Objective: To determine the frequency of arrhythmias in patients with acute coronary syndrome (ACS) in a tertiary care hospital, Karachi, Pakistan. Methodology: This cross-sectional study was conducted at cardiology department of a tertiary care hospital of Karachi, Pakistan. A total of 189 consecutive patients of either gender presented with ACS during six months of study period were included. Continuous cardiac monitoring (telemetry) was done to record any arrhythmia within 24 hours of onset of symptoms. Results: 189 patients with ACS were included, 152 patients (80.4%) were males with the mean age of 48.23 ± 6.717 years. This included 95 patients (50.3%) with unstable angina, 36 patients (19.1%) with ST elevation myocardial infarction (STEMI), and 58 patients (30.7%) with Non-STEMI. Arrhythmias were seen in 39 patients (20.6%), most commonly observed type of arrhythmia was premature ventricular contractions (12), atrial fibrillation (nine), ventricular tachycardia (seven), and ventricular fibrillation (five). Conclusion: Arrhythmias were reported in 39 patients from the total, accounting for 20.63% of the entire population. The incidence of cardiac arrhythmia was more in the age group 40-60 years and male population.
Background Angiotensin receptor blocker and a neprilysin inhibitor (ARNI) has emerged as an innovative therapy for patients of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to assess the safety and tolerability of Sacubitril/Valsartan in patient with HFrEF in Pakistani population. Methods This proof-of-concept, open label non-randomized clinical trial was conducted at a tertiary care cardiac center of Karachi, Pakistan. Patients with HFrEF were prescribed with Sacubitril/Valsartan and followed for 12 weeks for the assessment of safety and tolerability. Safety measures included incidence of hypotension, renal dysfunction, hyperkalemia, and angioedema. Results Among the 120 HFrEF patients, majority were male (79.2%) with means age of 52.73 ± 12.23 years. At the end of 12 weeks, four (3.3%) patients died and eight (6.7%) dropped out of the study. In the remaining 108 patients, 80.6% (87) of the patients were tolerant to the prescribed dose. Functional class improved gradually with 75.0% (81) in class I and 24.1% (26) in class II, and only one (0.9%) patient in class III at the end of 12 weeks. Hyperkalemia remains the main safety concern with incidence rate of 21.3% (23) followed by hypotension in 19.4% (21), and renal dysfunction in 3.7% (4) of the patients. Conclusions Sacubitril/Valsartan therapy in HFrEF patients is safe and moderately tolerated among the Pakistani population. It can be used as first line of treatment for these patients. Trial registration NCT05387967. Registered 24 May 2022—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05387967
Objectives: To elucidate the involved culprit arteries and proportion of spontaneous arterial recanalization (SAR) in acute lateral wall myocardial infarction (ALWMI) patients in Pakistan. Methodology: This cross-sectional study was conducted in the outpatient department (OPD) of a tertiary care cardiac center from February 2019 to July 2019. Patients meeting selection criteria of ALWMI were included. Key angiographic outcomes were recorded for each patient. Proportion of SAR in terms of involved culprit arteries was assessed. Results: One hundred fifty two (152) patients were included, out of which 81% (124) were males. Mean age was 54.73 ± 11.03 years. Most (46.4%) of the study patients presented with single vessel disease. Overall, 89 (59%) patients showed SAR with settled ECG changes. Of them 73 (66%), 8 (33%) and 8 (47%) patients had diagonal artery involvement, 1st obtuse marginal artery involvement and ramus intermedius artery involvement respectively. Statistical significance (p=0.006) is observed for relationship of involved culprit arteries and SAR in ALWMI patients. Conclusion: This cross-sectional study reports the proportion of arterial recanalization in terms of involved culprit arteries. Diagonal was the culprit artery (~ 73%) in most patients presented with ALWMI. SAR proportion is also highest in patients with diagonal artery involvement. This tendency of SAR was more in single vessel diseases patients compared to double vessel and triple vessel diseases patients.
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