Introduction: Coronary artery diseases are currently the major cause of death in developing countries. Acute coronary syndrome (ACS) is defined as any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST elevation myocardial infarction (NSTEMI) to STelevation myocardial infarction (STEMI). Accurate diagnosis and management of ACS has life-saving implications of its outcome. Objective: To compare the outcomes of STEMI and NSTEMI in a percutaneous coronary intervention (PCI) capable centre. Materials and Methods: The patients who undergone percutaneous coronary intervention (PCI) in Combined Military Hospital, Dhaka were considered from January 2013 to January 2017. Diagnosis of acute MI was based on the clinical presentation, electrocardiogram (ECG) and raised highly sensitive troponin I. Acute MI patients were classified into 2 groups, STEMI and NSTEMI. Their coronary risk factors, co-morbidity, ECG, echocardiogram, coronary angiographic (CAG) findings and short-term outcomes were collected. All statistical data were analysed by SPSS 22.0 software. Results: There were 464 patients enrolled for analysis. Among them, 208(44.8%) patients had STEMI and 256(55.2%) had NSTEMI. The ratio of male/female was greater in STEMI as compared to NSTEMI (4.0 vs 1.9; p=0.041). Among NSTEMI patients, 88(34.4%) had ST depression, 168(65.6%) patients had other ECG changes like T wave abnormalities in 66(25.7%) and poor R-wave progression in 16(6.3%). NSTEMI patients had less regional wall motion abnormality on echo cardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2 vs 0.78 %), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3 % vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. NSTEMI patients had less regional wall motion abnormality on echocardiogram (p=0.0045). As a complication heart failure (36% vs 9.3%), cardiogenic shock (16.8% vs 15.6%), atrial fibrillation (7.2% vs 0.78%), ventricular tachycardia (2.8% vs 0.5%), reinfarction (3% vs 0.78%) and death (2.4% vs 0.40%) were observed more in STEMI patients than NSTEMI respectively. Coronary angiogram shows that left anterior descending artery was the most commonly involved artery in STEMI; however, the left circumflex artery or right coronary artery was involved more commonly in NSTEMI (p<0.001). Conclusion: The first step in successful treatment of acute MI depends on early diagnosis. Inspite of immediate management, STEMI had relatively worse outcome compared to NSTEMI. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 22-27
Introduction: When there is a difference of patient's blood pressure (BP) which is measured in a physician's office and patient’s home, it is said to have White Coat Hypertension (WCH). Prevalence of WCH is very much common among aircrew, because they need to face everyday preflight medical checkup. Objective: To find out the incidence of WCH among the aircrew of Bangladesh Air Force (BAF) as well as to ascertain the long-term clinical implications of WCH. Materials and Methods: This cross-sectional observational study was conducted among 150 aircrew, reported to Central Medical Board (CMB), Bangladesh Air Force (BAF) for periodical medical evaluation, during the period January 2014 to December 2018. Study subjects were selected purposively with age range 25-50 years; those who did not have any history of hypertension or received any anti-hypertensive medication but were detected elevated BP having clinical recording of BP ≥ 140/90 mm of Hg. Ambulatory blood pressure monitoring (ABPM) was performed on them for 24 hours in order to distinguish between those who were truly hypertensive and those who were suffering from WCH. To exclude secondary causes of hypertension as well as to assess for evidence of target organ damage (TOD), a thorough clinical and laboratory examination as well as regular follow-up were also performed. Results: White Coat Hypertension was observed in 26.7% of the aircrew. There was no evidence of target organ involvement, such as left ventricular dysfunction, left ventricular hypertrophy, hypertensive retinopathy or renal involvement. Conclusion: WCH is comparatively common among the aircrew. This highlights the importance of the requirement for regular follow up of all cases of WCH, over the normotensive subjects with a view to identify early organ involvement and therapeutic intervention are often initiated as and once needed. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 14-17
Objectives: The objectives were to study the incidence of the normal coronary artery anatomy, to determine their clinical, electrocardiographic, stress testing, echocardiographic and angiographic characteristics. Methods: This is a retrospective study carried out in cardiac center, Combined Military Hospital, Dhaka, Bangladesh on patients seen during the period from November 2010 to Dec 2011. The coronary artery angiography data was collected by a check list and was revised by the authors. Results: Twelve hundred and two fifty patients who had coronary angiography which showed normal coronary artery or minor coronary artery disease were included in this study. 13% were females. The mean age of the patients was 45.6. 74% patients had one or more coronary risk factors and predominant risk factor was hypertension (31%). More than 50% patients had significant cardiac symptoms and about 40% study subjects were found to have prominent ECG changes which preclude noninvasive tests. Only 38% of study subjects underwent exercise ECG tests, among them 12% had positive ETT. Two hundred and forty nine patients (20%) had normal coronary artery anatomy. Right dominant circulation was found in 79% of the patients. Conclusions: The incidence of normal coronary artery anatomy is similar to those reported in other literatures. Although there are limitations of common noninvasive tests to exclude coronary artery disease, proper clinical evaluation and appropriate use of other noninvasive investigations will definitely reduce the burden of coronary angiogram in patients with angina or suspected ischemic heart disease. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16078 University Heart Journal Vol. 8, No. 2, July 2012
Introduction: The main purpose of thrombolysis in acute myocardial infarction is early and complete reperfusion. Incomplete or delayed thrombolysis is associated with an increased risk of death and left ventricular dysfunction. The time to reperfusion and complete reperfusion remain the key determinants for appropriate outcome of cardiovascular events. Objective: To find out the effect of thrombolytic therapy and its outcome in relation with timing of thrombolysis and associated risk factors in ST elevated myocardial infarction (STEMI) patients. Materials and Methods: This cross-sectional interventional study was carried out in combined military hospital, Dhaka from July 2017 to May 2018. Total 85 patients of acute STEMI having specified criteria were selected and treated with Streptokinase at a dose of 1.5 million units diluted in 100 mL normal saline. Twelve-lead ECG was recorded immediately before the start of thrombolytic therapy and 180 min afterwards. Results: Among 85 STEMI patients 65 were male and the age range was 40-80 years. Sixty nine patients (81.2%) underwent thrombolysis within 12 hours of onset of chest pain among them complete resolution of ST segment occurs in 45(65.2%) patients while 16 patients (18.8%) received thrombolysis after 12 hours among them complete resolution occurs only in 7(43.8%) patients. Fully reperfused patients have no complications. Patients having diabetes mellitus, presented with atypical chest pain and received thrombolytic therapy after 12 hours had various types of complication. Conclusion: STEMI patients received thrombolysis therapy within 12 hours of onset of chest pain responded well to thrombolytic therapy. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 42-44
Background: Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide. Recent studies had shown that cardiac injury in COVID-19 is not uncommon and may leads to death. The aim of this study was to assess cardiac troponin in patients with COVID-19 and to evaluate the incidence of myocardial injury. Methods: A cross-sectional study was designed among 100 hospitalized patients with moderate to severe COVID-19 in Combined Military Hospital (CMH), Dhaka from January to April, 2021, after considering inclusion and exclusion criteria, study population was divided into two groups on the basis of normal and elevated troponin level. Results: Participants had mean age of 67.33 ± 7.63 years with 76% men. 42% population had elevation in troponin levels. Risk factors like age, Diabetes (DM), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D- Dimer, Ferrtin level were more in elevated troponin group and statistically significant. Troponin levels significantly increased with increasing severity of COVID-19 staging (Kendall’s tau-b =0.479, p= 0.004) with reflected moderate positive correlation. Multivariate analysis was performed for association of COVID- 19 severity with elevated troponin separately after adjusting for other known confounding factors. Independent association between COVID-19 severity and troponin remained significant after that along with other acute phase reactants and inflammatory markers. Conclusion: COVID-19 can significantly leads to myocardial injury. This data suggested elevated troponin level is one of the determinants of clinical outcome in patients with COVID-19. University Heart Journal 2022; 18(1): 29-35
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