Frequency of Angiotensin Converting Enzyme Inhibitor [ACEI] induced cough

The objective was to assess the frequency of ACE inhibitor induced cough in our patients. The study was prospective open labeled one centre, in and out patients of cardiology department Sheikh Zayed Hospital, Lahore 2011. 200 patients using six different types of ACEI were used. Preference was given to patients to whom ACEI were prescribed for the first time. Patients with chronic respiratory diseases were excluded. Patients were follwed up on fortnightly basis for three months. On each visit besides recording their blood pressure, they were not specifically inquired about occurrence of any cough. Patients themselves came with the complaint of cough. The dry cough frequency with different ACEI was 17%, ranging from almost 20% with Enalopril, 16.6% with Captopril, 10% with Lissinopril and Ramipril, 15% with Qurinapril and Perindopril. The dry cough was moderate in the majority of our patients and they were not willing to continue their ACEI, although their blood pressure was well controlled with it. They were switched over to other group of anti hypertensive drugs. Incidence was almost same in males and females. ACEI have a relatively high frequency of dry cough and our patients don't want to take it if cough occurs

Frequency of clot in left atrium [LA] in patients of severe mitral stenosis [MS] with atrial fibrillation [AF]

To determine the frequency of clot in left atrium [LA] in patients suffering from tight mitral stenosis [MS] with atrial fibrillation. A cross-sectional descriptive type study at two centers was performed. A total of 50 adult patients with tight MS and AF were included. A 12 leads electrocardiography was performed once for each patients to look for AF after transthoracic echocardiography [TTE] and clinical examination features revealed tight MS. Patients with AF were selected and TTE was done to detect clot in LA. Tran esophageal echocardiography [TEE] was performed whenever clot could not be detected with TTE. Among 50 patients studied. There were 20 males and 30 females, TTE was done of all patients and LA clot were detected in 10 patients [20% of total] and TEE were performed in remaining 40 patients [80% of total] and additional 12 patients [24% of total] with clot in LA were detected. Therefore total of 44% of patients had LA clot. Among them 4% had clot in LA body and 40% had in LA appendage. LA dimension was found to be relevant [P value = 0.004] with the presence of clot in patients of severe MS with AF. LA spontaneous echo contrast [LASEC] was found in all patients. LA clot was present in 44% patients with tight MS and AF. Larger LA diameters is a strong predictor- of presence of LA clot in severe MS with AF