Armed Forces Institute of Cardiology

Rāwalpindi, Pakistan

Armed Forces Institute of Cardiology

Rāwalpindi, Pakistan
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Gul U.,Rawalpindi Institute of Cardiology RIC | Hussain S.,Armed Forces Institute of Cardiology | Munir R.,Rawalpindi Institute of Cardiology RIC | Kayani A.M.,Rawalpindi Institute of Cardiology RIC
Journal of the College of Physicians and Surgeons Pakistan | Year: 2017

Objective: To investigate if neutrophil lymphocyte ratio (NLR) predicts in-hospital adverse events and mortality, and shortterm (30-day) mortality in ST-elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK). Study Design: An observational study. Place and Duration of Study: Rawalpindi Institute of Cardiology, from June 2014 till January 2015. Methodology: The STEMI patients, thrombolysed with SK had blood samples at admission, analysed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Mann-Whitney test was used to compare median NLR between patients died and discharged alive. Logistic regression analysis was used to estimate predictive ability of NLR for 30-day mortality. Results: A total of 145 (45.3%) patients had complications; 49 (15.3%) died in hospital, and 13 (4.06%) died in 30 days. Patients in high NLR group had higher rate of complications (63.5% vs. 25.5%, p < 0.0001) and death (19.2% vs. 11.1%, p=0.046) in hospital than those in low NLR group. Cardiogenic shock (27.5% vs.11.1%, p < 0.0001), heart failure (19.2% vs. 7.2%, p=0.002), arrhythmias (18% vs. 6.5%, p < 0.0001), reinfarct/angina (9.6% vs.2% p=0.004) occurred more in high NLR group. Median NLR in patients died was higher than those discharged alive (7.46 vs. 4.70, p < 0.0001). Regression analysis showed NLR an independent predictor of mortality (OR 1.131 at 95% CI, p = 0.029). Age, serum creatinine, Killip class were other predictors (p=0.002 and p=0.02, respectively). ROC curve showed AUC 0.908 (p < 0.0001). Conclusion: A high NLR predicted increased in hospital complication rate, and in-hospital as well as 30-day mortality in STEMI patients thrombolysed with streptokinase.

Khan M.A.,Oncology and Radiotherapy Institute | Khan M.T.,Nuffield Brentwood Hospital | Shahzad M.F.,Oncology and Radiotherapy Institute | Iqbal S.,Armed Forces Institute of Cardiology
Asian Pacific Journal of Cancer Prevention | Year: 2015

Background: There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. Our objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasons of delay and its association with different socio-demographic variables in our North Pakistan setting. Materials and Methods: We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to consultation with a doctor. Questions were asked from each patient which could reflect their understanding about the disease and which could be the likely reasons for their delayed presentation. Results: 39.0 % (n=123) of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2 % did not having enough resources; 17.1 % presented late due to painless lump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, < 8 school years of education and low to middle socio-economic status were significantly associated with delayed presentation (p< 0.05). Education and socioeconomic status were two independent variables related to the delayed presentation after adjustment for others (OR of 2.26, 2.29 and 95%CI was 1.25-4.10, 1.06-4.94 respectively). Conclusions: Significant numbers of women with breast cancer in North Pakistan experience presentation delay due to their misconceptions about the disease. Coordinated efforts with public health departments are needed to educate the focused groups and removing the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.

Younus Z.,Intensive Care ITC Anaesthesiology | Iftikhar R.,Combined Military Hospital | Ahmed I.,Armed Forces Institute of Cardiology
Journal of the College of Physicians and Surgeons Pakistan | Year: 2013

Anomalous origin of the left coronary artery from the pulmonary artery also recognized as Bland White Garland syndrome is a very rare congenital condition. A two-months old baby boy presented with dyspnoea for two weeks and a pansystolic murmur on auscultation. The base line investigations showed cardiomegaly and bilateral basal haze on X-ray chest. ECG showed ST elevation in leads l and AVl and echocardiography showed situs solitus, levocardia, hypokinetic intraventricularseptum, ejection fraction of 30%, mitral regurgitation of grade-I and an anomalous origin of the left coronary artery from pulmonary artery was diagnosed. Patient was in left heart failure. It was rectified surgically by creating a transpulmonary tunnel (Takeuchi repair). Postoperative course was uneventful and he was finally discharged in stable condition.

Bhalli M.A.,Combined Military Hospital | Kayani A.M.,Armed Forces Institute of Cardiology | Samore N.A.,Combined Military Hospital
Journal of the College of Physicians and Surgeons Pakistan | Year: 2011

Objective: To determine the frequency of risk factors in male patients presenting with acute coronary syndrome. Study Design: Observational study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from October 2007 to September 2008. Methodology: Male patients with acute coronary syndrome were included in this study. Patients having angioplasty (PCI), coronary artery bypass surgery, chronic liver and kidney diseases were excluded. Presence of diabetes, smoking, hypertension, dyslipidemia, physical activity, stress, a family history of coronary artery disease (CAD) and medication was documented. Blood pressure, ECG, cardiac enzymes, fasting blood glucose, lipid profile and echocardiography were done within 24 hours of admission. Body mass index and waist circumference were measured. Data was analysed using SPSS-15. Results: A total of 135 male patients of ACS were studied having mean age of 54.26±11.60 years. Maximum number of patients aged between 51 to 60 years, (n = 41, 31.9%). STEMI (ST-elevation myocardial infarction) was diagnosed in 96 (71.1%) patients, non-STEMI in 12 (8.9%) while 27 (20%) patients were having unstable angina. Smoking was ocumented in 60 (44%) patients, hypertension in 50 (37%), diabetes in 34 (25.2%) and a family history of premature CAD as recorded in 24 (17.8%) patients. Fifty one (37.8%) patients were overweight (BMI = 25-9.9) while 22 (16.3%) were bese (BMI ≥ 30). Waist circumference > 90 cm was found in 86 (63.6%) subjects. Sixty four (47.4%) patients were active hysically. Psychosocial stress was documented in 33 (23.75). Hypertension, diabetes and dyslipidemia were the most requent combinations, observed in 24 (17.9%) subjects. Conclusion: Dyslipidemia, smoking, hypertension and diabetes were most frequent risk factors. Public awareness to ontrol risk factors can reduce the prevalence of CAD. © 2011. College of Physicians & Surgeons Pakistan.

Saleem S.,Quaid-i-Azam University | Hussain M.M.,Army Medical College | Majeed S.M.I.,Armed Forces Institute of Cardiology | Khan M.A.,Army Medical College
Journal of the Pakistan Medical Association | Year: 2012

Objective: To identify the basic values of heart rate variability in Pakistani population and to verify our hypothesis that there are gender differences in cardiovascular autonomic modulation. Methods: The descriptive cross sectional study based on convenience probability sampling was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Pakistan. The duration of the study was from December 2009 to July 2010. It involved 24-hour holter monitoring of 45 healthy individuals using holter electrocardiography (ECG) recorder. Heart rate variability was analysed in time (SDNN, SDANN, SDNNi, rMSSD, pNN50) and frequency domains (power, VLF, LF, and HF). Results: The time domain indices; SDNN (male=140±36ms vs. females=122±33ms; p =0.09), SDANN (male=123±34ms vs. females=111±34ms; P= 0.23), SDNNi (male=64±19ms vs. females=52±14ms; P= 0.03), and pNN50 (male=14±10ms vs. females=12±7ms; P= 0.43) were decreased in female volunteers when compared with males. Comparison of frequency domain indices; Total power (male=4041±3150ms 2 vs. females=2750±1439ms 2; P= 0.07), VLF (male=2912±2675ms 2 vs. females=1843±928ms 2; P= 0.06), LF (male=788±397ms 2 vs. females=556±346ms 2; P= 0.04) and HF (male=318±251ms 2 vs. females=312±277ms 2; P= 0.94) amongst males and females showed attenuated heart rate variability in females. Of all the observed values, SDNNi and LF were found significantly (p <0.05) decreased in women. Conclusion: In healthy population, heart rate variability is low in women than men. It reflects sympathetic dominance in women in our population.

Nuri M.M.H.,Army Medical College | Hafeez S.,Armed Forces Institute of Cardiology
Journal of the Pakistan Medical Association | Year: 2012

Objective: To evaluate the effects of autologous bone marrow stem cell transplant on clinical symptoms, overall left ventricle ejection fraction and myocardial perfusion in patients with recent anterior myocardial infarction in left anterior descending artery territory. Methods: The study was conducted in the department of interventional cardiology of Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi from June 2004 to November 2006. There were 26 male patients with recent anterior myocardial infarction, having anterior/apical hypokinesia and disease process involving only left anterior descending artery, who were recruited. The whole procedure was explained to the patients in the language of their best understanding and informed consent was obtained. Stem cell harvest was obtained from both posterior superior iliac crests, which were processed to note total and mean mononuclear cell counts. Stem cells were transplanted into the damaged myocardium using stop flow technique through lumen of over-the- wire balloon catheter, placed in mid left anterior descending artery. All patients tolerated the procedure well except for a few complications which were tackled by the experienced operators. The patients were advised to continue conventional medical therapy. The efficacy of stem cell transplant was objectively assessed by comparing effects on three parameters - clinical, left ventricle cineangiographic, and nuclear scintigraphic status - at baseline and at 12 weeks after transplantation. Results: There is improvement in general well being, left ventricle ejection fraction and myocardial perfusion after stem cell therapy. Conclusion: Autologous bone marrow stem cell transplant seems to be a favourable and secure way of treatment for improvement of post-myocardial infarction ejection fraction and perfusion. There is dire need to conduct larger randomised controlled trials to assess efficacy of this cost-effective mode of therapy, especially in our part of the world.

Choudhry S.,Shifa International Hospital | Raja M.H.,Shifa International Hospital | Maadullah M.,Armed Forces Institute of Cardiology
Journal of the Pakistan Medical Association | Year: 2012

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly which presents in early infancy with congestive cardiac failure, sometimes precipitated by inter current respiratory tract infections. We report a case of an eight week old baby boy, with a short history of cough, difficulty in breathing, marked tachycardia and signs of respiratory distress. He was managed for bronchiolitis but eight hours later had major desaturation during feeding which needed intubation and mechanical ventilation. He improved over the next few hours and self extubated but after 12 hours needed reintubation and ventilation following a similar event of desaturation as observed previously. The chest x ray revealed cardiomegaly and diuretics were added in the on going management and he was gradually weaned off from the ventilator. The echocardiography examination revealed ALCAPA, resulting in myocardial ischaemia. Surgical revascularization was performed and baby was discharged after ten days on regular anti failure medication in a stable condition.

Ali N.,Armed Forces Institute of Cardiology | Rizwi F.,Islamabad Medical and Dental College | Iqbal A.,Armed Forces Institute of Cardiology | Rashid A.,Armed Forces Institute of Cardiology
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To determine the role of remote ischemic pre-conditioning (rIPC) on myocardium, against ischemia reperfusion injury in patients undergoing coronary artery bypass graft (CABG) surgery by measuring CKMB levels. Study Design: A randomized controlled trial. Place and Duration of Study: The Surgical Department of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from January to June 2008. Methodology: One hundred patients with double and triple vessels coronary artery disease were randomized in two groups of 50 each. rIPC protocol consisted of 3 x 5 minutes of forearm ischemia, induced by a blood pressure cuff inflated to 200 mmHg, with an intervening 5 minutes of reperfusion, during which the cuff was deflated. Patients in the control group were not subjected to limb ischemia. The protocol of induced ischemia was completed before placing patients on extracorporeal bypass circuit. At the end of surgery serum CKMB levels were measured and compared at 8, 16, 24 and 48 hours from both the groups. Written informed consent was taken from patients. Study was approved by the hospital ethical committee. Results: Remote ischemic pre-conditioning significantly reduced CKMB levels at 8, 16, 24 and 48 hours after surgery with p-values of 0.026, 0.021, 0.052 and 0.003 respectively. There was mean reduction of 3 iu/l in CKMB levels, in patients who underwent rIPC protocol prior to CABG surgery, compared to control group. Conclusion: This study showed a significant reduction of enzyme marker CKMB in patients subjected to rIPC prior to CABG surgery. This suggests lesser degree of myocardial damage compared to control group in CABG patients.

Rehman S.,Institute of Biomedical and Genetic Engineering | Akhtar N.,Shifa Tameer e Millat University | Saba N.,Institute of Biomedical and Genetic Engineering | Munir S.,Institute of Biomedical and Genetic Engineering | And 3 more authors.
Cytokine | Year: 2013

Inflammation is an important contributor to the pathogenesis of rheumatic heart disease (RHD), a disorder of heart valves caused by a combination of immune, genetic and environmental factors. Cytokines are important mediators of inflammatory and immune responses. The aim of this study was to investigate the role of cytokine gene polymorphisms and their potential usefulness as biomarkers in RHD patients from Pakistan. We screened 150 RHD patients and 204 ethnically matched controls for tumor necrosis factor (TNF)-α-308G/A, interleukin (IL)-10-1082 G/A, interleukin (IL)-6-174 G/C and a variable number of tandem repeats (VNTRs) polymorphism of the IL-1Ra gene using polymerase chain reaction. The results showed that TNF-α-308 A and IL-6-174 G alleles were associated with susceptibility to RHD (p=0.000; OR=2.81; CI=1.5-5.14 and p=0.025; OR=1.50; CI=1.04-2.16 respectively). The TNF-α-308 AA and GA genotypes were associated with susceptibility to RHD (p=0.012; OR=9.94; CI; 1.21-217.3 and p=0.046; OR=1.97; CI=0.98-3.97 respectively) while the GG genotype seemed to confer resistance (p=0.003; OR=0.39; CI=0.20-0.76). The GG genotype for IL-6-174 was significantly associated with predisposition to RHD (p=0.015; OR=2.6; CI=1.17-5.85). The A1 (four repeats) and A2 (two repeats) alleles at the IL-1Ra VNTR polymorphism were associated with resistance and susceptibility to RHD respectively. However, this polymorphism deviated from Hardy-Weinberg equilibrium in both patients and controls in our population. TNF-α-308 and IL-6-174 polymorphisms may be useful markers for the identification of individuals susceptible to RHD in Pakistan. These individuals could be provided aggressive prophylactic intervention to prevent the morbidity and mortality associated with RHD. © 2012 Elsevier Ltd.

Sharif H.,Armed Forces Institute of Cardiology | Hussain S.,Armed Forces Institute of Cardiology
Journal of the College of Physicians and Surgeons Pakistan | Year: 2014

Myocardial perforation (MP) is an uncommon entity which occurs most commonly in the setting of acute myocardial infarction. We report a case of accidental left ventricular perforation during a routine coronary angiogram. A 55-year-old male, known diabetic with moderate renal impairment, non-hypertensive, suffered an acute inferior wall myocardial infarction for which he was thrombolyzed with streptokinase. Coronary angiogram was done for postmyocardial infarction angina. Judkin right, 6F diagnostic catheter was used for left ventriculogram. After the ventriculogram the patient became hemodynamically unstable. A repeat left ventriculogram with a 6F pigtail catheter showed a perforation of the basal inferoposterior wall. Two pigtail catheters were inserted into the pericardial cavity to relieve the pericardial tamponade. Emergency surgical repair of a 1.5 cm rent in the inferior wall of the left ventricle was attempted. The friable and infarcted myocardium prevented a successful repair and the patient died after 24 hours.

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