Utility of transradial coronary angioplasty in patients with chronic stable angina discharged on same day

To study the utility of Transradial Coronary Angioplasty in Patients with Chronic stable Angina discharged on same day. This was a single center observational study with prospective data collection of 228 patients underwent transradial coronary angioplasty from January to December 20JO, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina and were discharged on same day were included in the study, using purposive non-probability sampling technique. Patients with unstable angina and acute coronary syndrome who had to stay for more than one day, were excluded from the study. Patients were followed at one month of hospital discharge in out patients department and clinical outcome data was recorded. A total of 228 patients were included in the study. Male were 64.9% and 35.1% were female with mean age of 56 +/- 9years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; diabetic 46.4%, hypertensive 45.6%, smokers 32.8%, dyslipidemic were 47.8% and mean values of serum creatinin and Hemoglobin were 1.2 +/- 0.5 and 12.8_2.4, respectively. The frequency of various complications were as follow; mild hem atom a 1.7%, nausea and vomiting 1.3%, pain in hand 10.5%, readmission to hospital for chest pain 7.4%, need for revascularization 3%, hand ischemia 2.5%, minor bleeding 0.8%, and mortality was 1.3%. There was no access site major bleeding or hematoma. The radial artery approach for coronary angiopalsty is found to be very useful with low degree of access site vascular complications and an early patient mobilization

Effect of heart rate on hemodynamics in mitral stenosis

To assess the effect of heart rate [HR] on haemodynamic parameters in patients with Mitral Stenosis [MS]. The study was conducted at Cardiology department, Lady Reading Hospital, Peshawar from November 2010 to April 2011. Patients with MS, regardless of severity, were included. Patients with severe heart failure, other valvular or structural heart disease were excluded. Echocardiographic parameters were recorded at slow and fast HR. Patients with tachycardia were given beta-blockers and patients with bradycardia were given parenteral Atropine. A total of 60 patients were included, females were 57 [78%]. Mean age was 31 +/- 9 years. Mean slow and fast HR was 77 +/- 12bpm and110 +/- 13 bpm, respectively. Peak mitral valve gradient [PMVG] slow vs. fast HR was 12.8 +/- 4.80 and 14.93 +/- 7.18 mm Hg [p=0.000]. Mean mitral valve gradient [MMVG] at slow vs. fast HR was 6.62 +/- 3.29 and 8.15 +/- 4.88 mm of Hg [p=0.000]. E pulse Doppler [E] at slow vs. fast HR was 168 +/- 35 and 181 +/- 40 cm/s [p=0.013], while E tissue Doppler [E] velocity was 10.47 +/- 2.81 and 10.97 +/- 2.38 cm/s / [P=0.098], respectively. E/E ratio for slow and fast HR was 17 +/- 5.63 vs. 17 +/- 5.41 [P=0.792]. Right ventricular systolic pressure [RVSP] at slow vs. fast HR was44 +/- 16 vs.49 +/- 17.05mm of Hg [P=0.001]. The above parameters had insignificant change with the HR when there was accompanying more than mild MR. Slowing HR in patients with MS significantly decreased PMVG, MMVG and RVSP. LV function did not change significantly with HR. Rate control drugs may be used in preference to improve symptoms in moderate and severe MS

Radial artery approach for coronary intervention - early experience

To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52 +/- 7years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1 +/- 0.3 and 11.5 +/- 1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, readmission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization

Comparison of the efficacy and safety of thrombolytic therapy for st-elevation myocardial infarction in patients with and without diabetes mellitus

This study compared the efficacy and safety of streptokinase as thrombolytic agent for ST-elevation myocardial infarction [STEMI] in patients with and without diabetes mellitus. This prospective interventional study was carried out in the department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients admitted to coronary care unit with STEMI and eligible for thrombolytic therapy [no contraindications per AHA/ACC guidelines] were studied from December 2009 to December 2010. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution [reduction] of elevated ST segment was evaluated after 90 min of streptokinase administration. Comlications of streptokinase infusion including hypotension, shock and hemorrhage was noted. Failed reperfusion [<30% ST resolution] was significantly higher in diabetic as compared to non-diabetic patients [21.6% vs. 9.5%; p<0.0003] while successful reperfusion [>/= 70% ST-resolution] was significantly higher in non-diabetic than diabetic patients [66.7% vs. 49.1%; p<0.0001]. Complication rates between the two groups were statistically similar. Hypotension occurred in 45 [20.3%] and 51 [23%]; p=0.458 patients in non-diabetic and diabetic group respectively while shock occurred in 10 [4.5%] and 13 [5.9%]; p= 0.506 and hemorrhagic manifestations in 13 [5.9%] and 10 [4.5%]; p=0.294 patients respectively. The outcome of thrombolytic therapy is adversely affected by Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly the risk of hazards associated with thrombolytic therapy is same in both diabetic and non-diabetic patients

Efficacy and safety of percutaneous transvenous mitral commisurotomy [ptmc] performed through patent foramen ovale [pfo]

The aim of this study was to assess efficacy and safety of PTMC in patients with severe mitral stenosis [MS] perform through patent foramen ovale. All symptomatic patients with severe MS were included in the study from January 1998 to December 2010, at Cardiology department, Lady Reading Hospital, Peshawar. Transthoracic and trans-esophageal echocardiogram was performed to exclude left atrial appendage/left atrial clot and check the anatomy of interatrial septum. Severely calcified mitral valve and severe mitral regurgitation were excluded. Patent foramen ovale was crossed in majority of cases to reach left atrium. Stenosed mitral valve was dilated with Inoue balloon. Total number of patients was 1818. Females were 74% [p<0.05]. The mean age was 26.51 +/- 7.82 years and mean Body Mass Index [BMI] was 2 19.05 +/- 1.2kg/m[2]. The number of patients who had PTMC through PFO were 2 92.08%. Mean valve area was 0.9 +/- 0.19cm[2] on 2D Echocardiography, which 2 increased to 1.82 +/- 0.17cm[2] [p<0.05], mean mitral valve gradient decreased from 18 +/- 4.04mmHg to 7 +/- 0.25mmHg [p<0.005] and mean right ventricular systolic pressure decreased from 70 +/- 17.4mmHg to 48 +/- 13mmHg [32% drop] [p<0.05] at 24hours after PTMC. Mean time of crossing interatrial septum via PFO was 17 +/- 05minutes. Post PTMC severe MR in PFO group was 3.6% and 2.8% in inter atrial septum group [p=0.21]. Pericardial effusion was noted in 0.11% patients in PFO group and 0.27% in interatrial septum group [p>0.05]. Stroke was present in 1.5% patients. PTMC through patent foramen ovale [PFO] is a safe procedure, with few complications

Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia

To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >/= 144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences [SPSS Ver. 15.0]. A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +/- 9.748 [95% CI 57.39 - 55.31]. Male were 58.1% [n=198]. The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation [AF] 15.8%, ventricular tachycardia [VT] 11.7%, ventricular fibrillation [VF] 10.9% and complete heart block [CHB] 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema [CPE] 7.9% and cardiogenic shock [CS] 11.7%. Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively

Correlation of functional class of dyspnea with left ventricular diastolic dysfunction

To correlate functional class of dyspnea with left ventricular diastolic dysfunction assessed by echocardiography. This was a single center descriptive study, conducted in Cardiology department Lady Reading Hospital Peshawar from March 2011 to October 2011. All male and female patients of any age with clinical diagnosis of heart failure with sinus rhythm and no to minimal mitral regurgitation were included in the study, using consecutive non-probability sampling technique. Six minute walk test was performed to place the patients in proper NYHA Class of dyspnea. Detailed echocardiographic study was performed to document left ventricular diastolic dysfunction. The data was analyzed on SPSS version 16. Spearman rank correlation coefficient was used to measure the strength of association between pairs of variables. P-value

Short term effects of rosuvastatin on plasma concentration of high sensitivity c-reactive protein in patients with chronic stable angina

To determine the short term effects of rosuvastatin on elevated base line high-sensitivity C-reactive protein [hs-CRP] in patients with chronic stable angina. This Quasi-experimental comparative study was conducted in Cardiology department, Lady Reading Hospital Peshawar, between March 2010 and February, 2011. We selected 44 consecutive patients age 40 years or above, of any gender having hs-CRP levels >/= 1.2mg/l with chronic stable angina. Base line levels of hs-CRP, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and creatine phosphokinase [CPK] were measured in fasting status. These patients were treated with rosuvastatin 20 mg once daily at night and followed up for one month. Using SPSS version 16 data was analyzed. Mean age was 53 +/- 7.2 and 50% were females. Following treatment with rosuvastatin 20mg for one month the mean hs-CRP levels reduced from 4.08 +/- 2.56 to 2.72 +/- 2.40 [95%CI, 0.41 to 2.29, p=0.006]. Similarly mean total cholesterol levels decreased from 185.88 +/- 37.62 to 147.45 +/- 38.35, [p=0.0001]. LDL cholesterol decreased from 118.34 +/- 31.31 to 86.63 +/- 35.72 [p= 0.0001]. But mean HDL cholesterol had no significant increase from baseline levels i.e. from 32.18 +/- 9.93 to 33.95 +/- 7.65 [p=0.174]. TGs levels reduced from 240.11 +/- 123.66 to 197.43 +/- 88.24 [p=0.008]. Mean CPK levels did not differ significantly from base line at follow up, from 101.43 +/- 58.63 to 96.22 +/- 55.10 [p=0.646]. Short term treatment with rosuvastatin significantly decreases elevated hs-CRP levels in patients with chronic stable angina

Echocardiographic findings in hypertrophic obstructive cardiomyopathy [hocm]

To find out various Echocardiographic findings in patients with HOCM. This was a retrospective cross-sectional study performed in Cardiology department Lady Reading Hospital, Peshawar. Data collected from the database computer section of echocardiography department from February 2009 to November 2011.The data was analyzed using SPSS version 14. Total study population was 28. Male were 14 [50%]. Mean age was 52.5_ 15.9 years. Mean left ventricular end diastolic dimension was 3.84cm; inter-ventricular septal thickness 2cm [1.1-3.1] and posterior wall thickness was 1.17cm [0.6-1.6]. Mean Left atrial [LA] diameter was 3.86cm [0.8-5.6]. Mean peak gradient across LVOT was 48.43 mmHg. Mitral regurgitation [MR] was found in 19 [67.9%] patients. MR was mild in 57.1%, moderate in 7.1% and severe in 3.6% of patients. Aortic regurgitation [AR] was found in 13 [46.4%] patients. AR was mild in 35.7%, moderate in 10.7% of patients. Left atrial size was increased in 14 [50%] patients. Mean LA diameter was 4.6cm, 5cm and 5.6cm in patients with mild, moderate, and severe MR respectively. So there was direct relation between severity of MR and LA diameter. The respective mean gradient across LVOT in patients mild, moderate and severe MR was 31mmHg, 43.5mmHg and 140mmHg. So higher the gradient across LVOT, more will be the MR and hence the LA size and the patient will be more symptomatic. HOCM is significantly associated with both MR and AR and there is direct relation between severity of MR with LA diameter and LVOT gradient

Does anxiety and depression cause acute myocardial infarction?

To study the frequency of depression and anxiety in patients admitted with acute myocardial infarction [AMI]. Two hundred consecutive patients of AMI without complications presenting to the coronary care unit of Cardiology department of Lady Reading Hospital and 200 healthy controls among patient's attendants were interviewed with standard scales of HADS and HRS for the presence of depression from to date. Two hundred consecutive patients of AMI and 200 healthy controls among patient's relatives were assessed on HADS and HRS scale for the presence of depression. Sixty three percent of the patients were male in both groups. Mean age of patients was 59 +/- 11 years while that of controls was 52 +/- 10 years. Although significantly different between the two groups, age had no significant effect on the presence of depression in any group [p < 0.4]. A significant difference was noted in the number of events reported between patients of AMI and control group, 4.21 +/- versus 2.71+ respectively [p<0.001]. On Hospital Anxiety and Depression Scale [HADS] 77.5% of the acute MI patients had depression compared to 64% in the control group [p< 0.003]. When HADS was used to asses the level of anxiety and depression in the two groups, 83% of patients in the AMI group reported abnormal i.e. scores above 17 compared to 70% in the control group [p< 0.001]. Depression was more common in patients presenting with acute myocardial infarction as assessed by standard scales as compared to controls

Frequency of cardiovascular disease risk factors among doctors

To find out frequency of risk factors for cardiovascular disease amongst doctors. This was a cross-sectional study involving doctors [working at Lady Reading Hospital] recruited in Peshawar Heart Study [PHS]. All participants were interviewed in detail including present and past medical history, family history, smoking, drug and dietary history. Pulse, blood pressure, body mass index [BMI] and waist/hip ratio were measured. Random blood sugar and total cholesterol was checked. A supine resting ECG was recorded. Data was analyzed for frequency of cardiovascular risk factors using SPSS Version 16. A total of 208 doctors were interviewed. Mean age was 30.33 +/- 7.0 years. Mean BMI was 24.69 +/- 4.73.Mean waist size was 84.68 +/- 10.571cm. Mean waist/hip ratio was 0.86 +/- 0.068. Mean systolic BP was 121.82 +/- 13.70 mm Hg while mean diastolic BP was 78.89 +/- 09.36 mm Hg. Mean random blood cholesterol was 163.97 +/- 27.93 mg / dl. Mean random blood sugar was 95.79 +/- 24.57 mg /dl. Most [98.55%] of doctors had random blood sugar of less than 180 mg /dl. The big majority of the doctors was not performing any regular exercise [n=157, 75.5%]. Mean duty hours per day were 8.98 +/- 2.073.Active smokers were 39 [18.8%], while 9 [4.3%] were using Naswar. None of the doctors enrolled in study was drinking alcohol. Among modifiable risk factors hypercholesterolemia, diabetes, and hypertension were less frequent amongst doctors while physical inactivity, obesity, unhealthy eating, and smoking were relatively more frequent

How aware are the educators of cardiovascular risk factors?

The aim of this study was to know the frequency of CVD risk factors in teachers of Peshawar. Data for this study was derived from Peshawar Heart study [PHS]. PHS was conducted by Cardiology Department Postgraduate Medical Institute, Lady Reading Hospital, Peshawar to determine various cardiovascular risk factors like diabetes hypertension, hypercholesterolemia, obesity, physical inactivity etc. in various occupational groups of Peshawar. Data of 174 school teachers recruited in Peshawar Heart Study [PHS] was analyzed for the frequency of CVD risk factors. Their mean age was 42.95 +/- 8.29 years. Mean BMI was 26.11 +/- 4.53 Kg/m[2] and 35.05% [n=61] were overweight and 47.07% [n=83] were found to be obese. Mean systolic blood pressure was 131.2 +/- 18.16 mmHg and 33.33% [n=58] had systolic blood of >/= 140 mmHg. Mean diastolic blood pressure was 89.25 +/- 12.13 mmHg and 59.77% [104] had their diastolic pressure >/= 90 mmHg and 5.75% [n=10] were known hypertensive. Mean cholesterol was 168 mg/dl while 20.68% [n=36] had cholesterol of >/=180mg /dl. Out of 174 school teachers 4% [n=7] were known diabetic and 6.32% [n=11] had RBS of >/=140 mg/dl. CAD was found in 3.44% [n=6]. Family history of CAD was positive in 18.96% [n=33]. Fifty eight percent subjects admitted to regular exercise. ECGs were also analyzed and it was found that 2.88% [n=5] were having LVH, 1.75% [n=3] were having right bundle branch block [RBBB] and 2.88% [n=5] have changes of previous myocardial infarction. It was demonstrated in this study that CVD risk factors especially lack of exercise, obesity and hypertension were common in school teachers

Mitral regurgitation in patients with mitral valve prolapse

To determine the frequency, severity and gender distribution of mitral regurgitation [MR] in patients with mitral valve prolapse [MVP] and effect of severity of MR on the left heart chambers enlargement. Echocardiography reports of patients from June 2003 to July 2006 were retrospectively searched for presence of MVP from the computerized database of Cardiology department, Lady Reading Hospital Peshawar. Demographic details and findings of comprehensive echocardiographic examination, including M-mode echocardiography, 2-dimensional echocardiography, and conventional and color Doppler ultrasonography conducted by experienced echocardiographers were recorded. Out of 25,303 echocardiographic examinations performed in the period, 1073 [4.24%] patients had MVP with mean age of 26 + 14 years. Males were 585[54.52%] and females were 488[45.48%]. MR was found in 444/1073 [41.37%] patients of which 211 [47.53%] were males and 233 [52.47%] were females. Overall MVP was more common in males however MVP with MR was more common in females. In patients of MVP having MR, mild, moderate and severe MR was noted in 312[70.3%], 54 [12.2%] and 78 [17.5%] patients respectively. In patients with MVP having severe MR, the mean LV end diastolic diameter was 6.94+0.93 cm, mean LV end systolic diameter was 4.13+0.75 cm and mean left atrial diameter was 5.56+1.12 cm. With no significant changes in gender distribution of MVP, a high proportion of patients with MVP have associated MR. Severity of MR in patients with MVP had significant effect on enlargement of left heart chambers

Percutaneous transvenous mitral commissurotomy [PTMC] through patent foramen ovale [PFO] a novel approach

To evaluate the safety and efficacy of percutaneous transvenous mitral commissurotomy [PTMC] via patent foramen ovale [PFO] in patients with severe mitral stenosis [MS]. All patients underwent trans-thoracic and trans-esophageal echocardiogram before PTMC. Patent foramen ovale was probed with assembly pointing posteriorly, a little below aortic valve in lateral view. If access to the left atrium could not be gained, transeptal puncture with Bronkenbrough needle was performed and the rest of the PTMC performed with standard Inoue balloon. Out of 500 patients 370 [64%] were females and 130 [36%] were males. The mean age was 27.51 +/- 7.82 years. PFO was probed and crossed in 435/500 [87%] patients. All PFO's were crossed within 15 +/- 04 minutes of commencement of probing. Spending a longer time searching for PFO did not increase the yield. Mean valve area was 0.86 +/- 0.19 cm[2], which increased to 1.86 +/- 0.17 cm[2] immediately after PTMC [p <0.05]. The mean mitral valve gradient decreased from 17 +/- 4.04 mmHg to 6.8 + 0.25 mmHg immediately after PTMC [p <0.005]. No pericardial effusion/tamponade observed in PFO group. The time to cross mitral valve was significantly reduced while accessing through PFO as compared to interatrial septal puncture. PTMC performed via patent foramen ovale is safe. It associated reduces the time of the procedure and complications