Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2687
Shakeela Naz, Faisal Qadir, R. A. Khawaja, Naveed Ullah Khan
Objectives: To assess reasons for lack of awareness regarding rheumatic heart disease among patients diagnosed with rheumatic heart disease. Methodology: In this cross-sectional study was conducted at the outpatient department of a tertiary care cardiac centre. We included consecutive patients of either gender between 18 to 60 years of age with the established diagnosis of RHD. Their knowledge and awareness regarding the disease itself and regarding its primary and secondary prevention and treatment options was assessed with the help of a structured self-developed questionnaire. Collected data was entered and analyzed using IBM SPSS 19. Results: A total of 502 patients were enrolled with almost equal number of male and female patients. Mean ± SD for patient age was 37.3 ± 10.9 years. Majority had received primary school education or above. 40% of the patients were not aware of rheumatic valvular heart disease as their diagnosis. Less than half of patients knew childhood fever and sore throat as cause of their disease. 72.6% of the patients were not aware of prophylactic treatment for the disease. 77.2% were referred to a cardiologist after more than four weeks. 47.9% of patients were not properly counselled about their disease. Conclusion: There was a very high incidence of lack of awareness regarding RHD among affected patients. Moreover, there was high incidence of inadequate physician-patient counselling about the disease and late referral to cardiologist. Healthcare providers should educate their patients, fostering community-based interventions this ultimately will lead to decrease morbidity and mortality among patients diagnosed with RHD and will help in early detection and prevention of RHD.
{"title":"Unveiling the Shadows: Exploring Factors Behind The Lack of Awareness of Rheumatic Heart Disease Among Diagnosed Patients","authors":"Shakeela Naz, Faisal Qadir, R. A. Khawaja, Naveed Ullah Khan","doi":"10.47144/phj.v56isupplement_2.2687","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2687","url":null,"abstract":"Objectives: To assess reasons for lack of awareness regarding rheumatic heart disease among patients diagnosed with rheumatic heart disease. Methodology: In this cross-sectional study was conducted at the outpatient department of a tertiary care cardiac centre. We included consecutive patients of either gender between 18 to 60 years of age with the established diagnosis of RHD. Their knowledge and awareness regarding the disease itself and regarding its primary and secondary prevention and treatment options was assessed with the help of a structured self-developed questionnaire. Collected data was entered and analyzed using IBM SPSS 19. Results: A total of 502 patients were enrolled with almost equal number of male and female patients. Mean ± SD for patient age was 37.3 ± 10.9 years. Majority had received primary school education or above. 40% of the patients were not aware of rheumatic valvular heart disease as their diagnosis. Less than half of patients knew childhood fever and sore throat as cause of their disease. 72.6% of the patients were not aware of prophylactic treatment for the disease. 77.2% were referred to a cardiologist after more than four weeks. 47.9% of patients were not properly counselled about their disease. Conclusion: There was a very high incidence of lack of awareness regarding RHD among affected patients. Moreover, there was high incidence of inadequate physician-patient counselling about the disease and late referral to cardiologist. Healthcare providers should educate their patients, fostering community-based interventions this ultimately will lead to decrease morbidity and mortality among patients diagnosed with RHD and will help in early detection and prevention of RHD.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"1 3","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268559","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2677
Asad Ali Khan, Farhat Ullah Khan, Said Amin, Rahmat Ghaffar
Objectives: Prompt diagnosis and management of hypertension, particularly in younger patients, are crucial to reducing complications, mortality, and expenses. A thorough history and careful physical examination are key steps. This article illustrates one such unusual case that had a subtle presentation and went undiagnosed until it was brought to our attention. Methodology: A 30-year-old male patient with a history of fatigue, poor exercise tolerance, and mild headaches was diagnosed with hypertension. He was commenced on amlodipine and had no family history of cardiac diseases or secondary hypertension. The patient appeared weak and thin, with a BMI of 16.6 kg/m2. His radial pulse was regular and 98 bpm, and his brachial blood pressure was recorded at 190/90 mmHg. Further examination revealed weak lower limb pulses, a radio-femoral delay, and an ankle blood pressure of 100/60 mmHg. A 3/6 systolic murmur was noted at the aortic area. Routine laboratory investigations revealed a chest x-ray showing notching of the ribs and an absent aortic knob. A transthoracic echocardiogram was performed, but it did not provide conclusive results. A CT angiography of the chest revealed a complete interruption of the aorta just below the left subclavian artery in a "rat tail fashion." The aortic valve was normal, and no other aortic or cardiac pathology was found. The patient was diagnosed with IAA type A and surgical correction was suggested. Antihypertensive medication was given to achieve blood pressure control, and surgical correction was done involving end-to-end anastomosis. The patient's postoperative period was uneventful, and at four weeks, his symptoms subsided, and his blood pressure was 130/80 mmHg without antihypertensive medications. Results: The patient had an interrupted Aortic Arch type A and underwent treatment with antihypertensive medications and surgical correction. After a month, symptoms subsided, blood pressure was 130/80 mmHg, and pulses were bilaterally normal. Post-op CT Aortogram showed good anatomic continuity and no complications. Conclusion: Mild symptoms might only be the tip of an iceberg, calling for further exploration. IAA, despite its rarity, should be considered a potential cause of hypertension.
{"title":"Exploring the Iceberg: Detection and Management of Isolated Interrupted Aortic Arch and Associated Hypertension- A Rare Entity","authors":"Asad Ali Khan, Farhat Ullah Khan, Said Amin, Rahmat Ghaffar","doi":"10.47144/phj.v56isupplement_2.2677","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2677","url":null,"abstract":"Objectives: Prompt diagnosis and management of hypertension, particularly in younger patients, are crucial to reducing complications, mortality, and expenses. A thorough history and careful physical examination are key steps. This article illustrates one such unusual case that had a subtle presentation and went undiagnosed until it was brought to our attention. Methodology: A 30-year-old male patient with a history of fatigue, poor exercise tolerance, and mild headaches was diagnosed with hypertension. He was commenced on amlodipine and had no family history of cardiac diseases or secondary hypertension. The patient appeared weak and thin, with a BMI of 16.6 kg/m2. His radial pulse was regular and 98 bpm, and his brachial blood pressure was recorded at 190/90 mmHg. Further examination revealed weak lower limb pulses, a radio-femoral delay, and an ankle blood pressure of 100/60 mmHg. A 3/6 systolic murmur was noted at the aortic area. Routine laboratory investigations revealed a chest x-ray showing notching of the ribs and an absent aortic knob. A transthoracic echocardiogram was performed, but it did not provide conclusive results. A CT angiography of the chest revealed a complete interruption of the aorta just below the left subclavian artery in a \"rat tail fashion.\" The aortic valve was normal, and no other aortic or cardiac pathology was found. The patient was diagnosed with IAA type A and surgical correction was suggested. Antihypertensive medication was given to achieve blood pressure control, and surgical correction was done involving end-to-end anastomosis. The patient's postoperative period was uneventful, and at four weeks, his symptoms subsided, and his blood pressure was 130/80 mmHg without antihypertensive medications. Results: The patient had an interrupted Aortic Arch type A and underwent treatment with antihypertensive medications and surgical correction. After a month, symptoms subsided, blood pressure was 130/80 mmHg, and pulses were bilaterally normal. Post-op CT Aortogram showed good anatomic continuity and no complications. Conclusion: Mild symptoms might only be the tip of an iceberg, calling for further exploration. IAA, despite its rarity, should be considered a potential cause of hypertension.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"7 6","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139266588","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2674
Sher Wali Khan, Farwa Munir
Objectives: The objective of current study was to assess the correlation between serum uric acid level and severity the severity coronary artery disease (CAD). Methodology: This descriptive study was carried at department of Cardiology, Lady Reading Hospital, Peshawar during the period 5th January 2023 till 10th August 2023.Patients with coronary disease were enrolled and graded according to syntax score. Serum uric acid level was determined. Correlation between serum uric level and severity of CAD was determined using spearman correlation coefficient. Data was entered and analyzed using SPSS version 25. Results: In this study 303 patients were enrolled. Age of the patients ranged from 40 to 70 years with mean age 59.28±12.33 years. 228 (75.2%) participants were male. Mean uric acid was 7.01±1.77mg/dl. Syntax score was 29.39±7.29. 43.6% patients had syntax score ≥33. The spearman correlation coefficient “r” value between serum uric acid and CAD was 0.498 showing moderately strong correlation. Hyperuricemia was observed in 56.8% patients with syntax score ≥33 as compared to 49.1% and 47.4% patients with syntax score 23-32 and 0-22 respectively. Conclusion: This study concluded that there's a positive and moderately strong correlation exists between serum uric acid level and severity of CAD.
{"title":"Correlation between Serum Uric Level and the Severity of Coronary Artery Disease","authors":"Sher Wali Khan, Farwa Munir","doi":"10.47144/phj.v56isupplement_2.2674","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2674","url":null,"abstract":"Objectives: The objective of current study was to assess the correlation between serum uric acid level and severity the severity coronary artery disease (CAD). Methodology: This descriptive study was carried at department of Cardiology, Lady Reading Hospital, Peshawar during the period 5th January 2023 till 10th August 2023.Patients with coronary disease were enrolled and graded according to syntax score. Serum uric acid level was determined. Correlation between serum uric level and severity of CAD was determined using spearman correlation coefficient. Data was entered and analyzed using SPSS version 25. Results: In this study 303 patients were enrolled. Age of the patients ranged from 40 to 70 years with mean age 59.28±12.33 years. 228 (75.2%) participants were male. Mean uric acid was 7.01±1.77mg/dl. Syntax score was 29.39±7.29. 43.6% patients had syntax score ≥33. The spearman correlation coefficient “r” value between serum uric acid and CAD was 0.498 showing moderately strong correlation. Hyperuricemia was observed in 56.8% patients with syntax score ≥33 as compared to 49.1% and 47.4% patients with syntax score 23-32 and 0-22 respectively. Conclusion: This study concluded that there's a positive and moderately strong correlation exists between serum uric acid level and severity of CAD.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"28 2","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269077","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2684
Bilal Ahmad, Hafiz-ur- Rehman, Umar Badshah
Objectives: To find simple clinical signs for diagnosing pulmonary embolism on bedside. Methodology: This was a hospital based cross sectional observational study conducted in cardiology department Saidu teaching hospital from July 2019 to December 2020. 89 patients of either sex and all age groups with suspected pulmonary embolism (PE) were included. Clinical data and basic tests of all these patients were obtained, then according to ESC diagnostic algorithm patients were divided into low, intermediate and high probability groups. 74 patients with intermediate and high probability went for CTPA, while 15 patients with low probability were exclude from study. In 67 patients pulmonary embolism was confirmed on CTPA. Clinical data of these 67 patients was analyzed for most common presenting symptoms and signs. Results: Data was available on 67 patients with confirmed PE, 58.2% were male and 41.8% were female. Mean age of study population was 53.15+/-16.29. Patients from different parts of Malakand division were included. 95.5 % patient presented with new onset dyspnea, 1.5 % presented with isolated chest pain, while 3% presented with other symptoms. 62.7 % patient had provoked and 37.3% had unprovoked PE. Mean heart rate of study population was 99.63. 95% patients had oxygen saturation of less than 96%. Other common findings included normal chest examination, sinus tachycardia on ECG, normal chest X-ray, and some form of right ventricular abnormality on Echo. Conclusion: Patient with new onset Dyspnea, resting Tachycardia, oxygen saturation below 95% at rest or mild exertion, and no other explanation for these findings should be evaluated for pulmonary embolism with CTPA.
{"title":"Simple Signs for Complex Problem","authors":"Bilal Ahmad, Hafiz-ur- Rehman, Umar Badshah","doi":"10.47144/phj.v56isupplement_2.2684","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2684","url":null,"abstract":"Objectives: To find simple clinical signs for diagnosing pulmonary embolism on bedside. Methodology: This was a hospital based cross sectional observational study conducted in cardiology department Saidu teaching hospital from July 2019 to December 2020. 89 patients of either sex and all age groups with suspected pulmonary embolism (PE) were included. Clinical data and basic tests of all these patients were obtained, then according to ESC diagnostic algorithm patients were divided into low, intermediate and high probability groups. 74 patients with intermediate and high probability went for CTPA, while 15 patients with low probability were exclude from study. In 67 patients pulmonary embolism was confirmed on CTPA. Clinical data of these 67 patients was analyzed for most common presenting symptoms and signs. Results: Data was available on 67 patients with confirmed PE, 58.2% were male and 41.8% were female. Mean age of study population was 53.15+/-16.29. Patients from different parts of Malakand division were included. 95.5 % patient presented with new onset dyspnea, 1.5 % presented with isolated chest pain, while 3% presented with other symptoms. 62.7 % patient had provoked and 37.3% had unprovoked PE. Mean heart rate of study population was 99.63. 95% patients had oxygen saturation of less than 96%. Other common findings included normal chest examination, sinus tachycardia on ECG, normal chest X-ray, and some form of right ventricular abnormality on Echo. Conclusion: Patient with new onset Dyspnea, resting Tachycardia, oxygen saturation below 95% at rest or mild exertion, and no other explanation for these findings should be evaluated for pulmonary embolism with CTPA.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"10 11","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269091","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}
Objectives: In this cross-sectional study we aim to assess the frequency of RVDD in chronic heart failure patients with reduced EF who visited as outpatient in a tertiary care hospital. Methodology: We included consecutive patients with chronic heart failure who had reduced EF. We assessed these patients for RVDD if they had normal RV systolic function and pulmonary artery pressures. The RVDD was categorized as normal, impaired relaxation, pseudonormal filling and restricted filling according to ASE guideline. RVDD grades were compared with LV systolic dysfunction and diastolic dysfunction grades. Results: Out of 199 patients evaluated, 66.3% (132) were male will with the mean age of 56.8 ± 12 years. The majority, 176, 88.4% of patients were with diagnosis if ICMP. The RVDD was noted in 112 (56.3%) patients out of which 30 (26.8%) had stage 1 (impaired relaxation) 78 (69.6%) had stage 2 (pseudonormal) and 4 (3.6%) patients had grade 3 (restrictive filling) RVDD. When compared a statistically significant association (P < 0.001) was observed between LV and RV diastolic dysfunction. Conclusion: RVDD is under diagnosed entity of neglected ventricle which is significantly associated with LV systolic and diastolic dysfunction even if the RV systolic function is normal. The prognostic significance of this diastolic ventricular interaction needs to be further investigated.
{"title":"Frequency of RV Diastolic Dysfunction in Chronic Heart Failure Patients","authors":"Sumyia Gurmani, Arij Arij, Fawad Fawad, Saba Hussain, Zubair Zubair, Salman Salman, Tahira Tahira, Tayabba Tayabba","doi":"10.47144/phj.v56isupplement_2.2681","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2681","url":null,"abstract":"Objectives: In this cross-sectional study we aim to assess the frequency of RVDD in chronic heart failure patients with reduced EF who visited as outpatient in a tertiary care hospital. Methodology: We included consecutive patients with chronic heart failure who had reduced EF. We assessed these patients for RVDD if they had normal RV systolic function and pulmonary artery pressures. The RVDD was categorized as normal, impaired relaxation, pseudonormal filling and restricted filling according to ASE guideline. RVDD grades were compared with LV systolic dysfunction and diastolic dysfunction grades. Results: Out of 199 patients evaluated, 66.3% (132) were male will with the mean age of 56.8 ± 12 years. The majority, 176, 88.4% of patients were with diagnosis if ICMP. The RVDD was noted in 112 (56.3%) patients out of which 30 (26.8%) had stage 1 (impaired relaxation) 78 (69.6%) had stage 2 (pseudonormal) and 4 (3.6%) patients had grade 3 (restrictive filling) RVDD. When compared a statistically significant association (P < 0.001) was observed between LV and RV diastolic dysfunction. Conclusion: RVDD is under diagnosed entity of neglected ventricle which is significantly associated with LV systolic and diastolic dysfunction even if the RV systolic function is normal. The prognostic significance of this diastolic ventricular interaction needs to be further investigated.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"4 5","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267132","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2675
Sumayya Sadiq, Muzdalfa Parvez, S. Sawar
Objectives: To determine the frequency of contrast induced nephropathy in STEMI patients undergoing primary PCI in patients at Hayatabad Medical Complex Peshawar. Methodology: 178 patients presenting with acute coronary syndrome were enrolled. Confirmation of ACS was based on typical chest pain, ECG findings and imaging findings including angiography. Patients was labelled having contrast induced nephropathy if their serum creatinine ≥25% from the baseline value within the 72- hour period is reported after percutaneous coronary intervention (PCI). Results: Age of the patients ranged from 40 to 80 years. Mean age of the patients was 52.80 ± 5.298 years. Male to female ratio was 2.4: 1. Contrast Induced nephropathy was recorded in 30 patients (16.8%). The association of contrast induced nephropathy with age, gender, diabetes mellitus and smoking status was statistically significant. Conclusion: CIN after primary PCI is strongly and positively associated with female gender, hypertension, diabetes mellitus and smoking.
{"title":"Frequency of Contrast Induced Nephropathy in STEMI Patients Undergoing Primry PCI in Patients at Hayatabad Medical Complex Peshawar","authors":"Sumayya Sadiq, Muzdalfa Parvez, S. Sawar","doi":"10.47144/phj.v56isupplement_2.2675","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2675","url":null,"abstract":"Objectives: To determine the frequency of contrast induced nephropathy in STEMI patients undergoing primary PCI in patients at Hayatabad Medical Complex Peshawar. Methodology: 178 patients presenting with acute coronary syndrome were enrolled. Confirmation of ACS was based on typical chest pain, ECG findings and imaging findings including angiography. Patients was labelled having contrast induced nephropathy if their serum creatinine ≥25% from the baseline value within the 72- hour period is reported after percutaneous coronary intervention (PCI). Results: Age of the patients ranged from 40 to 80 years. Mean age of the patients was 52.80 ± 5.298 years. Male to female ratio was 2.4: 1. Contrast Induced nephropathy was recorded in 30 patients (16.8%). The association of contrast induced nephropathy with age, gender, diabetes mellitus and smoking status was statistically significant. Conclusion: CIN after primary PCI is strongly and positively associated with female gender, hypertension, diabetes mellitus and smoking.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"C-29 3","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270540","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2683
S. Ashraf, Sibgah Masood, Amir Shahbaz, Q. Saboor
Objectives: The aim of the study is to compare the outcomes among STEMI cases with early treatment vs delayed treatment. To identify the contributing factors behind treatment delays and worse outcomes following STEMI symptoms. Methodology: It was a prospective comparative study on 186 patients with consecutive (non-probability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (i.e. within 2 hours of symptom onset = Group-A; after 2 hours of symptom onset = Group-B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. Results: The mean age of all patients was 46.62 ± 9.76 years and there were 140(75.27%) male and 46(24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment versus non- delayed treatment were poor social economic status (65.6% versus 20.4%), history of chronic stable angina (33.3% versus 11.8%), delayed response in the emergency room (20.4% versus 8.6%), delayed ECG acquisition (26.9% versus 8.6%), delayed ECG interpretation (25.8% versus 4.3%), pain at night 12:00 to 6:00 am (21.5% versus 9.7%) and belief that the chest pain is non-cardiac (26.9% versus 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group-A (2.2%), Re- infarction was 18.3% in group B in comparison with 7.5% group-A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in hospital mortality were higher in group B (12.9%, 14 % and 12.9% respectively). Conclusion: Our study highlights that while most post-AMI patients receive the recommended minimum statin therapy, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.
{"title":"Factors Responsible for Worse Outcomes in Stemi Patients with Early vs Delayed Treatment Presenting in a Tertiary Care Center","authors":"S. Ashraf, Sibgah Masood, Amir Shahbaz, Q. Saboor","doi":"10.47144/phj.v56isupplement_2.2683","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2683","url":null,"abstract":"Objectives: The aim of the study is to compare the outcomes among STEMI cases with early treatment vs delayed treatment. To identify the contributing factors behind treatment delays and worse outcomes following STEMI symptoms. Methodology: It was a prospective comparative study on 186 patients with consecutive (non-probability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (i.e. within 2 hours of symptom onset = Group-A; after 2 hours of symptom onset = Group-B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. Results: The mean age of all patients was 46.62 ± 9.76 years and there were 140(75.27%) male and 46(24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment versus non- delayed treatment were poor social economic status (65.6% versus 20.4%), history of chronic stable angina (33.3% versus 11.8%), delayed response in the emergency room (20.4% versus 8.6%), delayed ECG acquisition (26.9% versus 8.6%), delayed ECG interpretation (25.8% versus 4.3%), pain at night 12:00 to 6:00 am (21.5% versus 9.7%) and belief that the chest pain is non-cardiac (26.9% versus 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group-A (2.2%), Re- infarction was 18.3% in group B in comparison with 7.5% group-A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in hospital mortality were higher in group B (12.9%, 14 % and 12.9% respectively). Conclusion: Our study highlights that while most post-AMI patients receive the recommended minimum statin therapy, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"64 10","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268566","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2682
Rubina Rauf, Muhammad Ismail Soomro, Muhammad Nauman Khan, Mukesh Kumar, N. Soomro, K. Kazmi
Objectives: Acute myocardial infarction (AMI) stands as a global leading cause of mortality. Following AMI, meticulous management of patients' lipid profiles for secondary prevention becomes paramount. We conducted this study to assess lipid profile practices and levels in post-AMI patients, which are crucial for secondary prevention. Methodology: In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past three years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥20 mg or atorvastatin ≥40 mg, with target total cholesterol levels set at <160 mg/dL and target LDL (low-density lipoprotein) cholesterol at <55 mg/dL. Results: Among 195 patients, 71.3% were male, and the mean age was 57.1±10.2 years. The median duration since AMI was 36 [IQR: 10-48] months and 60% were diagnosed with STEMI (ST-segment elevation myocardial infarction). Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-cholesterol within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs. 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs. 11.7%). Conclusion: Our study highlights that while most post-AMI patients receive the recommended minimum statin therapy, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.
{"title":"Assessment of Lipid Profile Treatment Practices and Lipid Levels in Post-Myocardial Infarction Patients: Results from a Tertiary Care Hospital of Pakistan","authors":"Rubina Rauf, Muhammad Ismail Soomro, Muhammad Nauman Khan, Mukesh Kumar, N. Soomro, K. Kazmi","doi":"10.47144/phj.v56isupplement_2.2682","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2682","url":null,"abstract":"Objectives: Acute myocardial infarction (AMI) stands as a global leading cause of mortality. Following AMI, meticulous management of patients' lipid profiles for secondary prevention becomes paramount. We conducted this study to assess lipid profile practices and levels in post-AMI patients, which are crucial for secondary prevention. Methodology: In this cross-sectional study, we analyzed patients who had experienced their first AMI event in the past three years. We assessed fasting and non-fasting lipid profiles, reviewed statin therapy prescriptions, and examined patient compliance. The recommended dose was defined as rosuvastatin ≥20 mg or atorvastatin ≥40 mg, with target total cholesterol levels set at <160 mg/dL and target LDL (low-density lipoprotein) cholesterol at <55 mg/dL. Results: Among 195 patients, 71.3% were male, and the mean age was 57.1±10.2 years. The median duration since AMI was 36 [IQR: 10-48] months and 60% were diagnosed with STEMI (ST-segment elevation myocardial infarction). Only 13.8% of patients were advised to undergo lipid profile testing after AMI, 88.7% of patients were on the recommended statin therapy, and 91.8% of patients were compliant with statin therapy. Only 11.5% had LDL-cholesterol within the target range and 71.7% had total cholesterol within the target range. Hospital admission in the past 12 months was reported by 14.4%, and the re-admission rate was significantly higher among non-compliant patients (37.5% vs. 5.6%). Subsequent AMI event rate was also significantly higher among non-compliant patients (43.8% vs. 11.7%). Conclusion: Our study highlights that while most post-AMI patients receive the recommended minimum statin therapy, the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"38 10","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268839","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}
Objectives: This study aimed to evaluate the occurrence of right ventricular infarction among patients with inferior wall MI and the risk factors leading to involvement of the right ventricle. Methodology: A prospective study was conducted at Hayatabad Medical complex in Peshawar from December 2022 to July 2023, involving 114 participants aged 40-80 years with inferior wall myocardial infarction. The study confirmed MI by chest pain, ECG changes, and elevated cardiac enzymes, while right ventricular infarction was assessed through specific ECG leads. Patients with specific medical histories were excluded. Ethical approval was obtained to ensure patient rights and data confidentiality. Results: Out of 114 patients with inferior wall myocardial infarction (MI), 42 (36.8%) had right ventricular infarction (RVI). RVI and Age: Most participants (59.6%) were aged 40 to 60 years, and the rest (40.4%) were aged 61 to 80 years. RVI occurrence was not significantly associated with age (p = 0.707). RVI and Gender: Among the participants, 61.4% were male, and 38.6% were female. RVI was significantly more common in males (45.7%) compared to females (22.7%) with a p-value of 0.013. Hypertension was present in 40.3% of participants, and RVI was significantly associated with hypertension (p < 0.001). RVI occurred in 65.2% of hypertensive patients compared to 17.6% of non-hypertensive patients. Smoking: Smoking was reported by 26.3% of participants, and RVI was significantly more prevalent among smokers (56.7%) compared to non-smokers (29.8%) with a p-value of 0.008. Diabetes Mellitus: Diabetes was present in 21.0% of patients, and RVI was significantly associated with diabetes (p = 0.014). RVI occurred in 58.3% of diabetic patients versus 31.1% in non-diabetics. Dyslipidemias: Dyslipidemia was found in 12.3% of patients, but the association with RVI was not statistically significant (p = 0.092). RVI occurred in 57.1% of dyslipidemic patients and 34.0% of non-dyslipidemic patients. Conclusion: The occurrence of RVI is seen in around 33% of instances in conjunction with IWMI. The identification of risk factors is crucial in the assessment of individuals with chronic heart disease. The use of this straightforward method has the potential to streamline the process of identifying and categorizing individuals who may be at a higher risk of developing right ventricular infarction in the context of inferior wall myocardial infarction. The risk variables included in this study consist of hypertension, diabetes mellitus, and smoking. Among these three options, people with hypertension have the greatest likelihood of experiencing RVI. Therefore, it may be inferred that this factor is among the most significant risk factors for respiratory viral infections in individuals with impaired immune systems. The use of timely management strategies for the aforementioned risk factors will lead to a decrease in the occurrence of RVI and therefore mitigate the related complication
{"title":"Right Ventricular Infarction in Patients with Inferior Wall Myocardial Infarction and its Association with Various Risk Factors","authors":"Hafeez Orakzai, Danish Ahmed, Tashfeen Tashfeen, Nazeef Nazeef","doi":"10.47144/phj.v56isupplement_2.2685","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2685","url":null,"abstract":"Objectives: This study aimed to evaluate the occurrence of right ventricular infarction among patients with inferior wall MI and the risk factors leading to involvement of the right ventricle. Methodology: A prospective study was conducted at Hayatabad Medical complex in Peshawar from December 2022 to July 2023, involving 114 participants aged 40-80 years with inferior wall myocardial infarction. The study confirmed MI by chest pain, ECG changes, and elevated cardiac enzymes, while right ventricular infarction was assessed through specific ECG leads. Patients with specific medical histories were excluded. Ethical approval was obtained to ensure patient rights and data confidentiality. Results: Out of 114 patients with inferior wall myocardial infarction (MI), 42 (36.8%) had right ventricular infarction (RVI). RVI and Age: Most participants (59.6%) were aged 40 to 60 years, and the rest (40.4%) were aged 61 to 80 years. RVI occurrence was not significantly associated with age (p = 0.707). RVI and Gender: Among the participants, 61.4% were male, and 38.6% were female. RVI was significantly more common in males (45.7%) compared to females (22.7%) with a p-value of 0.013. Hypertension was present in 40.3% of participants, and RVI was significantly associated with hypertension (p < 0.001). RVI occurred in 65.2% of hypertensive patients compared to 17.6% of non-hypertensive patients. Smoking: Smoking was reported by 26.3% of participants, and RVI was significantly more prevalent among smokers (56.7%) compared to non-smokers (29.8%) with a p-value of 0.008. Diabetes Mellitus: Diabetes was present in 21.0% of patients, and RVI was significantly associated with diabetes (p = 0.014). RVI occurred in 58.3% of diabetic patients versus 31.1% in non-diabetics. Dyslipidemias: Dyslipidemia was found in 12.3% of patients, but the association with RVI was not statistically significant (p = 0.092). RVI occurred in 57.1% of dyslipidemic patients and 34.0% of non-dyslipidemic patients. Conclusion: The occurrence of RVI is seen in around 33% of instances in conjunction with IWMI. The identification of risk factors is crucial in the assessment of individuals with chronic heart disease. The use of this straightforward method has the potential to streamline the process of identifying and categorizing individuals who may be at a higher risk of developing right ventricular infarction in the context of inferior wall myocardial infarction. The risk variables included in this study consist of hypertension, diabetes mellitus, and smoking. Among these three options, people with hypertension have the greatest likelihood of experiencing RVI. Therefore, it may be inferred that this factor is among the most significant risk factors for respiratory viral infections in individuals with impaired immune systems. The use of timely management strategies for the aforementioned risk factors will lead to a decrease in the occurrence of RVI and therefore mitigate the related complication","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"36 3","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269517","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}
Pub Date : 2023-11-16DOI: 10.47144/phj.v56isupplement_2.2678
Aiysha Nasir, Fateh Ali Tipoo Sultan, R. A. Khawaja, Muhammad Ahmed Tamiz
Objectives: The aim of this study is to evaluate clinical characteristics and long-term outcome of the patients with bio-prosthetic mitral valve replacement at a tertiary care hospital of a South Asian country. Methodology: The study is a retrospective observational observational study involving patients who underwent bio-prosthetic mitral valve replacement at a tertiary care hospital in Karachi, Pakistan, between 2006 and 2020, and had at least two complete echocardiograms. Patients with incomplete clinical data, no electronic reports of echocardiograms, and mechanical mitral valve replacement were excluded. Results: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bio-prosthetic mitral valve replacement from the year 2006 to 2020. Patients were divided into two groups based on normal functioning bio-prosthetic mitral valve and bio-prosthetic mitral valve dysfunction (BMVD). Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. Mitral valve replacement was done as an elective procedure due to NYHA II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 + 2.99 years, bio-prosthetic mitral valve dysfunction (BMVD) was observed in 183 (36.5%) patients. However, re-do mitral valve surgery was done in only 49 (9.8%) patients. Comparing the two groups, individuals with normal functioning bio-prosthetic mitral valve had a mean age of 51.6 + 14.27 years, while those with BMVD had a mean age of 45.639 + 14.33 years at the time of index surgery (p value=0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%) and death (n = 6, 3.28%) in BMVD group which were statistically significant. Conclusion: This study is distinct because it demonstrates the outcomes of bio-prosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bio-prosthetic valve in younger patients, a significant number of cases developed BMVD along with poor long-term clinical outcomes even at a short follow up period of less than ten years. These findings are like international data and signify that mechanical mitral valve replacement may be a more reasonable alternative in younger patients.
{"title":"Clinical Characteristics and Long-Term Outcome of Patients with Bio-Prosthetic Mitral Valve – Experience From a South Asian Country","authors":"Aiysha Nasir, Fateh Ali Tipoo Sultan, R. A. Khawaja, Muhammad Ahmed Tamiz","doi":"10.47144/phj.v56isupplement_2.2678","DOIUrl":"https://doi.org/10.47144/phj.v56isupplement_2.2678","url":null,"abstract":"Objectives: The aim of this study is to evaluate clinical characteristics and long-term outcome of the patients with bio-prosthetic mitral valve replacement at a tertiary care hospital of a South Asian country. Methodology: The study is a retrospective observational observational study involving patients who underwent bio-prosthetic mitral valve replacement at a tertiary care hospital in Karachi, Pakistan, between 2006 and 2020, and had at least two complete echocardiograms. Patients with incomplete clinical data, no electronic reports of echocardiograms, and mechanical mitral valve replacement were excluded. Results: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bio-prosthetic mitral valve replacement from the year 2006 to 2020. Patients were divided into two groups based on normal functioning bio-prosthetic mitral valve and bio-prosthetic mitral valve dysfunction (BMVD). Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. Mitral valve replacement was done as an elective procedure due to NYHA II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 + 2.99 years, bio-prosthetic mitral valve dysfunction (BMVD) was observed in 183 (36.5%) patients. However, re-do mitral valve surgery was done in only 49 (9.8%) patients. Comparing the two groups, individuals with normal functioning bio-prosthetic mitral valve had a mean age of 51.6 + 14.27 years, while those with BMVD had a mean age of 45.639 + 14.33 years at the time of index surgery (p value=0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%) and death (n = 6, 3.28%) in BMVD group which were statistically significant. Conclusion: This study is distinct because it demonstrates the outcomes of bio-prosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bio-prosthetic valve in younger patients, a significant number of cases developed BMVD along with poor long-term clinical outcomes even at a short follow up period of less than ten years. These findings are like international data and signify that mechanical mitral valve replacement may be a more reasonable alternative in younger patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"206 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269813","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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