Introduction:Ischaemic heart diseases is a global health burden including Bangladesh and one of the major cause of mortality and morbidity. In a study of WHO non communicable diseases country profile, 2014 showed 17% death was due to cardiovascular diseases 1 . For a long time the 12-lead electrocardiogram (ECG) is considered an essential part of the diagnosis and initial evaluation of patients with chest pain 2 . ECG reflects the physiology of the myocardium during acute ischaemia, where as the coronary angiography identifies vessel anatomy 3 . For this reason, coronary angiography remains the "gold standard" for identifying the infarct related artery and the ECG remains the gold standard for identifying the presence and location of acute myocardial infarction 3 . Patients presenting with STEMI requiring risk assessment shortly after admission, when only history, physical examination and the ECG are available 4 . The purpose of this study was to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent MI. This study provide information regarding prognostic value of interpretation of ECG. With this cost effective and easily available diagnostic tool, we can easily predict the outcome of patient and help in early referral, follow up and decision regarding early myocardial revascularization in patient with STEMI. Thus improve overall approach of management of the patients and prevent early cardiac death. Methods:Patients: This observational prospective study was conducted in BSMMU during the period of July 2014 to June 2015. We studied 60 patients of STEMI admitted within 12 hours of onset of chest pain which lasted for at
Worldwide, the major cause of mortality and morbidity is coronary artery disease (CAD). In the pathogenesis and progression of atherosclerosis, lipid and its metabolites play an important role. The aim of the study was to find out the association of triglyceride (TG) level on the severity of coronary artery disease (CAD) in patients with ischemic heart disease (IHD). In this cross-sectional study, 431 patients with ischemic heart disease were enrolled after taking informed written consent. TG level were categorized into normal (< 150 mg/dl), borderline (150-199 mg/dl) and high (³200 mg/dl). Patients with ischemic heart disease (IHD) were stratified according to TG level. Severity of CAD was assessed by the Gensini score. Most of the patients (33.4%) belonged to the age group 51–60 years. The mean age was 51.31±10.30 years. The majority (74.5%) of patients were male. Among risk factors, 205 (47.6%) patients were smokers, followed by hypertension 190 (44.1%) and diabetes mellitus 175 (40.5%). The association of TG with the whole spectrum of IHD was found statistically significant (p < 0.05). Moderate to severe CAD was found to be higher in the high TG level group compared with the other groups and was statistically significant. University Heart Journal 2022; 18(2): 101-105
Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of in hospital adverse outcome This observational prospective study was carried out in the department of cardiology, BSMMU, Dhaka from July 2014 to June 2015 to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent myocardial infarction, with GRACE scoring assessment. Total 60 patients with STEMI (age 54.33±10.37, 55M/5/F) were included in this study after analysing the selection criteria. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ³50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration. Global Registry of Acute Coronary Events (GRACE) risk score was evaluated and compared in between two groups. Out of 60 patients of STEMI, 30 patients had distortion of QRS complex. There were 7 deaths, 16 heart failure, 3 cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (1 vs. 6 patients p=0.04; 4 vs. 12 patients p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0 vs. 3 patients p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value < 0.05 ; OR=16.25, p value< 0.05 respectively). GRACE risk score was significantly high in distorted QRS group and low in without QRS distorted group (6 vs 15 patients p=0.014; 6 vs 16 patients p=0.007; respectively). Intermediate GRACE score did not show any statistically significant difference between two groups (p=0.77). Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization procedure. Assessment of GRACE risk scoring is strongly encourage in everyday clinical practice as it provides reliable identification of STEMI patients who are at high risk of death. Bangladesh Medical Res Counc Bull 2022; 48(3): 211-218
Background: Distorted terminal portion of QRS complex on initial electrocardiogram ( ECG) in patients with ST segment elevation myocardial infarction ( STEMI) is a strong predictor of adverse outcome. Objectives: Our purpose of this study was to assess the relationship of distortion of QRS on initial ECG in STEMI with chronic kidney diseases (CKD). Methods: We evaluated 60 patients of STEMI admitted within 12 hours and receiving thrombolytic therapy. Patients having serum creatinine < 1.5 mg/dl were group-I and ?1.5 mg/dl were group-II. We defined two ECG groups according to absence of distortion of terminal QRS and presence of distorted terminal QRS in two or more adjacent leads. Distorted QRS group further divided into pattern-A J point originating at ?50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration. Additionally study population was divided into two groups on the basis of serum creatinine level. Results: CKD patients had more QRS distortion (43.2% vs 68.8%, p=0.008) and worse inhospital outcome. Out of 60 patients 7(11.6%) death, 16(26.7%) heart failure and 37(61.7%) uneventful recovery. Hospital mortality and heart failure were significantly higher in STEMI with CKD group (4.5% vs 31%, p=0.004; 16% vs 56%, p=0.001; respectively), uneventful recovery was significantly higher in STEMI without CKD group(12.5% vs 80%, p=<0.001). In multiple logistic regression analysis, CKD ( serum creatinine ?1.5) and Killip class ?II were independent predictors of QRS distortion (OR= 5.702, p=0.014; OR= 3.578,p=0.036; respectively). Conclusion: Among the CKD patients with STEMI the distorted terminal portion of QRS complex on initial ECG is more frequent and significantly related to adverse prognosis. Careful analysis of ECG which is simple, chief, universally available, bed side investigation may offer important information regarding prompt risk stratification and management in patients of CKD with STEMI.University Heart Journal Vol. 11, No. 1, January 2015; 7-12
Congenital coronary artery anomalies are rare heart defect that has been associated with myocardial ischemia and sudden death. Only 1-2% of population having variation in the origin, course or distribution of the epicardial coronary arteries. Anomalous origin of coronary arteries may be present as isolated defect or as a part of complex congenital heart disease. The clinical presentation, diagnostic work up, prognosis and treatment of these anomalies are highly variable. Most of the patients are asymptomatic but manifestation of these patients are chest pain, dyspnoea, palpitation, dizziness, ventricular fibrillation, syncope and sudden death. It is the second most common cause of sudden death in young athletes. Selective coronary angiography is the gold standard for identification of such type of anomaly. Patients of anomalous origin of coronary artery from the opposite sinus may require medical treatment, coronary angioplasty with stenting or surgical repair.University Heart Journal Vol. 12, No. 2, July 2016; 98-101
Background: Mortality risk is quite variable among fibrinolytic treated ST elevation myocardial infarction patients. Careful and early risk evaluation of each patient is therefore important. Until now, the most evaluated biomarker has been troponin I on admission, which gives strong prognostic information. NT pro BNP has shown reasonable promise in predicting the adverse outcome of STEMI. This research will provide the information regarding its efficacy as a predictor of adverse outcome following STEMI. Objective: To assess the prognostic value of N-terminal pro-brain natriuretic peptide in fibrinolytic treated ST elevation myocardial infarction (STEMI) patients. Method: This short term prospective study was done in Cardiology dept. of BSMMU. We valuated 115 patients of STEMI admitted within 12 hours and receiving thrombolytic therapy. Venous blood sample was collected for NT pro BNP before starting fibrinolytic therapy. Additional clinical data was recorded including detailed complications of STEMI. Results: Out of 115 patients of STEMI 32.2% patient had adverse outcome among them 9.6% patients died, heart failure 13.0%, cardiogenic shock 7.8%, VT & VF 5.2%, acute MR 2.6%, VSR 0.9%, CHB 2.6% and 67.8% patient had no adverse outcome. According to association between hospital outcomes with N-terminal pro BNP level, it was observed that the mean Nterminal pro BNP level was higher in adverse outcome group. Based on the receiver-operator characteristic (ROC) curves N-Terminal Pro BNP level gave a cut off value ?480.0 pg/ml, with 88.5% sensitivity and 100.0% specificity for prediction of complications and similarly N-terminal pro BNP level gave a cut off value ?725.5 pg/ml, with 72.7% sensitivity and 93.3% specificity for prediction of mortality. Conclusion: N-Terminal Pro BNP level was highly sensitive and very much effective in the evaluation of adverse outcome of fibrinolytic treated ST elevation myocardial infarction (STEMI).University Heart Journal Vol. 11, No. 1, January 2015; 13-17
Background: Spontaneous coronary artery dissection (SCAD) is frequently underdiagnosed and often considered as a rare cause of acute coronary syndrome (ACS). Although it predominantly affects young women in the peripartum period, it can also occur in men. Most of the reported dissections have occurred in the left anterior descending coronary artery. The optimal treatment modalities are yet to be defined. Case Summary: A 50- year-old man who presented to us at National Institute of Cardio-Vascular Diseases (NICVD), Dhaka with an acute Non-ST-elevation myocardial infarction secondary to a spontaneous dissection of the Left anterior descending coronary artery. Due to ongoing chest pain, percutaneous coronary intervention (PCI) was done with drug eluting stent (DES) successfully, and the patient was discharged from the hospital on medical therapy. Conclusion: All clinicians should remain vigilant and aware of this condition, as patient outcomes and treatment guidelines differ substantially from conventional atherosclerotic ACS. Although initial conservative strategy is preferred strategy in SCAD management but timely intervention is warranted in selected cases. Bangladesh Heart Journal 2021; 36(2): 151-157
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