Background: Delay between onset of symptoms and hospital presentation is a critical factor in determining the management strategy and subsequent outcome. Objective of the study was to identify predictors of late presentation in patients with acute myocardial infarction (AMI) and target interventions for those at high risk of late presentation.Methods: In our cross sectional study we prospectively analyzed a cohort of 1032 AMI patients for 1 year (August, 2014 to July, 2015). Demographic factors, clinical characteristics, perception of health and access to health care were compared between early (within 12 hours of symptom onset) and late presenters (>12 hours of symptom onset). Bivariate comparison and multivariate logistic regression were done to identify independent predictors of late presentation .Odds ratio and 95% confidence intervals were calculated directly from the estimated regression coefficient.Results: Of the total 1032 patients 385 (37.3%) were early presenters and 647 (62.7%) were late presenters. Mean time interval between onset of symptom and presentation to hospital were 6.85±8.06 hrs (range 1.5 to 12 hrs) in early and 37.88±25.13 hrs (range 13 to 120 hrs) in late presenters. Bivariate comparison found that in the late presentation group was higher age group patients and employed citizens, had ? one angina episode over past 4 weeks, was unable to use emergency medical transport, had no nearby ECG facilities and misinterpreted chest pain as peptic ulcer disease (PUD). Multivariate analysis showed older age ?65 yrs, traveling long distance ?50 miles from home residence, reporting one or more angina episode over past 4 weeks, attending PHC/clinic and misinterpreting chest pain as PUD were associated with late presentation.Conclusion: A significant majority of patients with AMI were late presenters. Misinterpreting chest pain as PUD was responsible for the delay in the majority. Reporting ?1 angina episodes over past 4 weeks was also independently associated with late presentation. Lack of emergency medical transport and traveling long distance were also significantly associated with the late presenters. Patient education, appropriate utilization of existing resources and use of tele-electrocardiography that allows transmission of ECG signal to a medical control officer may decrease late presentation and improve outcome.Cardiovasc. j. 2016; 9(1): 3-8

Abstract:Background

Introduction:Coronary heart disease (CHD) is a major cause of mortality globally and this health problem is reaching epidemic in both developed, as well as, in developing countries. 1 It will be the leading cause of disability worldwide by the year 2020. 2 Non-ST segment elevation acute coronary syndrome (NSTE ACS) accounts for approximately 2-2.5 million hospital admission annually worldwide. 3 MA Siddique has explained that multiple cardiovascular risk factors along with ignorance about risk factors as a cause of recent increases of occurrence of unstable angina in Bangladesh. 4 Rapid risk stratification is crucial for appropriate management of this group of patient. Prognostic value of ST segment deviation (both elevation and depression) was studied in the Thrombolysis In Myocardial Ischemia (TIMI) III registry by Cannon CP 1997. 5 Specifically prognostic value of ST segment depression in coronary artery diseases was assessed by various studies. [6][7][8][9][10][11][12][13] Kaul et al. found that a categorical quantification of the amount and distribution of ST segment depression can identify a gradient of risk independent of clinical variables. 10

Background: Heart failure with reduced ejection fraction has a significant association with considerable morbidity and mortality, but there is still inadequacy in appropriate treatment to prevent this condition. We observed the effect of angiotensin receptor neprilysin inhibitor (ARNi) with such disorder compared to valsartan. Methods: In this single-blind trial, the patients were enrolled with chronic HF aged on or above 40 years, symptomatic NYHA class II-IV, an elevated NT-proBNP above 400 pg/ml level and a reduced LVEF of 40% or less. The patients were randomly assigned 1:1 to the treatment arms either ARNi (50 mg titrated to 100 mg twice a day) or valsartan (40 mg titrated to 80 mg twice a day) and followed for a median of 88 days. The primary outcome was mode of cardiovascular death and re-hospitalization for heart failure. Changes in the level of NT-proBNP and rate of ejection fraction were also measured. Results: Cardiovascular deaths occurred 4 (8%) in the ARNi treatment arm, while 11 (22%) in the valsartan treatment arm with significant hazard ratio in the ARNi group [Hazard Ratio = 0.37; 95% CI: 0.34, 0.64; p = 0.042] during a median of 88 days of follow up period and 2 (4%) of the patients from the ARNi treatment arm were hospitalized due to HF, while in the valsartan treatment arm, 10 (20%) patients were hospitalized due to HF followed by receiving treatment respectively with hazard ratio in the ARNi group [Hazard Ratio = 0.

Background: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982. Objective: The aim of this study was to audit the procedural success, in- hospital outcome in patients undergoing PTMC in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted in northern division of Bangladesh with the collaboration of department of cardiology, Rangpur Medical College Hospital, Rangpur & Zia Heart Foundation, Dinazpur from February 2018 to November 2019. Materials and Methods: Total Thirty patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study. Among them the procedural success & immediate results were assessed. Results: Among 30 patients , 22(73.33%) were female and 8(26.66%) were male showing a female predominance. The mean age was 28.28±8.4.The procedure was successful in 29(96.66%) patients. In 1(3.3%) patient, we failed due to inability to puncture the septum for unfavourable anatomy. There was no mortality related to the procedure, no systemic embolization but one patient (3.33%) had significant MR(G II ). Pre PTMC mean MVA (cm2) was 0.801± 0.1325 and post PTMC it was 1.545± 0.292 cm2. Mean MVPG pre PTMC was 27.108±5.94 mmHg and post PTMC , 6.61±5.008 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 28.65±8.456 mmHg and post PTMC, 11.27±6.34 and p value was 0.0001. Most of the patients 25(83.3%) before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 21(70%) were in mild pulmonary hypertension.We successfully done 7 special cases like pregnancy, re do cases, H/O CVD etc. Conclusions: We conclude that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases. University Heart Journal Vol. 17, No. 1, Jan 2021; 47-54

Background: Cardiomyopathy is a primary disorder of heart muscle with abnormal myocardial performance. It is an important cause of heart failure and accounts for upto 25% of causes of heart failure. In view of the high prevalence of chronic heart failure due to underlying dilated cardiomyopathy and the lack of data on DCM, the study was undertaken. Methods: A total of 100 patients (71 males and 29 females) of dilated cardiomyopathy were taken who was undergone Echocardiography at popular Diagnostic centre, Rangpur. ECG and echocardiography was done among all these patients using standard techniques. Results: Majority of the patient was above the age 50 years with male to female ratio is 2.4 :1. Sinus tachycardia, non specific ST-T change, LVH, non progression of R in v1-v5 were common ECG abnormalities. Conclusion: ECG may be normal in patients with DCM though sinus tachycardia and non specific ST-T abnormalities were common. Cardiovasc. j. 2020; 12(2): 109-112

Mycobacterium Endocarditis is a very rare case. A 5 years old boy presented us with the history of fever and breathlessness. CXR shows huge cardiomegaly, patient is anemic and temperature is raised. On echo revels vegetation on Tricuspid &Mitral valve ç huge pericardial effusion ç features of early tamponade. Pericardial fluid was drawn and the symptoms improved. Pericardial fluid colour was milky and exudative in nature. ADA for mycobacterium tuberculosis was positive. The patient was given anti tuberculosis drug & improved with time. Cardiovasc j 2021; 14(1): 76-78

Angioplasty opened the stenotic coronary artery but faced complication like abrupt vessel closure. Deployment of bare metal stent within the lesion solved the problem but another complication like restenosis emerged. Neointimal hyperplasia and vessel wall remodeling were identified as the underlying mechanism and lead to the development of drug eluting stent. In the selected patient group, drug eluting stent (sirolimus and paclitaxel) are proved to be extremely promising in respect to reduction of target vessel failure, clinical restenosis (target vessel revascularization), binary restenosis, stent thrombosis and other parameters. Importantly initial positive outcome persisted in the subsequent later follow ups. Outcome in the unfavourable groups are also encouraging but needs few more studies and follow ups. There are scopes for future improvement also. With the immense success, drug eluting stents are increasingly used worldwide and becoming an integral part of percutaneous coronary intervention. (J Bangladesh Coll Phys Surg 2007; 25 : 86-91)