Background: Coronary Heart Disease (CHD) is the most common category of the heart disease and is found to be the single most important cause that leads to premature death in the developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has shown itself as a very sensitive and specific marker for AMI. Ventricular function is the best predictor of death after an ACS. It serves as a marker of myocardial damage and provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of LVEF on elevated troponin-I level in patients with first attack of NSTEMI. Methods: This cross-sectional analytical study was conducted in the department of cardiology in Mymensingh Medical College Hospital from December, 2015 to November, 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with first attack of NSTEMI with LVEF: ≥55%. Group-II: Patients with first attack of NSTEMI with LVEF: <55%. Then LVEF and troponin-I levels were correlated using Pearson's correlation coefficient test. Results: In this study mean troponin-I of group-I and group-II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). The mean LVEF value of groups were 65.31±10.30% and 40.17±4.62% respectively. It was statistically significant (p<0.05). The echocardiography showed that patients with high troponin-I level had low LVEF and patients with low troponin-I level had preserved LVEF. Analysis showed that patients with highest level of troponin-I had severe left ventricular systolic dysfunction (LVEF <35%) and vice versa-the patients with the lowest levels of troponin-I had preserved systolic function (LVEF ≥55%). In our study, it also showed that the levels of troponin-I had negative correlation with LVEF levels with medium strength of association (r= -0.5394, p=0.001). Our study also discovered that Troponin-I level ≥6.6ng/ml is a very sensitive and specific marker for LV systolic dysfunction. Conclusions:The study has enabled the research team to conclude that the higher is the Troponin-I level the lower is the LVEF level and thus more severe is the LV systolic dysfunction in first attack of NSTEMI patients.
Background: Worldwide primary angioplasty is a recommended strategy of reperfusion in patient with acute myocardial infarction as because it ensures reperfusion of the infarct-related vessels more than 90% where as, with thrombolytics it is only 60-70%. Methods: It is a retrospective observational study includes all patients treated with primary angioplasty at United Hospital from Between6. Written consent must be taken from the patients or patient's relative.7. We have ongoing program to analysis outcomes. Study population:Inclusion criteria-1. Patient presented with chest pain, ECG changes suggestive of STEMI 2. Duration of pain < 12hours 3. All age group 4. Both sexes Underwent Primary PCI as a reperfusion strategyExclusion criteria 1. patient presented with cardiogenic shock 2. Chest pain > 12hours Medications and technique:All patients got aspirin 300mg and 600mg clopidogrel, GTN-oral/IV, 5000units IV heparin at Emergency Department immediacy after diagnosis. In Cath lab 10,000 units IV Heparin before initiation of PCI was given, some times more Cardiovas Journal heparin needed to keep ACT .300. We used intracoronary GTN, Adenosine if there was slow flow or no flow. IV GPIIb/IIIa receptor blockers bolus followed by IV infusion no flow or slow or huge thrombus burden. We did not use distal protection device. Following PCI 3-6 doses of LMWH subcutaneously given routinely if there is no bleeding episodes. Introducing sheath were removed 2 hours after completion of GPIIb/IIIa receptor blockers or 6 hours after completion of the procedure.From emergency patients were shifted directly to the cath-lab. Both arterial and venous femoral access was achieved immediately. TPM was implanted if bradycardia or heart block present at presentation. We used aspiration thrombectomy catheter before ballooning if there was thrombus burden. Pre-dilatation with balloon was done if lesion morphology were complex and critical after thrombus aspiration. In our protocol we did angioplasty to the infarct related artery then staged PCI or CABG. Most of the cases we put DES stents except when clinical condition demand BMS. We routinely did post dilatation after stent implantation. Results:Total 237 Discussion:There is no question that primary PCI, when available, is the treatment of choice. 7 But in our country it is not a widely used reperfusion strategy due to lack facilities. Only a few centers at Dhaka city are performing primary PCI but mostly during the office hours. But in our centre we have Primary PCI facilities 24hours a day, 365days a year. Study population was mostly male like all over the world. Regarding age we had younger age group, mean age 55.8± 11.5yrs, another study at USA showing their mean age 61±.13yrs. 8 Lowest age in our series was 28yrs. Risk factors analysis showed HTN is the most common it was 58.4%, it is also like other studies. A study at USA described HTN as the most common risk factor. 8 Primary PCI holds a survival advantage if it can be performed in a timely fashion. The principle that "time ...
IntroductionSuccessful revascularization of the epicardial coronary artery can be achieved in over 90% of percutaneous coronary intervention procedures. However, post procedural microvascular obstruction, despite the presence of normal epicardial flow, remains an important limitation which substantially reduces the beneficial effects of percutaneous coronary intervention. In this review article, a number of different methods available to diagnose microvascular obstruction after percutaneous coronary intervention are outlined. We also discussed the various pharmacological and mechanical strategies to reduce the occurrence of microvascular obstruction. In this regard, pretreatment with antiplatelet therapy remains crucial. In urgent percutaneous coronary intervention for acute myocardial infarction, available data suggest that manual thrombus aspiration device is beneficial in reducing the occurrence of procedure-related microvascular obstruction and possibly improve long-term clinical outcomes.In the setting of ST-segment elevation myocardial infarction (STEMI), urgent PCI restores coronary perfusion, reduces myocardial damage, and improves survival. Over the last decade, the paradigm has shifted from epicardial artery patency to microvascular perfusion Distal embolization of atherosclerotic and/or thrombotic materials is most likely the predominant pathophysiological mechanism leading to post-PCI microvascular obstruction Other proposed contributing factors include coronary spasm, dissection, endothelial dysfunction, and inflammation. The relative contribution of these factors may differ in different clinical settings. Microvascular obstruction after PCI is associated with adverse long-term clinical outcomes, including higher risk of death and myocardial infarction. As a result, various pharmacological and nonpharmacological strategies have been evaluated to prevent post-PCI microvascular obstruction. Recently, lesion composition determined by IVUS(necrotic core and thin-cap fibroatheroma) MSCT has been shown to be of predictive value for occurrence of post-PCI microvascular obstruction.
Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.
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