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Ayub A.,Islam Medical College | Anwar I.,Punjab Institute of Cardiology
Pakistan Journal of Medical and Health Sciences | Year: 2016

Background: Non-ST elevation myocardial infarction (NSTEMI) may be present among young adults and its association with high body mass index (BMI) among young adults with first NSTEMI is not known. No precise data is available in South Asian countries. Aim: To determine the frequency of young adults among patients presenting with first NSTEMI and to compare the frequency of BMI in young versus old patients with NSTEMI. Study design: Cross sectional validation survey. Setting: Emergency department, Punjab Institute of Cardiology, Lahore. Duration of study: Six months. Sample size: This study included 300 patients with NSTEMI. Results: There were 51(17%) young adults and 249 (83%) old age patients. Among 51 patients of young adults group, high BMI was noticed among 41 (80.4%) patients and in old age group, high BMI was calculated in 72 (28.9%) patients (p<0.05). Conclusion: A high frequency of young adults suffered from NSTEMI. High BMI was frequently present among young adults with NSTEMI as compared to old age. © 2016, Lahore Medical And Dental College. All rights reserved.


Sadiq M.,Childrens Hospital | Kazmi T.,Childrens Hospital | Rehman A.U.,Punjab Institute of Cardiology | Latif F.,Punjab Institute of Cardiology | And 2 more authors.
Cardiology in the Young | Year: 2012

Background: There are concerns over the outcome of device closure of secundum atrial septal defect with special reference to erosions and aortic regurgitation. Aim: To assess the medium-term outcome of device closure of atrial septal defects with special reference to complications. Methods: A total of 205 patients with secundum atrial septal defects underwent transcatheter closure from October, 1999 to April, 2009. The median age was 18 (1.4-55) years. Amplatzer Septal Occluder was used in all the patients. Medium-term follow-up was available in 176 of 200 (88%) patients. Results: Device closure was successful in 200 out of 205 (98%) patients. The device embolised in four patients and was associated with short inferior caval vein margin (p = 0.003). Balloon sizing in 71 patients (35%) resulted in implantation of a larger device (p = 0.002). Early complications included pericardial effusion, 2:1 heart block, and infective endocarditis (1 patient each). There were eight patients who reported migraine (3.9%). At median follow-up of 5.8 (0.6-10.3) years, complete closure occurred in 197 out of 200 patients. Short superior caval vein margin was associated with a residual shunt (p < 0.001). There were two patients who developed mild aortic regurgitation (1%), which correlated with a device-to-defect ratio of >1.3:1 (p = 0.001). There were no erosions, late embolisation, or thromboembolism. Atrial fibrillation occurred in three adults (1.5%). Conclusions: Device closure of secundum atrial septal defects using Amplatzer Septal Occluder is safe and effective in the medium term. Short inferior caval vein margin correlates with increased risk of embolisation and short superior caval vein margin with a residual shunt. The risk of developing aortic regurgitation is low and correlates with increased device-to-defect ratio. © Copyright Cambridge University Press 2011.


Mairaj M.I.,Punjab Institute of Cardiology | Naseer M.M.,Institute of Space Technology
Health Information and Libraries Journal | Year: 2013

Background: Punjab Institute of Cardiology (PIC) is a recognised teaching hospital for cardiac care in the Punjab province of Pakistan. PIC has established a library to fulfil the research and information needs of health care professionals. This study aims to evaluate the satisfaction of users with the services of PIC library. Methodology: A purposive sample of 15 health care professionals was selected. A semistructured interview technique based on an interview guide was used for collection of data. The data were qualitatively analysed using a thematic approach. Results: Users of PIC library were satisfied with the library collection, organisation, reference and circulation services, staff attitudes, cooling and heating. They were concerned about library space, hours, furniture and environment, and suggested more availability of electronic library services, newer collections, better Internet access and comfortable furniture. Conclusion: The study proved useful to investigate users' satisfaction with the services of PIC library. It concludes that the PIC library should maintain and strengthen the services with which users are satisfied, and improve those about which they are concerned. The study will be useful to libraries in other developing countries for improvement in their services. © 2013 Health Libraries Group.


Akbar A.M.,Punjab Institute of Cardiology
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Exercise treadmill test is interpreted as positive or negative for ischemia in the presence or absence of ST depression respectively. This study was conducted to evaluate the diagnostic value of chest pain without ST depression during exercise treadmill test. A total of 180 patients who had abnormal exercise treadmill test result and subsequently underwent coronary angiography were studied. Patients were categorised as having ST depression and angina (group A), only ST depression (group B) and only angina (group C). Coronary angiograms of all patients were assessed and compared. Out of 180 patients [159 (88.3%) men and 21 (11.7%) women], 84 patients were in Group A, 64 in Group B and 32 in Group C. Characteristics like age, sex distribution and risk factors were similar in three groups. Significant coronary artery disease was seen in 77 (91.7%), 40 (62.5%) and in 25 (78.1%) patients in groups A, B and C respectively (p=0.02). Triple vessel disease was seen in 21 (25%), 11 (17.2%) and 5 (15.6%) patients in groups A, B and C respectively. Significant disease of left anterior descending artery was seen in 61 (72.6%), 26 (40.6%) and 23 (71.9%) in groups A, B and C respectively (p=0.001). Occurrence of both ST depression and angina during exercise treadmill test has strong association with angiographic coronary artery disease whereas occurrence of either of the two has similar association with angiographic coronary artery disease with a trend towards more disease in the latter.


Khan M.,Punjab Institute of Cardiology
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Heart Failure (HF) is a common disease with a high mortality rate. Anaemia and renal failure (RF) are often present in patients with HF and associated with worse prognosis. Objective of study was to evaluate the prevalence of anaemia and RF in patients with HF. Patients admitted in Punjab institute of cardiology Lahore with diagnosis of heart failure were enrolled from February, 2008 to December, 2008. Anaemia was defined as haemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. Of the 276 patients included in this study, 42.03% (116) had anaemia and 38.40% (106) had moderate to severe renal failure (GFR < 60 ml/min). The prevalence of anaemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).


Faisal A.W.,Punjab Institute of Cardiology
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of 1st Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us.


Iqbal J.,Punjab Institute of Cardiology
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Coronary artery bypass without cardiopulmonary bypass (CPB) has gained popularity recently with the development of devices that allow for improved exposure and standardization in off pump coronary artery bypass surgery. Off pump coronary artery bypass surgery reduces some of the morbidities traditionally attributed to CPB. The primary goal of off pump coronary artery bypass surgery is to provide an equally comprehensive operational result as the conventional operation. The purpose of the study was to compare intra operative and postoperative arrhythmias in off pump coronary artery bypass (OPCAB) verses conventional CABG. This study was a sub-group as part of a randomised control trial and was conducted from January 2006 to March 2007 at Punjab Institute of Cardiology. One hundred patients were included in 'on pump' group-A, and 100 patients in off pump' group-B. Thirty-three patients in group-A and 22 in group-B developed arrhythmias. Twenty-six patients developed atrial fibrillation in group-A and 16 patients in group-B. Mortality due to arrhythmias was 5, three were in on pump group, and 2 were in off pump group. There is non-significant tendency towards less frequency of postoperative arrhythmias in the off pump patients as compared to on pump coronary artery bypass surgery patients.


Shahid M.,Punjab Institute of Cardiology
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2011

To compare the severity of carotid artery disease in diabetic and non-diabetic patients undergoing coronary artery bypass grafting. From January to June 2008, 379 patients undergoing elective coronary artery bypass surgery were preoperatively evaluated for the presence of carotid stenoses by duplex scanning. Patients were divided into two groups, Group I, 156 (41.2%) diabetic patients and Group II, 223 (58.8%) non-diabetic patients. There were 314 (82.8%) males and 65 (17.2%) females with a mean age of 57.2 +/- 9.1 years. In diabetic group there were 125 (80.1%) males and 31 (19.9%) females with a mean age of 56.3 +/- 8.9 years. Left main stem stenosis was present in 59 (37.8%) diabetics and 45 (20.2%) non-diabetics (p<0.0001). Diffuse disease in left anterior descending (LAD) artery was observed in more diabetic patients 72 (46.2%) as compared to non-diabetics 83 (37.2%) (p<0.295). Single tight stenosis in LAD was observed in more non-diabetics. Significant carotid artery stenosis was observed in 50 (13.2%) patients. Carotid artery stenosis was observed in 30 (19.2%) diabetics as compared to 20 (9%) non-diabetics (p<0.004). Analysis of percentage stenosis of carotid artery disease in the study population revealed that >70% stenosis was present in 20 (5.3%) with 13 (8.3%) diabetics and 7 (3.1%) non-diabetics (p<0.025). Stenosis of 50-70% was observed in 30 (7.9%) of which 17 (10.9%) were diabetics and 13 (5.8%) were non-diabetics. Presence of diabetes mellitus is associated with diffuse coronary artery disease and significant carotid artery disease in patients undergoing coronary artery bypass grafting.


Khan M.A.,King Edward Medical University | Khawaja M.N.,King Edward Medical University | Hakeem F.,Punjab Institute of Cardiology
Journal of the Pakistan Medical Association | Year: 2011

Objectives: To compare, the post Myocardial Infarction in-patient outcome after thrombolytic therapy in diabetics and non diabetics, in a South Asian population. Methods: This was a prospective cross sectional study done at the Punjab Institute of Cardiology, Lahore from January to July 2009. Consecutive patients with ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent for thrombolysis. ECG was taken at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups: (A) Non Diabetics, (B) Diabetics. This cohort was followed up through the in hospital stay for major complications which were recurrent ischaemic chest pain,heart failure, arrhythmias and death. Results: A total of 182 patients were included in the study, 146 males and 36 females. In non diabetic group, ST segment resolution occurred in 74 (84%) out of 88 patients and in diabetics, 13 (13.8%) out of 94 patients. In non diabetics, complications developed in 29 (32.9%) out of 88 patients and in diabetics, 75 (79.8%) out of 94 patients (p< 0.001). Diabetes with incorporate ST resolution compared to complete resolution were found to have more in hospital complications such as: recurrent chest pain (71.6% vs 23%, p < 0.0001), heart failure (39.5% vs 15.3%, p= 0.0007), arrhythmias (59.2% vs 15.3%, p < 0.0001), mortality (7.4% vs 0%, p= 0.0082). A similar trend was observed in non diabetics: recurrent chest pain (57.1% vs 17.5%, p < 0.0001), heart failure (42.8% vs 14.8%, p= 0.0002) and arrhythmias (50% vs 12.1%, p < 0.0001). Significant interaction was seen between diabetic status and ST segment resolution with respect to clinical outcome (recurrent chest pain p < 0.0001, heart failure p = 0.025, arrhythmias p < 0.0001, and death p = 0.014). Conclusion: Diabetics with Acute Myocardial Infarction (AMI) encounter more adverse clinical outcome as predicted by incomplete ST resolution after thromboysis.


Qureshi A.E.,Punjab Institute of Cardiology | Hameed S.,Punjab Institute of Cardiology | Noeman A.,Punjab Institute of Cardiology
Pakistan Journal of Medical Sciences | Year: 2013

Background and objective: The association between serum uric acid and ischemic heart disease remains controversial and it has not yet been established as cardiovascular risk factor. Our objective was to study the association of serum uric acid level with angiographic severity of coronary artery disease in men with acute coronary syndrome (ACS). Methods: This cross-sectional study was conducted on 100 consecutive male patients presenting with ACS at Punjab Institute of Cardiology. Hyperuricemia was defined as serum uric acid level ≤ 6.5 mg/dl. Severity of ischemic heart disease was assessed on the basis of Gensini score, number of diseased vessels, critical lesions and total occlusions on coronary angiogram. Results: Mean age of normouricemic group (n=59) was 52.62 ± 9.46 years and mean age of hyperuricemic group (n=41) was 50.52 ± 9.40 years (p=0.273). Mean uric acid level; normouricemic group (4.75 ± 1.05), hyperuricemic group (7.61 ± 1.24), p < 0.001. Mean Gensini score; normouricemic group (22.15 ± 21.52), hyperuricemic group (35.69 ± 26.80). Mann Whitney U test was applied to compare the Gensini score of two groups and it showed statistically significant difference (p value <0.006). Critical lesions, total occlusions and multi-vessel disease were more frequent in hyperuricemic group but statistically significant difference was found only for total occlusions (p=0.013) and critical lesions (p=0.046). Conclusions: Hyeruricemia is associated with higher Gensini score and more frequent total occlusions and critical lesions in men presenting with acute coronary syndrome.

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