Frequency of depression in patients with chronic heart failure

Heart failure is a prevalent debilitating disease of poor prognosis in which heart cannot fill with or eject the sufficient amount of blood that is required due to structural or functional cardiac disorder. Depression is 4-5 times as common in heart failure [HF] patients as in the general population, and it might confer a higher risk of developing HF and negatively affect prognosis in established HF. To determine the frequency of depression among patients presenting with chronic heart failure. This descriptive cross sectional study was conducted in cardiology department Hayat Abad Medical Complex Peshawar from November 2011 to April 2012. In this study a total of 121 patients were observed by using 13% proportion of depression in heart failure, 95% confidence level and 6% margin of error, under WHO software for sample size determination. Mean age was 55 +/- 1.26 years. Sixty-eight percent patients were male and 32% were female. Fifteen percent patients had chronic heart failure for less than 1 year, 37% had chronic heart failure for 2-3 years and 48% patients had chronic heart failure for 3-4 years. Seventy percent patients had HADS score <11 and 30% had HADS scored of >11. Thirty percent patients had depression in chronic heart failure while 70% did not have depression in heart failure. Depression is common among CHF patients. Severe depression is more frequent than mild depression.

Can computerized tomographic angiography be used to triage patients with chest pain presenting to the emergency department?

To confirm the findings of Computerized Tomography Angiography by invasive angiography. This comparative study on 50 patients fulfilling the inclusion criteria were admitted in cardiology ward. Then they were shifted to catheterization lab of Lady Reading Hospital Peshawar for invasive angiography and segmental analysis of all four vessels i.e. right coronary, left coronary circumflex and left anterior descending artery was done. A total of 50 patients were studied both with CT angio and invasive angio and 750 segments were analyzed for the 4 main arteries that is LMS, LAD, RCA and Circumflex. The sensitivity of CT angiography for the LMS was 87.5%, Specificity 100%, PPV 100% and NPV 97.6%, PPV was 100% and NPV was also 100%. Similarly the diagnostic accuracy of CT angiography for the circumflex was sensitivity 100%, PPV 100% and NPV 97.91 to 100%. For RCA the sensitivity was from 60 to 100%, specificity 100%, PPV 100% and NPV 95 to 100%. Coronary CT angio with the highest resolution scanners could be a suitable means for rapid triage of patients presenting to emergency departments with chest pain and for evaluation of patients with equivocal stress test results who might otherwise need invasive angiography

An audit of the complications of dual and single chamber pacemaker in adult patients followed over a period of one year

To determine the frequency of dual and single chamber pacemaker complications in adults. This study was conducted in 151 pacemaker implanted patients and they were followed every month for 1 year, for evaluation /programming of pacemaker function and examining for device related complications. Out of 151 patients with pacemaker, 111[73.5%] patients received single chamber pacemaker and 40[26.5%] patients were implanted with dual chamber pacemakers. In one year follow up 21[13.9%] patients developed different complications while 130 patients had uneventful follow up. The different complications seen were infection 9[6%] patients, lead displacement 4[2.6%] patients, heart failure 3[2.0%] patients, Pacemaker syndrome, lead fracture, diaphragmatic twitching, pocket hematoma and keloid formation at scar site was noted in 1[0.7%] patient each. As a whole complications in single chamber was 73.5% compared to patient with dual chamber pacemaker which was 26.5%.The rate of complications associated with PPM is not significant, but the rate of complications were more in single chamber pacemaker compared to dual chamber pacemaker. Infection was the major complication seen

Prevalence of hyperlipidemia in obese and non obese coronary artery disease patients

To determine the prevalence of hyperlipidemia in obese and non-obese patients with diagnosed coronary artery disease. This hospital based descriptive study was conducted in Cardiology Department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from 15[th] March 2005 to 30[th] May 2006. A total of 200 patients with diagnosed coronary artery disease were enrolled, 100 were classified as obese and 100 as non-obese. There were 139 males and 61 females in total 200 CAD patients. Serum triglycerides level was 184 +/- 82 in obese patients and 158 +/- 68 in non-obese patients [p = 0.015]. Serum cholesterol level was 208 +/- 61 in obese and 180 +/- 67 in non obese [p = 0.001]. Serum HDL level was significantly more in non obese [48 +/- 36] as compared to obese [37 +/- 8] [p =0.005]. Serum LDL was more [157 +/- 49] in obese as compared to [148 +/- 44] in non obese but with no statistical difference [p =0.156]. Obese CAD patients had significantly had higher levels of triglycerides, total cholesterol with lower HDL levels as compared to non obese CAD patients

Pattern of coronary artery disease with no risk factors under age 35 years

Coronary artery disease [CAD] is no more deemed to be an ailment of the 4[th] or 5[th] decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors. This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography. Out of a total of 104 patients, 85 [81.73%] patients were men, and 19 [18.27%] were women. The mean age of the whole group was 32.66 +/- 3.237 [22-35] years. Significant CAD [>50% diameter narrowing of at least one major coronary artery] was found in 87 [83.7%] patients while 17 [16.3%] patients had non-atherosclerotic coronary artery disease, including 12 [11.53%] patients having normal coronary arteries, 1 [1%] patient had anomalous origin of right coronary artery [RCA], 1 [1%] patient had coronary arteritis, 2 [1.92%] patients had coronary artery ectasia, and 1 [1%] patient had a myocardial bridge over left anterior descending artery [LAD]. Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 [51.9%], 22 [21.2%] and 11 [10.6%] respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient [1%] had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions. In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with

Comparison of effect of locally available brands of clopidogrel on platelet aggregation in patients with coronary artery disease

Anticoagulant effect of clopidogrel is of utmost importance in coronary artery disease, especially in prevention of coronary stent thrombosis. Recently, many new local brands of clopidogrel have been launched, with unknown efficacy. This study was conducted with the aim to compare two locally prepared clopidogrel brands, in terms of the effect of a loading dose of 600 mg on inhibition of platelet aggregation in patients with coronary artery disease. This was a double blind randomised study. Sample population consisting of 35 patients, were admitted at Lady Reading Hospital, Peshawar, for the management of coronary artery disease. Baseline platelet aggregation of all these patients was measured. These patients were divided in two groups randomly. Group-A consisting of 18 patients was given brand 'A' clopidogrel 600 mg, while Group-B consisting of 17 patients was give brand 'B' of clopidogrel 600 mg. The platelet aggregation of both groups was then measured at baseline, and at 2, 4, and 6 hours after taking the loading dose of 600 mg. Platelet aggregation time at baseline in Group-A was 2.61 +/- 2.28 sec. and in Group-B it was 2.24 +/- 1.52 sec. [p=0.57]. After 2 hours of clopidogrel administration in Group-A the platelet aggregation time was 1.44 +/- 1.58 sec. and in Group-B it was 1.53 +/- 1.107 sec. [p=0.85]. Platelet aggregation time after 4 hours in Group-A was 0.28 +/- 0.57 sec. and in Group-B 1.06 +/- 1.03 sec. [p=0.009], and after 6 hours it was 0.00 +/- 0.00 sec. in Group-A and in Group-B it was 0.59 +/- 0.71 sec. [p=0.001]. The two brands of clopidogrel had a significant difference in their effect on inhibition of platelet aggregation. Different brands of clopidogrel may not be equally effective

Frequency and predictors of renal artery stenosis in patients with coronary artery disease

Renal artery stenosis [RAS] is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease [CAD]. A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Forty-one of the patients were female [20.4%]; ninety patients were hypertensive [44.8%]; 49 patients [24.4%] were smokers; 19 patients [9.5%] had renal insufficiency; 88 patients [43.8%] had high cholesterol levels; 44 patients [21.9%] were diabetic. Thirty-two patients [15.9%] had single coronary artery disease, 59 patients [29.4%] had two vessel disease, and 110 patients [54.7%] had three vessel disease. Significant renal artery stenosis [>/= 0.50% stenosis] was present in 26 patients [12.9%]. Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis [24.39% vs 10.0%, p=0.01]. The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD

Radiofrequency catheter ablation for supraventricular tachycardias: experience at Peshawar

Drug therapy is mostly employed in the management of supraventricular tachycardias [SVTs]. However, radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of SVTs. The current study is aimed at sharing our experience of 320 patients who presented with SVTs, and were treated with radiofrequency catheter ablation. This descriptive study was carried out in the Cardiac Electrophysiology Laboratory of Lady Reading Hospital, Peshawar from October 2006 to December 2009. Standard 4-wire electrophysiological study was carried out to identify the mechanism of SVT in 320 consecutive patients. Radiofrequency catheter ablation was used to interrupt the tachycardia circuit. Out of a total 320 patients who underwent electrophysiologic study, 168 were found to have atrioventricular nodal re-entry as underlying mechanism; 121 patients were having accessory pathway responsible for re-entry [of these 95 presented with orthodromic reciprocating tachycardia and 26 as antidromic reciprocating tachycardia]; 19 patients were having focal atrial tachycardia, 4 atrial fibrillation and 8 atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success of 94% and a complication risk of complete AV block in 0.3% and recurrence rate of 3%. Radiofrequency catheter ablation is safe and highly effective mode of treatment of SVTs

Patterns of presentation of chronic ischemic heart disease with and without previous myocardial infarction

The prevalence of Ischemic Heart Disease [IHD] is on the rise, from increasing lifespan of population and availability of better medical facilities. We studied chronic IHD cases with and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate left ventricular [LV] dysfunction, wall motion abnormalities and complications of IHD. All patients presenting with history of chest pain in Medical 'C' Unit, Ayub Teaching Hospital, Abbottabad from June 2004 to May 2005 were included in the study. Patients with non-cardiac chest pain were excluded from the study. Cases with congenital and rheumatic heart disease, cardiomyopathies, unstable angina and acute MI were excluded. Patients with IHD with or without myocardial infarction [MI] were studied for left ventricular dysfunction [ejection fraction, left atrial size, E/A ratio], wall motion abnormalities and complications of IHD [Mitral regurgitation, Ventricular Septal Defect [VSD], LV aneurysm, LV clot]. Clinical and echocardiographic evaluation was done in each case. Out of 183 cases of chronic IHD, 123 patients were without previous MI and 60 had had previous MI. Ejection fraction [EF] was 45% +/- 15 in the group without MI and 35 +/- 11% in cases with MI. Left Atrium [LA] size was 35 +/- 6 mm and 39 +/- 4 mm in the two groups respectively. LV diastolic dysfunction was seen in 17% in the first and 24% in the second group respectively. Global hypokinesia was seen in 8% and 17% in the 2 groups respectively. Regional Wall Motion Abnormality [RWMA] was observed in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation was seen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in 8.4, 5, and 6.5% respectively, only in cases with previous MI. LV dysfunction, wall motion abnormalities and mitral regurgitation were more common in IHD cases with previous heart attack

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

Flutter wave polarity on surface ECG and endocaridal activation in typical counter clockwise atrial flutter

To analyse the endocardial activation of typical counter clock wise atrial flutter [CCW]. A retrospective study of 24 cases admitted over a period of 5 years for atrial flutter ablation at St. Georges Hospital, London. The electrophysiological study were reviewed from optical disc and right atrial activation analysed in all cases of typical CCW atrial flutter. In all the 24 cases of typical CCW atrial flutter the right atrial activation is in upward direction along the septum and downward along the right atrial lateral wall, the inferior leads on ECG represent it as "F" waves. In CCW atrial flutter the negative flutter wave in inferior leads represent lateral and anterior right atrial activation while descending limb represents septal activation

prevalence study of congenital heart disease in NWFP, Pakistan

To assess the frequency of congenital heart disease in patient referred for the echocardiography. This echocardiographic study focused on findings of congenital heart disease in unselected subjects referred for echocardiography. This study was conducted in a private cardiac diagnostic facility in Peshawar, NWFP, Pakistan between July 2000 to June 2001. Patients and Method: Patients referred for echocardiography were studied. Standard echocardiographic 2 doppler studies were done on all cases while TEE was not used in any case. Twenty three hundred and seventy four patients were studied in 12 months period. Three hundred and ninety eight cases of congenital heart disease were found, forming 16.76% of total VSD 45, ASD 14, PS 14, TOF 9.5 and PDA were found in 9.7 percent cases respectively. Congenital heart disease contributes significantly to the overall burden of cardiovascular diseases