Mahrukh Mansoor Khosa, Fizza Mobasher, S. Sehar, Ali Nasir, Aneeqa Ilyas, H. Shoaib
BACKGROUND: Heart disease is the most significant cause of death worldwide and ST- elevation myocardial infarction (STEMI) is a prime cause of death in developing nations. PCI has progressed to the point where overnight monitoring is unnecessary for some patients because of its increased safety and effectiveness. Improved patient satisfaction, shorter hospital stays, and more efficient use of healthcare resources are the key advantages of same-day release following PCI. PCI has always been viewed as an inpatient or short-stay surgery, requiring up to 24 hours of observation time. The purpose of this research was to make comparison of the outcomes of early and delayed discharge strategy after primary PCI in patients with STEMI and to establish the frequency of early discharge following primary PCI in patients having STEMI. METHODOLOGY: The study was conducted in Cardiology department of Punjab Institute of Cardiology, Lahore from August 10, 2020 to February 10, 2021. Total 200 patients presenting with STEMI were enrolled in the study. Patients underwent primary PCI by a single team with assistance of researcher. If patients were discharged within 36 hours, then earlier discharge was labeled. Patients were asked to present after 1 month in OPD. Patients were advised to present in case they feel similar symptoms of myocardial infarction, stroke, heart failure or mortality. The collected data were analysed statistically by using SPSS v25.0. Both groups were compared using chi-square test for clinical outcome. Data were stratified for age, gender, h/o diabetes, hypertension, smoking and duration of symptoms. Post-stratification, both groups were compared by using chi-square test for clinical outcome in each strata. A p-value ?0.05 was taken as significant. RESULTS: Total 200 patients presenting with STEMI and underwent primary PCI were enrolled in this study. There were 146(73.0%) were males and 54(27.0%) were females. The mean age of patients was 50.6±19.2 years. Out of 200 patients with STEMI, 86(43.0%) were early discharged and 114(57.0%) had delayed discharged. CONCLUSION: This study showed that early discharge is also safe and feasible among patients with STEMI who underwent PCI as compared to delayed discharge. Early discharge may help in lowering down healthcare costs for Primary PCI service providers
{"title":"Clinical Outcomes of Early Versus Delayed Discharge After Primary Percutaneous Coronary Intervention","authors":"Mahrukh Mansoor Khosa, Fizza Mobasher, S. Sehar, Ali Nasir, Aneeqa Ilyas, H. Shoaib","doi":"10.55958/jcvd.v18i4.119","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.119","url":null,"abstract":"BACKGROUND: Heart disease is the most significant cause of death worldwide and ST- elevation myocardial infarction (STEMI) is a prime cause of death in developing nations. PCI has progressed to the point where overnight monitoring is unnecessary for some patients because of its increased safety and effectiveness. Improved patient satisfaction, shorter hospital stays, and more efficient use of healthcare resources are the key advantages of same-day release following PCI. PCI has always been viewed as an inpatient or short-stay surgery, requiring up to 24 hours of observation time. The purpose of this research was to make comparison of the outcomes of early and delayed discharge strategy after primary PCI in patients with STEMI and to establish the frequency of early discharge following primary PCI in patients having STEMI. \u0000METHODOLOGY: The study was conducted in Cardiology department of Punjab Institute of Cardiology, Lahore from August 10, 2020 to February 10, 2021. Total 200 patients presenting with STEMI were enrolled in the study. Patients underwent primary PCI by a single team with assistance of researcher. If patients were discharged within 36 hours, then earlier discharge was labeled. Patients were asked to present after 1 month in OPD. Patients were advised to present in case they feel similar symptoms of myocardial infarction, stroke, heart failure or mortality. The collected data were analysed statistically by using SPSS v25.0. Both groups were compared using chi-square test for clinical outcome. Data were stratified for age, gender, h/o diabetes, hypertension, smoking and duration of symptoms. Post-stratification, both groups were compared by using chi-square test for clinical outcome in each strata. A p-value ?0.05 was taken as significant. \u0000RESULTS: Total 200 patients presenting with STEMI and underwent primary PCI were enrolled in this study. There were 146(73.0%) were males and 54(27.0%) were females. The mean age of patients was 50.6±19.2 years. Out of 200 patients with STEMI, 86(43.0%) were early discharged and 114(57.0%) had delayed discharged. \u0000CONCLUSION: This study showed that early discharge is also safe and feasible among patients with STEMI who underwent PCI as compared to delayed discharge. Early discharge may help in lowering down healthcare costs for Primary PCI service providers","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114099242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Nasir, Syed Ali Hamza Syed Ali Hamza, Hurmah Shoaib Hurmah Shoaib, Fizza Mobasher Fizza Mobasher, Sana Sehar Sana Sehar, Mahrukh Mansoor Khosa Mahrukh Mansoor Khosa
INTRODUCTION: The incidence and prevalence of cardiovascular disease is growing in communities with lower and intermediate incomes. This illness is the main cause of mortality and disability adjusted life years across the globe. Consumption of fried foods and its consequences on the risk of developing cardiovascular disease are still debatable topics. The current body of research has a number of major holes in it, the most notable of which are a lack of information on the specific types of oils that were used for frying foods, a classification of the various kinds of foods that were fried, a procedure for frying, temperature and duration of frying, the frequency with which oils were recycled, and an absence of consideration of overall dietary patterns. The purpose of this study was to examine whether or not consuming fried foods is associated with a higher risk of developing acute coronary syndrome in individuals who presented themselves at an emergency room. METHODOLOGY: The study was conducted at Department of Cardiology of Punjab Institute of Cardiology in Lahore from April 5, 2020 to September 5, 2020. Total 400 (200 in each group) patients were enrolled in the study. Patients were divided in two groups i.e. cases with acute coronary syndrome and controls without acute coronary syndrome. Then patients were admitted in Cardiology Ward and asked for history of fried food consumption including frequency of consumption per week. If patient had history of fried food consumption for ?3 days per week, then it was labelled as case. The collected data were analysed statistically by using SPSS v25.0. Odds ratio was calculated to measure association of fried food consumption with acute coronary syndrome. Odds ratio >1 was taken as significant. RESULTS: Fried food consumption per week in case group, 47.5% patients consumed fried and in control group, 29.5% patients consumed fried food. CONCLUSION: There is a correlation between the eating of fried meals on a regular basis and an increased risk of acute coronary syndrome. There was a significant association in fried food consumption with acute coronary syndrome in patients presenting in emergency department.
{"title":"Association of fried food consumption with acute coronary syndrome in patients presenting in emergency department","authors":"Ali Nasir, Syed Ali Hamza Syed Ali Hamza, Hurmah Shoaib Hurmah Shoaib, Fizza Mobasher Fizza Mobasher, Sana Sehar Sana Sehar, Mahrukh Mansoor Khosa Mahrukh Mansoor Khosa","doi":"10.55958/jcvd.v18i4.111","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.111","url":null,"abstract":"INTRODUCTION: The incidence and prevalence of cardiovascular disease is growing in communities with lower and intermediate incomes. This illness is the main cause of mortality and disability adjusted life years across the globe. Consumption of fried foods and its consequences on the risk of developing cardiovascular disease are still debatable topics. The current body of research has a number of major holes in it, the most notable of which are a lack of information on the specific types of oils that were used for frying foods, a classification of the various kinds of foods that were fried, a procedure for frying, temperature and duration of frying, the frequency with which oils were recycled, and an absence of consideration of overall dietary patterns. The purpose of this study was to examine whether or not consuming fried foods is associated with a higher risk of developing acute coronary syndrome in individuals who presented themselves at an emergency room. \u0000METHODOLOGY: The study was conducted at Department of Cardiology of Punjab Institute of Cardiology in Lahore from April 5, 2020 to September 5, 2020. Total 400 (200 in each group) patients were enrolled in the study. Patients were divided in two groups i.e. cases with acute coronary syndrome and controls without acute coronary syndrome. Then patients were admitted in Cardiology Ward and asked for history of fried food consumption including frequency of consumption per week. If patient had history of fried food consumption for ?3 days per week, then it was labelled as case. The collected data were analysed statistically by using SPSS v25.0. Odds ratio was calculated to measure association of fried food consumption with acute coronary syndrome. Odds ratio >1 was taken as significant. \u0000RESULTS: Fried food consumption per week in case group, 47.5% patients consumed fried and in control group, 29.5% patients consumed fried food. \u0000CONCLUSION: There is a correlation between the eating of fried meals on a regular basis and an increased risk of acute coronary syndrome. There was a significant association in fried food consumption with acute coronary syndrome in patients presenting in emergency department.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114998232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shirjeel Murtaza Shirjeel Murtaza, Zohaib Sadiq Zohaib Sadiq
Acute limb ischemia is a limb threatening emergency condition which requires immediate diagnosis, treatment plan and action. In low income countries still the options of catheter directed thrombolysis under imaging is still not a practical option at many centers. We report a case of 60 years old asthmatic female on inhalers with no history of HF, heart disease, IHD, Afib, hypercholesterolemia, stroke, DM, or HTN who presented at 8 pm at our hospital with 2 hours history of sudden onset severe left hand pain with discoloration. Examination showed absent radial and ulnar artery pulsation. Brachial artery pulse was palpable. Blue discoloration of fingers and hand upto mid palm was noted. Muscular power of hand was intact. Mild sensory loss was present on the tips of all digits. The condition was diagnosed as “Immediately threatened acute limb ischemia”. At night the facility of Doppler or CT angiography was not available so a decision was made to proceed with local thrombolysis with Antegrade A line through brachial artery. Arterial access was gained by usual IV line of 20 gauge (used for intravenous access) and then thrombolysis was started with streptokinase at a dose of 75000 I.U / hour continuous infusion without any bolus. Infusion was planned to continue for 24 hours. After 12 hours the radial and ulnar artery pulsations were palpable (3+), hand was warm, pain had settled and colour of hand normalized so the infusion was discontinued and further imaging was planned. Patient developed weakness of right side of the body and altered sensorium 2 hours after stopping the infusion. Immediate CT brain was done along with the upper limb with contrast. Brain CT turned out to be normal without any intracranial bleed (Figure A). No other significant finding was observed on CT brain. CT angiogram of upper limb showed a large thrombus at 1st part of left subclavian artery. (Figure.1a and b). 2nd and 3rd part of subclavian artery were normal and so was brachial artery and proximal half of radial artery. Only distal half of radial artery showed linear non occlusive thrombus upto bifurcation of distal radial artery in superficial and deep branches (Figure 3). Weakness resolved in next 12 hours but slow mentation continued for next 3 days and then completely recovered. Subsequent management was continued with statin, aspirin and anticoagulation with enoxaparin. After removal of the intra-arterial line a hematoma formed due to poor compression at that time extending from cubital fossa to mid forearm. The hematoma settled in next 30 days. Despite the complications the limb was salvaged. DISCUSSION Currently catheter directed thrombolysis holds class 1 indication in ACC guidelines (2016) for salvageable acute limb ischemia.1 Various types of hardware are available for catheter directed thrombolysis but in low income populations the cost is a limitation to the access of such equipment. Once access is gained, various regimes are available for thrombolysis.
{"title":"Case report: Intra arterial thrombolysis with iv line can save an acutely ischemic limb","authors":"Shirjeel Murtaza Shirjeel Murtaza, Zohaib Sadiq Zohaib Sadiq","doi":"10.55958/jcvd.v18i4.125","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.125","url":null,"abstract":"Acute limb ischemia is a limb threatening emergency condition which requires immediate diagnosis, treatment plan and action. \u0000In low income countries still the options of catheter directed thrombolysis under imaging is still not a practical option at many centers. We report a case of 60 years old asthmatic female on inhalers with no history of HF, heart disease, IHD, Afib, hypercholesterolemia, stroke, DM, or HTN who presented at 8 pm at our hospital with 2 hours history of sudden onset severe left hand pain with discoloration. Examination showed absent radial and ulnar artery pulsation. Brachial artery pulse was palpable. Blue discoloration of fingers and hand upto mid palm was noted. Muscular power of hand was intact. Mild sensory loss was present on the tips of all digits. The condition was diagnosed as “Immediately threatened acute limb ischemia”. At night the facility of Doppler or CT angiography was not available so a decision was made to proceed with local thrombolysis with Antegrade A line through brachial artery. \u0000Arterial access was gained by usual IV line of 20 gauge (used for intravenous access) and then thrombolysis was started with streptokinase at a dose of 75000 I.U / hour continuous infusion without any bolus. Infusion was planned to continue for 24 hours. \u0000After 12 hours the radial and ulnar artery pulsations were palpable (3+), hand was warm, pain had settled and colour of hand normalized so the infusion was discontinued and further imaging was planned. \u0000Patient developed weakness of right side of the body and altered sensorium 2 hours after stopping the infusion. Immediate CT brain was done along with the upper limb with contrast. Brain CT turned out to be normal without any intracranial bleed (Figure A). No other significant finding was observed on CT brain. CT angiogram of upper limb showed a large thrombus at 1st part of left subclavian artery. (Figure.1a and b). 2nd and 3rd part of subclavian artery were normal and so was brachial artery and proximal half of radial artery. Only distal half of radial artery showed linear non occlusive thrombus upto bifurcation of distal radial artery in superficial and deep branches (Figure 3). \u0000Weakness resolved in next 12 hours but slow mentation continued for next 3 days and then completely recovered. \u0000Subsequent management was continued with statin, aspirin and anticoagulation with enoxaparin. \u0000After removal of the intra-arterial line a hematoma formed due to poor compression at that time extending from cubital fossa to mid forearm. The hematoma settled in next 30 days. Despite the complications the limb was salvaged. \u0000DISCUSSION \u0000Currently catheter directed thrombolysis holds class 1 indication in ACC guidelines (2016) for salvageable acute limb ischemia.1 Various types of hardware are available for catheter directed thrombolysis but in low income populations the cost is a limitation to the access of such equipment. Once access is gained, various regimes are available for thrombolysis.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125001814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khurshid Ali Khurshid Ali, Kashif Zafar Kashif Zafar, Muhammad Amad Abbasi Muhammad Amad Abbasi, Omer Mustafa Omer Mustafa, Muhammad Zubair Tariq Muhammad Zubair Tariq, Muhammad Aamir Rafique Muhammad Aamir Rafique
Background: Stent thrombosis is less common but life-threatening that in most cases leads to death or a big non-fatal ST-elevation myocardial infarction (STEMI). Past research data suggests multiple predisposing factors play role in sub-acute thrombosis (usually with ST elevation). However, very few studies have been conducted regarding the predisposing factors of subacute stent thrombosis (SST) in Pakistan, and hence, there is very limited knowledge regarding the trend of risk factors associated with SST. Objective: This study will determine the predisposing factors that lead to subacute stent thrombosis in patients with the acute coronary syndrome who have undergone PCI. Methodology: Retrospective demographical and angiographical data of the patients who have undergone PCI and also were presented with ACS was gathered from the hospital registry. All the data were analyzed using SPSS and were presented as mean ± SD and percentages for continuous and categorical variables, respectively. Univariate and multivariate analysis was carried out to analyze the subacute stent thrombosis predictors. Results: The occurrence of subacute stent thrombosis was found to be 4..9 %. A significant higher number of patients who have developed subacute stent thrombosis were male (81.4 %, p = 0.037), suffered from diabetes mellitus (48.1 %, p = 0.034), had hypertension (59.2 %. P = 0.016), with pre-procedural decreased left ventricular ejection fraction (LVEF) (36.11?±?6.86, p < 0.001) and Killip Class (p < 0.001). Significantly higher odds were observed among patients with diabetes (2.13 [1.01–4.34]), hypertension (2.33 [1.17–4.86]), and the Killip Class III or IV patients (6.4 [2.35–17.41]). The single independent predictor of the subacute stent thrombosis was found to be Killip Class III-IV with an adjusted ratio of 5.1 [1.81–15.32]. Conclusion: Subacute stent thrombosis in patients who have undergone PCI for acute myocardial infarction is not as infrequent as demonstrated by the previous studies accruing with a frequency of 4.9 % with a death rate of 7 % in the patients with SST. Diabetes and hypertension were observed to be associated and served as risk factors for the development of SST. Killip class III-IV was demonstrated to be the single independent predictor of subacute stent thrombosis.
{"title":"Predisposing factors leading to subacute stent thrombosis (SAT) in patients who have undergone percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome","authors":"Khurshid Ali Khurshid Ali, Kashif Zafar Kashif Zafar, Muhammad Amad Abbasi Muhammad Amad Abbasi, Omer Mustafa Omer Mustafa, Muhammad Zubair Tariq Muhammad Zubair Tariq, Muhammad Aamir Rafique Muhammad Aamir Rafique","doi":"10.55958/jcvd.v18i4.130","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.130","url":null,"abstract":"Background: Stent thrombosis is less common but life-threatening that in most cases leads to death or a big non-fatal ST-elevation myocardial infarction (STEMI). Past research data suggests multiple predisposing factors play role in sub-acute thrombosis (usually with ST elevation). However, very few studies have been conducted regarding the predisposing factors of subacute stent thrombosis (SST) in Pakistan, and hence, there is very limited knowledge regarding the trend of risk factors associated with SST. \u0000Objective: This study will determine the predisposing factors that lead to subacute stent thrombosis in patients with the acute coronary syndrome who have undergone PCI. \u0000Methodology: Retrospective demographical and angiographical data of the patients who have undergone PCI and also were presented with ACS was gathered from the hospital registry. All the data were analyzed using SPSS and were presented as mean ± SD and percentages for continuous and categorical variables, respectively. Univariate and multivariate analysis was carried out to analyze the subacute stent thrombosis predictors. \u0000Results: The occurrence of subacute stent thrombosis was found to be 4..9 %. A significant higher number of patients who have developed subacute stent thrombosis were male (81.4 %, p = 0.037), suffered from diabetes mellitus (48.1 %, p = 0.034), had hypertension (59.2 %. P = 0.016), with pre-procedural decreased left ventricular ejection fraction (LVEF) (36.11?±?6.86, p < 0.001) and Killip Class (p < 0.001). Significantly higher odds were observed among patients with diabetes (2.13 [1.01–4.34]), hypertension (2.33 [1.17–4.86]), and the Killip Class III or IV patients (6.4 [2.35–17.41]). The single independent predictor of the subacute stent thrombosis was found to be Killip Class III-IV with an adjusted ratio of 5.1 [1.81–15.32]. \u0000Conclusion: Subacute stent thrombosis in patients who have undergone PCI for acute myocardial infarction is not as infrequent as demonstrated by the previous studies accruing with a frequency of 4.9 % with a death rate of 7 % in the patients with SST. Diabetes and hypertension were observed to be associated and served as risk factors for the development of SST. Killip class III-IV was demonstrated to be the single independent predictor of subacute stent thrombosis.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124410234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamran Dawood Ahmad Kamran Dawood Ahmad, Khurram Shahzad Khurram Shahzad, Maryam Mansoor Maryam Mansoor, Sadaf Naeem Sadaf Naeem, Samra Yasmin Samra Yasmin, Sajjad Ahmad Sajjad Ahmad
Introduction: Worldwide, Coronary Artery Diseases (CADs) cause significant disability and death. Primary PCI (PPCI) is the gold-standard of emergency care in management of patients suffering from STEMI. Gender-based differences may be present in the major cardiovascular outcomes (MACE) of PPCI. Objective: This article aims at comparing major adverse cardiovascular outcomes male vs female STEMI patients going through PPCI. Study design: Descriptive case series Study setting: Emergency Department, Punjab Institute of Cardiology (PIC), Lahore. Methodology: With mean age just over 50.3 ± 9.7 years, 193 (78.8%) males and 52 (21.2%) female, a total of 245 patients were enrolled in the study. Risk factors included diabetes, hypertension, familial IHD and active smoking. We recorded in-hospital outcomes post-pPCI: mortality, cerebrovascular accident, acute and subacute stent thrombosis, heart failure, acute kidney injury and arrhythmias. Results: Post PPCI in-hospital outcomes in 193 males: mortality 0, heart failure 3 (1.6%), acute stent thrombosis 0 and acute kidney injury in 11 patients (5.7%). Among 52 females: mortality 2 (3.8%), heart failure 2 (3.8%), acute stent thrombosis 1 (1.9%) and acute kidney injury 3 (5.8%). The only significant association was found between female gender & post PPCI mortality after STEMI (P = 0.006). Conclusion: Results of in-hospital complications among male & female patients following PPCI for acute STEMI seem to show association of female gender with post-PPCI mortality which is significantly greater than the male population under study.
{"title":"Measuring Major Adverse Cardiovascular Events (MACE) in male vs female suffering from acute ST-Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention (PPCI) at PIC, Lahore","authors":"Kamran Dawood Ahmad Kamran Dawood Ahmad, Khurram Shahzad Khurram Shahzad, Maryam Mansoor Maryam Mansoor, Sadaf Naeem Sadaf Naeem, Samra Yasmin Samra Yasmin, Sajjad Ahmad Sajjad Ahmad","doi":"10.55958/jcvd.v18i4.129","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.129","url":null,"abstract":"Introduction: \u0000Worldwide, Coronary Artery Diseases (CADs) cause significant disability and death. Primary PCI (PPCI) is the gold-standard of emergency care in management of patients suffering from STEMI. Gender-based differences may be present in the major cardiovascular outcomes (MACE) of PPCI. \u0000Objective: \u0000This article aims at comparing major adverse cardiovascular outcomes male vs female STEMI patients going through PPCI. \u0000Study design: \u0000Descriptive case series \u0000Study setting: \u0000Emergency Department, Punjab Institute of Cardiology (PIC), Lahore. \u0000Methodology: \u0000With mean age just over 50.3 ± 9.7 years, 193 (78.8%) males and 52 (21.2%) female, a total of 245 patients were enrolled in the study. Risk factors included diabetes, hypertension, familial IHD and active smoking. We recorded in-hospital outcomes post-pPCI: mortality, cerebrovascular accident, acute and subacute stent thrombosis, heart failure, acute kidney injury and arrhythmias. \u0000Results: \u0000Post PPCI in-hospital outcomes in 193 males: mortality 0, heart failure 3 (1.6%), acute stent thrombosis 0 and acute kidney injury in 11 patients (5.7%). Among 52 females: mortality 2 (3.8%), heart failure 2 (3.8%), acute stent thrombosis 1 (1.9%) and acute kidney injury 3 (5.8%). The only significant association was found between female gender & post PPCI mortality after STEMI (P = 0.006). \u0000Conclusion: \u0000Results of in-hospital complications among male & female patients following PPCI for acute STEMI seem to show association of female gender with post-PPCI mortality which is significantly greater than the male population under study.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128647930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION: Percutaneous transvenous mitral commissurotomy (PTMC), a procedure that treats certain individuals with mitral stenosis, is now frequently used as an alternative to closed surgical mitral commissurotomy (CMC). Cardiologists disagree on which is superior when comparing the total echo score (also known as the Wilkin's score) and the commissural morphology score (TC) for predicting excellent and bad outcomes of PTMC procedures. Therefore, we created this study so that a good predictive score can be used in the future with supporting data before PTMC. AIMS & OBJECTIVE: To evaluate the diagnostic efficacy of the total echo score and the total commissural morphology score for the prognosis following percutaneous transvenous mitral commissurotomy (PTMC). MATERIALS & METHODS: This research was a cross-sectional analysis of patients at the Punjab Institute of Cardiology. This research took place over the course of 6 months, from August 20, 2014 to February 20, 2015. A total of 110 participants participated in the study. RESULTS: The mean age of patients in this study was 43.80 ± 14.18 years with 49(44.5%) males and 61(55.5%) female patients in this study. According to operational definition success of procedure was seen in 103(93.6%) of the patients while 7(6.4%) had unsuccessful procedure. On comparing Total Echo score and “successful procedure” the sensitivity and specificity of Total echo score was 83.5% and 85.71% while PPV and NPV were 98.85% and 26.09% respectively with diagnostic accuracy of 83.64%. The sensitivity and specificity of Commissural score was 92.23% and 57.14% while PPV and NPV were 96.94% and 36.33% respectively with diagnostic accuracy of 90%. CONCLUSION: Total ECO score has high sensitivity, specificity and over diagnostic accuracy but total commissural morphology score has high sensitivity but with less specificity with high diagnostic score. So total echo score can be used as predictive tool for outcome of PTMC in our population KEYWORDS: Rheumatic Heart Disease, Mitral Stenosis, PTMC, Mitral Commissurotomy
{"title":"Diagnostic accuracy of total echo score and total commissural morphology score for the prediction of outcome after percutaneous transvenous mitral commissurotomy (PTMC)","authors":"Tehseen Javed Tehseen Javed, Syeda Rubab Zahra Syeda Rubab Zahra, Imrana Nawaz Imrana Nawaz, Shirjeel Murtaza Shirjeel Murtaza, K. Sheikh, Rabea Rashed Rabea Rashed","doi":"10.55958/jcvd.v18i4.120","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.120","url":null,"abstract":"INTRODUCTION: Percutaneous transvenous mitral commissurotomy (PTMC), a procedure that treats certain individuals with mitral stenosis, is now frequently used as an alternative to closed surgical mitral commissurotomy (CMC). Cardiologists disagree on which is superior when comparing the total echo score (also known as the Wilkin's score) and the commissural morphology score (TC) for predicting excellent and bad outcomes of PTMC procedures. Therefore, we created this study so that a good predictive score can be used in the future with supporting data before PTMC. \u0000AIMS & OBJECTIVE: To evaluate the diagnostic efficacy of the total echo score and the total commissural morphology score for the prognosis following percutaneous transvenous mitral commissurotomy (PTMC). \u0000MATERIALS & METHODS: This research was a cross-sectional analysis of patients at the Punjab Institute of Cardiology. This research took place over the course of 6 months, from August 20, 2014 to February 20, 2015. A total of 110 participants participated in the study. \u0000RESULTS: The mean age of patients in this study was 43.80 ± 14.18 years with 49(44.5%) males and 61(55.5%) female patients in this study. According to operational definition success of procedure was seen in 103(93.6%) of the patients while 7(6.4%) had unsuccessful procedure. On comparing Total Echo score and “successful procedure” the sensitivity and specificity of Total echo score was 83.5% and 85.71% while PPV and NPV were 98.85% and 26.09% respectively with diagnostic accuracy of 83.64%. The sensitivity and specificity of Commissural score was 92.23% and 57.14% while PPV and NPV were 96.94% and 36.33% respectively with diagnostic accuracy of 90%. \u0000CONCLUSION: Total ECO score has high sensitivity, specificity and over diagnostic accuracy but total commissural morphology score has high sensitivity but with less specificity with high diagnostic score. So total echo score can be used as predictive tool for outcome of PTMC in our population \u0000KEYWORDS: Rheumatic Heart Disease, Mitral Stenosis, PTMC, Mitral Commissurotomy","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132399591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stress is something that affects all of us and when we do not take time to handle our stress, it can lead to some serious health issues. 1 We face daily stressors in life as it is a reaction of our body to any change from outside or inside of the body which can be positive limited to a short period of time such as arranging an event, preparing for exam which can motivate us to study more or it can be negative when we hear about anyone suddenly feeling ill in family or an accident and some stressors when they persist for too long and generate due to lack of coping skills, begin to affect our physical wellness and mental wellness, with the first and immediate reactions being cardiovascular where heart rate goes up, blood pressure goes up and sweating starts or muscle spasm, and long term affects can cause damage to the arteries of the heart and the rest of body due to shear stress inside arteries, diabetes millets, anxiety and depression. 2,3 These can certainly contribute to high blood pressure, can lead to adrenaline and cortisol secretions in our bodies which increase our cholesterol levels and can trigger insulin resistance which can lead to diabetes, smoking can be aggravated as for many smoking is a stress reducer though it’s not a healthy stress reducer, emotional responses in eating and excessive stress increases craving for unhealthy food and that it can contribute to obesity. While stress from grief can trigger a problem known as stress induced cardiomyopathy (Takotsubo cardiomyopathy or "Broken Heart Syndrome”) 4 mainly occurs in females aged 60 to 80 years, which cause temporary change in heart structure and its function, luckily more than 95% of patients do recover from stress induced cardiomyopathy with two or four weeks. Who is more stressed? Women are more likely than men (28% vs. 20%) to report having a great deal of stress.5 How do I manage stress? The first steps is awareness and solely think about the present moment, engaging with the present moment, delaying judgment, paying attention to environment around us and following the basic stress management principles which are gratitude, compassion/love, acceptance, higher meaning, forgiveness. Adequate healthy diet including more vitamin c, magnesium, omega, avoiding junk and fast food, adequate hydration, a healthy sleep cycle and adequate sleep of 6 to 8 hours per 24 hours, in which night sleep should not be replaced with day. Physical activity of 30 minutes in the form of walk or jogging keeps us not only physically fit but also mentally up to the mark. Talk to family members with whom you feel relaxed to share thoughts and feelings, use all senses to bring oneself back in present from past and future stressful thinking with the most important attempt is to involve your own self in others happiness to be relaxed. 6,7 Proper follow up and care of long standing illness control of blood pressure, healthy lifestyle and engaging in healthy activities has a positive influence
{"title":"Editorial: Stress Can Lead to Cardiovascular Disease","authors":"J. Jalaludin","doi":"10.55958/jcvd.v18i4.132","DOIUrl":"https://doi.org/10.55958/jcvd.v18i4.132","url":null,"abstract":"Stress is something that affects all of us and when we do not take time to handle our stress, it can lead to some serious health issues. 1 \u0000We face daily stressors in life as it is a reaction of our body to any change from outside or inside of the body which can be positive limited to a short period of time such as arranging an event, preparing for exam which can motivate us to study more or it can be negative when we hear about anyone suddenly feeling ill in family or an accident and some stressors when they persist for too long and generate due to lack of coping skills, begin to affect our physical wellness and mental wellness, with the first and immediate reactions being cardiovascular where heart rate goes up, blood pressure goes up and sweating starts or muscle spasm, and long term affects can cause damage to the arteries of the heart and the rest of body due to shear stress inside arteries, diabetes millets, anxiety and depression. 2,3 \u0000These can certainly contribute to high blood pressure, can lead to adrenaline and cortisol secretions in our bodies which increase our cholesterol levels and can trigger insulin resistance which can lead to diabetes, smoking can be aggravated as for many smoking is a stress reducer though it’s not a healthy stress reducer, emotional responses in eating and excessive stress increases craving for unhealthy food and that it can contribute to obesity. While stress from grief can trigger a problem known as stress induced cardiomyopathy (Takotsubo cardiomyopathy or \"Broken Heart Syndrome”) 4 mainly occurs in females aged 60 to 80 years, which cause temporary change in heart structure and its function, luckily more than 95% of patients do recover from stress induced cardiomyopathy with two or four weeks. \u0000Who is more stressed? \u0000Women are more likely than men (28% vs. 20%) to report having a great deal of stress.5 \u0000How do I manage stress? \u0000The first steps is awareness and solely think about the present moment, engaging with the present moment, delaying judgment, paying attention to environment around us and following the basic stress management principles which are gratitude, compassion/love, acceptance, higher meaning, forgiveness. \u0000Adequate healthy diet including more vitamin c, magnesium, omega, avoiding junk and fast food, adequate hydration, a healthy sleep cycle and adequate sleep of 6 to 8 hours per 24 hours, in which night sleep should not be replaced with day. Physical activity of 30 minutes in the form of walk or jogging keeps us not only physically fit but also mentally up to the mark. Talk to family members with whom you feel relaxed to share thoughts and feelings, use all senses to bring oneself back in present from past and future stressful thinking with the most important attempt is to involve your own self in others happiness to be relaxed. 6,7 \u0000Proper follow up and care of long standing illness control of blood pressure, healthy lifestyle and engaging in healthy activities has a positive influence ","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131801496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a 13 years old girl with cyanotic heart disease who presented to the OPD of a tertiary care facility for the first time. Her echocardiography showed features of tetralogy of fallot and dilated coronary sinus. An unusual structure was visualized below the aortic valve in PLAX and 4 chamber view. It also had systolic colour flow in it (Figures 1-4). Origin of the structure could not be traced so a cardiac CT was planned for delineation of the anatomy. DISCUSSION; Tetralogy of fallot is associated with multiple other abnormalities, one of which is abnormal coronary origins1. Our patient had normal coronary origins although the coronary arteries were markedly dilated and LAD had a brief retro-aortic course before emerging onto the anterior interventricular groove. RAC (retro-aortic coronary) sign is well known sign on echocardiography for retro-aortic course of one of the coronary arteries.2 A typical RAC sign is shown in figure 6. Since our patient did not have normal sized coronaries so typical RAC sign was not seen on echo. The typical location of the structure of interest and systolic colour flow demonstration in it raised the suspicion of it being a coronary artery. Dilated coronary sinus was due to Left persistant SVC which is also one of the associations of TOF. CONCLUSION; RAC sign is typical for retro-aortic coronary artery course. Slight variation in the appearance can occur due to variability in anatomic features of the coronary of interest. But still it is fairly reliable to predict the course of a coronary artery.
{"title":"An unusual Echo finding in a patient with TOF: unusual RAC sign","authors":"Shirjeel Murtaza, Asif ur Rehman Asif ur Rehman","doi":"10.55958/jcvd.v18i3.124","DOIUrl":"https://doi.org/10.55958/jcvd.v18i3.124","url":null,"abstract":"We report a 13 years old girl with cyanotic heart disease who presented to the OPD of a tertiary care facility for the first time. Her echocardiography showed features of tetralogy of fallot and dilated coronary sinus. An unusual structure was visualized below the aortic valve in PLAX and 4 chamber view. It also had systolic colour flow in it (Figures 1-4). Origin of the structure could not be traced so a cardiac CT was planned for delineation of the anatomy.\u0000DISCUSSION;\u0000Tetralogy of fallot is associated with multiple other abnormalities, one of which is abnormal coronary origins1. Our patient had normal coronary origins although the coronary arteries were markedly dilated and LAD had a brief retro-aortic course before emerging onto the anterior interventricular groove. \u0000RAC (retro-aortic coronary) sign is well known sign on echocardiography for retro-aortic course of one of the coronary arteries.2 A typical RAC sign is shown in figure 6. Since our patient did not have normal sized coronaries so typical RAC sign was not seen on echo. The typical location of the structure of interest and systolic colour flow demonstration in it raised the suspicion of it being a coronary artery. Dilated coronary sinus was due to Left persistant SVC which is also one of the associations of TOF.\u0000CONCLUSION;\u0000RAC sign is typical for retro-aortic coronary artery course. Slight variation in the appearance can occur due to variability in anatomic features of the coronary of interest. But still it is fairly reliable to predict the course of a coronary artery.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130674942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Myocardial infarction (MI) is diagnosed by history of typical angina chest pain of prolonged duration along with ST segment elevation and ECG and or raised cardiac biomarkers. Increased levels of CRP are associated with increased risk of HTN, DM and ischemic heart disease. Increased intake of trans fatty acids lead to increased levels of CRP, endothelial dysfunction and ischemic heart disease. Vessel wall is damaged after the inflammation and CRP is a marker of inflammation, so it can predict the cardiovascular disease. Objective: The objective of this study is to determine the level of high sensitivity CRP in MI patients with or without diabetes mellitus. Materials and methods: Total 60 patients were enrolled in the study. Patients having age from 40 to 70 years, diabetic patients and non-diabetic (male) and patients with acute myocardial infarcted patients were included. Patients having heart disease other than MI, patients less than 40 years were excluded. Level of high sensitivity CRP of patients of MI was analyzed by using chemiluminescence technique. High sensitivity CRP was analyzed quantitatively. Results: In this study 60 individuals with AMI were divided into two groups based on presence(n=30) 50% and absence (n=30) 50% of diabetes mellitus. The mean age of the population was 58.32 ± 11.24 years. Levels of high sensitivity CRP were distributed in four groups, the first group includes hsCRP < 10 mg/l, group-2 includes hsCRP 11-50 mg/l, group-3 comprises levels of hsCRP from 51-100mg/l and group-4 includes hsCRP level from 101-150mg/l. Both groups of AMI patients without and with DM had significantly higher levels of hsCRP as 40% and 31% patients have CRP level lies in group 3 and group 4 respectively. Moreover, the diabetic patients had higher levels of hsCRP as 50% of diabetic patients having levels of hsCRP fall in category of group 3 whereas only 13.3% non-diabetic patients have hsCRP falls in category of group 3. And this difference is statistically significant with the p value (p=0.007). Conclusion: The raised hsCRP is seen in AMI patients with history of diabetes, smoking and hypertension as compared to those AMI patients who had no previous history of all these risk factors.
{"title":"Level of high sensitivity C-reactive protein in patients of acute myocardial infarction with or without diabetes mellitus","authors":"Faiza Ilyas, Farhana Shehzad, A. Anam","doi":"10.55958/jcvd.v18i3.104","DOIUrl":"https://doi.org/10.55958/jcvd.v18i3.104","url":null,"abstract":"Introduction: Myocardial infarction (MI) is diagnosed by history of typical angina chest pain of prolonged duration along with ST segment elevation and ECG and or raised cardiac biomarkers. Increased levels of CRP are associated with increased risk of HTN, DM and ischemic heart disease. Increased intake of trans fatty acids lead to increased levels of CRP, endothelial dysfunction and ischemic heart disease. Vessel wall is damaged after the inflammation and CRP is a marker of inflammation, so it can predict the cardiovascular disease. \u0000Objective: The objective of this study is to determine the level of high sensitivity CRP in MI patients with or without diabetes mellitus. \u0000Materials and methods: Total 60 patients were enrolled in the study. Patients having age from 40 to 70 years, diabetic patients and non-diabetic (male) and patients with acute myocardial infarcted patients were included. Patients having heart disease other than MI, patients less than 40 years were excluded. Level of high sensitivity CRP of patients of MI was analyzed by using chemiluminescence technique. High sensitivity CRP was analyzed quantitatively. \u0000Results: In this study 60 individuals with AMI were divided into two groups based on presence(n=30) 50% and absence (n=30) 50% of diabetes mellitus. The mean age of the population was 58.32 ± 11.24 years. Levels of high sensitivity CRP were distributed in four groups, the first group includes hsCRP < 10 mg/l, group-2 includes hsCRP 11-50 mg/l, group-3 comprises levels of hsCRP from 51-100mg/l and group-4 includes hsCRP level from 101-150mg/l. Both groups of AMI patients without and with DM had significantly higher levels of hsCRP as 40% and 31% patients have CRP level lies in group 3 and group 4 respectively. Moreover, the diabetic patients had higher levels of hsCRP as 50% of diabetic patients having levels of hsCRP fall in category of group 3 whereas only 13.3% non-diabetic patients have hsCRP falls in category of group 3. And this difference is statistically significant with the p value (p=0.007). \u0000Conclusion: The raised hsCRP is seen in AMI patients with history of diabetes, smoking and hypertension as compared to those AMI patients who had no previous history of all these risk factors.","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125869272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omer Aslam, M. Raza, Zainab Asghar, F. Umair, Syed Ali Hamza, S. Munir
BACKGROUND: Acute coronary syndromes (ACS) includes non ST elevation (NSTEMI) or ST elevation myocardial infarction (STEMI) along with unstable angina and is associated with high morbidity and mortality despite advances in treatment. Statins is one of the pharmacological agent in the management of acute coronary syndrome (ACS). After remarkable advances in medical management over many years, a significant proportion of patients still do not respond to Statins. AIMS; OBJECTIVE: To assess the frequency of non-responders of statins in acute coronary syndrome patients METHODOLOGY: This cross-sectional study was carried-out at Punjab Institute of Cardiology, Lahore (PIC) from August 10, 2015 to February 10, 2016. Total 325 patients who fulfilled the inclusion criteria were enrolled and counseled about the details of the study. After taking consent, detailed history and examination was recorded. Details were recorded regarding age, gender of the patient. All patients received 10mg of rosuvastatin. Data stratification was done for age, gender and duration of ACS. Chi-square test was used after stratification to check the significance. p-value was taken as significant when less than 0.05. CONCLUSION: There is a significant number of patients with no response to statins. Lipid-lowering statin regimen gives individuals who have recently experienced ACS increased protection against mortality or experiencing serious cardiovascular events. Results show that such patients benefit from early and ongoing LDL cholesterol reduction
{"title":"Frequency of non-responders of statins in acute coronary syndrome patients","authors":"Omer Aslam, M. Raza, Zainab Asghar, F. Umair, Syed Ali Hamza, S. Munir","doi":"10.55958/jcvd.v18i3.117","DOIUrl":"https://doi.org/10.55958/jcvd.v18i3.117","url":null,"abstract":"BACKGROUND: Acute coronary syndromes (ACS) includes non ST elevation (NSTEMI) or ST elevation myocardial infarction (STEMI) along with unstable angina and is associated with high morbidity and mortality despite advances in treatment. Statins is one of the pharmacological agent in the management of acute coronary syndrome (ACS). After remarkable advances in medical management over many years, a significant proportion of patients still do not respond to Statins. \u0000AIMS; OBJECTIVE: To assess the frequency of non-responders of statins in acute coronary syndrome patients\u0000METHODOLOGY: This cross-sectional study was carried-out at Punjab Institute of Cardiology, Lahore (PIC) from August 10, 2015 to February 10, 2016. Total 325 patients who fulfilled the inclusion criteria were enrolled and counseled about the details of the study. After taking consent, detailed history and examination was recorded. Details were recorded regarding age, gender of the patient. All patients received 10mg of rosuvastatin. Data stratification was done for age, gender and duration of ACS. Chi-square test was used after stratification to check the significance. p-value was taken as significant when less than 0.05.\u0000CONCLUSION: There is a significant number of patients with no response to statins. Lipid-lowering statin regimen gives individuals who have recently experienced ACS increased protection against mortality or experiencing serious cardiovascular events. Results show that such patients benefit from early and ongoing LDL cholesterol reduction","PeriodicalId":227176,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128555888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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