Pakistan Heart Journal最新文献

{"title":"Forearm Compartment Syndrome due to Transradial PCI in STEMI: Case Series of What Can Go Wrong and Lesson Learned","authors":"Rismarini Asanti, Sidhi Laksono","doi":"10.47144/phj.v56i3.2599","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2599","url":null,"abstract":"The trans-radial approach (TRA) is shown to be superior in reducing bleeding complications and associated with lower mortality with a similar procedural success rate in ST-Elevated Myocardial Infarction (STEMI) patients compared to the trans-femoral approach. Nevertheless, complications such as forearm hematoma and, in rare cases, acute compartment syndrome (ACS) may develop, thus requiring a prompt surgical procedure. Here, we present two successful emergency fasciotomy cases as ACS treatment following primary percutaneous coronary intervention after STEMI. Both patients show normal neurological and muscular function and normal artery flow on both hands afterward.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136342898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular End-Diastolic Pressure and Extent of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"Bashir Ahmed, Khalil Ahmed Shaikh, Jehangir Ali Shah, Rajesh Kumar, Kamran Ahmed Khan, Mahesh Kumar Batra, Ambreen Nisar, Tahir Saghir, Nadeem Qamar","doi":"10.47144/phj.v56i3.2481","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2481","url":null,"abstract":"Objectives: This study aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with the extent and severity of coronary artery diseases (CAD) in individuals undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center in Karachi, Pakistan. Methodology: This descriptive cross-sectional study included consecutive patients undergoing primary PCI. LVEDP was assessed with the help of a multipurpose catheter. The Association of LVEDP with the extent and severity of CAD was assessed. Results: LVEDP was stratified as ≤15 mmHg, 15-25 mmHg, and >25 mmHg. Out of 498 patients included in this study, 76.3% (380) were male, and mean age was 53.7±11.7 years. Mean LVEDP was 19.35±6.17 mmHg. Burden of diseases was found to be significantly associated with LVEDP level (p<0.001) with mean LVEDP of 18.5±5.6 mmHg, 19.5±6 mmHg, and 21.4±7.2 mmHg among patients with single, two and three-vessel disease respectively. Proportion of three-vessel diseases was 15.5% (37/239), 22.5% (47/209), and 36% (18/50) at LVEDP ≤15 mmHg, 15-25 mmHg, and >25 mmHg, respectively. Conclusion: There was a strong inverse relationship between LVEDP and initial TIMI flow grade (p=0.013) and a positive relationship between LVEDP and total length of the lesion (p=0.002). In conclusion, increased LVEDP was found to be associated with increased burden and extent of coronary artery disease, poor initial TIMI flow grade, and longer length of lesion.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance","authors":"Imran Hameed","doi":"10.47144/phj.v56i3.2617","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2617","url":null,"abstract":"Systemic blood pressure, recorded by various parameters, always shows variation. This is known as ‘variability’, an entity not assessed routinely. Research has shown greater prognostic importance of it than routine parameters. Various intrinsic and extrinsic factors modulate it. Depending on the interval of successive readings, blood pressure variability is of five types, with different non-invasive methods utilized for recording. It is calculated by various statistical parameters, the most common being standard deviation, but average real variability is the most accurate and easily applied. Clinical evidence is increasing rapidly, indicating variability as a prognostic marker for stroke, ischemic heart disease, renal failure, cognitive dysfunction, heart failure, and mortality. Therapeutic measures for the control of variability have also been forwarded. The paucity of clinical application of blood pressure variability is the stimulus to narrate this review, especially for physicians managing hypertensive patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling Coronary Artery Disease vulnerability in patients with ABO gene polymorphism: A Case-Control Study in Pakistan perspective","authors":"Saadia Saad, Syed Tousif Ahmed, Ambrina Khatoon, Jawaid Ansari, Asaad Javaid Mirza","doi":"10.47144/phj.v56i3.2601","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2601","url":null,"abstract":"Objectives: This study was aimed to explore the association of ABO gene variants with coronary artery disease. Methodology: This was a case-control study. Cases and controls were individuals with greater than 50% and less than 30% stenosis, respectively. One hundred thirty-eight samples were obtained, with 69 cases and 69 controls. The operator completed a proforma regarding demographics, medical history, and blood group. The bench work included blood typing, followed by blood genotyping by DNA extraction, PCR, and then Sanger's sequencing. The single nucleotide polymorphisms (SNPs) selected for the ABO gene were rs8176746 and rs8176719. Results: The results show that 68.1% of the participants were male cases, compared to 49.27% controls. The frequency of patients belonging to the old age group (60-75 years) was 65.21% in cases and 34.78% in controls. A+ was the most prevalent group in cases, with 33.33%, followed by 24.6% B+, 23.2% O+, and 4.3% AB+. Patients with Rh-ve groups were rare. On the contrary, 33.33% of patients were O+ in controls. A chi-square test showed that the A+ blood group was significantly associated with CAD, having a p-value of 0.01. Although blood genotypes did not show a significant p-value, the odds of having genotype AA was 1.35 times higher in cases compared to the controls. Conclusion: This study shows that the A+ group is significantly associated with CAD. The data obtained through Sanger’s sequencing determined the genetic variants of blood groups, but no statistically significant association was found between them and CAD.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital Mortality in Heart Failure Patients with Acute Kidney Injury","authors":"K. I. Bhatti, Madiha Imdad, Gulzar Ali, N. Khan, Shakir Zada, Shueeta Kumari","doi":"10.47144/phj.v56i2.2543","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2543","url":null,"abstract":"Objectives: Acute kidney injury (AKI) is frequently present co-morbid condition in patients admitted with acute heart failure (AHF). This study aimed to determine the frequency of in-hospital mortality in AHF patients presenting with AKI.\u0000Methodology: This descriptive case series of AHF patients with AKI was conducted at a tertiary care cardiac hospital in Karachi, Pakistan. In accordance with the “Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale,\" the AKI was defined as a 3.0‐fold increase in serum creatinine (sCr) or sCr > 4.0 mg/dL within 48 hours. All the patients were followed for seven days in order to assess the outcome variable, i.e., in-hospital mortality.\u0000Results: A total of 149 patients were included with a mean age of 59.7 ± 11.03 years, and 80 (53.7%) patients were male. Hypertensive patients were 59.1% (88) of the sample, and 38.9% (58) of the patients were diabetics. In-hospital mortality was found in 11 (7.4%) patients. The mortality rate was 14.1% vs. 2.4%; p=0.008 among patients >60 and 40 to 60 years, respectively. The mortality rate was 12.5% vs. 3.5%; p=0.038 among diabetic and non-diabetic patients. Similarly, the mortality rate was 11.4% vs. 1.6%, p=0.022, among hypertensive and non-hypertensive patients.\u0000Conclusion: It is to conclude that AKI in AHF patients carries a significant burden of in-hospital mortality. The mortality rate was significantly higher for patients with older age and co-morbid conditions such as hypertension and diabetes.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45512713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Experience of Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation from a Tertiary Cardiac Care Center of Pakistan: A Retrospective Chart Review","authors":"Muhammad Sarim Ansari, G. Irfan, Z. Mumtaz, F. Qadir, Maqsood Alam, S. Shaikh, A. Mueed","doi":"10.47144/phj.v56i2.2514","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2514","url":null,"abstract":"Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan.\u0000Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up.\u0000Results: We enrolled all 50 patients (34 male, 68%; mean age 55.14 ± 7.94 years) treated with PVI using CB-Adv. The mean duration of symptoms was 30.28 ± 13.48 months. PVI with CB-Adv was found to be curative in 49 patients (98%). Following the procedure, pericardial effusion was found in one patient (2%), whereas one patient (2%) had a retroperitoneal hematoma. On a six-month follow-up, only one patient (2%) had a recurrence of Ata, which was PAF.\u0000Conclusion: Our experience of PVI with CB-Adv has shown a high success rate of the procedure for rhythm control in patients who have PAF, which is resistant to antiarrhythmic drugs (AADs).","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48122710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Recurrent Syncope: To Pace or not to Pace is the Question?","authors":"F. Hussain, Aman Qureshi, I. Ahmed, A. Khan","doi":"10.47144/phj.v56i2.2387","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2387","url":null,"abstract":"Syncope is a frequently encountered condition in the emergency room, with vagal syncope being the most prevalent form. However, overlapping symptoms can pose diagnostic challenges when distinguishing between vagal syncope and symptomatic sinus node dysfunction. A comprehensive history and careful evaluation of hemodynamics and electrocardiogram findings are crucial for accurate differentiation. Vagal syncope is typically associated with an upright posture, and supine syncope is considered atypical. In this case report, we describe an intriguing instance of supine vagal syncope, highlighting the importance of correct diagnosis to avoid unnecessary pacemaker implantation.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46083304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacogenomics and the Concept of Personalized Medicine for the Management of Hypertension","authors":"K. Ashiq, Sana Ashiq, N. Mustafa","doi":"10.47144/phj.v56i2.2553","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2553","url":null,"abstract":"Hypertension poses a significant global burden due to low adherence to antihypertensive medications. Hypertension treatment aims to bring blood pressure within physiological ranges and reduce the risk of cardiovascular disease and organ damage associated with high blood pressure. It is estimated that around 1.13 billion people have hypertension, accounting for 13% of all fatalities worldwide. The World Health Organization aims to reduce this number by 25% by 2025 compared to the baseline year of 2010.1,2 Despite the availability of effective antihypertensive medications and decreased main risk factors, achieving optimal blood pressure control remains challenging for various reasons, including apparent drug resistance and poor compliance.3,4 One of the contributing factors to poor blood pressure control is the difficulty in predicting which antihypertensive medication will be most effective for a specific patient. An individualized approach to hypertension treatment, considering risk factors, pharmacokinetic properties, genetic phenotypes, and other patient-specific characteristics, holds promise.\u0000Pharmacogenomics and other 'omics' technologies can help identify genetic signals indicative of a favorable or unfavorable response to specific antihypertensive drugs. By conducting research in this field, we can better understand how to optimize blood pressure response using different classes of antihypertensive medications.4 Pharmacogenetics studies the genetic basis of medication response variability, particularly the influence of genetic factors on drug metabolism. In recent years, simple nucleotide polymorphisms (SNPs) have emerged as the primary genetic variation markers. High-throughput genotyping approaches can detect SNPs, which are widespread throughout the genome, often involve substitutions, and rarely result in mutations. SNPs in drug-metabolizing enzymes have been reliable indicators for dose-related treatment decisions.\u0000Genetic studies conducted over the past two decades have identified various genetic polymorphisms associated with hypertension, including changes in the number of tandem repeats, microsatellites, single nucleotide polymorphisms (SNPs), and insertions/deletions (I/D). These studies have also revealed significant inter-individual variability in responsiveness to antihypertensive medications, highlighting the importance of pharmacogenomic research and the potential for individualized pharmacological therapy. Genetic factors may contribute to a 30-50% increase in blood pressure.5 A comprehensive approach is required to advance personalized medicine, incorporating data and insights from genomic, genetic, and proteomic sciences. This applies to both approved medications and therapeutic candidates in various stages of clinical trials. Personalized medicine aims to administer the right drug to the right patient at the right time and dosage. By embracing this concept, we can significantly improve hypertension treatment outcomes.6\u0000Th","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45941712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction Presenting At a Tertiary Care Hospital, Peshawar","authors":"Rahid Ullah, J. Ali, Adil Bilal, Daud Ahmad Jan, A. Rahim, W. Sajjad","doi":"10.47144/phj.v56i2.2372","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2372","url":null,"abstract":"Objectives: Right ventricular infraction has prognostic significance in the setting of acute “inferior wall myocardial infarction (IWMI)”, this research is intended to determine the frequency of “right ventricular infarction (RVI)” in patients with acute IWMI.\u0000Methodology: This descriptive cross-sectional study took place at a tertiary care hospital in Peshawar, Pakistan. The study included consecutive patients who were diagnosed with acute IWMI. The presence of RVI was determined based on specific ECG findings showing >1.0mm ST segment elevation on right-sided chest leads.\u0000Results: In a sample of 150 patients, 87 (58%) were male. The average age of the patients was 61 ± 10.7 years. Among the patients, 111 (74%) had hypertension, 64 (42.7%) were diabetic, and 45 (30%) were smokers. A body mass index (BMI) exceeding 25 kg/m2 was observed in 83 (55.3%) patients. RVI was observed in 62 (41.3%) of the patients. The occurrence of RVI did not show statistically significant differences between males and females (41.4% vs. 41.3%; p=0.989), hypertensive and non-hypertensive individuals (41.4% vs. 41.0%; p=0.964), diabetics and non-diabetics (42.2% vs. 40.7%; p=0.855), smokers and non-smokers (42.2% vs. 41.0%; p=0.885), and patients with BMI ≤25 kg/m2 and >25 kg/m2 (41.8% vs. 41.0%; p=0.920), respectively.\u0000Conclusion: Based on the research findings, it can be concluded that RVI is a relatively common occurrence in patients with acute IWMI, as it was observed in more than 40% of the patients studied. However, no statistically significant association exists between RVI and various demographic and clinical factors.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48989783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Non-Alcoholic Fatty Liver Disease with Cardiac Arrhythmias and Cardiac Conduction Defects: A Review of the Literature","authors":"Muhammad Umer Mukhtar, Sarmad Zahoor, M. Abid, Zi Rehman, M. A. Aslam, H. M. Jehangir, Samar Firdous","doi":"10.47144/phj.v56i2.2236","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2236","url":null,"abstract":"Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition that affects a significant portion of the global population and imposes a heavy clinical and economic burden. Recent studies have provided substantial evidence linking NAFLD to cardiac electrical abnormalities, including atrial and ventricular arrhythmias, heart blocks, conduction delays, and ECG changes. These cardiac electrical disturbances play a significant role in cardiac diseases that are the leading cause of death in NAFLD patients. This paper aims to provide an update on the proposed mechanisms underlying arrhythmogenesis in NAFLD and summarize the latest research findings in this field. Managing NAFLD requires a comprehensive approach that includes treating the underlying liver condition and regular ECG monitoring to detect and address any potential cardiac complications. Meta-analyses are recommended for future research further to elucidate the association between NAFLD and cardiac arrhythmias. Understanding and effectively managing the cardiac implications of NAFLD will contribute to improved patient care and outcomes.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47644053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}