Short-term Treatment Outcome of Patients with Acute ST-elevation Myocardial Infarction in a Tertiary Care Hospital.

Outcome of acute ST-elevation myocardial infarction patients varies time to time. The present study was intended to find out the short-term treatment outcome of the patients admitted in hospital. This descriptive study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15 January 2014 to 14 July 2014. A total of 100 patients admitted with Acute ST-elevation Myocardial Infarction confirmed on the presence of the (a) Typical chest pain of acute ST-elevation Myocardial Infarction (b) Electrocardiogram (ECG) evidence of ST segment elevation in two or more contiguous leads (c) Raised cardiac marker (Troponin I) were included in the study. Patients were randomly enrolled according to the inclusion and exclusion criteria and observe for one week. Data were processed and analyzed by using computer bases software SPSS version 19.0. Descriptive statistical methods were applied for data analysis. P value was considered as statistically significant when it is less than 0.05. Short-term treatment outcome of acute ST-elevation myocardial infarction include mechanical, arrhythmic, ischemic and inflammatory sequelae, as well as left ventricular mural thrombus. In addition to these broad categories, heart failure, arrhythmia, death are other common complications of AMI. The initiation of the complications usually results in explicit sign and symptoms of the acute MI patients. Learning of the complications in the post infarction period and the clinical syndromes develop with each complication, will allow the health care worker to evaluate and manage the complication appropriately.

Association of Body Mass Index with Angiographic Severity of Coronary Artery disease in patients with Acute Coronary Syndrome.

Coronary artery disease (CAD) is the leading cause of death in developed and developing countries. Associated co-morbidities like diabetes, hypertension and obesity are making the situation worse. WHO enlisted obesity as an epidemic which also affects a great number of young population. Some recent studies showed the presence of an apparent paradoxical relationship between obesity and cardiovascular prognosis in certain subsets of patents. As BMI is an established marker of obesity; an attempt has been made to assess relationship between BMI and angiographic severity of coronary artery disease in Acute Coronary Syndrome (ACS) patients of Bangladeshi origin. To assess the association between body mass index and angiographic severity of coronary artery disease in patients with acute coronary syndrome; this cross sectional analytical study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital (MMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from December 2016 to February 2018 among purposively selected 65 patients. Relevant ethical issues were taken into consideration. Coronary angiogram was done in the same index hospitalization period. After coronary angiogram performed patients were grouped into two groups according to their BMI. Patients with BMI <25kg/m² as Group I and those ≥25kg/m² as Group II. Angiographic severity of coronary artery disease was assessed by vessel score and Syntax score. Mean age of Group I was 54.45±10.42 years, while in Group II it was 50.76±8.89 years reflecting the early presentation of higher BMI patients. Male to female ratio was 12:1. Mean BMI of Group I and Group II was 22.56±1.59 and 28.67±2.64 respectively. In Group I, 10(25.0%) had single vessel lesion, 15(37.5%) had double vessel lesion and 14(35.0%) had triple vessel lesion, while in Group II, 6(24.0%) had single vessel lesion, 12(48.0%) had double vessel lesion and 5(20.0%) had triple vessel lesion. Mean Syntax score of Group I and Group II was 13.18±8.45 and 10.42±7.14 respectively. Patients in the increasing BMI class had a higher prevalence of diabetes, hypertension and dyslipidaemia. A negative correlation was observed between BMI and angiographic severity (Vessel score, Syntax score and HRCA e.g. LM disease) of CAD indicating that patients with higher BMI had a lower coronary artery disease (CAD) severity than their normal BMI counterparts. Patients with high BMI have a lower CAD severity than usually expected. After adjustment for co-morbidities, BMI was not found as an independent predictor of severity of coronary artery disease.

Simple Treadmill Score: Does It Have Better Predictability for Coronary Artery Disease?

Coronary artery disease is one of the most prevalent causes of increasing mortalitiy in current time. Early detection of such dreadful condition by a non-invasive test like exercise treadmill test, is a much-required option to prevent future complications like myocardial infarction. The aim of this study was to find out how different the predictability of simple treadmill score in comparison to other treadmill scores namely the well-known Duke treadmill score and Cleveland clinic score. In a cross-sectional analytical study of total 130 individuals with stable angina were included according to criteria set before the study. The treadmill scores of these patients were calculated and compared to coronary angiogram findings where coronary artery angiograms were done according to clinical need. Simple treadmill test had similar predictability for coronary artery disease when we compared it with much-applied Duke Treadmill Test and Cleveland Clinic Score- which is currently used for mortality prediction. Receiver Operator Characteristics (ROC) Curve showd all scores had around 0.7 area under the curve (AUC) which is highly statistically significant (p<0.0001) though simple treadmill score in females has higher sensitivity (92.3%). Simple treadmill score can be considered to exclude female patients from undergoing invasive investigation as it has higher sensitivity than other currently practiced treadmill scores i.e., Duke treadmill score.

An Echocardiographic Study of the Right Ventricular Diastolic Function in Systemic Hypertension and Its Relation with the Left Ventricular Homologous Changes.

Diastolic dysfunction is a major predictor of mortality and morbidity in hypertensive patients. Not only LV, the RV is also expected to be affected in this overall procedure. To observe the Echocardiographic changes of diastolic function of the RV in systemic HTN and their relation with similar parameters of the LV was the objective. TDI was used in association with standard Doppler modality. In this cross-sectional study, 50 hypertensive subjects were studied who were devoid of any other conditions that may influence the diastolic function of the RV from 01 May 2012 to 31 October 2012 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. In addition to 2D and M-mode evaluation, standard Doppler and pulsed tissue Doppler assessment of both ventricles were performed. Measurements were obtained for diastolic as well as systolic function of both ventricles. The RV diastolic parameters were impaired in both standard Doppler and tissue Doppler analysis in association with LV parameters. Systolic functions (LV FS and RV TAPSE) were preserved. Doppler-derived tricuspid peak E and E/A were related negatively to septal thickness, but tissue Doppler-derived RV Em/Am showed negative association with both RVAWT and septal thickness. RV RTm was related positively to RVAWT. The RV diastolic parameters showed positive relation with the LV similar parameters both in standard Doppler (E peak velocity, E/A ratio and EDT) and tissue Doppler (Em peak velocity, Em/Am and PCTm) assessment. So, in systemic HTN, LV diastolic dysfunction is also associated with diastolic disturbances of the RV. Pulsed tissue Doppler is a useful tool to detect the changes. RV diastolic parameters correlate well with those of the LV. Prolongation of the active relaxation (RTm) phase of RV is due to its increased wall thickness.

Pattern and Extent of Tricuspid Valve Involvement in Chronic Rheumatic Heart Disease.

Rheumatic heart disease causes a significant number of morbidity and mortality in Bangladesh. Although the mitral and the aortic valve are the two most involved valves in rheumatic heart disease, the tricuspid valve disease is not uncommon secondary to, or in association with, mitral or aortic valve disease, but receives less attention as compared to the primary left-sided valve disease. Appropriate treatment of the tricuspid valve disease may improve long-term functional outcome. But the pattern and extent of the tricuspid valve involvement was not studied recently. This study was carried out to observe the pattern and extent of tricuspid valve involvement in Rheumatic Heart Disease patients. This observational analytical study was undertaken in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2010 to September 2011. Considering all ethical issues, data were collected from 173 subjects who underwent Echocardiography for their Chronic Rheumatic heart disease. Pattern of tricuspid valve involvement was observed by using Transthoracic Echocardiography by 2D, M mode and Doppler assessment. One hundred seventy three (173) patients with Rheumatic Heart disease was studied, out of these, 36 patients had evidence of tricuspid valve involvement based on echocardiographic findings. Fifteen (15) patients had Tricuspid stenosis and 36 patients had Tricuspid Regurgitation in the patients with TV involvement. All the patients with TV involvement had thickened leaflets. Doming, restriction of motion and calcification were present in different proportions. From this study, it can be concluded that organic tricuspid valve involvement in RHD is not uncommon in our country.

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.

Association of heart rate response with scan and left ventricular function on adenosine stress myocardial perfusion imaging.

To evaluate the association of heart rate (HR) response with abnormal scan and/or left ventricular (LV) function in patients undergoing adenosine myocardial perfusion imaging, we prospectively studied 164 consecutive patients who underwent a standard adenosine stress test (without exercise) and myocardial perfusion imaging (MPI) using technetium-99m sestamibi radioisotope. Change in HR was calculated by subtracting HR at rest from peak HR. The percentage change in HR was calculated. All patients underwent stress and resting single photon emission computed tomography (SPECT) imaging. Left ventricular ejection fraction (EF) was calculated using gated SPECT. Mean age was 54 ± 11.7 years and 126 of the patients (72%) were men. We divided the patients into 2 groups: group 1(42 patients, 25%) had normal scans and group 2(122 patients, 74.3%) had abnormal scans; abnormal scans were defined as presence of either fixed defects, reversible defects, or both. Average HR increased by 35 beats/min in the normal scan group compared with 23 beats/min in the abnormal scan group (p=0.002). Sixty four (64) patients (39%) had reduced EF (<45%). This group had an average HR and percentage HR increase of 23 beats/min (27%) compared with an increase of 35 beats/min (38%) in patients with normal EF (p=0.002 and p=0.02, respectively). Thus, a diminished HR response had a significant association with both an abnormal scan and reduced EF on adenosine MPI.

Coronary angiographic profile in bangladeshi patients with metabolic syndrome and ischemic heart disease.

The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. We evaluated interrelationships between angiographic CAD and the metabolic syndrome, in 478 patients who were referred for coronary angiography to evaluate suspected myocardial ischemia in the department of cardiology of BSMMU between June 2007 and May 2008. We applied the criteria for the metabolic syndrome proposed by ATP III guideline. Study populations were divided into two groups on the basis of presence or absence of metabolic syndrome. Age was similar in both groups. Body mass index (BMI) was higher (26.22 ± 1.94 vs. 22.07 ± 1.55) in metabolic syndrome group (p ≤ 0.0001). All parameters, waist circumference (103.16 ± 10.21 vs. 91.45 ± 7.61) cm, blood pressure both systolic (141.34 ± 21.49 vs. 127.94 ± 13.01) and diastolic (86.8 5 ± 8.42 vs. 79.28 ± 7.77) mm of Hg, serum triglyceride (248.32 ± 77.88 vs. 128.35 ± 19.00)mg/dl, fasting blood glucose (125.40 ± 22.86 vs. 95.65 ± 10.63)mg/dl were significantly higher in metabolic syndrome group (p value=0.0001), whereas HDL (33.10 ± 6.55 vs. 39.30 ± 6.17)mg/dl was lower (p value = 0.0001). More subjects in metabolic syndrome were having type B (55.60% vs. 31.00%) and type C (9.50% vs. 2.70%) lesion as compared to non-metabolic syndrome group. Involvement of left main artery was more (4.80% vs. 0.90%) in metabolic syndrome group. Metabolic syndrome has primary predictive ability for CAD. A metabolic profile should form part of the risk assessment in all patients with coronary disease, not just those who are obese.

Profiles of pain in Mississippi: results from the Southern Pain Prevalence Study.

OBJECTIVES: To estimate the prevalence, intensity, frequency, and origins of pain in Mississippi residents and explore the social and cultural aspects of pain and pain management by measuring the impacts of pain on everyday life as well as respondents' beliefs and attitudes toward pain. STUDY DESIGN: Cross-sectional survey of Mississippi adults. SUMMARY OF BACKGROUND DATA: Data from previous population surveys and clinical studies indicate that pain is a pervasive part of everyday life. The prevalence, intensity and frequency of reported pain is substantial throughout these studies. The literature documents large and profound consequences of pain both for individual lives and for society. The data also suggest that beliefs and attitudes rooted in the social and cultural context of society may help explain how pain is managed or endured. METHODS: Telephone interviews with a representative sample (random digit dialing) of 604 Mississippi adults were conducted utilizing a computer-assisted telephone interviewing system. The cooperation rate was 94.8% (5.2 % refusal). The Code of Standards and Ethics for Survey Research rate was 67.4% and the maximum sampling error was +/- 4.0% (95% confidence interval). The Mississippi survey data represent a subset of the data obtained in the six-state Southern Pain Prevalence Study. RESULTS: The pain prevalence rate was estimated to be 37% of the overall Mississippi sample: 9% of the sample reported severe pain on at least a monthly basis; 16% reported moderate pain; and 12% reported mild pain. Among those reporting pain, a majority (52%) experienced pain on a daily basis. The most commonly reported origins of pain were back pain (49%), leg and knee pain (41%), and shoulder.and arm pain (20%). Respondents also reported that both moderate and severe pain had substantial negative impacts on multiple facets of everyday life, including interference with sleep (84%), recreational/leisure activities (78%), ability to work (68%), sexual relations (43%), and relationships with others (36%). Mental health impacts for respondents with moderate to severe pain on at least a monthly basis included increased feelings of anxiety (66%), self-reported depression (63%), and loneliness (46%). When responding to questions regarding beliefs and attitudes about pain and pain management, the majority of respondents (62%) considered pain to be a normal part of everyday life. Many respondents felt that medicine should be saved until the pain becomes worse (55%), and a substantial number of respondents felt that good patients do not complain about pain to their doctors (22%). CONCLUSIONS: This study expands the body of knowledge about the prevalence of pain in Mississippi, suggesting that approximately one-third of the state's adults are affected by pain on at least a monthly basis. Most of this pain is moderate to severe and quite frequent--occurring daily for the majority of pain sufferers. The study also illuminates social and cultural dimensions of pain, revealing that a) the presence of pain negatively affects almost every facet of life, from sleep and work to relationships, leisure activities, and mental health, and b) respondents attitudes and beliefs are often at variance with modern approaches to pain management. Knowledge gained could have critical implications for understanding patients and the treatment of pain.