Objective: To highlight association of coronary artery disease on angiograms and high altitude-related ECG abnormalities that is thought to be ischemic in origin. Place and Duration of Study: This was a cross sectional study done in Armed Force Institute of Cardiology/National Institute of Heart Disease from Oct 2016 to Oct 2021. Methodology: This was a cross sectional study done in AFIC/NIHD from Oct 2016–Oct 2021 (5years). A total of 103 patients at a range of 9000 to 22000 feet in altitude, with new ECG changes were selected via consecutive sampling. Data was analyzed by SPSS version-23. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α= 5%). Results: The data was collected from a total of 103 respondents, mean age (years) of the respondents was 30.57±6.27, and mean duration of stay (days) at high altitude was 64.8±68.3 (Table-I). ECG changes that were recorded were: T-wave inversion in anterior leads (V1, V2, V3) were reported in n=33(32%), T- wave inversion in Inferior leads (II, III, aVF) in 21(20.3%), T-wave inversion in lateral leads (V3-V6) 10(9.7%). Normal Ejection fraction was observed in 97% of the study participants while only 3% had mild left ventricular systolic impairment. Angiographic findings were found to be normal in n=92 (89.30%), minor coronary artery disease (CAD) in n=9 (8.70%), muscle bridge in LAD in n=2 (1.90%). Our results also showed that amongst other final diagnosis, of note were vasovagal syncope (n=5; 4.8%), pulmonary embolism (n=5; 4.8%) and pulmonary arterial hypertension (n=3; 2.9%). Conclusion: Our work leads us to the conclusion that ECG abnormalities at high altitude do not indicate coronary artery disease since they do not reflect a delay in electrical conduction or ischemia. These patients should be treated separately based on their high altitude disease symptoms (HAI).
Objective: To evaluate the role of Cardiac Magnetic Resonance Imaging in differentiating cardiac masses (thrombus vs tumor and benign tumor vs malignant tumor) in local population. Study Design: Analytical cross-sectional study. Place and Duration of Study: Tertiary Cardiac Care Center, Department of Cardiac Magnetic Resonance Imaging, Rawalpindi Pakistan, from Oct 2017 to Jun 2021. Methodology: This retrospective study included (n=56) patients via universal sampling, enrolled for Cardiovascular magnetic resonance imaging with a suspicion of cardiac masses either on echocardiography or Computed Tomography scan. Cardiovascular magnetic resonance imaging sequences were reviewed as SSFP cine images for mass location, size and mobility.T1 weighted turbo spin echo, T2 weighted turbo spin echo with and without fat saturation and TIRM sequences told their intensity as compared to normal myocardium, myomaps evaluated the relaxation time, while contrast first pass perfusion indicated the vascularity and delayed gadolinium enhancement images with standard and long TI were analyzed for contrast enhancement. Results: Total n=56 patients with a confirmed diagnosis of mass were included for the analysis. Mean age of participants was found to be 45.21(18.3%), height 168.4(8.69%) and weight 68.6(14.94%). There were 47(83.9%) males and females were 9(16.1%). 22(39.3%) had hypertension, 12(21.4%) had diabetes mellitus, 24(42.9%) had previous myocardial infarction. Maximum number of masses were found in LV 31(55.4%) followed by RV 11(19.6%). Sensitivity of T1 map to detect fibrosis intumor is 100%. Sensitivity of T2 map to detect edema in tumor is 82%. Conclusion: Cardiac masses like thrombi and tumors accurately diagnosed by cardiac MRI with etiology..
Objective: To assess whether status of allergies is accurately documented in clinical notes and drug prescription charts in two medical wards in Armed Forces Institute of Cardiology (AFIC) as compared to NICE guidelines. Study Design: We designed a classic audit of measuring current practice against guidelines.Place and duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from May to Oct 2020.Methodology: Each cycle contained of a two weeks’ period in which all new patients admitted in coronary care ward 3 and ward 10 were assessed. A total of 110 patients were assessed in each cycle. Repeat audit cycle was performed after 6 months similarly.Results: In first audit cycle, we assessed 110 patients. The status of allergies for most patients was recorded in clerking proforma (n=103, 93%) but there were deficiencies found in recording of allergies on drug kardex (n=25, 22%). After education and awareness, the second cycle showed that the status of allergies for all patients was recorded in clerking proforma (n=110, 100%) and documentation on drug kardex also improved from 22% to 78%. Conclusion: Repeat audit cycle showed significant improvement in documentation of allergies in clerking proforma and on drug kardex.
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