Factors precipitating congestive heart failure--role of patient non-compliance.

OBJECTIVE: This study was aimed to identify systematically the precipitating factors causing decompensation of heart failure and subsequent hospitalisation. We specially assessed the role of patient non-compliance with therapy as an important precipitating factor for heart failure, since it has not been systematically studied previously in an Indian setting where rheumatic heart disease is common. METHODS: In this cross-sectional analytical study, 125 cases of congestive heart failure hospitalized in Government Medical College, Nagpur, were studied. All the patients were thoroughly evaluated and investigated to identify the precipitating factors for heart failure. A patient was categorized as being non-compliant with therapy if he/she was consuming less than 80% prescribed drugs (assessed by pill count) or was non-compliant with dietary advice (assessed by an interviewer-administered questionnaire). RESULTS: Rheumatic heart disease was the commonest underlying heart disease (52.8%) followed by ischemic and/or hypertensive heart disease (27.2%). The most common precipitating factor was patient non-compliance with diet or drug therapy (49.6%) followed by arrhythmias (16.8%), uncontrolled hypertension (14.4%), infective endocarditis (13.6%), anemia (14.4%) and infections (11.2%). CONCLUSION: The results emphasize the importance of patient non-compliance with prescribed therapy as a leading precipitating factor for congestive heart failure in an Indian setting, which can be prevented by appropriate cost-effective strategies aimed to improve patient compliance.

Efficacy of intravenous magnesium sulphate in supraventricular tachyarrhythmias.

This study was conducted to evaluate the clinical efficacy of intravenous (i.v.) magnesium sulphate 2 gm bolus in sustained supraventricular tachycardia (SVT) and atrial flutter-fibrillation with fast ventricular rate of more than 160/min (AF-FVR) and to compare it with i.v. verapamil 5 mg. In this randomised controlled trial, 68 cases of SVT and 86 cases of AF-FVR were studied. Patients with evidence of renal dysfunction and systolic blood pressure less then 90 mm Hg were excluded. Response was considered when the heart rate fell to less than 100/min. In SVT, 33.3% (11 out of 33) responded to magnesium sulphate which was significantly less than verapamil (23 out of 35, 65.7%) p = 0.007. Similarly, in AF-FVR, response was more with verapamil (25 out of 45, 55.6%) than magnesium sulphate (8 out of 41, 19.5%) p < 0.0001. Response to magnesium sulphate was better in patients with IHD. There were no significant side effects, except flushing and sense of warmth with i.v. magnesium sulphate. Serum magnesium rose significantly after i.v. magnesium bolus. Though magnesium sulphate is a weaker antiarrhythmic drug than verapamil, further studies are needed to identify subgroups of supraventricular tachyarrhythmias which would respond to magnesium sulphate.

Evaluation of QRS score as an index of infarct size and prognosis.

Present study comprises of 44 patients with Acute Myocardial Infarction. Their QRS score was correlated with Infarct Size by estimating the CPKMB levels and the post infarction complications during hospital stay. A statistically significant correlation was found between the 2 parameters of QRS score and infarct size (r = 0.75). It was better in anterior wall infarction (r = 0.96) than in inferior wall infarction (r = 0.64). The interobserver agreement between 2 observers for QRS score was excellent (rho = 0.99) QRS score was found to be a good prognostic indicator in the post infarction phase.