Effect of sildenafil in primary pulmonary hypertension

Primary pulmonary hypertension is a disorder with limited treatment options and poor outcome. We demonstrated a beneficial role of sildenafil, a phosphodiesterase 5 inhibitor, in a patient with primary pulmonary hypertension. After the initiation of sildenafil the pulmonary artery pressure decreased from 40/20mmHg to 16/6mmHg, while mean pulmonary arterial systolic pressure decreased from 25mmHg to 10mmHg. Sildenafil has a beneficial effect in patients with primary pulmonary hypertension in improving the functional class and decreasing the pulmonary artery pressures

Echocardiogram: Screening for valvular heart disease in an out- patient clinic

Congenital and acquired Valvular heart diseases [VHD] remain a frequent cause of morbidity and mortality especially in the developing countries. It presents a diagnostic challenge in all age groups and often occurs in association with other types of heart diseases. Echocardiogram remains a gold standard for the diagnosis and periodic assessment of patients with VHD. Early recognition is important in the management of VHD. Therefore, this study was conducted to describe the pattern of various VHD in patients presenting at the National Institute of Cardiovascular Diseases [NICVD] Karachi, Pakistan. Among 525 patients studied we found 403 patients with Mitral Regurgitation [MR], 187 Tricuspid Regurgitation [TR], 182 Aortic Regurgitation [AR], 134 Mitral Stenosis [MS], 60 Aortic Stenosis [AS], 11 Pulmonic Stenosis [PS], 8 Tricuspid Stenosis [TS] and 8 Pulmonic Regurgitation [PR]. Combined mitral valve disease [both MS and MR] 90 [17.1%], combined aortic valve disease [both AS and AR] 50 [9.5%], mixed valvular heart disease i-e both aortic and mitral valves disease were 85 [16.2%]. Rheumatic heart disease [RHD] was present in 189 patients [36%] with mean age of 28.4 +/- 11.8 years

Can presence of multivessel disease be predicted on exercise tolerance test on the basis of exercise capacity

Despite the wide variability of sensitivity and specificity of exercise tolerance test [ETT], it still a useful tool for the evaluation of chest pain because of its simplicity and cost-effectiveness. However, data regarding prediction of severity of disease on the basis of ETT is limited. Therefore, we conducted a study to evaluate that whether we can predict the presence of multi-vessel coronary artery disease [CAD] on the basis of exercise capacity as judged by exercise tolerance test so that such patients can be offered early invasive studies. The mean age was 49.7 +/- 10.7 years, male to female ratio was 5.3:1 Abnormal ETT was found in 70 patients [58.3%] while 50 [41.7%] had normal ETT results. Angiographic evidence of normal coronaries was found in 20.8%, while single vessel CAD was found in 25.8% and multi-vessel CAD in 53.3%. The sensitivity, specificity and test accuracy of ETT in our study was 64.6%, 66.7% and 65%, respectively. Among abnormal ETT results, majority of those who exercised < 8.0 METS were found to have multi-vessel CAD on coronary angiogram vs those who were able to exercise for > 8, 0 METS p-value <0.02]. Thus, low exercise capacity in the presence of abnormal ETT response can predict the multi-vessel CAD. In conclusion, patients with poor exercise capacity of less than 8.0 METS should be subjected to early invasive approach. However, large-scale studies are needed to prove this hypothesis

Sensitivity and specificity of exercise tolerance test in patients with chest pain and normal baseline electrocardiogram

Inspite of wide variability of sensitivity and specificity of exercise tolerance test [ETT], this test still is useful for the evaluation of chest pain because of its simplicity and cost-effectiveness. Therefore, we conducted a study to evaluate the sensitivity and specificity of ETT in our population as wells as to risk stratify these patients. A total of 120 patients were included in this study. The mean age was 49.7 +/- 10.7 years, male to female ratio was 5.3: 1.0. Abnormal exercise tolerance test [ETT] was found in 70 patients [58.3%] while 50 [41.7%] had normal ETT results. Angiographic evidence of normal coronaries was found in 20.8%, while single vessel coronary artery disease [CAD] was found in 25.8% and multi-vessel CAD in 53.3%. The sensitivity, specificity and test accuracy of ETT in our study was 64.6%, 66.7% and 65%, respectively. Age > 50 years, hypertension, diabetes mellitus, hypercholestrolemia and family history of premature ischemic heart disease [IHD] were the significant risk factors for the development of CAD [p-values = 0.001, 0.011, 0.021, 0.011 and 0.001, respectively]