Objective: To determine the frequency and in-hospital mortality of patients with complete heart blocks after STEMI. Study Design: Comparative Cross Sectional study. Study Setting: Department of Cardiology, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: January 2019 to December 2019. Material & Methods: Patients meeting selection criteria having age 35 to 65 of both genders with STEMI either thrombolysed or not were enrolled in the study after their informed consent, whereas patients with prior history of MI, PCI or CABG or patients with prior AV blocks were excluded from the study. All patients remained admitted and followed up for 3 to 4 days. Patients were evaluated by ECG for diagnosis of AV blocks. Two groups were made, one with and second without complete heart blocks. Incidence and mortality of CHB after STEMI noted. Data was analyzed with SPSS -23. Results: Out of167 patients, 103(61.6%) male, while 64(38.4%) were female. Mean age was 50.5+10. Patients with AWMI 85 (50.8%), IWMI 63(37.7%) and LWMI were 18(10.77%). Ten (5.9%) developed CHB. Two groups were made on the basis of presence or absence of CHB. In first group 7 out of 10 having CHB were expired, 2 discharged and one referred for permanent pacemaker or revascularization. In second group 23 (15%) expired out of 157, 110(70%) discharged while 24(15%) were referred for invasive management. Patients having IWMI (60%) developed CHB more as compared to anterior (20%) or lateral wall MI (20%). Mortality due to CHB complicating STEMI was 4.19% while overall mortality was 17.96% (30). Conclusion: Complete heart block is a known complication of patients with STEMI and is associated with poor prognosis. Thrombolytic agents were very useful in patients with STEMI for reversal of CHB in most of the patients.
Objective: To determine the Incidence of myocarditis in patients with COVID-19 and in-hospital mortality. Study Design: Observational Cohort study. Setting: Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: 15 to 30 March 2020. Material & Methods: Patients with positive PCR results for COVID-19 were included in this study after informed consent; patients with prior history of any cardiovascular, pulmonary or other co-morbidity were excluded while patients having history of hypertension, diabetes or smoking were included in the study. All the patients remain admitted for 14 days. Patients were evaluated clinically, by ECG, troponins and echocardiographically for diagnosis of myocarditis. Patients were managed conservatively. Incidence of myocarditis and in-hospital mortality was noted. Successful treatment towards hospital discharge was relief of clinical symptoms, a-febrile, clear chest X-Ray and at least two consecutive negative PCR for covid-19. P-value <0.05 was considered as significant. Data was analyzed with SPSS -23. Results: Out of fifty five, 5(9%) patients were diabetics and 4 were hypertensive. Five (9%) developed mild pneumonia which recovered conservatively and three (5.4%) patients developed myocarditis. One (1.8%) patient expired having myocarditis. Duration of follow up was only during hospital stay. So our in-hospital mortality was 1.8%, p value was calculated as significant < 0.05. Conclusion: Myocarditis is a known but less common complication of COVID-19. Cardiac injury is more in those with previously having cardiovascular or other co-morbidities. In healthy and immunocompetent population its incidence is quite low.
Background: Percutaneous Coronary intervention (PCI) is a routinely performed procedure in coronary care units. The aim of our study was to investigate the frequency of major adverse cardiac events (MACEs) after percutaneous coronary angiography in acute ST-elevation myocardial infarction (STEMI) patients in our institution. The objective of the study is to determine the frequency of MACEs after Percutaneous Coronary Intervention (PCI) in patients with acute myocardial infarction.Patients & Methods: This prospective observational study was carried out at Punjab Institute of Cardiology, Lahore from May 2017 to June 2017. A total 35 patients with STEMI who underwent Primary PCI were enrolled by consecutive sampling technique. An inclusion criterion was chest pain of 30 minutes to 12 hours duration with ECG showing ≥ 0.1mm ST-elevation in at least two contiguous leads. An exclusion criterion was thrombolysis within last 24 hours, malignancy, stroke and Left Main or equivalent disease on coronary Angiogram. Patients were followed after 2 weeks till 1 month for any MACES. (Including re-admission, need for repeat revascularization, stent thrombosis, recurrent acute MI, angina, stroke, and mortality). Frequency and percentages were calculated for MACEs by using SPSS 23.0.Results: Out of 35 cases, 34 (97.1%) were male and 1 (2.9%) were female. Mean age was 47.11±10.59 years, 14 (40%) patients had hypertension, 10 (28.6%) were diabetics and 12(34.3%) were current smokers while 4 (11.4%) were ex-smokers, 10 (28.6%) had family history of CAD, and 3 (8.6%) had hyperlipidemia. Successful revascularization with TIMI-III flow was attained in 34(97.1%) cases. 33minutes was mean door to balloon time. At one month follow-up, out of 35 patients, angina was reported only in 1 (2.9%) patient. There was no readmission, repeat revascularization, stent thrombosis, myocardial infarction, stroke and death reported in study subjects.Conclusion: Successful revascularization by Primary PCI was associated with very few early MACEs. For the treatment of coronary artery disease, PCI is an effective option. It has a few early MACEs and uses less contrast and has fewer distal complications than conventional angioplasty and invasive procedures.
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