Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality.
Background: The whole world is going through a grim crisis instigated by the Novel Coronavirus (COVID-19) pandemic. Health systems of Bangladesh are overburdened in response to the disease. Healthcare workers (HCWs) are at a high risk of getting the infection and the source of transmission in the community. Objectives: This study was designed to explore the real scenario about knowledge, perception and practical behavior about COVID-19 among healthcare professionals of Bangladesh to combat the pandemic during the first outbreak of the COVID-19 pandemic in Bangladesh. Findings of this study might be utilized for the promulgation of policy and program for upcoming days. Materials and Methods: This cross-sectional survey was conducted among the adult Bangladeshi healthcare professionals of purposively selected three type of healthcare facilities- a Tertiary level hospital: Bangabandhu Sheikh Mujib Medical University as well as District hospital and Upazila health Complex from highly infected district Narayangonj and low infected district- Brahmanbaria. A number of 241 HCWs were interviewed using a semi-structured self-administered questionnaire electronically via-email, Facebook Messenger or other social media communication. Result: It is observed that knoledge level is higher among the elder people (age >40 years) than the young people (age <30 years) (10.84±0.48 vs 10.13±1.39, p value is 0.003 at 1% level of confidence). Although there was no significant difference in attitude among them (Attitude score in age >40 years vs <30 years age group was 3.24±0.96 vs 2.96±0.635 with p value is >0.05 at 5% level of significance). Conclusion: To reduce the risk of infection among health care professionals who are not in direct contact with patients. Policy and education should be implemented to convey the importance of possible exposure to the virus. KYAMC Journal. 2022;12(04): 190-195
Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management. Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not. Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p<0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p<0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p>0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%). Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found. University Heart Journal 2022; 18(1): 3-9
Background: Heart failure (HF) is one of the most important health problems in terms of prevalence, morbidity, mortality and health service use. It affects around 2 to 3 % of the population. NYHA class can be used for the prioritization, triage and tailoring the HF management which is the foundation for the selection of therapies. The patient with higher NYHA class may need Mechanical Circulatory Support therapy or palliative care or hospice care. The identification of the patients with lower NYHA class helps to tailor vigorous drug therapy and close follow up program, the prognosis of these low risk patients maybe further improved. It is a simple tool for risk stratification in clinical practice. Objective: The principal objective of this study was to determine frequency of transition of NYHA class III / IV to NYHA class I / II / III of stage C & D HF with drugs in a tertiary level hospital. Methods: This was a crosssectional study. A total of 45 patients with stage C and D HF were enrolled in the study by consecutive sampling from October 2019 to September 2020. Detailed history including NYHA functional class of stage C and D HF, physical examination, relevant investigations and Echocardiography were done in all the subjects. The subjects were treated accordingly. The treatment response was assessed again with NYHA functional class on discharge. Result: Patients had mean age of 62 &60 and 54 & 54 years for NYHA class III & IV of stage C and D HF. Majority of the patients were male. Primary cause of HF for both stage were IHD followed by DCM and valvular heart disease. The clinical presentation of stage C & D HF was improved significantly on discharge. Haematological, biochemical, radiological and echocardiographic findings of NYHA class IV of stage C & D HF was more worst. Conclusion: There is statistically significant transition of NYHA class III of stage C and D HF to lower NYHA class but there is no statistically significant transition of NYHA class IV of stage C and D HF with pharmacotherapy in a tertiary level hospital. Higher NYHA class is associated with poor outcome of stage C & D HF patients. University Heart Journal 2022; 18(1): 14-21
Introduction: Chronic heart failure with reduced ejection fraction is a major complication of diseases involving myocardium. Despite numerous pharmacological interventions and invasive therapeutic techniques, therapeutic options for end stage heart failure remain limited to left ventricular assist device & organ transplantation. Regenerative medicine may bring hope here. Method: This pilot study was carried out at the Department of cardiology in collaboration with department of haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from October 2017 to March 2018. Considering inclusion & exclusion crieteria ten (10) patients were taken in stem cell group and ten (10) patients in control group. Patients in the control arm received standard of care in accordance with practice guidelines for heart failure management (GDMT). Patients in the cell therapy arm received, in addition to standard of care, bone marrow–derived cardiopoietic stem cells (G-CSF) meeting quality release criteria. Baseline clinical and echocardiographic data were obtained and recorded in pre-formed data sheet. Close liaison was maintained with all patients and followed up after 30 days & after 3 months and for any complication. The absolute change in 6 MWD from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But significant improvement was found at 6 months follow up of 6MWD between the two groups (300±28 vs 375±25, p= 0.04). Baseline BORG scale was similar in the control group and the SCT group (8.1±0.56 and 8.3±0.67 respectively, P= 0.45). The absolute change in BORG scale from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But improvement was not statistically significant in between the two groups (p= 0.32, 0.45, 0.23 respectively). Echocardiographic observation also revealed a similar baseline LVIDd, LVEF level in the control group and the SCT group which was not statistically significant (p = 0.45, 0.52 respectively). Gradual improvement in LVIDd were found at 30 days, 3 months, 6 months follow up observation but statistically significant absolute change was found only at 6 months follow up in between groups (62.4±1.8 vs 56±2.4, p=0.03). Baseline LVEF were less than 30% in both control & SCT group (29.5±0.8% & 28.7±1.3% respectively). The echocardiographic evaluation also revealed a significant increase in LVEF at 6 months (34% ±1.6 and 40% ± 2.5%, p = 0.04) of follow-up in between group but not at 30 days & 3 months follow up. University Heart Journal Vol. 16, No. 2, Jul 2020; 52-58
Background: Optimal timing of PCI and comparative outcome between early invasive strategy and ischaemia guided delayed invasive strategy is still in debate in reducing long-term cardiovascular complications in NSTEMI. Objective: The aim of the study was to assess the impact of an early invasive strategy or ischaemia guided delayed invasive strategy on six months clinical outcomes in NSTEMI patients undergoing PCI, from a Bangladesh health service perspective. Materials and Method: It was an observational cross-sectional comparative study conducted in cardiology department of BSMMU from November 2019 to February 2021. Study procedure: This study enrolled 389 adult patients of NSTEMI who underwent PCI which met inclusion and exclusion criteria. Study subjects were divided into two groups: early and delayed groups. This study considered an early invasive strategy as - revascularization within 72h for patients presented with NSTEMI with high-risk features defined by a GRACE score > 140 and for those at lower risk with GRACE score <140; delayed ischaemia driven strategy as - revascularization after 72h, reserved for refractory, recurrent or severe exercise-induced ischaemia. Coronary angiogram (CAG) and PCI were performed by respective consultant according to current practice guidelines. After index PCI, patients were followed up at 06 months for MACEs (Myocardial re-infarction, target vessel revascularization, stroke, hospitalization due to ischaemic causes and cardiac death) and findings of 2 groups were compared. Results: At 6 months after index PCI, patients in the early group despite having worse initial presentation and higher GRACE score had better outcome in comparison with the delayed group who had a statistically significant higher incidence of cardiac death, MI, and target vessel revascularization (p=0.002, p=0.004 and p=0.031). However, incidence of stroke, major bleeding and hospitalization due to ischemia were not significantly different between the groups (p>0.05). Conclusion: Adoption of an early invasive strategy in NSTEMI patients undergoing PCI may be beneficial in reducing the risk of MACEs and associated with improved clinical outcome after PCI at 6 months follow-up. University Heart Journal 2022; 18(1): 22-28
Background: Thromboembolism is a major complication of atrial fibrillation. Vitamin K antagonist is the main oral anticoagulant which was used for prevention of thromboembolism in atrial fibrillation for many years. New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. Objective: The aim of the study was to compare safety and efficacy of dabigatran and rivaroxaban for prevention of thromboembolism in tertiary level hospital. Methodology: This Randomized controlled trial study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka. Patients were divided into two groups, in group A 37 patients were given dabigatran 110 mg twice daily and in group B 37 patients were given rivaroxaban 20 mg daily for 6 months duration. Data was collected according to the pre designed semistructured data collection sheet. Statistical analyses were carried out by using the Statistical Package for Social Sciences (SPSS) version 23.0 for Windows Software. Results: The mean CHADS2- VASC score (Risk of stroke) in rivaroxaban group and in dabigatran group was 3.95±1.37 and 3.74±1.42 respectively. There was no significant difference of CHADS2- VASC score between the two groups. Regarding outcome of 6th month follow up 2(5.4%) patients were lost to follow up in dabigatran group and 3(8.1%) in rivaroxaban group. Comparaing effectiveness and safety study we found that ischemic stroke rate with rivaroxaban group was higher than dabigatran group although statistically not significant. We also found higher bleeding rate in rivaroxaban group than dabigatran group although statistically not significant. Conclusion: Dabigatran is a safe and effective anticoagulant same as rivaroxaban for prevention of thromboembolism in the treatment of non valvular atrial fibrillation. University Heart Journal 2022; 18(1): 10-13
Clinicians have long recognized that acute myocardial infarction (MI) can occur in the absence of atherothrombosis . The Universal Definition of MI Global Taskforce introduced a classification system in 2007 (and reaffirmed in 2012) that defined type 2 MI (following standard diagnostic criteria) as MI occurring due to an imbalance in myocardial oxygen supply and/or demand not caused by atherosclerotic plaque disruption. Nevertheless, ambiguity remains regarding how to diagnose type 2 MI and how to distinguish it from both type 1 MI and myocardial injury. Here we report a case of a 23 year old young woman attended to emergency department, with typical chest pain and shortness of breath for 6 hours, Diarrhoea for 2 days, and single time loss of consciousness for 5 minutes, 6 hours before attending to hospital. Cardiac enzymes were rising titres in subsequent samples, Serum Creatinine was also high. Echocardiography performed 36 hour later, showed no regional wall motion abnormality, coronary angiogram showed normal coronary arteries. So, a diagnosis of Myocardial Infarction (Type 2 MI) with Non Obstructive Coronary Artery (MINOCA) was made, and MINOCA was attributed to hypovolemic shock (resulting from Dirrrahoea), manifested as MI, Syncope and AKI. University Heart Journal 2022; 18(2): 128-131
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