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Background:Coronary Artery Disease being the leading cause of death in patients with Type 2 Diabetes Mellitus often may remain asymptomatic due to silent Myocardial ischemia. People suffering from diabetes mellitus have 2-4 times higher risk of developing coronary artery disease. In such patients periodical clinical examinations and resting ECG may not detect the impending coronary artery disease. Therefore, we analysed the diagnostic utility of Treadmill Test in predicting Silent cases of Myocardial Ischemia. Methods: Our study was conducted as an Observational study over a period of 1.5 years including 50 patients of Type 2 Diabetes Mellitus. This study was conducted at a tertiary care centre of Western Uttar Pradesh. Results: The results of Treadmill test demonstrated that amongst the studied cases of Type 2 diabetes mellitusapproximately one-third of the cases showed positive association whereas the rest were negative. These positive TMT cases were associated with longer duration of Type 2 Diabetes Mellitus. In this study we also evaluated possible association between Autonomic Dysfunction with Positive Treadmill Test. Conclusion: Our study concluded that Screening for Coronary Artery Disease should be done in all Type 2 Diabetes Mellitus patients with prolong duration of Diabetes and with Autonomic Neuropathy. As it will lead to early detection of Coronary Artery Disease and its management will reduce the morbidity and mortality due to the same.
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Background: The electrocardiography (ECG) is considered as a fundamental tool in identifying the location and managing the symptoms of acute myocardial infarction. The aim of the present study is to study different ECG patterns according to the vessel involved and then it is correlated with the angiographic findings. Methods: It is a prospective and observational study conducted on 50 patients suffering from myocardial infarction with elevated ST segment in ECG who subsequently underwent coronary angiography. Based on the various ECG criteria the vessel involved was recognized and then correlated with angiographic findings. The sensitivity and specificity of individual parameters were calculated. Results: The present study demonstrated that ST depression in inferior leads >1mm had maximum sensitivity and specificity in localizing the position of occlusion proximal to S1. Presence of Q wave in aVL had maximum sensitivity and ST depression in the inferior leads showed extreme specificity in patients with occlusion proximal to D1. Presence of Q wave in V4-V6 had 95% specificity and Absence of inferior ST depression presented 89% sensitivity in patients with occlusion in distal S1. Presence of ST depression in aVL showed 98% specificity in patients with distal D1 occlusion. In patients with right coronary artery, ST elevation in LIII>ST elevation in LII and in case of left circumflex occlusion, ST ↑elevation in LII > LIII is the parameter with highest sensitivity and specificity. Conclusion: The ECG in patients with ST elevation myocardial infarction is important not only for defining which patient should receive early reperfusion treatment, but also for deciding the site and degree of acute myocardial injury.
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Background: Telmisartan, an angiotensin II receptor blocker, has a higher affinity for AT1 receptors. It has also been recognized as partial agonist of the nuclear hormone receptor PPAR-gamma. The present study is conducted to study the effect of telmisartan on various metabolic parameters in hypertensive patients who have satisfied the standards of metabolic syndrome. Methods: This is a prospective and randomised study done on twenty hypertensive patients suffering from metabolic syndrome. All the patients underwent following investigations like Fasting plasma glucose, post prandial plasma glucose, HbA1c levels, lipid profile including total triglyceride, LDL, total cholesterol and HDL, C-peptide level, blood pressure, body mass index and weight were also measured. All the patients were recommended 40 mg of telmisartan orally every day. The above mentioned investigations were repeated after 4 months. Data was tabulated and compared with the previous readings by using paired t- test and P value < 0.05 was considered significant. Results: The change in both weight and body mass index is statistically insignificant. All the three haemodynamic parameters (SBP, DBP, MAP) showed significant decrease after intake of 40 mg telmisartan for four months. All the parameters (Total cholesterol, LDL, Triglycerides) of lipid profile of the patients except HDL demonstrated decrease in value. Regarding glucose metabolism, fasting c- peptide level, glycosylated haemoglobin concentration showed no difference in the value, whereas both fasting and post prandial blood glucose decreased significantly. Conclusion: The present study proves that telmisartan has agonistic and modulating action on PPAR Gamma receptor and is thus associated with lipid and glucose metabolism.