The Journal of Cardiovascular Diseases

Clinical outcomes and complications between femoral and radial artery approach of Coronary Angiography

Thu, 28 Mar 2024 00:00:00 +0000

Background: Coronary Angiography has become the most suitable invasive procedure to image coronary atherosclerotic burden. The access of choice still comes down to operators’ experience and comfort level.

Objective: To compare the clinical outcomes and complications between femoral and radial artery approach of Coronary Angiography

Material and methods: This cross-sectional research was conducted at the Cardiology Department of Central Park Teaching Hospital, Lahore, over a period of one year. Total 96 patients enrolled who fulfilled the inclusion criteria. Two groups of participants were formed. In group-A, angiography was done through femoral artery and in group-B, angiography was done through radial route. Then patients were followed-up for 6 months and outcomes were noted.

Results: The mean age of patients in femoral artery group of this study was 53.15±9.10years while mean age of patients in radial artery group was 50.72±10.46years. Death occurred in 4 (8.7%) patients in femoral artery group while in 3 (6.5%) radial artery group patients. MI occurred in 2 (4.3%) femoral artery patient group while in 0 (0.0%) patients which were included in radial artery group. Hematoma formed in 5 (10.9%) patients in femoral artery group while in 2 (4.3%) patients in radial artery group. Stroke / TIA, pseudoaneurysm, arteriovenous fistula, arterial occlusion and nerve injury did not occur in any patient in any group. Major bleeding occurred in 2 (4.3%) patients in femoral artery group while in 0 (0.0%) patients in radial artery group. The difference was insignificant (p>0.05).

Conclusion: Complications are high in femoral artery but insignificant results have been obtained. So radial approach can be obtained as preferred method for coronary angiography.

Frequency of hypotension after intravenous streptokinase in patients presenting with ST elevation myocardial infarction

Thu, 28 Mar 2024 00:00:00 +0000

INTRODUCTION: One of the primary causes of death and disability worldwide is Acute Myocardial Infarction. Streptokinase is still widely used in many countries for its treatment, despite percutaneous advancements in the field. This study was conducted to appraise the incidence with which hypotension occurred by streptokinase in patients suffering from acute ST-elevation Myocardial Infarction (STEMI) due to the significance of this disease and the potential side effects of streptokinase to the patient. The purpose of this study was to ascertain the frequency of hypotension in patients presenting with ST Elevation Myocardial Infarction, who are being administered streptokinase.

METHODOLOGY: The study was conducted at the Emergency Department of Punjab Institute of Cardiology, Lahore from August 25, 2020 to February 25, 2021. A total 280 patients with STEMI were enrolled in the study. Electrocardiographic diagnosis of ST Elevation Myocardial Infarction was performed by a consultant cardiologist. Bedside echocardiography was also performed by a consultant cardiologist. Manual blood pressure recording of the patients was carried out every five minutes during administration of Streptokinase Injection and every hour and three hours after completion. Data was input and analysed using SPSS v25.0. To account for these impact modifiers, we stratified the data according to age, gender, diabetes status, family history, smoking status, and hypercholesterolemia. The chi-square analysis will be performed when the stratification process is complete. A p-value of 0.05 or below was taken to be of statistical significance.

RESULTS: A total of 280 patients with STEMI were selected for this study. There were 165(58.9%) males and 115(41.1%) females. Mean age was 38.46±9.81 year. Among 280 patients with STEMI, 39(13.9%) patients had hypotension.

CONCLUSION: Streptokinase, given intravenously, had lower incidence of cardiovascular complications like hypotension. A future with less illness burden may be possible if we take a more targeted approach to lowering the risks that contribute to it via health education and promotion.

Incidence of Ventilator Associated Pneumonia in Post-operative Cardiac Surgery Patients

Thu, 28 Mar 2024 00:00:00 +0000

BACKGROUND: Major cardiac surgery patients are at high risk for nosocomial infections. Our objective was to identify risk factors for ventilator-associated pneumonia (VAP) in post-operative cardiac surgery patients. One of the leading cause of morbidity and mortality in cardiac intensive care is VAP. So this serious nosocomial infection is a real threat to post-operative cardiac surgery patients.

OBJECTIVE: The objective of the study was to find the incidence of ventilator associated pneumonia in post-cardiac surgery patients.

MATERIALS AND METHODS: This was a prospective, clinical study conducted at Punjab institute of cardiology between 01-06-2021 to 31-12-2021 for six months. A total of 120 post-cardiac surgery patients of both genders in ICU were enrolled in the study. Informed consent and demographic details were taken. Baseline investigations were taken. With properly designed Questionnaire data regarding the observations were entered by working personnel in ICU. VAP was confirmed by history of patients and by microbiology aspect. The data was collected and was analyzed by the help of SPSS v20 software.

RESULTS: All of 120 patients underwent controlled ventilation. In 5 patients microbiological results confirmed VAP. Among patients who were diagnosed as case of VAP average patient age was a 59.40±5.12 years. 2 (40%) males and 3(60%) females suffered VAP. Predominant organism isolated was pseudomonas aeroginosa4 (80%). CABG with and without valve surgery 4 (80%) was the commonest type of surgery. Majority of patients 4(80%) remained on mechanical ventilation for more than 48 hours.

CONCLUSION: VAP is relatively most common nosocomial infection in post-cardiac surgery patients. Post CABG patients especially with multiple risk factors, compromised left ventricular systolic function and longer duration on mechanical ventilation are at high risk of developing VAP. Such population should be given special attention.

Prevalence of hypertension among university going students

Thu, 28 Mar 2024 00:00:00 +0000

Hypertension is a severe but modifiable problem that notably increases the risk for heart and renal diseases. This study sought to provide information about hypertension in undergraduate students in different universities in Lahore. In Pakistan, there are few surveys nationwide and population-based on the prevalence of hypertension but there is no current research on university students aged 18-25 in Lahore. This was a cross-sectional study with nonprobability sampling technique. Objective of this study was to determine the prevalence of hypertension among undergraduate students. According to SPSS v.23 test the significant value was less then 0.05 which shows that the hypothesis was prove. These results indicate that there is a statistically significant association between blood pressure and BMI categories at a significant level of 0.05. The study found that approximately 8% of the participants were hypertensive, and there was a higher prevalence among male students. However, lack of physical exercise was not found to be correlated with hypertension. The study highlights the importance of educating young adults about the consequences of hypertension and promoting healthy lifestyle habits

Key words: Hypertension, Nutrition, Dietary Choices

Clinical Association among GRACE score and SYNTAX score in Non ST Elevation Acute Coronary Syndrome patients

Thu, 28 Mar 2024 00:00:00 +0000

INTRODUCTION: American College of Cardiology, American Heart Association, and the European Society of Cardiology advocate utilization of variety of risk assessment tools for assessment of ischemia.^{1, 2}

OBJECTIVE: To find association among GRACE and SYNTAX scores in acute coronary syndrome individuals excluding STEMI.

METHADOLOGY: This research was carried out in Cardiology Department of Central Park Teaching Hospital, Lahore over a period of 6 months. Total 273 patients satisfying the inclusion criteria were included in this research project. All patients underwent an examination for the calculation of GRACE risk score. After cardiac catheterization, SYNTAX score was calculated. The researcher personally calculated both scores. The parameters was recorded on a pre- designed proforma.

RESULTS: The patients exhibited mean age of 54.81 ± 13.14 years, spanning a range from 30 to 80 years. A higher male-to-female ratio was observe with 164(60.07%) cases being male and 109(39.93%) cases being female. The mean duration of diagnosis was 14.35 ± 5.23 hours with minimum and maximum duration as 6 and 23 hours. The mean Grace risk score was 137.40 ± 13.52 and the syntax score exhibited mean value of 28.68 ± 3. There was correlation of 0.775 among Grace risk score and Syntax score, with significant p-value i.e. < 0.001.

CONCLUSION: A robust positive association exists among GRACE and SYNTAX scores in non-STEMI acute coronary syndrome patients. Hence, grace and syntax score may be applied in our clinical setting for identification of high risk patients (with higher GRACE score) with acute coronary having lower health resources is of much importance to avoid unnecessary work up in low risk patients (low GRACE score) and accurate referral of high risk patients for further workup and management.

Case report: Acute massive pulmonary embolism treated by alteplase.

Khawar Shoaib — Thu, 28 Mar 2024 00:00:00 +0000

Background: Pulmonary embolism is a common and some time fatal disease that continues to persist despite advance in diagnosis and management. Pulmonary embolism (PE) is caused by emboli, which have originated from venous thrombi, travelling to and occluding the arteries of the lung. PE is the most dangerous form of venous thromboembolism, and undiagnosed or untreated PE can be fatal. Acute PE is associated with right ventricular dysfunction, which can lead to arrhythmia, haemodynamic collapse and shock. Furthermore, individuals who survive PE can develop post-PE syndrome, which is characterized by chronic thrombotic remains in the pulmonary arteries, persistent right ventricular dysfunction, decreased quality of life and/or chronic functional limitations. Several important improvements. In patients younger than 55 years, the incidence of pulmonary is higher in females. Once deep venous thrombosis develops, clots may dislodge and travel through the venous system and the right side of the heart to lodge in the pulmonary arteries, where they partially or completely occlude one or more vessels.

CASE PRESENTATION

A 65 year old hypertensive male resident of Lahore was in usual state of health when he develop shortness of breath which was sudden in onset and gradually worsen. It was not associated with chest pain, swelling of legs, edema. Previously he was only hypertensive. He has no family history of such illness. On presentation his vitals show hypotension, tachycardia and tachypnea with drop in saturation. Investigations of the patient carried out, blood investigation showed increase TlC,

D-dimer raised, trop positive, PT, aptt normal, Hb, PLT count were also normal. ECG OF THE Patient showed sinus tachycardia with large S wave in lead 1, Q wave in lead 3 and inverted T wave in lead 3. Echocardiography of this patient showed dilated RV with intact LV systolic function. X-RAY of the patient shows Hampton hump sign (wedge shape peripheral air disease). CT pulmonary angiogram done which shows bilateral extensive pulmonary embolism involving almost entire left main pulmonary artery with extension into distal right pulmonary artery. there was poor opacification of bilateral lower limb deep veins for which Doppler bilateral lower limb planned. On above these finding patient was treated at line of pulmonary embolism. Patient symptom improved and was discharged on oral anticoagulant with follow up care advise.

ECG showed sinus tachycardia. Large S wave in lead 1, Q wave in lead III and invented T wave in lead III.

There was Bilateral Pleural Effusion and Right side consolidation.

DISCUSSION

We report an interesting case of PE. Although cases of DVT have been associated with this syndrome in the past, only a few cases have presented with acute bilateral pulmonary emboli. This vascular variant should be considered with high suspicion in left lower extremity DVT in young patients with no other etiology to justify thrombosis. Prolonged anticoagulation, thrombectomy or stent placement for the relief of mechanical obstruction have been used in various clinical settings.

A multidisciplinary team input from specialists is the key to provide primary care fundamentally in poorly defined management strategies. Identification of the triggers of thromboembolism is crucial to prevent disease progression and recurrence. In pulmonary embolism with or without infarction in haemodynamically stable patients, anticoagulation should be considered as first-line therapy to yield optimum outcomes.

CONCLUSION:

PE is the result of a clot in the pulmonary artery or one of its branches. If untreated, PE can result in death. Goals of initial treatment include clot resolution; long-term and extended treatment aim to decrease the risk of recurrence. All patients of pulmonary embolism taking anticoagulant medication should have proper follow-up and routine investigations done every 1 to 3 months.

Addressing the Public Health Crisis of Dyslipidemia

Mudabbar Mahboob — Thu, 28 Mar 2024 00:00:00 +0000

Dyslipidemia, characterized by abnormal levels of lipids (cholesterol and/or fats) in the blood, poses a significant threat to public health worldwide. While often asymptomatic, its ramifications are profound, increasing the risk of cardiovascular diseases (CVDs), including heart attacks and strokes. As the prevalence of dyslipidemia continues to rise globally, it has become imperative to address this silent but deadly health concern.

One of the primary causes of dyslipidemia is poor dietary habits, marked by the excessive consumption of saturated fats, trans fats, and cholesterol-rich foods. Sedentary lifestyles further exacerbate the problem, leading to obesity and metabolic syndrome, both closely linked to dyslipidemia. Additionally, genetic factors play a significant role in predisposing individuals to this condition. The consequences of dyslipidemia extend far beyond individual health, imposing a considerable economic burden on healthcare systems. The management of dyslipidemia and its associated complications requires significant financial resources, including medication, medical interventions, and long-term care. Moreover, the indirect costs, such as lost productivity and diminished quality of life, further amplify its socioeconomic impact.

Preventive measures are crucial in mitigating the burden of dyslipidemia. Public health initiatives aimed at promoting healthier lifestyles, including balanced diets and regular physical activity, are paramount. Educating individuals about the importance of cholesterol screening and early detection of dyslipidemia can facilitate timely interventions, thus reducing the risk of CVDs. Furthermore, healthcare systems must prioritize the management of dyslipidemia through comprehensive strategies. This includes ensuring access to affordable medications, implementing guidelines for lipid-lowering therapies, and integrating preventive measures into primary care settings. Additionally, targeted interventions, such as community-based programs and public awareness campaigns, can enhance population-wide efforts to combat dyslipidemia. Collaboration between governments, healthcare organizations, advocacy groups, and the private sector is essential to address the multifaceted nature of dyslipidemia effectively. By fostering partnerships and leveraging resources, we can develop sustainable solutions that promote cardiovascular health and reduce the burden of dyslipidemia on society.

In conclusion, dyslipidemia represents a major public health challenge with far-reaching implications for individuals and societies worldwide. By adopting a holistic approach that combines preventive measures, comprehensive healthcare strategies, and collaborative efforts, we can mitigate the impact of dyslipidemia and safeguard the cardiovascular well-being of current and future generations. It is imperative that we act decisively to confront this silent epidemic and pave the way towards a healthier, more resilient society.