Background:Sparse published data are available regarding the prognostic importance of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute ischemic stroke.Materials and Methods:We prospectively studied 74 consecutive patients presenting with acute ischemic stroke within 24 hours of onset. All of them underwent laboratory and imaging evaluation and were treated as per guidelines. In all subjects, plasma NT-proBNP levels were measured at initial admission and again on day 7.Results:Their mean age was 54 ± 13.5years; there were 49 males; 18 (24%) patients died during the hospital stay. A statistically significant negative correlation between log NT-proBNP and Glasgow coma scale (GCS) score (P < 0.001); and a significant positive correlation between log NT-proBNP and National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001) were observed. Baseline log NT-proBNP levels were higher among non-survivors compared with survivors (6.7 ± 0.47 vs. 5.37 ± 0.62; P = 0.06); day 7 log NT-proBNP levels were significantly higher in non-survivors compared with survivors (7.3 ± 0.26 vs. 4.5 ± 0.4; P = 0.000). In survivors, there was a statistically significant decline in log NT-proBNP levels from baseline to day 7 (5.3710 ± 0.620 vs. 4.5320 ± 0.451; P < 0.001). In contrast, among non-survivors, log NT-proBNP levels showed a statistically significant increase from baseline to day 7 (4.5322 ± 0.451 vs. 7.2992 ± 0.263; P < 0.001). On receiver operator characteristic curve (ROC) analysis, at a cut-off value of ≥ 6.0661, log NT-proBNP had a sensitivity and specificity of 98.2 and 88.9, respectively, in predicting death.Conclusions:Plasma log NT-pro-BNP level appears to be a useful biological marker for predicting in-hospital mortality inpatients presenting with acute ischemic stroke.
Myocardium is usually supplied by three coronary arteries, although there are several variations in the number, origin, course and distribution of coronary arteries. Major contribution to left ventricular myocardial blood flow is by left anterior descending coronary artery (LAD) (50%), rest is equally contributed by right coronary artery (RCA) and left circumflex artery (LCx). In addition, most of the right ventricle is supplied by RCA. The need for a rapid reperfusion therapy is largely determined by how close the occlusion site is to the origin of the coronary artery, which corresponds to the area of ischaemic myocardium.Each artery contributes its blood supply to specific regional areas in the heart. These areas are topographically represented by the following groups of leads: 1 (Table 1). MYOCARDIAL DISTRIBUTION OF THREE MAIN CORONARY ARTERIES Left anterior descending arteryThe LAD travels along the anterior interventricular groove towards the apex of the heart. The major branches of LAD are septal and diagonal branches.The septal branches arise perpendicularly from the LAD and pass into the interventricular septum. The diagonal branches of the LAD course over the anterolateral aspect of the heart. Considerable variations exist in the number and size of the diagonal branches. In most (80%) patients, the LAD courses around the apex of the left ventricle and terminates along the diaphragmatic aspect of the left ventricle. In the remaining patients, the LAD terminates either at or before the cardiac apex. In these patients, the left ventricular apical portion is supplied by the posterior descending branch (PDA) of the RCA or LCx, which is larger and longer than usual. Left circumflex arteryThe LCx artery passes within the left atrioventricular groove toward the inferior interventricular groove. The LCx artery is the dominant vessel in 15% of patients, supplying the left PDA from the distal continuation of the LCx. In the remaining patients, the distal LCx varies in size and length, depending on the number of posterolateral branches supplied by the distal RCA. The major ABSTRACTThe electrocardiogram (ECG) remains a crucial tool in the identification and management of acute myocardial infarction (MI). A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of reperfusion therapy. The early and accurate identification of the infarct-related artery on the ECG can help predict the amount of myocardium at risk and guide decisions regarding the urgency of revascularization. The specificity of the ECG in acute MI is limited by individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease, particularly in patients with a previous MI, collateral circulation, or previous coronary-artery bypass surgery. The ECG is also limited by its inadequate representation of the posterior, lateral, and apical walls of the left ventricle. Despite these limitations, the electrocardiogram can help in identifying proximal occlusion of the coronary arte...
Background: Post surgical mitral valve disease individual focus their cardiac rehabilitation training on two major goal that is to improve cardiac output response exercises and place an important role in determining exercise tolerance and to improve quality of life. Cardiac rehabilitation programs involve prescribed exercise and education however various other method are being used to improve quality of life. But our study to find out the effectiveness of graded aerobic exercise protocol on ejection fraction and quality of life in post surgical mitral valve disease individuals. Methods:The study design was open label studies total of 100 post surgical mitral valve disease individuals patients from the age group of 20-60 years were recruited from SVIMS hospital. They were randomly divided into two groups. Group I underwent a twelve week structured graded individually tailored exercises. The group II received only none graded (not individualized) exercise training. The ejection fraction and quality of life was measured before and after 12 weeks of exercise training for two groups.Results: Repeated measures ANOVA was used to compare mean values of continuous variables between baseline and at the time of discharge and three months after surgery for each parameter. Comparison of means between groups was done by the unpaired student t test. Mean age of the subjects was 40.18±10.29. There was a significant increase in the ejection fraction in the group I(61.34±2.49 to 64.4±3.31) compared to with the group II (61.06±2.51. to 61.62 ±2.37.) QOL had improved in group I than group II at p<0.05. Conclusion:A 12 week structured graded aerobic exercise training significantly improved ejection fraction and quality of life in post surgical mitral valve disease individuals.
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