Maqsood Alam, G. Irfan, A. Ammar, P. Akhtar, K. Aamir, T. Saghir
Objectives: The objective of the study is to evaluate the incidence and predictors of permanent pacemaker (PPM) implantation in patients undergoing transaortic valve implantation (TAVI). Methodology: This study was conducted at the “National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan”. All the consecutive patients who underwent TAVI between July 2015 and February 2020 were included in the study. Patient data were extracted from Hospital TAVI Registry. We included patients with severe symptomatic aortic stenosis (AS) with moderate to high surgical risk as per “society of thoracic surgeon score (STS)” and “EURO II score”, underwent TAVI. Patients were stratified into two groups based on the implantation of PPM, demographic characteristics, clinical characteristics, co-morbid conditions, valve pathology, and procedural characteristics were compared between both groups. Results: Among 100 patients included only 22 patients (22%) underwent PPM implantation. The indication for implantation of PPM for all patients was complete heart block. Clinical characteristics which shows statistical significance for PPM implantation are preprocedural left ventricular dysfunction (p=0.015), right bundle branch block (RBBB) p<0.001, and left anterior hemiblock (p<0.001) noted on ECG and post-deployment valve area post-procedure (p<0.001). Multivariate analysis showed that pre-procedure RBBB and large post-deployment valve area are independent predictors for PPM implantation in Post TAVI patients. Conclusion: The incidence of PPM implantation in patients who underwent TAVI at NICVD is 22%. Preprocedural left ventricular dysfunction, RBBB, and post-procedure large post-deployment valve area were noted to be significant predictors for PPM implantation.
{"title":"INCIDENCE AND PREDICTORS OF PERMANENT PACEMAKER IMPLANTATION AFTER TRANS AORTIC VALVE IMPLANTATION (TAVI) – A SINGLE CENTER EXPERIENCE","authors":"Maqsood Alam, G. Irfan, A. Ammar, P. Akhtar, K. Aamir, T. Saghir","doi":"10.47144/phj.v55i4.2389","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2389","url":null,"abstract":"Objectives: The objective of the study is to evaluate the incidence and predictors of permanent pacemaker (PPM) implantation in patients undergoing transaortic valve implantation (TAVI).\u0000Methodology: This study was conducted at the “National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan”. All the consecutive patients who underwent TAVI between July 2015 and February 2020 were included in the study. Patient data were extracted from Hospital TAVI Registry. We included patients with severe symptomatic aortic stenosis (AS) with moderate to high surgical risk as per “society of thoracic surgeon score (STS)” and “EURO II score”, underwent TAVI. Patients were stratified into two groups based on the implantation of PPM, demographic characteristics, clinical characteristics, co-morbid conditions, valve pathology, and procedural characteristics were compared between both groups.\u0000Results: Among 100 patients included only 22 patients (22%) underwent PPM implantation. The indication for implantation of PPM for all patients was complete heart block. Clinical characteristics which shows statistical significance for PPM implantation are preprocedural left ventricular dysfunction (p=0.015), right bundle branch block (RBBB) p<0.001, and left anterior hemiblock (p<0.001) noted on ECG and post-deployment valve area post-procedure (p<0.001). Multivariate analysis showed that pre-procedure RBBB and large post-deployment valve area are independent predictors for PPM implantation in Post TAVI patients.\u0000Conclusion: The incidence of PPM implantation in patients who underwent TAVI at NICVD is 22%. Preprocedural left ventricular dysfunction, RBBB, and post-procedure large post-deployment valve area were noted to be significant predictors for PPM implantation.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49592894","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. Shah, B. Solangi, Rajesh Kumar, Gulzar Ali, M. Butt, J. Shaikh, Ambreen Nisar, Muhammad Asad Baqai, T. Saghir, N. Qamar
Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan. Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia). Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21). Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.
{"title":"NONCOMPLIANCE TO TREATMENT AND COMMON PRECIPITATING FACTORS IN STAGE C HEART FAILURE","authors":"J. Shah, B. Solangi, Rajesh Kumar, Gulzar Ali, M. Butt, J. Shaikh, Ambreen Nisar, Muhammad Asad Baqai, T. Saghir, N. Qamar","doi":"10.47144/phj.v55i4.2310","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2310","url":null,"abstract":"Objectives: The objective of this study was to determine the frequency of non-compliance to treatment and common precipitating factors in stage C heart failure (HF) patients at a tertiary care cardiac hospital of Karachi, Pakistan.\u0000Methodology: This descriptive cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan. Required number of consecutive patients of either gender between 18 to 75 years of age who were diagnosed with stage C HF were included in this study. Data for the study were collected on a pre-defined proforma consisted of demographic characteristics (gender, age), clinical factors, and precipitants of decompensation of HF (duration of disease, non-compliance to the treatment, infection, arrhythmias, uncontrolled hypertension, and anemia).\u0000Results: A total of 114 patients with stage C HF were included. Mean age was 56.7 ± 9.9 years with 34.2% (39) patients above 60 years of age. Male patients were 51.8% (59) of the total sample and median duration of disease was 36 [20 to 60] months. Non-compliance to the HF treatment was observed in 48.2% (55), while among other precipitants, infection was observed in 21.9% (25), arrhythmias in 20.2% (23), uncontrolled hypertension in 13.2% (15), and anemia in 18.4% (21).\u0000Conclusion: A significant proportion of stage C HF patients were found to be non-adherent to the prescribed treatment. The most commonly observed triggering factor was infection followed by arrhythmias. Routine practice must include an ongoing assessment of compliance to the treatment and lifestyle modifications among HF patients for the proper counseling of non-complying individuals.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41652578","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 N. Khan, Erum Shahzadi Malik, Zeeshan A. Shaikh, S. Shabbir, Jawad Abbas, Mahesh Kumar Harwani
Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVD) is regarded to be one of the highest common cause of death especially in athletes due to sudden cardiac arrest. Epidemiologically, 1 among 5000 populations has estimated prevalence of ARVD. ARVD clinical indications or symptoms before the age of 12 are difficult to diagnose and it is also rare to acquire ARVD symptoms after the age of 60. 34-year-old male patient with no-known co-morbid received at Emergency Department of PNS Shifa Hospital Karachi. This case report is a typical case of ARVD in stage 4 with bi ventricular involvement.
{"title":"A CASE REPORT OF ARRYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA PRESENTING WITH STABLE VENTRICULAR TACHYCARDIA AND LEFT VENTRICULAR DYSFUNCTION","authors":"Ali N. Khan, Erum Shahzadi Malik, Zeeshan A. Shaikh, S. Shabbir, Jawad Abbas, Mahesh Kumar Harwani","doi":"10.47144/phj.v55i4.2332","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2332","url":null,"abstract":"Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVD) is regarded to be one of the highest common cause of death especially in athletes due to sudden cardiac arrest. Epidemiologically, 1 among 5000 populations has estimated prevalence of ARVD. ARVD clinical indications or symptoms before the age of 12 are difficult to diagnose and it is also rare to acquire ARVD symptoms after the age of 60. 34-year-old male patient with no-known co-morbid received at Emergency Department of PNS Shifa Hospital Karachi. This case report is a typical case of ARVD in stage 4 with bi ventricular involvement.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960054","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: To find out the role spiritual and existential wellbeing in health promoting lifestyles that are mediated through perceived health status in Coronary Heart Disease (CHD) Patients. Methodology: After obtaining approval (reference #331) from Institutional Review Board of the affiliated university as sample of 257 males and 228 females consecutive CHD patients (age range 18-65 years; M = 47.56, SD = 2.30) meeting the inclusion criteria were recruited in the study. Patients who suffered from strokes or other chronic diseases like hypothyroidism, cancer, liver or renal malfunctioning were excluded from the study. Participants were requested to complete three scales (and a demographic form) that included Spiritual Wellbeing Scale (SWBS), Short Form 12 Health Survey (SF-12HS), and Health Promoting Lifestyle Profile-II (HPLP-II). Data was collected from outdoor patients at a public hospital in Lahore, Pakistan between November 5 and March 31, 2021-22, and correlations were run across constructs using a macro-process (version 3.3) in SPSS (version 26.0). Results: Results indicated that spiritual (religious and existential) wellbeing had a significant direct effect on health promoting lifestyles significant at p < 0.001. Further, results showed a significant direct and indirect path coefficients of physical and mental health components of perceived health status with spiritual, religious, existential wellbeing, and health promoting lifestyles but not for physical functioning and bodily pain, p >0.05. Conclusion: Spirituality and positive health perceptions for cardiac patients can maintain their health through engaging in healthy lifestyles. Study highlighted the importance of adopting such perceptions to relieve cardiac symptoms to avoid further complications.
{"title":"IMPACT OF SPIRITUAL WELLBEING ON HEALTH PROMOTING LIFESTYLES IN CORONARY HEART DISEASE PATIENTS: MEDIATING ROLE OF PERCEIVED HEALTH STATUS","authors":"Hina Sultan, M. N. Javed, Ghulam Ishaq","doi":"10.47144/phj.v55i4.2340","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2340","url":null,"abstract":"Objectives: To find out the role spiritual and existential wellbeing in health promoting lifestyles that are mediated through perceived health status in Coronary Heart Disease (CHD) Patients.\u0000Methodology: After obtaining approval (reference #331) from Institutional Review Board of the affiliated university as sample of 257 males and 228 females consecutive CHD patients (age range 18-65 years; M = 47.56, SD = 2.30) meeting the inclusion criteria were recruited in the study. Patients who suffered from strokes or other chronic diseases like hypothyroidism, cancer, liver or renal malfunctioning were excluded from the study. Participants were requested to complete three scales (and a demographic form) that included Spiritual Wellbeing Scale (SWBS), Short Form 12 Health Survey (SF-12HS), and Health Promoting Lifestyle Profile-II (HPLP-II). Data was collected from outdoor patients at a public hospital in Lahore, Pakistan between November 5 and March 31, 2021-22, and correlations were run across constructs using a macro-process (version 3.3) in SPSS (version 26.0).\u0000Results: Results indicated that spiritual (religious and existential) wellbeing had a significant direct effect on health promoting lifestyles significant at p < 0.001. Further, results showed a significant direct and indirect path coefficients of physical and mental health components of perceived health status with spiritual, religious, existential wellbeing, and health promoting lifestyles but not for physical functioning and bodily pain, p >0.05.\u0000Conclusion: Spirituality and positive health perceptions for cardiac patients can maintain their health through engaging in healthy lifestyles. Study highlighted the importance of adopting such perceptions to relieve cardiac symptoms to avoid further complications.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41638497","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}
Adnan Fazal, S. Babar, A. Asad, Abdul Wahab Buzdar, Muhammad Asim Shaikh, Nasir Zaki
Objectives: To determine the frequency of sustained ventricular arrhythmias in Non-ST segment elevation myocardial infarction (NSTEMI) patients. Methodology: This is a Cross sectional study was done at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan Pakistan from 10th August 2018 to 9th February 2019. We included 170 patients fulfilling the inclusion criteria with diagnosis of NSTEMI presented in department of cardiac emergency were selected. Informed consent was taken. The data was collected on prepared proforma. Results: In our study mean age of patients was 50.90+7.25 years. There were 139 (81.76%) male patients and 31 (18.24%) female patients. There were 58 (34.12%) patients who were having diabetes mellitus, 68 (40.0%) patient’s having hypertension, 71 (41.76%) patients were smokers, 15 (8.82%) patients were having hypercholesterolemia, and 18 (10.59%) patients who were having positive family history of coronary artery disease (CAD). Sustained ventricular arrhythmias (VA) occurred in 9 (5.29%) patients of non-STEMI. Conclusion: The incidence of Sustained ventricular arrhythmias in patients of non-ST elevation myocardial infarction (NSTEMI) is 5.29%. The occurrence of such events remains difficult to predict. Cardiac monitoring should be done in all patients to monitor occurrence of such Sustained ventricular arrhythmias in these patients.
{"title":"FREQUENCY OF SUSTAINED VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION AT A TERTIARY CARE HOSPITAL","authors":"Adnan Fazal, S. Babar, A. Asad, Abdul Wahab Buzdar, Muhammad Asim Shaikh, Nasir Zaki","doi":"10.47144/phj.v55i4.2329","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2329","url":null,"abstract":"Objectives: To determine the frequency of sustained ventricular arrhythmias in Non-ST segment elevation myocardial infarction (NSTEMI) patients.\u0000Methodology: This is a Cross sectional study was done at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan Pakistan from 10th August 2018 to 9th February 2019. We included 170 patients fulfilling the inclusion criteria with diagnosis of NSTEMI presented in department of cardiac emergency were selected. Informed consent was taken. The data was collected on prepared proforma.\u0000Results: In our study mean age of patients was 50.90+7.25 years. There were 139 (81.76%) male patients and 31 (18.24%) female patients. There were 58 (34.12%) patients who were having diabetes mellitus, 68 (40.0%) patient’s having hypertension, 71 (41.76%) patients were smokers, 15 (8.82%) patients were having hypercholesterolemia, and 18 (10.59%) patients who were having positive family history of coronary artery disease (CAD). Sustained ventricular arrhythmias (VA) occurred in 9 (5.29%) patients of non-STEMI.\u0000Conclusion: The incidence of Sustained ventricular arrhythmias in patients of non-ST elevation myocardial infarction (NSTEMI) is 5.29%. The occurrence of such events remains difficult to predict. Cardiac monitoring should be done in all patients to monitor occurrence of such Sustained ventricular arrhythmias in these patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43825486","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. Ahmed, G. Shah, T. Saghir, Shehzad Ahmed, A. Mueed, N. Roy
Objectives: Data are available regarding pattern of acute coronary syndrome (ACS) in urban areas of Southeast Asia. We conducted a study to assess the demographic, clinical, and angiographic characteristics and management strategies in patient presenting with ACS arriving in emergency room (ER) of satellite center located in rural area. Methodology: It was a cross-sectional study done at tertiary cardiac care center located in rural area of Pakistan. In February to March 2021, 355 patients with ACS were included in this study. Patients were categorized into STEMI (ST-segment elevation myocardial infarction), NSTEMI (Non ST-segment elevation myocardial infarction), and USA (unstable angina). Results: A total number of 4210 patients visited the ER out of which 355 patients were with ACS. Mean age was 56±10 years and 43% of patients were <60 years of age, 80.6% of patients were male and presentation with symptoms duration of ranging from 1 hour to 7 days range. Hypertension was prevalent in (52.7%) followed by diabetes in 33% and smoking (29%). STEMI and NSTEMI were the predominant types of ACS (50.4% and 33.5%). Primary PCI was done in 97% of eligible patient presenting within window period and percutaneous revascularization was performed in 69% of ACS patients. In-hospital mortality was noted in 1.1%. Conclusion: STEMI and NSTEMI were the predominant type of ACS. Majority of patients were male and hypertension was the most prevalent risk factor followed by diabetes and smoking. Significant improvement has been achieved in the management of ACS with in-hospital mortality remain 1.1%.
{"title":"THE CROWD OF ACUTE CORONARY SYNDROME IN A RURAL EMERGENCY ROOM OF PAKISTAN: DISTRIBUTION OF DEMOGRAPHIC, CLINICAL, AND ANGIOGRAPHIC CHARACTERISTICS","authors":"S. Ahmed, G. Shah, T. Saghir, Shehzad Ahmed, A. Mueed, N. Roy","doi":"10.47144/phj.v55i4.2346","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2346","url":null,"abstract":"Objectives: Data are available regarding pattern of acute coronary syndrome (ACS) in urban areas of Southeast Asia. We conducted a study to assess the demographic, clinical, and angiographic characteristics and management strategies in patient presenting with ACS arriving in emergency room (ER) of satellite center located in rural area.\u0000Methodology: It was a cross-sectional study done at tertiary cardiac care center located in rural area of Pakistan. In February to March 2021, 355 patients with ACS were included in this study. Patients were categorized into STEMI (ST-segment elevation myocardial infarction), NSTEMI (Non ST-segment elevation myocardial infarction), and USA (unstable angina).\u0000Results: A total number of 4210 patients visited the ER out of which 355 patients were with ACS. Mean age was 56±10 years and 43% of patients were <60 years of age, 80.6% of patients were male and presentation with symptoms duration of ranging from 1 hour to 7 days range. Hypertension was prevalent in (52.7%) followed by diabetes in 33% and smoking (29%). STEMI and NSTEMI were the predominant types of ACS (50.4% and 33.5%). Primary PCI was done in 97% of eligible patient presenting within window period and percutaneous revascularization was performed in 69% of ACS patients. In-hospital mortality was noted in 1.1%.\u0000Conclusion: STEMI and NSTEMI were the predominant type of ACS. Majority of patients were male and hypertension was the most prevalent risk factor followed by diabetes and smoking. Significant improvement has been achieved in the management of ACS with in-hospital mortality remain 1.1%.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48211812","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}
F. Ali, K. Aamir, Asif Nadeem, R. Ghafar, M. ul Hassan, P. Akhtar, S. Haque, Shirjeel Murtaza, F. Tipoo, Ishtiaq Rasool, T. Ashraf
Objectives: To determine frequency of LA clot resolution in patients with severe MS after three months of anticoagulation. Methodology: A descriptive study was conducted over 6 months from Jul 2018 to Jan 2019 including 49 patients who fulfilled the inclusion criteria and visited Cardiology department, NICVD Hospital-Karachi. After clinical evaluation, warfarin therapy was given for 3 months followed by Transesophageal echocardiography (TEE) to access the resolution of LA thrombus. Chi-square test and Fisher Exact test were used to assess the effect of patient characteristics and echocardiographic findings on the resolution of thrombus. Results: The mean age of the study patients was 47.51±9.93 years. The average mitral valve area (cm2) was observed to be 0.68±0.16, while the average size of left atrial (mm) was 54.38±7.19. At the end of 2 months, TEE showed successful resolution of clot in 11 (22.4%). While by the end of 3 months, only 6 (12.2%) patients showed successful resolution of clot. Conclusion: After 3 months of oral anticoagulation, the LA thrombus resolved in almost 1/4th of the study patients. Successful clot resolution showed positive correlation with history of stroke, hemoptysis and clot mobility and negative correlation with severity of tricuspid regurgitation.
{"title":"RESOLUTION OF LEFT ATRIAL THROMBUS IN SEVERE MITRAL STENOSIS PATIENTS AFTER THREE MONTHS OF ANTICOAGULATION","authors":"F. Ali, K. Aamir, Asif Nadeem, R. Ghafar, M. ul Hassan, P. Akhtar, S. Haque, Shirjeel Murtaza, F. Tipoo, Ishtiaq Rasool, T. Ashraf","doi":"10.47144/phj.v55i4.2327","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2327","url":null,"abstract":"Objectives: To determine frequency of LA clot resolution in patients with severe MS after three months of anticoagulation.\u0000Methodology: A descriptive study was conducted over 6 months from Jul 2018 to Jan 2019 including 49 patients who fulfilled the inclusion criteria and visited Cardiology department, NICVD Hospital-Karachi. After clinical evaluation, warfarin therapy was given for 3 months followed by Transesophageal echocardiography (TEE) to access the resolution of LA thrombus. Chi-square test and Fisher Exact test were used to assess the effect of patient characteristics and echocardiographic findings on the resolution of thrombus.\u0000Results: The mean age of the study patients was 47.51±9.93 years. The average mitral valve area (cm2) was observed to be 0.68±0.16, while the average size of left atrial (mm) was 54.38±7.19. At the end of 2 months, TEE showed successful resolution of clot in 11 (22.4%). While by the end of 3 months, only 6 (12.2%) patients showed successful resolution of clot.\u0000Conclusion: After 3 months of oral anticoagulation, the LA thrombus resolved in almost 1/4th of the study patients. Successful clot resolution showed positive correlation with history of stroke, hemoptysis and clot mobility and negative correlation with severity of tricuspid regurgitation.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43627811","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}
Hassan Mottaghi Moghaddam Shahri, S. Ghiasi, Z. Abbasi Shaye, Fatemehsoltan Zegheibizadeh
Objectives: Congenital heart disease (CHD) is the most common congenital anomaly and in association with diaphragmatic hernia (DH) develops significant morbidity and mortality outcomes. We aimed to determine the frequency of CHD in patients with DH and the effect of their relationship at our center. Methodology: This retrospective study considered all patients with congenital DH, who were referred to the pediatric cardiology Clinic of Imam Reza Hospital to evaluate for congenital heart disorders from March 2002 and December 2019. Findings were divided into two groups: normal structure heart and minor anomalies and major congenital heart disease that needs follow-up and interferes with surgical planning. Results: Twenty-five cases of congenital heart disease were identified, 17 patients were male (68%), and the mean age of cases was 5.5 months. Moreover, 17 patients (68%) suffered from CHD which was the major congenital heart disease in 10 cases (40%). Eight patients (32%) were diagnosed with normal echocardiography or minor defects such as patent foramen oval or floppy mitral valve with no mitral regurgitation. The most common CHD was ventricular septal defect, observed in six patients (24%). The most frequent non-cardiac malformations were gastrointestinal anomalies, chest deformity and genitourinary anomalies. Conclusion: The most common anomaly in the infants with a congenital diaphragmatic hernia is congenital heart diseases, particularly septal defects. Cardiac consultation in in patients with a congenital diaphragmatic hernia is significant, which is recommended for all the patients before surgery.
{"title":"CONGENITAL HEART DEFECTS IN INFANTS WITH A CONGENITAL DIAPHRAGMATIC HERNIA: A SINGLE-CENTER EXPERIENCE","authors":"Hassan Mottaghi Moghaddam Shahri, S. Ghiasi, Z. Abbasi Shaye, Fatemehsoltan Zegheibizadeh","doi":"10.47144/phj.v55i4.2343","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2343","url":null,"abstract":"Objectives: Congenital heart disease (CHD) is the most common congenital anomaly and in association with diaphragmatic hernia (DH) develops significant morbidity and mortality outcomes. We aimed to determine the frequency of CHD in patients with DH and the effect of their relationship at our center.\u0000Methodology: This retrospective study considered all patients with congenital DH, who were referred to the pediatric cardiology Clinic of Imam Reza Hospital to evaluate for congenital heart disorders from March 2002 and December 2019. Findings were divided into two groups: normal structure heart and minor anomalies and major congenital heart disease that needs follow-up and interferes with surgical planning.\u0000Results: Twenty-five cases of congenital heart disease were identified, 17 patients were male (68%), and the mean age of cases was 5.5 months. Moreover, 17 patients (68%) suffered from CHD which was the major congenital heart disease in 10 cases (40%). Eight patients (32%) were diagnosed with normal echocardiography or minor defects such as patent foramen oval or floppy mitral valve with no mitral regurgitation. The most common CHD was ventricular septal defect, observed in six patients (24%). The most frequent non-cardiac malformations were gastrointestinal anomalies, chest deformity and genitourinary anomalies.\u0000Conclusion: The most common anomaly in the infants with a congenital diaphragmatic hernia is congenital heart diseases, particularly septal defects. Cardiac consultation in in patients with a congenital diaphragmatic hernia is significant, which is recommended for all the patients before surgery.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48457507","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}
Mohammad Assadian Rad, H. Moladoust, A. Pourrajabi, Zohreh Heidarnezhad, Amir Savarrakhsh
Objectives: We investigated the diagnostic accuracy of fragmented QRS (fQRS) numbers in surface electrocardiogram (ECG) in heart failure (HF) patients for prediction of cardiac resynchronization therapy (CRT) non-responders. Methodology: In this study, patients with HF who were candidates for CRT implantation were enrolled. A 12-lead surface electrocardiogram was conducted with the aim of finding fQRS. Presence of more than 2 notching in the R or S wave in wide QRS complexes in at least two adjacent leads corresponding to a coronary bed, considered as fQRS. All patients underwent transthoracic echocardiography 3-6 months after the CRT implantation for the evaluation of Left Ventricular End Diastolic Volume (LVEDV), Left Ventricular End Systolic Volume (LVESV), and Left ventricle ejection fraction (LVEF). The data were analyzed by SPSS v.22 software. P-value of less than 0.05 considered significant. Results: We investigated on a total of 73 patients with HF that 64.38% of them responded to CRT. Most of responders were patients without fQRS complexes (80%). LVEF, LVESV, and LVEDV were different significantly before and after CRT implantation in patients with fQRS (p<0.001). Our results showed that the presence of at least one fQRS can lead to non-responsiveness to CRT. Therefore, we take cut-off point equal-greater than one into account as the best cut-off point for response to CRT. The area under the curve (AUC) for CRT prediction was 0.715 (95% CI: 0.598-0.815, P=0.003). Conclusion: In conclusion, the presence of even one fQRS in the surface ECG can predict CRT non-responsiveness with good accuracy.
{"title":"DIAGNOSTIC ACCURACY OF NUMBER OF FRAGMENTED QRS LEADS IN PREDICTION OF CARDIAC RESYNCHRONIZATION THERAPY RESPONSE IN PATIENTS WITH HEART FAILURE","authors":"Mohammad Assadian Rad, H. Moladoust, A. Pourrajabi, Zohreh Heidarnezhad, Amir Savarrakhsh","doi":"10.47144/phj.v55i4.2262","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2262","url":null,"abstract":"Objectives: We investigated the diagnostic accuracy of fragmented QRS (fQRS) numbers in surface electrocardiogram (ECG) in heart failure (HF) patients for prediction of cardiac resynchronization therapy (CRT) non-responders.\u0000Methodology: In this study, patients with HF who were candidates for CRT implantation were enrolled. A 12-lead surface electrocardiogram was conducted with the aim of finding fQRS. Presence of more than 2 notching in the R or S wave in wide QRS complexes in at least two adjacent leads corresponding to a coronary bed, considered as fQRS. All patients underwent transthoracic echocardiography 3-6 months after the CRT implantation for the evaluation of Left Ventricular End Diastolic Volume (LVEDV), Left Ventricular End Systolic Volume (LVESV), and Left ventricle ejection fraction (LVEF). The data were analyzed by SPSS v.22 software. P-value of less than 0.05 considered significant.\u0000Results: We investigated on a total of 73 patients with HF that 64.38% of them responded to CRT. Most of responders were patients without fQRS complexes (80%). LVEF, LVESV, and LVEDV were different significantly before and after CRT implantation in patients with fQRS (p<0.001). Our results showed that the presence of at least one fQRS can lead to non-responsiveness to CRT. Therefore, we take cut-off point equal-greater than one into account as the best cut-off point for response to CRT. The area under the curve (AUC) for CRT prediction was 0.715 (95% CI: 0.598-0.815, P=0.003).\u0000Conclusion: In conclusion, the presence of even one fQRS in the surface ECG can predict CRT non-responsiveness with good accuracy.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43606047","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 Asad, Talha Bin Nazir, Qurban Hussain Khan
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterised by morphological and histological changes in the ventricles. Progressive myocyte loss and fibrofatty tissue replacement, producing islands of scar, can lead to reentrant ventricular tachycardia and sudden cardiac death. It usually presents as chest pain, palpitations, heart failure, or syncope. The majority of cases are seen before the age of 40. Ventricular arrhythmia as a first presentation in the elderly is seen infrequently. We present a case of a previously asymptomatic 62-year-old gentleman who had an episode of ventricular tachycardia as the first manifestation of ARVC without having any positive family history for this disease. He was managed with amiodarone and was later planned for an implantable cardiac defibrillator (ICD).
{"title":"VENTRICULAR TACHYCARDIA AS A FIRST PRESENTATION OF ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY (ARVC) IN A PREVIOUSLY ASYMPTOMATIC SEXAGENARIAN","authors":"Muhammad Asad, Talha Bin Nazir, Qurban Hussain Khan","doi":"10.47144/phj.v55i4.2281","DOIUrl":"https://doi.org/10.47144/phj.v55i4.2281","url":null,"abstract":"Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterised by morphological and histological changes in the ventricles. Progressive myocyte loss and fibrofatty tissue replacement, producing islands of scar, can lead to reentrant ventricular tachycardia and sudden cardiac death. It usually presents as chest pain, palpitations, heart failure, or syncope. The majority of cases are seen before the age of 40. Ventricular arrhythmia as a first presentation in the elderly is seen infrequently. We present a case of a previously asymptomatic 62-year-old gentleman who had an episode of ventricular tachycardia as the first manifestation of ARVC without having any positive family history for this disease. He was managed with amiodarone and was later planned for an implantable cardiac defibrillator (ICD).","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45554083","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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