Atypical chest pain in soldiers serving in hard areas: a cardiovascular and psychodiagnostic assessment

Objective: To assess the relationship between psychological illnesses and atypical chest pain in reported cases of soldiers serving in hard areas

Study Design: A cross-sectional study

Place and Duration of Study: Armed Forces Institute of Cardiology [AFIC] and National Institute of Heart Diseases [NIHD] Rawalpindi from Nov 2012 to Oct 2013

Patients and Methods: Forty patients through non-probability convenience sampling were studied with complaints of chest pain besides no evidence of heart disease once assessed by ECHO, computerized tomography [CT] Angio, Thallium Scan and echocardiography [ECG], they were subjected to psychometric assessment

Results: Out of 40 patients 72.5% [n=29] were found to have psychiatric illnesses including, depressive disorder [n=26], adjustment disorder [n=2], and malingering [n=1]. Of these 29 patients, 42.5% [n=17] appeared with mild [acute] symptoms of depression and 15% [n=6.6] with moderate and severe depression respectively

Conclusion: Psychiatric illnesses mostly go unrecognized and in order to over come the current stressor generally an individual tries to display it in socially acceptable organic disorders to avoid stigmatization

Association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hyperten

Objective: To determine the association of ventricular late potentials with left ventricular hypertrophy in patients with systemic arterial hypertension

Study Design: Cohort retrospective study

Place and Duration of Study: Department of Cardiac Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi from 11[th] Nov, 2014 to 10[th] Nov, 2015

Material and Methods: Sixty four patients with systemic arterial hypertension were divided into two equal groups on the basis of left ventricular hypertrophy. Patients with acute or old myocardial infarction, diabetes mellitus, cerebrovascular accident, heart failure, structural heart disease, bundle branch block and cardiomyopathies were excluded from the study. DMS 300 4L Holter monitors were used to obtain 3 channel signal averaged ECG recording. CardioScan premium luxury software was used for analysis of ventricular late potentials

Results: There were 49 [76.6%] males and 15 females [23.4%] with the mean age of 60 +/- 11.83 years. Ventricular late potentials were revealed in 10 [31.3%] out of 32 patients with left ventricular hypertrophy whereas in patients without hypertrophy only 1 [3.1%] patient showed it. Ventricular late potentials were strongly associated with left ventricular hypertrophy [p-value=0.03] and the relative risk of developing ventricular late potentials was 10 times higher in patients with left ventricular hypertrophy as compared to those without left ventricular hypertrophy

Conclusion: Ventricular late potentials were strongly associated with left ventricular hypertrophy

Arrhythmogenesis in mitral valve prolapse; risk stratification - role of high resolution ECG, Holter monitoring and Mitral leaflet geometry

Mitral valve prolapse is generally considered a benign condition, however, a subset of patients remains at high risk of arrhythmogenesis which may lead to sudden cardiac death. To stratify risk of arrhythmogenesis in patients with mitral valve prolapse on the basis of high resolution ECG, Holter monitoring, resting heart rate and mitral leaflet geometry. Cross sectional comparative study. Armed Forces Institute of Cardiology [AFIC]/National Institute of Heart Diseases, Rawalpindi and Army Medical College, Rawalpindi, Pakistan Mitral leaflet displacement and thickness were measured on echocardiography in 37 patients with mitral valve prolapse. Resting heart rate and time domain indices of heart rate variability of each patient were recorded from 24 hours Holter monitoring. High resolution ECG of all the patients was carried out to record ventricular late potentials. Statistical analysis was performed using SPSS and the alpha value was set at <0.05 for significance. The mean values for resting heart rate, leaflet displacement and leaflet thickness were 77.19 +/- 6.29 per minute, 3.64 +/- 0.92 mm and 4.96 +/- 0.79 mm respectively. Ventricular late potentials were present in 8 [21.62%] whereas heart rate variability was reduced in 5 [13.51%] patients. Leaflet thickness was significantly greater in patients with ventricular late potentials as compared to those without [p-value 0.004]. Patients with reduced heart rate variability had significantly higher resting heart rate as compared to those with normal variability [p-value 0.02]. One patient [2.7%] had ventricular late potentials, reduced heart rate variability, resting heat rate of 88 beats per minute and leaflet thickness over 5 mm. Combined effects of high resolution ECG, holter monitoring and leaflet geometry identified the high risk subset, comprising of 2.7% of the study population

Association of ventricular late potentials with mitral regurgitation in patients with mitral valve prolapse

To determine association of ventricular late potentials with mitral valve regurgitation in patients with mitral valve prolapse. Descriptive cross sectional study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2006 to February 2007. Thirty Seven Patients with confirmed diagnosis of mitral valve prolapse on 2 dimensional echo echocardiography were selected for the study. Patients having myocardial infarction, ischemic heart disease, hypertension and diabetes mellitus were excluded. Signal Averaged ECG of every patient was recorded using 1200 EPX High Resolution Electrocardiograph and was analyzed for the presence or otherwise of ventricular late potentials. Male to female ratio of study patients was 23:14 with mean age of 26.27 +/- 6.18 years. Twelve patients out of 37 had mitral valve regurgitation. Out of these, 8 [67%] patients had ventricular late potentials on signal averaged ECG. Only 1 [4%] patient without mitral valve regurgitation showed ventricular late potentials. Association between ventricular late potentials and mitral regurgtation was found statistically significant [p = 0.001]. Ventricular late potentials are hghly associated with mitral valve regurgitation in patients with mitral valve prolapse. These can act as noninvasive predictors of ventricular tachyarrhythmias and sudden cardiac death in these patients

Screening of High Risk Patients with Mitral Valve Prolapse - Role of Heart Rate Variability

To screen out patients with Mitral Valve Prolapse at high risk of ventricular arrhythmogenesis, based upon Heart Rate Variability. Department of Cardiac Electrophysiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi from May 2007 to March 2008. This cross sectional study included 37 patients with mitral valve prolapse. Patients with acute or old myocardial infarction, diabetes mellitus, ischemic heart disease and systemic hypertension were excluded. Patients were holtered for 24 hours and time domain analysis of heart rate variability was carried out. Statistical time domain measures of heart rate variability i.e. SDNN, SDANN and RMSSD were calculated. Descriptive statistics were used to calculate frequencies and percentages of categorical variables using SPSS version 22. Mean values of SDNN, SDANN and RMSSD were 141.62 +/- 30.80, 125.16 +/- 25.58 and 28.40 +/- 8.06 milliseconds respectively. Two patients [5.40%] had reduced HRV in all the three indices. In one patient [2.70%] values of SDNN and SDANN were reduced whereas in another one patient [2.70%] the values of SDNN and RMSSD were reduced. In remaining one patient only SDNN was found to be reduced. There is a subset of patients with mitral valve prolapse with reduced heart rate variability which may be at risk of ventricular arrhythmogenesis

Impact of Functional Class of Heart Failure on Severity of Ventricular Arrhythmia

To study the impact offunctional class of heart failure [NYHA] on the severity of ventricular arrhythmias in patients with heart failurebased upon 48 hours ambulatory ECG [Holter] recordings. Descriptive cross sectional study. Study was conducted at Armed Forces Institute of Cardiology/Nationallnstitute of Heart Diseases, from April2013 to August 2013. A descriptive cross sectional study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from April 2013 to August 2013. In 53 heart failure patients' detailed history and 2 dimensional echocardiography were recordedto assess the functional class and left ventricular ejection fraction. Patients were then subjected to 48-hour Holter monitoring using ambulatory [Holter] electrocardiography recorders. Digital ECG data was acquired and manually edited. Arrhythmias were analyzed for frequency, type and severity. Statistical analysis was done to determine associations between arrhythmia severity and NYHA class of heart failure. Male: female ratio was 3.4: 1with mean age of 60 years. Mean ejection fraction was 21.69% and 86% patients had NYHAclass Ill and IV. 57% of these patients also had severe cardiac arrhythmias. Prevalence and severity of arrhythmias in heart failure is dependent upon degree of ventricular dysfunction and presenting NYHA functional class.There is a significantly higher prevalence of severe ventriculararrhythmias amongst patients with reduced ejection fraction and advanced NYHA functional class

Types and frequency of cardiac arrhythmias in patients with heart failure

To determine the types and frequency of cardiac arrhythmias in patients with heart failure based on 48 hours ambulatory ECG recordings. Cross sectional descriptive study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from April 2013 to August 2013. Fifty three heart failure patients with ejection fraction of

Detection of congenital heart disease by fetal echocardiography

The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Validation study. This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology [AFIC] Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. There were 207 [90.4%] true negative cases, 15 [6.6%] true positive, 2 [0.9%] false positive and 6 [2.2%] false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus

Impact of Diabetes on heart rate variability in patients with acute myocardial infarction

Diabetes is a well-known cause of sudden mortality. Due to autonomic imbalance, those patients who are suffering from ischemic heart disease and diabetes concurrently are at a greater risk of manifesting arrhythmias. Heart rate variability [HRV] can be utilised for assessment of autonomic nervous system. The purpose of this study was to identify the values of HRV in diabetic and non-diabetic patients with acute myocardial infarction [AMI]. This noninterventional descriptive study was carried out at Armed Forces Institute of Cardiology over a period of 6 months. A total of 50 healthy volunteers and 50 patients with myocardial infarction [MI] were Holter monitored for 24 hours and HRV was analysed in time and frequency domains. The time domain indices; SDNN [non diabetics=78 +/- 30 ms vs diabetics=58 +/- 20 ms; p=0.01], SDANN [non diabetics=68 +/- 28 ms vs diabetics=49 +/- 19 ms; p=0.23], SDNNi [non diabetics=36 +/- 13 ms vs diabetics=26 +/- 14 ms; p=0.02], RMSSD [non diabetics=29 +/- 11 ms vs diabetics=23 +/- 15 ms; p=0.16] and pNN50 [non diabetics=7 +/- 10 ms vs diabetics=4 +/- 12 ms; p=0.43] were declined in diabetic patients with acute myocardial infarction when compared with non diabetic patients inflicted with infarction. Frequency domain indices, Total power [non diabetics=1479 +/- 12 ms[2] vs diabetics=759 +/- 6 ms[2], p=0.01], VLF [non diabetics=997 +/- 9 ms[2] vs diabetics=495 +/- 5 ms[2], p=0.04], LF [non diabetics=292 +/- 2 ms[2] vs diabetics=123 +/- 1 ms[2], p=0.01] and HF [non diabetics=121 +/- 1 ms[2] vs diabetics=54 +/- 5 ms[2], p=0.01] showed attenuated HRV in diabetic patients with acute myocardial infarction. Comparison of diabetic and non diabetic infracted patients with healthy volunteers revealed decreased HRV in patients with myocardial infarction but gets even worse in diabetic patients with myocardial infarction. Heart rate variability is attenuated in diabetic patients with acute myocardial infarction. It reflects sympatho-vagal imbalance in coronary patients with co-existent diabetes mellitus

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