Objective To determine the prevalence of tricuspid regurgitation in patients with dual-chamber permanent pacemaker implantation. Methods This study included 153 patients undergoing permanent pacemaker implantation. All eligible candidates had baseline transthoracic echocardiography to rule out preexisting tricuspid regurgitation. Echocardiography across the tricuspid valve was repeated one month after permanent pacemaker implantation, and the frequency of significant tricuspid regurgitation was determined. The associations of potential effect modifiers (age, sex, height, body mass index categories, diabetes, and hypertension) with tricuspid regurgitation were assessed individually using simple and multivariable logistic regression models. Results After dual-chamber permanent pacemaker implantation, significant tricuspid regurgitation was present in 22 (15.8%) patients. Tricuspid regurgitation was significantly associated with body mass index >30 kg·m−2 (odds ratio = 32.84, 95% confidence interval: 1.26–853.82, p = 0.04). Conclusion Significant tricuspid regurgitation was present in substantial number of patients after dual-chamber pacemaker implantation and was independently associated with body mass index >30 kg·m−2.
Objectives: To find out the prevalence of undiagnosed atrial fibrillation and the risk factors associated with atrial fibrillation in patients with complaints of palpitations having normal sinus rhythm on electrocardiogram. Methodology: The descriptive cross-sectional study was carried out from 1st of January 2017 to 31st of December 2020 at Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan. All the patients presented with the complaints of palpitations for six months with normal sinus rhythm on standard 12 lead electrocardiogram were included in the study. After written informed consent, a Holter monitor was applied for 48 h. Data regarding gender, age, diabetes mellitus, hypertension, smoking, obesity, stable ischemic heart disease, valvular or nonvalvular structural heart defect and hyperthyroidism was collected on a preformed Performa for each patient. Presence of atrial fibrillation was noted on Holter monitoring. Results: Total 1891 patients were studied over the period of 4 years. The mean age of the studied population was 55.99 ±16.28 years. There was male dominance with 70.3% (n=1329) males and 29.7% (n=562) females. 12.50% (n=236) patients had been diagnosed with atrial fibrillation on Holter monitoring. Age group of patients with age more than 75 years has high burden of atrial fibrillation (31.34%). Conclusion: A large number of studied population has been diagnosed with atrial fibrillation on Holter monitoring who presented with palpitation and have normal sinus rhythm on electrocardiogram.
Objective: The study was conducted to determine the association of increased serum Uric acid level (SUA) with critical coronary artery disease (CAD) in patients subjected to coronary angiography. Methodology: 360 patients (180 cases with critical CAD and 180 controls without critical CAD) were enrolled in the study after taking informed consent. Demographic data like age, gender, diabetes mellitus, hypertension, family history of CAD, dyslipidemia, smoking and BMI was collected. Serum uric acid was advised and recorded in the questionnaire. Results: 360 patients with mean age 51.37 ± 6.5 years were included. 262 patients (72.8%) were male. 54 patients (20.8%) had hyperuricemia. 26.6% cases and 15.0% controls had hyperuricemia. Hyperuricemia was significantly associated with critical CAD (OR=2.06, CI 1.22-3.49, p=0.007). The association persisted after stratification according to age, gender, diabetes, hypertension, dyslipidemia, smoking, family history of IHD and BMI. Conclusion: There is a positive association between critical CAD and hyperuricemia. Keywords: Coronary artery disease, Hyperuricemia, IHD
Objective: Diabetic neuropathy may mask the typical ischemic chest pain and diabetics may carry longer presentation times in cases of acute STEMI. Diabetics may complain of chest pain less frequently, while atypical clinical presentations of STEMI could be more common compared to non-diabetics. Aim of this study was to assess the potential impact of diabetes on STEMI related chest pain, its severity, characteristics and non-specific clinical features. Methodology: The descriptive, cross-sectional study included 254 patients with first episode of STEMI. Data was acquired regarding feeling of chest pain, its severity, different characters, sites of radiation, and occurrence of associated clinical features. These variables were compared among diabetic and non-diabetic groups by Pearson’s Chi-square test. Results: Diabetics were more likely ‘not to feel’ any STEMI related chest pain compared to non-diabetics (22.2% vs. 2.4% p<0.001), severe chest pain was a less frequent complaint in diabetics compared to non-diabetics (21.1% vs. 89% p<0.001). The characters of “chest tightness”, “strangulating pain” and “squeezing chest pain” were less frequent in diabetics (45.6% vs. 68.3% p<0.001, 8.9% vs. 56.7% p<0.001 and 1.1% vs. 18.3% p<0.001 respectively). Syncope and shortness of breath were observed more frequently in diabetics (37.8% vs. 20.7% p=0.003 and 23.3% vs. 17.1% p=0.001 respectively). Conclusion: Diabetics can frequently present without pain or with less severe chest pain and infrequent typical characters compared to non-diabetics and may have atypical symptoms like syncope and shortness of breath more commonly than non-diabetics.
Objective: To determine the incidence and risk factors of forearm hematoma after trans-radial percutaneous coronary intervention (TRA-PCI). Methodology: In this observational study we included 450 consecutive patients who were referred to catheterization unit of Ch. Pervaiz Elahi Institute of cardiology between February 2019 and September 2019 were included. Patients planned for TRA were only included in analysis. We recorded demographic details, previous and presenting medical and clinical history, and renal parameters for each patient. Allen’s test was performed in each patient to determine the eligibility TRA. Incidence of forearm hematoma was noted immediately after the procedure. Results: Out of 450 subjects enrolled in this study included, 324 (72%) were men and 126 (28.0%) were women, the mean age of the patients was 54±10 years. Forearm hematoma was diagnosed in only 51 (11.3%) patients. out of 51, 24 (47.0%) had grade I, 17 (33.3%) had grade II and 9 (17.6%) had grade III and 1 (1.96%) patients had grade IV hematoma. On univariate analysis, being women [odds ratio 2.2 (1.2-4.0), p-value=0.01], obesity [odds ratio 2.8 (1.54-5.76), p-value=0.001], and >1 puncture attempt [odds ratio 4.5 (2.36-8.51), p<0.001], were independent risk factors of forearm hematoma. Conclusion: Incidence of hematoma after trans-radial percutaneous coronary intervention is 11.3%. Female gender, obesity and higher number of puncture attempts are independent risk factors of hematoma. Hematoma is mostly grade I-II in nature and can be managed easily only through conservative management.
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