Objective: To assess the in-hospital outcomes in Anterior wall ST Elevation Myocardial Infarction patients presenting with Right Bundle Branch Block with different reperfusion strategies. Study Design: Analytical Cross-Sectional Study. Place and Duration of Study: Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Sep 2020 to Feb 2021. Methodology: Patients with myocardial infarction who presented to the emergency department of the hospital were included in the study. Further evaluation was performed on individuals with ST elevation in anterior chest leads and new-onset or presumably new Right bundle branch block on electrocardiogram. Anterior wall myocardial infarction was diagnosed based on 4th universal definition of Myocardial infarction. Patients excluded were those with non-anterior ST-elevation myocardial infarction, prior coronary artery bypass grafting, previous percutaneous coronary intervention, or Left bundle branch block.The treatment plan was chosen by the interventional cardiologist. Various parameters were used to measure the outcomes ofdifferent therapies. Results: 93 patients were included with 72(77.4%) males and 21 females (22.5%). Mean age was 59.91±11.93 years. Premorbid seen was 41.9% diabetes, 32.3% hypertension, 18.3% smoking. Transient RBBB was seen in 64.5% of the study population and persistence RBBB was 35.5%. Mortality was associated with higher Killip class (p=<0.001), AV block (p=0.078), increased no of coronary vessels involved (p=0.014), increased amplitude of ST elevation (p=0.083) and with lower EF values (p=0.032). Worst outcomes were common in patients on medical treatment. Conclusion: Poor outcomes in Anterior Wall Myocardial Infarction with Right Bundle Branch Block are linked to length ofstay, co morbidities, Killip class, amplitude of ST elevation, coronary artery disease complexity and those managed on medicaltreatment.
Objective: To determine frequency of diastolic dysfunction in asymptomatic type 2 diabetic patients by employing twodimensional (2D) echocardiography as a measurement method. Study Design: It was an Analytical Cross sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jul 2021 to Nov 2021 Methodology: Patients, already diagnosed as diabetics for more than 5 years and on dietary control or on medications,presenting to the outpatient department of the hospital were enrolled. They were subjected to a 2D echocardiography in left lateral position. We excluded patients with valvular heart disease, ischemia, congestive heart failure, cardiomyopathy of any aetiology, renal failure, pulmonary illness, anemia, hemoglobinopathies, prior myocardial infarctions in any region, smokers,and hypertension. Diastolic dysfunction was evaluated as per the guidelines of American society of Echocardiography. Results: Overall (n=150) patients were calculated with reference to 11% prevalence of LVDD by sample size calculator, being the part of study who were fulfilling the inclusion criteria. There were 102(68.0%) male and 48(32.0%) female patients; mean age was 45.02±6.07 years. Mean duration of diabetes mellitus in years was 6.93±2.53 with ranges from 5 to 16 years. Patients on oral hypoglycemic were 121(80.7%), on insulin were 5(3.3%), on dietary control were 12(8%) and on mixed treatment were 12(8%). There were 58 (38.7%) patients who had diastolic dysfunction present on echocardiogram. Effect modifiers of durationof diabetes (p=0.2) did not show significant association; however, Age (p=0.001) and Gender (p=0.038) significantly associated with Diastolic Dysfunction. Conclusions: One of the simple and noninvasive approaches to diagnose diastolic dysfunction is doing 2D echocardiography which can identify large percentage of diabetic subjects having pre-clinical diastolic dysfunction. Thus, by on time detection we can initiate treatment and retard the progression of diastolic dysfunction.
The duration between the onset of myocardial infarction and first intervention plays a pivotal role in saving the life of the patients. Objective: To determine the frequency of various pre-hospital factors causing delay among patients presenting with STEMI in the emergency department of a teaching hospital. Methods: This is a descriptive observational study conducted at the Cardiology Department, Rawalpindi Institute of Cardiology (RIC), Rawalpindi from March to August 2019. A total of 142 patients presenting with ST-elevation myocardial infarction (STEMI) to the Emergency Department (ED) of RIC were enrolled. Electrocardiograms (ECGs) were reviewed for confirmation of STEMI and find the type of MI. Echo-cardiography was done to find out the ejection fraction (EF) of the left ventricle. Type of reperfusion therapy either thrombolytic therapy or primary percutaneous coronary intervention (PCI), time of symptom onset, and time of presentation in ED of RIC were noted. Patients were divided into four major groups depending upon the possible factors for delayed presentation: 1) Misinterpretation of symptoms, 2) Ignorance Of reporting urgently or waiting for symptoms to resolve, 3) Transportation problem and 4) First presentational facility where thrombolytic unavailable. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23.0 (IBM, Armonk, U.S.). Results: The mean age was 53.2(SD=15.5). Out of 142 patients, most of them were males 130(91.5%). In our study, the majority 46.5% had a primary level of education. Transportation problems were the main reason for delayed presentation accounting for 45(34.5%), followed by misinterpretation of symptoms 40(28.2%), patients first presented at a facility where thrombolytic therapy was unavailable 27(19%) and patients were either ignorant of reporting urgently to a hospital or they waited for symptoms to resolve 26(18.3%). There was a significant difference in point of the first consultation, MI type, and time duration of delayed presentation among groups (P<.05). Conclusion: Transportation problems and misinterpretation of symptoms are the main reasons for the delay in getting reperfusion treatment for ST-elevation MI. Providing better primary care facilities available to rural areas as well as targeted awareness campaigns will greatly help in this regard.
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