BackgroundTo determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population.MethodsThis cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score <7) depending on Gensisni score.ResultThere were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ≥25 and waist to height ratio (≥0.55) than Group B which showed a statistically significant association (p < 0.001). Though a significant positive correlation (r = 0.296, p = 0.006) was observed between BMI and Coronary artery disease score in group A patients, scenario was reverse fro group B (r = 0.076, p = 0.659). The statement was also true for Waist-to-height ratio and Waist-to-height ratio with BMI. Multivariate analysis also yeilded that a patient with BMI ≥25 kg/m2 and waist-to height ratio of ≥0.55 are 3.06 times and 6.77 times, more likely to develop significant coronary artery disease respectively.ConclusionThe waist-to-height ratio showed better correlation with the severity of coronary artery disease than the BMI.

Aims: Coronary artery disease is a devastating disease precisely because an otherwise healthy person in the prime of life may die or become disabled without warning. The objectives were to study the clinical profile, risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients admitted in Cardiology Department of Dhaka Medical College Hospital, Dhaka. Materials and Methods: A total of 800 patients of ACS were analyzed for various risk factors, angiographic patterns and severity of coronary artery disease at DMCH, Dhaka, Bangladesh. Results: Mean age of presentation was 51.27±8.80 years. Majority were male 628 (78.5%) and rest were females (21.5%). Most patients had ST elevated myocardial infarction (STEMI) 509 (63.6%) followed by non-STEMI (NSTEMI) 207 (25.9%) and Unstable Angina (UA) 84 (10.5%). Risk factors: smoking was present in 388 (48.5%), hypertension in 289 (36.13%), diabetes in 235 (29.38%), dyslipidaemia in 169 (21.13%) and obesity in 356 (44.5%) patients. Singlevessel disease was present in 30.32% patients, Doublevessel disease was present in 23.23% patients and Triple vessel disease was present in 27.15% patients. Conclusion: STEMI was the most common presentation. ACS occurred earlier in comparison to Western population. Smoking was most prevalent risk factor. Diabetic patients had more multivessel disease.

Abstract:Introduction: Brain abscess is a complication of congenital cyanotic heart disease with or without shunt anomaly. It is more common in children. Here, we delineated a case of 19-year-old young BangladeshiBengali male who presenting with brain abscess, an unusual presentation of cyanotic complex congenital heart disease. This case report focuses not only on the unusual presentation of congenital heart disease but also emphasizes the importance of early recognition of neurological complication for referal management.

Background: Due to socio-economic improvement and changes in the life style, ischeamic heart disease is becoming a major burden to our health care system. In recent years, the incidence is increasing among younger age groups as well.Methods: A total of 120 patients with ischeamic heart disease admitted for coronary angiogram were included in the study and were divided into two groups. Among them, 60 younger patients were in Group-I (d” 40 years of age); 60 older patients in Group-II (>40 years of age). We compared demographic profiles, different risk factors and angiographic profiles between two age groups.Results: Among the common risk factors, smoking (63.3% vs 40%, p=0.011) & family history of ischeamic heart disease (21.7% vs 8.3%, p=0.040) were more common in younger group. Whereas, hypertension (41.7% vs 65.0%, p=0.010) and DM (18.3% vs 36.7%, p=0.024) were more common in older patients. Serum Homocysteine level was found significantly higher in younger patients (30.0% vs 13.3%, p=0.026). In group-I. coronary angiography revealed normal coronaries in 15 patients (25%), single vessel disease in 29 (48.3%) and multi-vessel disease in 16 patients (26.6%). Whereas, 40(66.6%) patients in group-II were found to have multi-vessel disease and 2 of them had significant left main coronary disease. However, young patients who had high serum homocysteine level showed more angiographic severity than older patients.Conclusion: There are significant differences in the clinical, biochemical and angiographic profile of young patients with ischeamic heart disease as compared to older patients. Young patients with ischeamic heart disease has got less angiographic severity, except in those with high serum homocysteine level.Cardiovasc. j. 2015; 8(1): 23-29

Basal ganglia calcification is associated with chronic hypoparathyroidism. We report a case of 37 year old lady with long standing iatrogenic hypoparathyroidism following total thyroidectomy. The clinical evaluation revealed neurological symptoms but without any neurological deficit. The CT scan of head showed calcification in caudate nucleus and part of lentiform nucleus of basal ganglia and in the cortical and subcortical white matter. Detection of brain calcinosis in patient’s who had total thyroidectomy can guide clinicians to further investigation for possible hypoparathyroidism.DOI: http://dx.doi.org/10.3329/jom.v16i1.22406 J MEDICINE 2015; 16 : 56-58

Background: Patients with acute anterior ST-segment elevation myocardial infarction (STEMI) and right bundle-branch block (RBBB) have high mortality risk, which may be stratified by early ECG changes. Our objective was to find out and to compare in-hospital outcome of patients presenting with acute anterior STEMI with or without complete RBBB.Methods: This prospective cohort study was conducted in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, over a period of one year from March 2016 to February 2017. A total of 184 patients were included in this study of which 32 patients were included in group A (acute anterior STEMI with complete RBBB) and 152 patients were included in group B (acute anterior STEMI without any BBB or fascicular block).Results: RBBB was documented in 17.4% (32) of patients with acute anterior STEMI. Acute LVF (50.0% vs. 26.3%, p<0.05), Cardiogenic shock (31.3% vs. 13.2%, p<0.05) and mortality (21.9% vs 7.9%, P<0.05) were more frequently observed in patients with complete RBBB in comparison to patients without any BBB or fascicular block (FB). Among the AMI patients with RBBB, permanent RBBB was associated with a greater incidence of acute LVF (54.2% vs 37.5%, p>0.05), cardiogenic shock (37.5% vs 12.5%, p>0.05) and mortality (25% vs 12.5%, p>0.05).Conclusion: In this study right bundle branch block accompanying acute anterior STEMI was associated with high in-hospital adverse outcomes.Cardiovasc. j. 2018; 11(1): 31-38

Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, usually congenital but may be acquired & rarely ruptures. A 24-year-old male presented with a history of prolonged fever, loss of appetite and significant weight loss along with exertional dyspnoea, palpitation and mild chest pain together with clubbed fingers and toes, mild splenomegaly and a continuous machinery murmur over the left sternal edge with associated thrill. Transthoracic echocardiogram revealed ruptured sinus of Valsalva aneurysm with shunt from aorta to right atrium (RA) and vegetation. He was diagnosed as infective endocarditis with rupture of sinus of Valsalva aneurysm and treated with antibiotics and referred to the cardiothoracic surgeon for repair of ruptured SVA.Key words: Sinus of Valsalva aneurysm, infective endocarditis. (Birdem Med J 2015; 5(Supplement 1): 52-55)

Every one of us has heard about tragic and sudden death of a healthy young person and which is often stated as ‘inexplicable’. The current case report focuses on a 20 year old young man with hypertrophic cardiomyopathy facing premature death with history of similar sudden premature death of his grandmother, father and brother. Hypertrophic cardiomyopathy is the commonest cause of sudden cardiac death in young adults and is also an important substrate for heart failure disability at any age.Cardiovasc. j. 2015; 8(1): 73-77