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Introduction Acute myocardial infarction (AMI) is a devastating medical emergency that requires immediate pharmacological and radiological intervention. With the advent of techniques such as percutaneous coronary intervention (PCI), pacemakers, and percussion pacing, survival rates have improved significantly. However, there are certain factors and complications associated with AMI that still lead to a high mortality rate, such as old age, advanced heart disease, diabetes mellitus (DM), and arrhythmias. Factors such as the type of arrhythmia, the heart rate, and the level at which dissociation occurs between atrial and ventricular rhythm all influence mortality and morbidity rates. Outcomes are further influenced by the sex of the patient, the type of AMI [ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)], history of smoking, arrival times at the hospital, presence of hyperglycemia, previous history of cardiac surgery, and the need for a temporary pacemaker or a permanent pacemaker. As with most scientific studies, local data from Pakistan is hard to find on this topic as well. With this study, we hope to contribute valuable information and updates to the study of a developing problem from the developing world. Objective We aimed to analyze the frequency and outcomes of different types of arrhythmia in AMI. Methods This study involved a retrospective observational cohort. It was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2019 to July 2019 (six months). All data were retrieved from the online database at the NICVD. Written consent was obtained from all patients. Patient confidentiality was ensured at all times. Results A total of 500 patients were included in the study. The mean age of our cohort was 56.17 ±14.01 years. NSTEMI was more prevalent than STEMI. Sinus arrhythmia (SA) was the most frequently recorded arrhythmia and had the best survival rates. Atrioventricular (AV) nodal blocks and ventricular tachycardia (VT) had the worst outcomes. The overall mortality rate was 11.4%, and the mean in-hospital length of stay was 2.07 ±1.54 days. Smoking increased mortality in all cases. Conclusions AMI is complicated by several types of arrhythmia. SA is the most common arrhythmia in AMI. Mortality in AMI is largely due to AV nodal blocks and VT. Smoking increases mortality in all cases.
RESUMO
Background Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the most commonly prescribed medications in cardiac patients. Just like any other class of drugs, they have the potential to cause liver injury over time even with judicious use. This drug-induced liver injury (DILI) can be either direct (hepatocellular) or idiosyncratic. As with multiple other hepatic pathologies, DILI may be asymptomatic or clinically silent. Therefore, it is prudent to carry out liver function tests (LFTs) from time to time. LFTs are an inexpensive, noninvasive, and quick first-line investigation to monitor liver status. However, the pattern of liver injury with statin use is not specific and a correlation over time may not be apparent. Aims To evaluate derangement in LFTs over time with respect to statin use and determine if a correlation exists. Methods This was a retrospective observational cohort. All data were collected from the online database of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Patients admitted to the NICVD from July 1, 2018, to December 31, 2018, were eligible for inclusion in the study. Only patients already taking a statin (in any dose) were considered for inclusion. LFTs were recorded from the database at inclusion, post-induction at six and 12 months. Extensive workup was done and great care taken to rule out other diseases that may have affected the LFTs. Results Two hundred and four patients were eventually inducted into the study after a meticulous exclusion process. The male to female ratio was 4:1. The mean duration of statin use before induction into the study was 19.92±14.34 months. Patients were predominantly using only one of two statins, i.e., rosuvastatin 20mg/day or atorvastatin 40 mg/day. Elevations of LFTs were seen with both drugs throughout the study period. These elevations were almost always <2x the upper limit of normal (ULN); greater elevations were seen with atorvastatin 40 mg/day. The derangement in LFTs persisted and improvement was not seen. Conclusions Statins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.
