aged between 51 to 60 years, [n= 41, 31.9%]. STEMI [ST-elevation myocardial infarction] was diagnosed in 96 [71.1%] patients, non-STEMI in 12 [8.9%] while 27 [20%] patients were having unstable angina. Smoking was documented in 60 [44%] patients, hypertension in 50 [37%], diabetes in 34 [25.2%] and a family history of premature CAD obese [BMI >/= 30]. Waist circumference > 90 cm was found in 86 [63.6%] subjects. Sixty four [47.4%] patients were active frequent combinations, observed in 24 [17.9%] subjects. Dyslipidemia, smoking, hypertension and diabetes were most frequent risk factors. Public awareness to control risk factors can reduce the prevalence of CAD

Outcome of radiofrequency catheter ablation as a non-pharmacological therapy for idiopathic ventricular tachycardia

To determine the outcome of Radiofrequency Catheter Ablation [RFCA] as a non-pharmacological curative therapy for idiopathic Ventricular Tachycardia [VT] and to identify procedure-related complications. Descriptive study. The Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from February 2001 to October 2008. Ninety eight consecutive patients with idiopathic VT, resistant to drug therapy, who underwent Electrophysiology Studies [EPS] radiofrequency catheter ablation were enrolled. Clinical and electrophysiological variables were recorded and a descriptive analysis was done. Out of the 98 patients, 79 were males [80.6%]. The mean age was 33.29 +/- 11.93 years. Modes of presentation were sustained VT, Repetitive Monomorphic VT [RMVT], Non-sustained VT [NSVT] and Ventricular Premature Beats [VPBs]. Right Ventricular Outflow Tract [RVOT] VT was found in 37 patients, 37 had Idiopathic Left Ventricular Tachycardia [ILVT], 20 had Left Ventricular Outflow Tract [LVOT] VT, and Inflow Right Ventricular Tachycardia [IRVT] was found in 7 patients. Other sites of origin of VT were infrequent. Eight patients had dual morphologies of VT. Atrioventricular Nodal Re-entry Tachycardia [AVNRT] was found in 8 patients. RFCA was successful in abolishing inducible VT in 88 patients. One patient developed complete AV block requiring a permanent pacemaker. Results of this study confirm a high degree of success and safety of radiofrequency catheter ablation as curative therapy for idiopathic ventricular tachycardia

Down syndrome clinical and cytogenetic analysis

To describe the clinical features and cytogenetic analysis of patients with Down syndrome [DS]. An observational study. The Departments of Paediatrics and Internal Medicine of Military Hospital, Rawalpindi [MH, RWP] from January 1998 to December 2001. Two hundred and ninety-five children <18 years of age clinically diagnosed as DS were included. The clinical presentation features, associated anomalies and maternal characteristics were noted. Out of 295, 170 boys and 125 girls had chromosomal findings consistent with the diagnosis of DS. The mean presentation age was 16.2 months while 49 [16.6%] children presented in the neonatal period and 124 [42%] in infancy. Mongoloid slant, epicanthal folds, hypertelorism, simian crease, flat nasal bridge, and microcephaly were observed in >60% of cases. Congenital heart disease was documented in 103 [34.9%] cases and ventricular septal defect was the commonest cardiac anomaly. The cytogenetic analysis revealed that 282 [95.6%] had trisomy 21, 11[3.7%] had translocation, and only 2[0.7%] were mosaic. The mean maternal age was 29.8 years. One hundred and sixty [56.7%] cases with trisomy 21 had maternal age> 35 years, whereas 9/11[81.8%] cases of translocation had maternal age < 35 years. The cytogenetic pattern of DS was similar to previously described series. Inadequate antenatal screening and scarce neonatal examination results in late presentation of DS. Majority of cases can be diagnosed on the clinical features of DS