BACKGROUND Coronary Artery Disease (CAD) is the leading cause of morbidity and mortality worldwide. The prevalence of CAD and the incidence of Acute Coronary Syndrome (ACS) are very high among Indians. ST Elevation Myocardial Infarction (STEMI) is one of the major presentations of Acute Coronary Syndrome. The data regarding the clinical presentations of STEMI is still lacking in the majority rural population of INDIA. MATERIALS AND METHODS All patients who were admitted with features of Acute ST Elevation myocardial infarction (STEMI) from 1 st January to 30 th September 2018 were included and analysed retrospectively in this study. The demographic features, Cardiovascular risk factors, Clinical presentation, Serial E.C.G findings & the 2-D Echocardiographic features were analysed and correlated with the clinical and E.C.G findings. RESULTS Out of 236 patients admitted with features of Acute STEMI 184 (77.97%) patients were male and 52(22.03%) were female. The commonly affected age group was 40-60years of age (51.27%). The female patients with STEMI increased with advancing age. Type II diabetes mellitus was the most common modifiable risk factor (36.01%). Smoking (9.75%) and alcoholism (7.63%) contributed as significant risk factors for male. Chest pain was the most common presenting symptom (72.88%). Majority of patients 98(41.53%) presented between 12-24hours after the onset of chest pain. AWMI (51.27%) was more common than IWMI (46.19%). RV infarction occurred in 33% of patients with Acute IWMI. There were more patients with LVEF <40% in AWMI group (64.46%) and in non-thrombolysed patients (66.67%). CONCLUSION Most of the patients with STEMI were male in the 40-60years of age. There were more female patients with STEMI with advancing age (>65years). Diabetes mellitus and systemic hypertension were the most common risk factors for STEMI. AWMI was more common than IWMI. 33% of patients with IWMI had RVMI. LV dysfunction with LVEF < 40% was more common in AWMI and in non-thrombolysed patients. The mortality is high among elderly female with multiple risk factors and more extensive STEMI.
BACKGROUNDPulmonary hypertension is a progressive disease with high morbidity and mortality. The W.H.O. Group II Pulmonary hypertension (Pulmonary hypertension due to left heart disease) is the most prevalent form of PHT worldwide. There is paucity of data regarding Group II Pulmonary hypertension from developing countries including India. This retrospective descriptive study was carried out at a tertiary care institute with an objective of establishing the epidemiological data of Group II Pulmonary hypertension by Echocardiography. MATERIALS AND METHODSAll patients who were referred for the first time echo between January 2016 and December 2016 were included and analysed in this study. Echocardiogram was performed by consultant cardiologist using Philips HD11XE and ALOKA SSD-4000 echo machines following ASE Guidelines. Pulmonary artery systolic pressure was derived from tricuspid regurgitation jet velocity by modified Bernoulli equation with the addition of estimated right atrial pressure. The standard echo doppler techniques were applied to diagnose the presence of left sided valvular diseases and left ventricular dysfunction by following ASE guidelines. RESULTSIn our study of 17,625 cases, 282 (16%) patients were diagnosed as pulmonary hypertension. The WHO Group II pulmonary hypertension (pulmonary hypertension caused by left heart disease) is the commonest echo group (72.7%) present in our study. Among the patients with Group II pulmonary hypertension 51.71% had rheumatic left sided valvular heart disease and 48.29% had LV dysfunction due to CAD and cardiomyopathy. RHD was more common in female (71.70%) while LV dysfunction was more common in male (67.68%). The mean age Group in our study was 35-45 years. Patients with combined mitral stenosis and mitral regurgitation (42.45%) commonly presented with significant pulmonary hypertension. Among the Group II PHT patients with LV dysfunction, 80.81% had LV systolic dysfunction with reduced ejection fraction and 19.91% had LV diastolic dysfunction with normal EF. The functional mitral regurgitation was present in 67.68% of patients with LV systolic dysfunction. CONCLUSIONThe Group II pulmonary hypertension (PHT due to left heart disease) is the leading cause of pulmonary hypertension. The rheumatic left sided valvular heart disease and LV dysfunction due to CAD and cardiomyopathy are the major causes of Group II pulmonary hypertension. The early diagnosis of the underlying left heart disease by echocardiography and its timely correction may improve the survival of the patients with Group II pulmonary hypertension.
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