Frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS], before the surgery, at discharge and at six months follow up

Introduction: Depression is much frequent in patients undergoing CABGS. However, severity was reduced post operatively. Counseling and psychosocial interventions can play an important role in recovery and functionality of patients

Objective: To compare the frequency of depression in patients undergoing coronary artery bypass grafting surgery [CABGS] before the surgery, at discharge and at six months follow up

Design: Prospective, observational study conducted from Dec 2008 to Dec 2009

Setting: National Institute of Cardiovascular Diseases [NICVD] Karachi

Methods: One hundred and thirty four [134] patients of 18+ years old who were consecutively listed for first time CABGS were included in the study after fulfilling the inclusion and exclusion criteria and addressing the ethical issues. ICD-10 criteria to diagnose and Hamilton Rating Scale for Depression [HAM-D] were applied to assess the frequency and severity of depressive disorder respectively. Results were analyzed using SPSS version 17.0

Results: One hundred and thirty four [134] patients undergoing CABGS fulfilled the criteria for Depressive disorder. One hundred and thirteen [84.3%] were male and 21 [15.7%] were female with age range 33 to 75 years [mean 53.7 +/-SD 8.57]. Preoperatively 132 [98.5%] patients and postoperatively 108 [80.6%] patients were depressed. At 6 months follow up which was available in 73 patients, only 12 [16.4%] were found depressed. Both genders were almost equally affected. Surprisingly age, ethnicity, education and co-morbids did not show a significant role

Conclusion: Depression is commonly reported before and after cardiac surgery procedures and it significantly influences the quality of life of the patients undergoing CABGS. The consequences can increase morbidity and mortality

Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery [CABGS]. An observational study. The National Institute of Cardiovascular Diseases [NICVD], Karachi, from December 2008 to December 2009. Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction [MI] within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 [84.3%] males and 21 [15.7%] females, with mean age of 53.7 +/- 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time

Anticoagulation therapy during pregnancy and puerperium

Thrombotic complications are three to five times higher than non-pregnant women and even in pregnant women anticoagulant therapy is indicated for the prevention and treatment of a number of cardiac and non-cardiac conditions. This therapy may have some serious concerns for the safety of the new life in the womb of the mother or to the mother if she has to undergo some type of operative delivery. Whether, anti-coagulation is achieved with oral or injectable drugs, we must be fully aware of the pharmacology, and the means to control the undesirable side effects

High total leukocyte count and heart failure after myocardial infarction

Background: Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI

Methods: A cross sectional study carried out from June-August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure

Results: Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [

Conclusion: This study shows that high TLC count appears to be associated with development of CHF and mortality after acute STEMI

High total leukocyte count and heart failure after myocardial infarction

Acute myocardial infarction ST-elevation [STEMI] is frequently associated with leukocytosis and relative increased in neutrophil count. It is believed that the peripheral leukocyte count have important prognostic implication in AMI. In this study we hypothesized that there is an association between absolute leukocytosis and neutrophilia to the short term development of congestive heart failure [CHF] after AMI. A cross sectional study carried out from June -August 2010. 200 patients with diagnosis of STEMI were included. Patients with a history of chest pain of more than 12 hours, recent trauma, infection, malignancy were excluded. Baseline demographic data was obtained. Blood sample was drawn for leukocyte count within 12 hours of admission.Echocardiogram [Echo] and X-ray chest was obtained during first four days. Chi square test was applied to seek association between high total leukocyte [TLC] and heart failure. Out of 200 patients, 98 [49%] remained uncomplicated and they were discharged without clinical evidence of CHF; whereas 91[45.5%] patients who developed clinical CHF underwent Echo and discharged later. Total 11[5.5%] patients expired in hospital. Out of 91 patients who developed CHF 61[67%] had high TLC [>11000 mm3], while 30 [33%] had normal [<11000 mm3] TLC. Significant association [P<0.008] of high TLC with development of CHF was observed.81 [89%] patients had high neutrophil count [>65 mm3], while 10 [11%] had normal [

Congenital giant aneurysm of the left atrial appendage: diagnosis and management

Left atrial [LA] aneurysm is a rare congenital abnormality [1] and associated with life-threatening complications. We report the natural history of Left atrial aneurysm which was complicated by supraventricular tachycardia [SVT] and stroke in early childhood and her condition deteriorate rapidly after development of progressive mitral regurgitation [MR] and heart failure and expired despite successful surgery

Our purpose of this case report is to give the natural history of LA aneurysm and review it along its current literature, surgical strategy, and patient outcome. In literature there is a very limited description of such cases and their management

Frequency of obesity and its risk of adverse outcomes associated with coronary artery bypass surgery

We aimed to investigate the prevalence of obesity in patients undergoing CABG, to assess in these patients the distribution of prognostic factors and the early outcomes after surgery. It was a perspective, observational and descriptive study, conducted at National Institute of Cardiovascular Diseases [NICVD] Karachi. All patients underwent first and elective CABG whether underwent on or off-pump were included. The prognostic variables noted were: age, gender. coronary risk profile, h/o prior myocardial infarction or unstable angina, cerebrovascular accident. The degree of obesity was assessed by BMI derived from Quetelet's formula i.e. Underweight [<20 kg/m2] Normal [> 20 and <25 kg/m], Overweight [> 25 and < 30kg/m2], Obese [> 30 and < 35 kg/m2] and Severely obese > 35 kg/m2. RESULTS: Total of 115 patients underwent CABG during the study period. Patients were classified as underweight 6 [5%]; as normal weight 57 [50.9%]; as overweight 38 [33.9%]; as obsess 5 [4.2%]; and as severely obese 6[5%]. Total obese patients were 11 [10%]. The incidence was more in obese patients as regard to postoperative arrhythmias 5 [45%]; pulmonary complications 5 [45%]; hours ventilated > 10 5 [45%]; perioperative MI occurred only obese patients 1 [9%] as compared to non-obese. There was no incidence of CVA, surgical and renal complications in obese patients

Case report of halofantrine induced QT interval prolongation with subsequent ventricular arrhythmias

A 45 years old lady, presented in emergency department of NICVD with 2 days history of high grade fever with rigors followed by severe vertigo. There was no previous history of any cardiac ailment nor she was hospitalized for any major illness. No family history of cardiac disease. No past history of palpitations or vertigo. She was prescribed antimalarial "halofantrine" in a dose of 500 mg 6 hourly [3 doses], a day prior to admission in NICVD. On examination, middle-aged lady appeared anxious and tachypnic. Apart from irregularly irregular pulse and relative hypotention rest of the examination was unremarkable. ECG:Initial ECG showed prolongation of QT interval, i.e., 0.48 seconds. QTc, 0.6 seconds. She developed unstable Torsade De pointes and then subsequent ECGs showed recurrent intermittent ventricular tachycardia. Management : Patient was cardioverted initially at 200 Joules, followed by i/v bolus of lignocaine; as she failed to respond, i/v magnesium sulphate was tried, as intermittent VT continued, temporary pacemaker was implanted and overdrive pacing successfully maintained normal sinus rhythm. Patient`s intrinsic heart rate was 80b/m, QT 0.48 sec. QTc, 0.6 see, while overdrive pacing was done at 120b/m, with QT 0.36 see, QTc 0.46 sec Investigations: All routine hemotological and biochemical investigations were found normal including [CBC, ESR, RBS, Urea. Creatinene, Electrolytes, Cholesterol, UrineD/R, LFTs], Chest XRay and echocardiagraphy reports were also normal. Course in the Hospital:Subsequently, temporary Pacemaker was switched off after few days. Serial ECGs showed normalization of QT interval. Last ECG showed QT of 0.4 seconds, QTc, 0.5 seconds. She was discharged after a week without any medication