Shakeela Naz, R. A. Khawaja, N. Khan, Muhammad Tariq Farman, M. Saeed, Atiqa Amir Ali, Arisha Mustafa Shah
Objectives: To assess the knowledge about valvular heart disease among the patients who are already diagnosed with rheumatic valvular heart disease (RVHD). Methodology: In this cross-sectional study was conducted at the outpatient 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 RVHD. 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. Results: Among the study sample of 505 patients, 255 (50.5%) were male and overall mean age was 37.3 ± 10.9 years. A majority (90.3%) of the patients had household income of ≤ PKR 40,000 and 35.3% were illiterate. More than 41% were not aware of their diagnosis, 40% were aware of childhood infection as the cause of RVHD. About 40% of the patients could not recall history of fever/sore throat in past. About 19.8% of the patients considered percutaneous transvenous mitral commissurotomy as complete cure for RVHD and 46.3% of the patients were not aware of a prophylactic treatment. Only 33.9% considered the need to maintain good dental hygiene as part of the prophylactic treatment. Conclusion: High incidence of lack of awareness regarding their disease and its prophylaxis in our study population is alarming. To improve the RHD awareness, sessions and seminars should be arranged in the general population. Further studies are required to identify the cause and hence identifying measures to improve awareness.
{"title":"Knowledge and Awareness of Rheumatic Valvular Heart Disease among Diagnosed Patients","authors":"Shakeela Naz, R. A. Khawaja, N. Khan, Muhammad Tariq Farman, M. Saeed, Atiqa Amir Ali, Arisha Mustafa Shah","doi":"10.47144/phj.v56i1.2463","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2463","url":null,"abstract":"Objectives: To assess the knowledge about valvular heart disease among the patients who are already diagnosed with rheumatic valvular heart disease (RVHD).\u0000Methodology: In this cross-sectional study was conducted at the outpatient 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 RVHD. 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.\u0000Results: Among the study sample of 505 patients, 255 (50.5%) were male and overall mean age was 37.3 ± 10.9 years. A majority (90.3%) of the patients had household income of ≤ PKR 40,000 and 35.3% were illiterate. More than 41% were not aware of their diagnosis, 40% were aware of childhood infection as the cause of RVHD. About 40% of the patients could not recall history of fever/sore throat in past. About 19.8% of the patients considered percutaneous transvenous mitral commissurotomy as complete cure for RVHD and 46.3% of the patients were not aware of a prophylactic treatment. Only 33.9% considered the need to maintain good dental hygiene as part of the prophylactic treatment.\u0000Conclusion: High incidence of lack of awareness regarding their disease and its prophylaxis in our study population is alarming. To improve the RHD awareness, sessions and seminars should be arranged in the general population. Further studies are required to identify the cause and hence identifying measures to improve awareness.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43655815","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}
Zeeshan A. Shaikh, Ali N. Khan, Ghulam Rasool Maken, S. Shabbir, Erum Shahzadi Malik, Mahesh Kumar, Yumna Siddiqui
Objectives: The objective of the current study was to determine the frequency of anxiety and depression among patients diagnosed with acute coronary syndrome (ACS) at a tertiary care cardiac center in Pakistan. Methodology: This cross-sectional study was conducted at a tertiary care cardiac center in Pakistan from May to November 2019. We included patients of either gender, between 30 and 70 years of age, diagnosed with ACS, and presented within 72 hours of onset of symptoms. After the standard treatment of the condition, the Beck Depression Inventory Scale (BDI) and Beck Anxiety Inventory (BAI) were used to assess post-AMI depression and anxiety. The BDI ≥17 was categorized as depression and BAI ≥11 was taken as anxiety. Results: In the selected sample of 122 patients, the mean age was 58.7 ± 10.2 years and 88 (72.1%) patients were male. Diabetes mellitus was detected in 76 (62.3%) patients and 64 (52.5%) patients were smokers. The mean BDI score was 28.6 ± 6.5 and mean BAI score was 19.5 ± 5.1. Anxiety and depression were observed in 36 (29.5%) and 51 (41.8%) patients, respectively. Conclusion: Depression and anxiety are a common remnants of ACS, hence, in our day to day clinical practice, appropriate consideration should be given to the psychological wellbeing of patients in addition to the management of ACS.
{"title":"Frequency of Depression and Anxiety in Patients with Acute Coronary Syndrome","authors":"Zeeshan A. Shaikh, Ali N. Khan, Ghulam Rasool Maken, S. Shabbir, Erum Shahzadi Malik, Mahesh Kumar, Yumna Siddiqui","doi":"10.47144/phj.v56i1.2401","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2401","url":null,"abstract":"Objectives: The objective of the current study was to determine the frequency of anxiety and depression among patients diagnosed with acute coronary syndrome (ACS) at a tertiary care cardiac center in Pakistan.\u0000Methodology: This cross-sectional study was conducted at a tertiary care cardiac center in Pakistan from May to November 2019. We included patients of either gender, between 30 and 70 years of age, diagnosed with ACS, and presented within 72 hours of onset of symptoms. After the standard treatment of the condition, the Beck Depression Inventory Scale (BDI) and Beck Anxiety Inventory (BAI) were used to assess post-AMI depression and anxiety. The BDI ≥17 was categorized as depression and BAI ≥11 was taken as anxiety.\u0000Results: In the selected sample of 122 patients, the mean age was 58.7 ± 10.2 years and 88 (72.1%) patients were male. Diabetes mellitus was detected in 76 (62.3%) patients and 64 (52.5%) patients were smokers. The mean BDI score was 28.6 ± 6.5 and mean BAI score was 19.5 ± 5.1. Anxiety and depression were observed in 36 (29.5%) and 51 (41.8%) patients, respectively.\u0000Conclusion: Depression and anxiety are a common remnants of ACS, hence, in our day to day clinical practice, appropriate consideration should be given to the psychological wellbeing of patients in addition to the management of ACS.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48683599","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}
Muhammad Abdullah, Ijaz Hussain, Aruba Nawaz, U. Umer, Zamara Sohail, A. Safi, H. Abid, Mahwish Jabeen
Objectives: To compare the diagnostic accuracy of cardiac Computed Tomography (CT) and echocardiography for the diagnosis of congenital heart diseases (CHD) at Rehman Medical Institute (RMI), Peshawar. Methodology: We conducted a cross sectional study at Rehman Medical Institute between January 2020 to July 2022. Patients of different ages referred for suspicion of congenital heart diseases were enrolled. The data was collected prospectively which included demographics, Echocardiography findings, CT scan results and procedure notes. Data was analyzed on SPSS the results of descriptive variables expressed as median and percentile. A p-value <0.05 was considered significant. Results: We included 129 patients, with 73 male and 56 females having age from few days to 18 years. The malformations were divided into intra and extra cardiac groups. 665 malformations were confirmed and analyzed keeping surgical and conventional angiography findings as gold standard. Among these 283 were intra and 99 extra cardiac findings. The echo and CT scan missed 2 and 4 intracardiac anomalies respectively. In case of extracardiac anomalies echo missed 14 anomalies however CT correctly diagnosed all. Both intra and extracardiac results are significant with a p value <0.05. Conclusion: We conclude that Echocardiography is preferred modality for intracardiac anomalies evident by 99.3% diagnostic accuracy while CTA provides better demonstration of extra cardiac abnormalities having diagnostic accuracy of 99.9%. Echocardiography and CTA are both complementary for assessment and evaluation of congenital heart diseases acting as guide to surgery.
{"title":"Comparison of Cardiac Computed Tomography and Echocardiography for the Diagnosis of Congenital Heart Diseases","authors":"Muhammad Abdullah, Ijaz Hussain, Aruba Nawaz, U. Umer, Zamara Sohail, A. Safi, H. Abid, Mahwish Jabeen","doi":"10.47144/phj.v56i1.2382","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2382","url":null,"abstract":"Objectives: To compare the diagnostic accuracy of cardiac Computed Tomography (CT) and echocardiography for the diagnosis of congenital heart diseases (CHD) at Rehman Medical Institute (RMI), Peshawar.\u0000Methodology: We conducted a cross sectional study at Rehman Medical Institute between January 2020 to July 2022. Patients of different ages referred for suspicion of congenital heart diseases were enrolled. The data was collected prospectively which included demographics, Echocardiography findings, CT scan results and procedure notes. Data was analyzed on SPSS the results of descriptive variables expressed as median and percentile. A p-value <0.05 was considered significant.\u0000Results: We included 129 patients, with 73 male and 56 females having age from few days to 18 years. The malformations were divided into intra and extra cardiac groups. 665 malformations were confirmed and analyzed keeping surgical and conventional angiography findings as gold standard. Among these 283 were intra and 99 extra cardiac findings. The echo and CT scan missed 2 and 4 intracardiac anomalies respectively. In case of extracardiac anomalies echo missed 14 anomalies however CT correctly diagnosed all. Both intra and extracardiac results are significant with a p value <0.05.\u0000Conclusion: We conclude that Echocardiography is preferred modality for intracardiac anomalies evident by 99.3% diagnostic accuracy while CTA provides better demonstration of extra cardiac abnormalities having diagnostic accuracy of 99.9%. Echocardiography and CTA are both complementary for assessment and evaluation of congenital heart diseases acting as guide to surgery.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42136563","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: Post-dilatation with non-compliant (NC) balloons is a commonly used strategy to improve inadequate stent expansion but this strategy carries an increased risk of slow flow/no-reflow (SF/NR) due to distal embolization. Therefore, our objective was to evaluate the demographic, clinical, angiographic, and procedure characteristics among patients undergoing primary percutaneous coronary intervention (PCI) who developed slow flow/no-reflow (SF/NR) after post-dilatation with non-compliant (NC) balloons. Methodology: In this cross-sectional observational study, we included consecutive patients with SF/NR after post-dilatation using NC balloon post stent deployment during primary PCI. The demographic, clinical, angiographic, and procedure characteristics were evaluated. Results: In the sample of 107 patients, male were 77.6% (83) and mean age was 56.94 ± 10.47 years. The median chest pain to ER (emergency room) arrival time was 292 [180-394] minutes. A majority of the patients (66.4%) had multi-vessel disease. Mean length NC balloon was 10.57±1.98 mm and diameter was 3.5±0.26 mm. The mean number of inflation were 3.62±1.08, at mean maximal pressure of 20.43±2.49 mmHg, proximal edge pressure of 19.25±2.74 mmHg, and distal edge pressure of 14.64±2.01 mmHg. A total of 5.6% (6) patients developed adverse events and final TIMI (thrombolysis in myocardial infarction) III flow was achieved in 89.7% (96) of the patients. Conclusion: SF/NR after post-dilatation during primary PCI is associated with a significant rate of adverse events and sub-optimal (
{"title":"Clinical Characteristics of Patents who Developed Slow Flow/ no-reflow After Post-dilatation with Non-compliant Balloon during Primary Percutaneous Coronary Intervention","authors":"","doi":"10.47144/phj.v56i1.2413","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2413","url":null,"abstract":"Objectives: Post-dilatation with non-compliant (NC) balloons is a commonly used strategy to improve inadequate stent expansion but this strategy carries an increased risk of slow flow/no-reflow (SF/NR) due to distal embolization. Therefore, our objective was to evaluate the demographic, clinical, angiographic, and procedure characteristics among patients undergoing primary percutaneous coronary intervention (PCI) who developed slow flow/no-reflow (SF/NR) after post-dilatation with non-compliant (NC) balloons.\u0000Methodology: In this cross-sectional observational study, we included consecutive patients with SF/NR after post-dilatation using NC balloon post stent deployment during primary PCI. The demographic, clinical, angiographic, and procedure characteristics were evaluated.\u0000Results: In the sample of 107 patients, male were 77.6% (83) and mean age was 56.94 ± 10.47 years. The median chest pain to ER (emergency room) arrival time was 292 [180-394] minutes. A majority of the patients (66.4%) had multi-vessel disease. Mean length NC balloon was 10.57±1.98 mm and diameter was 3.5±0.26 mm. The mean number of inflation were 3.62±1.08, at mean maximal pressure of 20.43±2.49 mmHg, proximal edge pressure of 19.25±2.74 mmHg, and distal edge pressure of 14.64±2.01 mmHg. A total of 5.6% (6) patients developed adverse events and final TIMI (thrombolysis in myocardial infarction) III flow was achieved in 89.7% (96) of the patients.\u0000Conclusion: SF/NR after post-dilatation during primary PCI is associated with a significant rate of adverse events and sub-optimal (","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42160485","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}
J. Henrina, Maria Teressa, Agustinus Wiraatmadja, Asep Purnama, A. Cahyadi
Coronary artery disease (CAD) is one of the main global causes of death. Early diagnosis by physical examination may play important role to identify population at risk and reduce morbidity and mortality. Diagonal Ear Lobe Crease (DELC), also known as Frank’s sign, was observed to be associated with coronary artery disease. We report a case of patient who presented with inferoposterior STEMI and findings of bilateral DELC. A systematic literature search was conducted to identify the latest evidence and its implications for clinical practice.
{"title":"Inferoposterior ST-Elevation Myocardial Infarction in a Patient with Frank’s Sign: A Case Report","authors":"J. Henrina, Maria Teressa, Agustinus Wiraatmadja, Asep Purnama, A. Cahyadi","doi":"10.47144/phj.v56i1.2395","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2395","url":null,"abstract":"Coronary artery disease (CAD) is one of the main global causes of death. Early diagnosis by physical examination may play important role to identify population at risk and reduce morbidity and mortality. Diagonal Ear Lobe Crease (DELC), also known as Frank’s sign, was observed to be associated with coronary artery disease. We report a case of patient who presented with inferoposterior STEMI and findings of bilateral DELC. A systematic literature search was conducted to identify the latest evidence and its implications for clinical practice.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47928202","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}
Muhammad Taha Khan, S. Saadia, A. Khan, F. Subhani, A. Shafquat, Y. Saeed
Objectives: Atrial high-rate episodes (AHRE) are associated with an increased risk of subclinical atrial fibrillation (SCAF) and can be identified in patients with cardiac implantable electronic devices (CIEDs). This first study from Pakistan aims to determine the incidence of AHREs and the characteristics of a Pakistani cohort with AHREs. Methodology: In this bicentric Cross-sectional study, there were 162 patients of more than 18 years with CIEDs presenting to the device clinics were enrolled. The AHREs cutoff was predefined and AHREs were documented if they last for >30 seconds. Patients with known atrial fibrillation were excluded. Results: Mean age of the patients was 64.69±11.64 years and men were of 62.3%. AHREs were found in 22 (13.6%) patients out of which 13(8%) lasted more than 5 minutes. Mean AHREs cutoff 182.27±20.93. Mean CHA₂DS₂-VASc score; 3.10±1.47. 54.9% on beta-blockers, and 37% on angiotensin receptor blockers (ARB). Dual-chamber pacemaker (75.3%) and AV block (60.5%) mostly complete AV block , were the most common CIED and indication for an implant respectively. 43.8% had mildly dilated LA, only 1.2 % had severe mitral stenosis, and 3.1% had severe mitral regurgitation. Multivariable binary logistic regression analysis showed that patients on ARB had fewer episodes of AHREs (OR=0.2, 95% CI= 0.05 -0.8, P-value =0.023) while positive family history for coronary artery disease (CAD) was associated with more episodes (OR=5.62, 95% CI=1.58 -20, P-value =0.008). Conclusion: The incidence of AHREs was considerably lower in our population on CIEDs interrogation as compared to prior studies, although the CHA₂DS₂-VASc score is higher. ARB use and positive family history of CAD had a statistically significant association with AHRE occurrence.
{"title":"Detection of Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices — a Multicenter Experience from Pakistan: A Cross-Sectional Study","authors":"Muhammad Taha Khan, S. Saadia, A. Khan, F. Subhani, A. Shafquat, Y. Saeed","doi":"10.47144/phj.v56i1.2412","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2412","url":null,"abstract":"Objectives: Atrial high-rate episodes (AHRE) are associated with an increased risk of subclinical atrial fibrillation (SCAF) and can be identified in patients with cardiac implantable electronic devices (CIEDs). This first study from Pakistan aims to determine the incidence of AHREs and the characteristics of a Pakistani cohort with AHREs.\u0000Methodology: In this bicentric Cross-sectional study, there were 162 patients of more than 18 years with CIEDs presenting to the device clinics were enrolled. The AHREs cutoff was predefined and AHREs were documented if they last for >30 seconds. Patients with known atrial fibrillation were excluded.\u0000Results: Mean age of the patients was 64.69±11.64 years and men were of 62.3%. AHREs were found in 22 (13.6%) patients out of which 13(8%) lasted more than 5 minutes. Mean AHREs cutoff 182.27±20.93. Mean CHA₂DS₂-VASc score; 3.10±1.47. 54.9% on beta-blockers, and 37% on angiotensin receptor blockers (ARB). Dual-chamber pacemaker (75.3%) and AV block (60.5%) mostly complete AV block , were the most common CIED and indication for an implant respectively. 43.8% had mildly dilated LA, only 1.2 % had severe mitral stenosis, and 3.1% had severe mitral regurgitation. Multivariable binary logistic regression analysis showed that patients on ARB had fewer episodes of AHREs (OR=0.2, 95% CI= 0.05 -0.8, P-value =0.023) while positive family history for coronary artery disease (CAD) was associated with more episodes (OR=5.62, 95% CI=1.58 -20, P-value =0.008).\u0000Conclusion: The incidence of AHREs was considerably lower in our population on CIEDs interrogation as compared to prior studies, although the CHA₂DS₂-VASc score is higher. ARB use and positive family history of CAD had a statistically significant association with AHRE occurrence.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70771174","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}
K. Kumar, A. Khuwaja, A. Mangi, S. A. Khan, Hamna Tariq, Sayed Zaheeruddin, Saleha Akhtar
Objectives: The objective of this study was to assess the effectiveness of ultrasound guided vs. conventional palpation method for radial artery cannulation in the operating room for patients undergoing elective open-heart operations. Methodology: This prospective observational study was carried at the National Institute of Cardiovascular Disease (NICVD) in Karachi and Sukkur. All cannulation procedures were performed by anesthesia residents (R-1). Two equal sized independent groups of patients based on radial artery cannulation technique, either ultrasound guided (USG) or conventional palpation method (CPM) were recruited. Artery cannulation success along with number of attempts, total duration, number of additional operators, need for change of site, and complications were recorded. Results: A total of 70 patients were recruited in each of the group, mean patient age was 52.43±13.53 years vs. 50.71 ± 14.1 years; p=0.605 with proportion of male patients as 65.7% (46) vs. 77.1% (54); p=0.290, for USG and CPM, respectively. Artery cannulation success rate was 74.3% (52) vs. 80% (56); p=0.569, mean number of attempts was 1.71±1.05 vs. 1.51±0.89; p=0.391, mean total duration was 7.76±3.78 minutes vs. 5.42 ± 8.2 minutes; p=0.131, mean number of additional operators was 0.74±0.44 vs. 0.89±0.32; p=0.128, need for change of site was 11.4% (8) vs. 2.9% (2); p=0.356, and complications were observed in 8.6% (6) vs. 2.9% (2); p=0.614 for USG and CPM, respectively. Conclusion: In this observational study, no significant differences were observed in the effectiveness of USG and CPM for radial artery cannulation when performed by newly inducted anesthesia residents.
目的:本研究的目的是评估超声引导与常规触诊方法在择期心内直视手术患者桡动脉插管的有效性。方法:这项前瞻性观察性研究在卡拉奇和苏库尔的国家心血管疾病研究所(NICVD)进行。所有插管过程均由麻醉住院医师(R-1)执行。采用超声引导(USG)和常规触诊(CPM)两种方法进行桡动脉插管技术，两组患者大小相等。记录动脉插管成功率、尝试次数、总持续时间、额外操作人员数量、更换位置的需要以及并发症。结果:两组共纳入患者70例，患者平均年龄分别为52.43±13.53岁和50.71±14.1岁;P =0.605，男性患者比例为65.7%(46例)比77.1%(54例);USG和CPM的p=0.290。动脉插管成功率74.3%(52例)vs. 80%(56例);P =0.569，平均尝试次数为1.71±1.05∶1.51±0.89;P =0.391，平均总病程为7.76±3.78 min vs 5.42±8.2 min;P =0.131，平均增加手术人数为0.74±0.44 vs 0.89±0.32;P =0.128，需要更换部位的患者分别为11.4%(8人)和2.9%(2人);P =0.356，并发症发生率为8.6%(6)比2.9% (2);USG和CPM的p=0.614。结论:在本观察性研究中，USG和CPM对新入局住院医师桡动脉插管的有效性无显著差异。
{"title":"A Prospective Comparison of Ultrasound Guided Versus Palpation Method for Radial Artery Catheter Placement","authors":"K. Kumar, A. Khuwaja, A. Mangi, S. A. Khan, Hamna Tariq, Sayed Zaheeruddin, Saleha Akhtar","doi":"10.47144/phj.v56i1.2414","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2414","url":null,"abstract":"Objectives: The objective of this study was to assess the effectiveness of ultrasound guided vs. conventional palpation method for radial artery cannulation in the operating room for patients undergoing elective open-heart operations.\u0000Methodology: This prospective observational study was carried at the National Institute of Cardiovascular Disease (NICVD) in Karachi and Sukkur. All cannulation procedures were performed by anesthesia residents (R-1). Two equal sized independent groups of patients based on radial artery cannulation technique, either ultrasound guided (USG) or conventional palpation method (CPM) were recruited. Artery cannulation success along with number of attempts, total duration, number of additional operators, need for change of site, and complications were recorded.\u0000Results: A total of 70 patients were recruited in each of the group, mean patient age was 52.43±13.53 years vs. 50.71 ± 14.1 years; p=0.605 with proportion of male patients as 65.7% (46) vs. 77.1% (54); p=0.290, for USG and CPM, respectively. Artery cannulation success rate was 74.3% (52) vs. 80% (56); p=0.569, mean number of attempts was 1.71±1.05 vs. 1.51±0.89; p=0.391, mean total duration was 7.76±3.78 minutes vs. 5.42 ± 8.2 minutes; p=0.131, mean number of additional operators was 0.74±0.44 vs. 0.89±0.32; p=0.128, need for change of site was 11.4% (8) vs. 2.9% (2); p=0.356, and complications were observed in 8.6% (6) vs. 2.9% (2); p=0.614 for USG and CPM, respectively.\u0000Conclusion: In this observational study, no significant differences were observed in the effectiveness of USG and CPM for radial artery cannulation when performed by newly inducted anesthesia residents.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70771374","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}
Atif Sher Muhammad, A. Ammar, Bella Khan, Danish Qayyum, U. H. Bhatti, Maroof Hassan, Arti Ashok, T. Saghir, F. Ali, N. Salahuddin
Objectives: To describe the clinical characteristics and angiographic features of COVID-19 patients presenting with acute coronary syndrome (ACS) and to compare with non-COVID-19 ACS patients presenting simultaneously. Methodology: In a case control design, data were extracted from a prospectively collected COVID-19 and NCDR registry. All ACS patients who underwent cardiac catheterization from April 2020 to May 2021 were included. All of the patients were taken to the Cath lab for diagnostic coronary angiography and possible percutaneous intervention. Demographic and clinical characteristics, angiographic features, and in-hospital outcomes were compared between ACS patients with and without COVID-19. Results: A total of 4027 COVID-19 negative patients, and 80 COVID-19 positive were included. Total of 83% in COVID-19 and 88% in non-COVID-19 group had ST elevation myocardial infarction. Majority of the COVID-19 positive patients had sub-optimal TIMI flow grade (
{"title":"Clinical Memory of COVID-19 Pandemic: A Comparative Analysis of Clinical and Angiographic Characteristics of Patients with Acute Coronary Syndrome","authors":"Atif Sher Muhammad, A. Ammar, Bella Khan, Danish Qayyum, U. H. Bhatti, Maroof Hassan, Arti Ashok, T. Saghir, F. Ali, N. Salahuddin","doi":"10.47144/phj.v56i1.2450","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2450","url":null,"abstract":"Objectives: To describe the clinical characteristics and angiographic features of COVID-19 patients presenting with acute coronary syndrome (ACS) and to compare with non-COVID-19 ACS patients presenting simultaneously.\u0000Methodology: In a case control design, data were extracted from a prospectively collected COVID-19 and NCDR registry. All ACS patients who underwent cardiac catheterization from April 2020 to May 2021 were included. All of the patients were taken to the Cath lab for diagnostic coronary angiography and possible percutaneous intervention. Demographic and clinical characteristics, angiographic features, and in-hospital outcomes were compared between ACS patients with and without COVID-19.\u0000Results: A total of 4027 COVID-19 negative patients, and 80 COVID-19 positive were included. Total of 83% in COVID-19 and 88% in non-COVID-19 group had ST elevation myocardial infarction. Majority of the COVID-19 positive patients had sub-optimal TIMI flow grade (<III) post procedure and had a high thrombus burden (11.2% vs. 2.9%; p<0.001). Majority of the patients who had COVID-19 and ACS required mechanical circulatory support (48.8% vs. 0.3%; p<0.001). The mortality rates were also higher in COVID-19 positive group (38.8% vs. 1.3%; p<0.001). Among the COVID-19 positive patients 66.3% (53) had high thrombus burden (≥4 grade), intervention was performed in 73.7% (59). Post-intervention myocardial blush grade ≤2 was observed in 57.6% (34), slow flow in 85.3% (29), and phasic flow possibly due to elevated LVEDP in 41.2% (14) patients.\u0000Conclusion: COVID-19 patients with ACS had a higher severity of illness at presentation and worse outcomes as compared to simultaneously presenting non-COVID patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49448672","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}
S. Ullah, A. Khowaja, Naveed Nek Merkhand, Raheela Khowaja, Waqar Khan, A. Mangi, Suhayb Ahmad Khushk, J. Sial
Objectives: The presence of concomitant obstructive coronary artery disease (CAD) in patients with valvular heart disease (VHD) carries significant prognostic implications. Therefore, the objective of this study was to determine the frequency and severity of obstructive CAD in patients undergoing valvular heart surgery for rheumatic heart disease (RHD) at a tertiary care hospital in Karachi, Pakistan. Methodology: This descriptive study included patients of either gender, between 40 to 70 years of age, diagnosed with RHD on transthoracic echocardiography, and undergone valvular heart surgery. As a routine, pre-operative diagnostic coronary angiography was performed and the presence and severity of obstructive CAD were recorded. Results: Among 126 patients, 73% (92) were male, and the mean age was 48.3 ± 7.1 years. Smoking was the most common risk factor with a frequency of 22.2%, followed by hypertension (7.1%) and diabetes (4.8%). Obstructive CAD was observed in 24.6% with 19.4% single-vessel disease, 16.1% with two-vessel disease, and 64.5% with three-vessel disease. The presence of obstructive CAD was found to be positively associated with older age (p=0.040) and type of RHD (p=0.048). Conclusion: The obstructive concomitant CAD is prevalent in around 1/4th of patients, most of them with multi-vessel diseases, undergoing valvular heart surgery for rheumatic heart disease. It has been further observed that older age and the type of RHD are positively associated with the incidence of concomitant CAD in these patients.
{"title":"Obstructive Coronary Artery Disease in Patients Undergoing Rheumatic Valvular Heart Surgery","authors":"S. Ullah, A. Khowaja, Naveed Nek Merkhand, Raheela Khowaja, Waqar Khan, A. Mangi, Suhayb Ahmad Khushk, J. Sial","doi":"10.47144/phj.v56i1.2399","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2399","url":null,"abstract":"Objectives: The presence of concomitant obstructive coronary artery disease (CAD) in patients with valvular heart disease (VHD) carries significant prognostic implications. Therefore, the objective of this study was to determine the frequency and severity of obstructive CAD in patients undergoing valvular heart surgery for rheumatic heart disease (RHD) at a tertiary care hospital in Karachi, Pakistan.\u0000Methodology: This descriptive study included patients of either gender, between 40 to 70 years of age, diagnosed with RHD on transthoracic echocardiography, and undergone valvular heart surgery. As a routine, pre-operative diagnostic coronary angiography was performed and the presence and severity of obstructive CAD were recorded.\u0000Results: Among 126 patients, 73% (92) were male, and the mean age was 48.3 ± 7.1 years. Smoking was the most common risk factor with a frequency of 22.2%, followed by hypertension (7.1%) and diabetes (4.8%). Obstructive CAD was observed in 24.6% with 19.4% single-vessel disease, 16.1% with two-vessel disease, and 64.5% with three-vessel disease. The presence of obstructive CAD was found to be positively associated with older age (p=0.040) and type of RHD (p=0.048).\u0000Conclusion: The obstructive concomitant CAD is prevalent in around 1/4th of patients, most of them with multi-vessel diseases, undergoing valvular heart surgery for rheumatic heart disease. It has been further observed that older age and the type of RHD are positively associated with the incidence of concomitant CAD in these patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45996574","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}
S. Akbar, J. Ali, W. Sajjad, Noor Faraz, Rahid Ayaz, A. Iqbal
Objectives: The objective of this study was to determine the frequency of modifiable risk factors in young patients diagnosed with acute ST elevation myocardial infarction (STEMI). Methodology: A cross-sectional study was conducted at the cardiology department of Lady Reading Hospital, Peshawar. A total of 236 patients presented with acute STEMI, between 18 to 50 years of age of either gender were included. All the included patients were subjected to detailed history and clinical examination and modifiable risk factors were observed. Results: Out of 236 patients, 42 (18%) patients were in age range 18-30 years and 194 (82%) patients were in age range 31-50 years. Mean age was 42±9.77 years, 156 (66%) patients were male. In total, 90 (38%) patients had sedentary lifestyle, 45 (19%) patients had positive history of atrial fibrillation. More over 92 (39%) patients were diabetic, 153 (65%) patients were hypertensive, 99 (42%) patients were smokers, 73 (31%) patients had dyslipidaemia, and 64 (27%) patients were obese. Conclusion: It has been observed that modifiable risk factors were prevalent in a vast majority of the young patients presenting with acute STEMI. Among these, sedentary lifestyle, smoking, obesity, and metabolic risk factors such as diabetes and dyslipidaemia need immediate attention.
{"title":"Modifiable Risk Factors in Diagnosed Cases of Acute ST Elevation Myocardial Infarction in Young Patients Presenting at Tertiary Care Hospital in Peshawar","authors":"S. Akbar, J. Ali, W. Sajjad, Noor Faraz, Rahid Ayaz, A. Iqbal","doi":"10.47144/phj.v56i1.2373","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2373","url":null,"abstract":"Objectives: The objective of this study was to determine the frequency of modifiable risk factors in young patients diagnosed with acute ST elevation myocardial infarction (STEMI).\u0000Methodology: A cross-sectional study was conducted at the cardiology department of Lady Reading Hospital, Peshawar. A total of 236 patients presented with acute STEMI, between 18 to 50 years of age of either gender were included. All the included patients were subjected to detailed history and clinical examination and modifiable risk factors were observed.\u0000Results: Out of 236 patients, 42 (18%) patients were in age range 18-30 years and 194 (82%) patients were in age range 31-50 years. Mean age was 42±9.77 years, 156 (66%) patients were male. In total, 90 (38%) patients had sedentary lifestyle, 45 (19%) patients had positive history of atrial fibrillation. More over 92 (39%) patients were diabetic, 153 (65%) patients were hypertensive, 99 (42%) patients were smokers, 73 (31%) patients had dyslipidaemia, and 64 (27%) patients were obese.\u0000Conclusion: It has been observed that modifiable risk factors were prevalent in a vast majority of the young patients presenting with acute STEMI. Among these, sedentary lifestyle, smoking, obesity, and metabolic risk factors such as diabetes and dyslipidaemia need immediate attention.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45212420","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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