Background & objective: Involvement of the right coronary artery frequently occurs in acute inferior myocardial infarction. Typical ECG changes in this condition involve ST-segment elevation in inferior leads. The present study was intended to predict the site of the lesion in the right coronary artery (RCA) in patients with acute inferior wall myocardial infarction using the height of ST-segment elevation as the predictor variable. Methods: The present cross-sectional study was carried out in the Department of Cardiology, National Institute Cardiovascular Diseases (NICVD), Dhaka, Bangladesh over a period of one year between July 2010 to June 2011. Patients with acute inferior myocardial infarction admitted to CCU of NICVD within 12 hours of the onset of chest pain and underwent coronary angiography within 4 weeks of acute myocardial infarction (AMI) were the study population. With the help of a 12-lead ECG, magnitudes of ST-segment elevation in leads II, III, and aVF were measured. The highest degree of stenosis along the RCA revealed by an angiogram was accepted as the culprit lesion. The right coronary artery was divided into proximal (from its ostium to the origin of the RV branch), mid (from the RV branch to the acute marginal branch), and distal (from the acute marginal branch onward) parts. The sum of ST-segment elevation was then computed and compared among the three groups of patients divided on the basis of the site of lesion in RCA. Result: The findings of the study showed that nearly half (48%) of the patients had lesions in the proximal, 38% in the mid, and the rest (14%) in the distal part of the right coronary artery (RCA). While patients with proximal lesions had the highest mean sum of the ST-segment elevation (12.1 ± 0.6 mm), those with distal lesions had the lowest mean sum of the ST-segment elevation (6.1 ± 0.2 mm). The three groups were significantly heterogeneous (p < 0.001). The magnitude of STsegment elevation in Lead II, III, and aVF and the sum of ST-segment elevation all were significantly higher in patients with proximal lesions than those in patients with mid and distal lesions (p < 0.001). Conclusion: The magnitude of ST-segment elevation can predict the site of lesion in RCA in inferior wall myocardial infarction. The greater the height of STsegment elevation, the higher the probability of lying the lesion in the proximal part of the RCA. Bangladesh Heart Journal 2023; 38(1): 58-62
Introduction: As coronary artery disease (CAD) is a major cause of morbidity and mortality; timely diagnosis and appropriate therapy is of paramount importance to improve clinical outcomes. Though there are major risk factors for CAD but sometimes it does not correlate with ACS. So, search for new risk factor is necessary for better management of CAD specially STEMI. Aim: To see the association between ABO blood group and severity of CAD in patients with STEMI. Methods: This study was done during the period of January 2016 to June 2016 with STEMI at National Institute of Cardiovascular diseases, Dhaka, Bangladesh. 100 patients were grouped in I and II where group-I having 50 patients of non-O blood group and group-II having 50 patients of O blood group. After CAG all reports were analyzed by two experts and SYNTAX score were calculated and data were analyzed by SPSS. Results: Baseline characteristics (100 patients) were well matched between the groups. Low SYNTAX score (d”22) was 16% and 56%; intermediate score (23-32) was 40% and 36% and high score (>32) was 44% and 8% in group- I and group-II respectively. These indicate that patients of non-O blood group have high SYNTAX score that is more severe CAD. Univariate and multivariate regression analysis showed that non-O blood group is an independent risk factor for CAD. So easily available ABO blood grouping can be helpful to determine the severity of CAD in patients with STEMI. Bangladesh Heart Journal 2022; 37(2): 107-115
Cardiac troponin I is a highly sensitive and specific marker of myocardial necrosis. In addition to the strong diagnostic role of cardiac troponin I its prognostic value has become increasingly well established for patients presenting with acute coronary syndrome. However, there have been conflicting reports on the value of troponin in the setting of PCI is stable and unstable coronary disease. Objective: To assess the role of cardiac troponin I in predicting outcome after PCI. Methods and results: CTnl was measured immediately before and at 8 hrs and at chest pain after PCI in 80 consecutive patients with stable coronary artery disease. Twenty of them with post procedural CTnl level 50.4 ng/ml were excluded because of the inability to do repeat estimation of CTnl at chest pain. Among the rest sixty patients, thirty had post procedural troponin <0.4 ng/ml were considered as group I and thirty had post procedural rise of CTnI >0.4 ng/ml were considered as group II. CTnl level, 0.4 ng/ml was consider as cut off value for grouping patients was based on ACC/ AHA/ ISCAI 2005 guide line definition of peri procedural myocardial infarction. The study end point was the following adverse cardiac events-recurrent angina, cardiogenic shock, significant arrythmias, congestive heart failure, Q wave MI, repeat PCI/ CABG, death during hospital stay and at 30 days follow up. In this study base line parameters like age, sex, BMI, risk factors, anginal class, base line ECG and LVEF showed no statistically significant difference between the two groups. Angiographic parameters such as types of lesion and procedural complications shows statistically significant difference between two groups. In-hospital adverse cardiac events after the procedure was significantly higher in group II than group 1 (P<0.01). The mean duration of post procedural hospital stay was also significantly higher in group II than group 1 (P<0.01). At 30 days follow up there has no incremental risk of adverse cardiac events. Conclusion: CTnl rise at peri procedural myocardial infarction level was observed in 37.5% of this study patient. This level of CTnl was significantly predictive of an increased risk of adverse cardiac events at hospital follow up. Central Medical College Journal Vol 5 No 2 Jul 2021 PP 106-115
Background: Worldwide, myocardial infarction (MI) is an important cause of death. Number of AMI among young adult is increasing day by day in Bangladesh. Acute MI occurs most commonly at an older age. However, the incidence of acute MI in adolescents is increasing. This is partly due to an increase in cardiovascular risk factors (e.g. smoking, unhealthy diet), which might lead to premature atherosclerosis. However, several non-atherosclerotic causes of MI in adolescents are also described in the literature, such as vascular spasm due to the use of cocaine, amphetamine etc. We may assume that acute MI is not considered to be the most likely cause of chest pain in adolescents. Therefore, the risk of a dramatic outcome in this patient category may be significant. Myocardial infarction (MI) in the young (age < 45 years) is a significant problem; however, there is a scarcity of data on premature coronary heart disease and MI in the adolescent patients. MI in adolescents (age between 10–19 years) is extremely rare.Premature AMI, particularly in the setting of obstructive CAD and/or female sex, is an aggressive disease with high rates of recurrence and mortality, attributed largely to suboptimal control of modifiable risk factors.1 Collet et al2 reported that 1 in 3 patients with premature (≤45 years of age) CAD, of whom the majority experienced AMI, had at least 1 recurrent event over a follow-up period of 20 years. Strong independent predictors for recurrent events were persistent smoking, diabetes, hypertension. We present a case of the 17-year-old girl with extensive ST-segment elevated anterior wall myocardial infarction and found to have complete thrombotic occlusion of proximal left anterior descending coronary artery. Central Medical College Journal Vol 6 No 1 January 2022 Page: 49-53
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