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
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
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