Echocardiographic Assessment of Valvular Involvement in Chronic Rheumatic Heart Disease in BSMMU, Bangladesh.

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years especially in the developing county like Bangladesh. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of sub-clinical disease. It has a progressive course and patients usually may require valve repair/replacement in future. Echocardiography is an easily available, non-invasive, widely used, standard tool for diagnosis and evaluation of RHD. But there is scarcity of echocardiographic study of Valvular Involvement in Chronic Rheumatic Heart Disease (CHRD) in Bangladesh. This study was aimed to utilize echocardiography as a tool to evaluate patients of CRHD in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This observational study was conducted in the Department of Cardiology, BSMMU from September 2018 to August 2019. Echocardiography was done in each patient only once with VividE9®machine. Among 1350 echocardiography, 101 patients (7.5%) were diagnosed as RHD including post valve replacement patients. The mean age of the patients was 40±14 years and 64.34% were female. Mitral stenosis (MS) was the commonest lesion in 84.15% followed by mitral regurgitation (MR) in 66.33%, tricuspid regurgitation (TR) in 57.43%, aortic regurgitation (AR) in 49.51%, aortic stenosis (AS) in 26.74% and pulmonary regurgitation in 10.89%. The frequency of complications like pulmonary hypertension, heart failure, atrial fibrillation (AF), LA thrombus, stroke and infective endocarditis was 67.33%, 61.05%, 18.81%, 6.93%, 3.96% and 0.99% respectively. History of Rheumatic fever was present only in 10.89% patient. Mitral stenosis was the commonest lesion seen mostly in female and most common complication was pulmonary hypertension. Mean age of patients in this study was higher than other contemporary studies and frequency as well as severity of complications was also more in female.

Determinants of Pre-Hospital Delay after Myocardial Infarction in Bangladesh: A Rural Center Experience.

Determinants of pre-hospital delay after myocardial infarction, strictly among South-Asian rural community, till now is largely unknown. And Bangladesh is not an exception. It is a fact that though around two third of its population still live in villages, we do not know what factors are having influence on such delay. To find out these primers of time consumption before seeking medical help, this is a picture of a medical college hospital situated in a rural precinct. This cross-sectional analytical study was conducted among 98 patients came with Myocardial Infarction (MI) who had met inclusion and exclusion criteria from July 2019 and December 2019. Both STEMI & NSTEMI patients were selected as they have similar attributes. Data was collected in the coronary care unit using a preformed questionnaire. Among 98 MI patients, where 16 female and 82 male patients had average age 53±12 years. Average income rural community was around 100 USD. Almost 50% of sample were illiterate or below 5th grade. On average 6.6 hours (95% CI: 3.5-12.3) were required to reach CCU after symptom onset, whereas distance to first medical contact (FMC) was about 10.2 Km (95% CI: 6.4-16.2). Median distance to nearest PCI-capable hospital was 140 Km (IQR- 20 Km). Only 28% of patients could reach hospital within 2 hours, where 85% had onset of symptom while they were at home. Tertiary level medical college (74.5%) followed by Upazilla (Sub-urban) government health complex (22.4%) were frequent site of FMC. Principle mode of transport to hospital was CNG-three-wheeler (75% of cases). Logistic regression analysis showed only low literacy was as significant predictor about more than 2 hours pre-hospital delay (OR=2.58; p=0.043). Other factors such as low income (OR=2.51; p=0.126), diabetes mellitus (OR=2.99; p=0.059), female sex (OR=1.56; p=0.753), house wife (OR=1.88; p=0.547), previous MI (OR=1.52; p=1.000), symptom ignorance (OR=2.14; p=0.455) increases pre-hospital delay and distance to FMC <10 Km (OR=0.44; p=0.079) no significant prediction of pre-hospital delay after myocardial infarction. As rural community has less access to education low literacy has a significant impact on pre-hospital delay after myocardial infarction. So measures should be taken in rural areas through patient education and social awareness program regarding MI symptom and danger of delayed medical attention.

Clinical Features of Covid-19 Infection: a Study of SARS-CoV-2 Positive Patients from Mymensingh Region, in Bangladesh.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to almost every country on the globe and it is considered by World Health Organization as a pandemic. SARS-CoV-2 causes the Coronavirus disease 2019 (COVID-19). Many of country are reporting the symptomatic characteristics of their cases to give better observations into the various clinical presentations of SARS-CoV-2 infection. However, the symptomatic literature is limited in Bangladesh. The aim of the study is to analyze the symptomatic characteristics of patients having the SARS-CoV-2 positive by real time reverse transcription polymerase chain reaction (rRT -PCR) test. Here, the data of 146 patients who were positive for the SARS-CoV-2 virus and were residents of different districts of Mymensingh region were analyzed. Patients' demographics, symptoms, history of co-morbidities condition like DM, HTN, Hypothyroid etc, travel and contact were collected from MMC Daily Reported data from April 1, 2020 to April 30, 2020. Among the total 3184 patients' nasopharyngeal samples, we have got 146 (4.58%) positive for SARS-CoV-2. Of the 146 positive patients most of the patients were male 95(65%), the majority 80(54.8%) were the 21 to 40year age group. Most of the patients 61(41.78%) were residents of Mymensingh include Mymensingh Sadar, Valuka, Trishal and Ishhorganj. Among the patients 94(64.4%) were symptomatic and 52(35.6%) were asymptomatic. The symptomatic patients presented mostly were with fever 45(30.82%), cough 33(22.6%) and breathlessness 9(6.16%). The majority of patients 54(36.9%) had a history of contact with SARS-CoV-2 patients and 16(11%) had a travel history within 14 days of their rRT-PCR test positive. The only 3(2%) patients had history of comorbidities condition like DM, HTN, Hypothyroid etc. The number of SARS-CoV-2 cases is rapidly increasing in our country. The education of the population about the most common symptoms of the virus infection is needed mostly; therefore, individuals may able to recognize these symptoms. So, that people might get themselves tested.

Assessment of Risk Factors of Heart Failure: A Case Control Study.

Heart failure (HF) is becoming an increasingly prevalent healthcare problem. Besides, Ischemic heart disease (IHD) and Hypertension (HTN), there is a number of other factors that continue to evolve as risk factors for heart failure. The aim of the study was to identify the different risk factors of heart failure patients. This case-control study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2014 to July 2015. It was included 75 patients of heart failure (cases) and 75 age and sex matched adult individuals (friends and relations of heart failure cases) as controls. The risk factors studied were grouped into demographic, clinical, behavioral and biochemical variables. The age distribution between case and control groups was almost identical with mean ages of either group being 55 years (p=0.922). The sex distribution was also fairly comparable with male being predominant in both the groups (p=0.574). In this study IHD followed by uncontrolled hypertension (p=0.001) are came out to be the predominant risk factors of heart failure followed by smoking and obesity (p<0.001). From the findings of the study, it can be concluded that a number of risk factors are involved in heart failure cases. Of them ischemic heart disease and uncontrolled hypertension are the predominant ones followed by smoking and obesity. The best strategy would, therefore, be to treat and control ischemic heart disease, hypertension, obesity, diabetes and smoking habit in the population. However, as the risk factors in the population continue to change; ongoing surveillance is important to guide right preventive strategy in future.

Detection of Vascular Changes in Systemic Lupus Erythematosus by Carotid Duplex Study in A Tertiary Cardiac Hospital.

Systemic lupus erythematosus (SLE) is a common autoimmune connective tissue disorder and mainly affected female patients. This cross sectional study was performed in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2008 to June 2012. A total fifty (50) SLE patients were diagnosed on the basis of ACR criteria, having no cardiovascular symptoms. Another 50 age-matched normal individuals were included to compare with SLE group. Congenital vascular disease, ischaemic heart disease, congenital heart disease, rheumatic heart disease, hypothyroidism and any other inflammatory disease along with SLE were excluded from study. All patients were evaluated by Carotid duplex study. Mean age of SLE was 26.70±7.3 and mean age of normal subject was 25.64±8.01. Most of the SLE patients were female (about 92%) and male (about 8%). And about 94% was female in normal group and 6% was male. In Right common carotid arteries (RCCA), mean Intema medial thickness (IMT) was 0.86±0.10 IN SLE group and 0.73±0.06 in normal group. In LCCA, mean IMT was 0.89±0.14 in SLE group and 0.76±0.10 in normal group. IMT in SLE group was increased than control group. There was a significant difference (p=0.001) in both right and left side. The percentage rate of change in PSV and EDV of Carotid arteries of the SLE group was significantly higher than the control group (Both left and right side p=0.001). In RCCA, the PSV was 91.72±19.46 in SLE group and 62.60±6.66 in normal group (p=0.001). And EDV was 27.02±8.23 in SLE group and 16.48±2.32 in normal group (p=0.001). In LCCA, the PSV was 82.06±22.28 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 27.82±6.61 in SLE group and 18.08±2.69 in normal group (p=0.001). In LICA, mean PSV was 83.46±23.54 in SLE group and 60.36±7.54 in normal group (p=0.001). And EDV was 29.36±8.56 in SLE group and 18.08±2.69 in normal group (p=0.001). In RICA, mean PSV was 61.56±7.66 in SLE group and 62.16±5.35 in normal group (p=0.651) which was not significant. And EDV was 26.36±2.26 in SLE group and 19.00±2.17 in normal group (p=0.001). But majority of the vessels showed significant P value which signifies that vascular changes were more evident in SLE group than normal control group. SLE patients with carotid artery blood flow velocity and structural changes in endothelial function changes more evident than control group. Compared with the normal control group, IMT, PSV and EDV were significantly higher in SLE group, the difference was statistically significant (P<0.05). Vascular changes are common in SLE when clinically asymptomatic. Carotid duplex study is a non invasive tool for early detection of vascular changes to prevent stroke in SLE patients.

Improvement of Left Ventricular Systolic Function after Percutaneous Coronary Intervention in Diabetic Patients with Non-ST elevated Myocardial Infarction.

Long term mortality is higher in Non-ST-segment elevated myocardial infarction (NSTEMI) patients than STEMI paitents. NSTEMI are a high risk factor for ensuing cardiovascular events in diabetic patients. But, use of drug eluting stents (DES) will further improve outcomes in patients with diabetes suffering early percutaneous coronary intervention (PCI). The aim of the study was to determine the changes in left ventricular (LV) systolic activity after successful PCI in NSTEMI diabetic patients was compared with non-diabetic patients. This comparative clinical study was performed in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2017 to June 2018. Thirty (30) diabetic and 34 non-diabetic patients with NSTEMI undergoing percutaneous coronary intervention were included in the study. In all patients PCI with drug eluting stent was performed successfully. Earlier echocardiography (2-Dimensional) was done, at release subsequent PCI and 3 months afterward to evaluate the LV systolic activity and compare to diabetics and non-diabetics at all levels of evaluation to assess the outcome of intervention. At baseline LVEF was rather lower in diabetic group than non-diabetic group patients. In diabetics patients segments with abnormal wall motion (WMA) was higher than non-diabetics patients. While the LVEDD, LVIDd and LVIDs were significantly larger in the earlier group than those in the latter group, the LVESV was no different in both groups. At release from hospital, no significant enhancement was observed in either group following PCI in terms of LVEF, number of segments with WMA, LVIDd and LVIDs. However, both LVEDV and LVESV reduced successfully in both groups with decrease of LVESV being more marked in non-diabetics compared with diabetics (p=0.018). However, 3 months after PCI, LVEF improved (8.4±1.2%) in diabetics and 7.9±1.2% in non diabetics patients but this improvement between two groups was not statically significant (p=0.631). Similarly baseline to 3 months after PCI LVIDs reduces in diabetics patients (5.7±1.9%) and 4.8±1.1% in non diabetics patients but the difference between both groups was not significant (p=0.201). Diabetic patients more frequently required 2 stents (p=0.30), while stent's diameter and length did not differ between the study groups. This study demonstrated that improvement of the parameters of left ventricular systolic function after using of drug eluting stent in NSTEMI diabetic patients was not lower to the non diabetic group under same condition. So, suggestion of PCI with drug eluting stent may be extended in NSTEMI diabetic patient.

A Case of Severe Coarctation of Aorta Associated With Bicuspid Aortic Valve Managed Surgically.

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. Long-term survival is exceptional in patients with untreated aortic coarctation. In this case report, we present a late diagnosis of aortic coarctation in a 45-year-old male. Our patient was relatively asymptomatic until he presented with exertional dyspnea and fatigue in his fourth decade of life in Bangabandhu Sheikh Mujib Medical University (BSMMU), on the month of August, 2016. The patient was managed by surgery of aorta. After the 6 months follow-up visit, the patient was in good clinical condition.

Assessment of Subvalvular Apparatus in Patients with Rheumatic Mitral Stenosis: Comparison between 2D and 3D Echocardiography.

Mitral valve is the most involved valve in rheumatic heart disease especially in the form of mitral stenosis. Treatment options of mitral stenosis depend upon pattern, extent & the severity of disease and echocardiography has the key role in this area. Severity of involvement of subvalvular apparatus (SVA) is an important factor for determining the treatment option. 2D echocardiography (2DE) is conventionally used. With the advancement of echocardiographic technology 3D echocardiography (3DE) would offer better assessment of subvalvular apparatus. This study compared transthoracic 2D versus 3D echocardiography for assessment of SVA in chronic rheumatic mitral valve disease. This cross sectional observational study was done in University cardiac centre, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2012 to October 2012. In this study, considering all ethical issues, data were collected from 50 subjects who underwent transthoracic 2D and 3D echocardiography for the assessment of extent and severity of mitral stenosis. Accurate measurement of Mitral valvular area is very important in assessment of severity, which is found similar by both 2DE (0.98±0.24cm²) and 3DE (0.92 ±0.23cm²). But assessment of subvalvular involvement especially chordal adhesion can be done better by 3DE (p<0.001). This observation suggests superiority of 3DE for assessment of SVA in chronic rheumatic mitral stenosis. The result of the study demonstrates that 3DE is superior to 2DE for the assessment of SVA in chronic rheumatic mitral stenosis.