Abstract:Like elsewhere, cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality in Bangladesh. Over the past few decades, because of epidemiological transition, the prevailing disease pattern in this country changed from predominantly communicable to predominantly non-communicable disease, CVD contributes to the latter a lot. Actually, CVD particularly coronary artery disease (CAD) is getting epidemic proportion day by day. Hypertension and heart failure are on the rise, whereas the prevalence of acute rheumatic fever is declining. However, despite some efforts, reliable data concerning various aspects of CVD is inadequate at present. The current prevalence of hypertension, CAD, rheumatic fever and rheumatic heart disease and stroke may be 20-25%, 4-6%, <1/1000, 0.3-1.0% respectively. Besides conventional risk factors for different CVD, genetic predisposition and some novel issues like high salt intake, arsenicosis, hypovitaminosis D and air pollution may play important role in the aetiopathogenesis of CVD in this population. Formulation of appropriate policy and more emphasis on preventive strategy may help combat CVD in Bangladesh.

Background: The presence of ischemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill   defined. The severity of ST-segment depression on admission ECG has a strong association with   adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. The study was done to observe the extent of ST-segment depression and in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome.   Methods: This study was conducted in the Department of Cardiology in NICVD Dhaka, from   January 2006 to December 2007. Considering inclusion and exclusion criteria, a total of 183 patients   were evaluated. All the patients were evaluated clinically after admission. ECG, blood biochemistry and echocardiography were done. Patients were categorized into three groups according to the extent   of ST- segment depression.   Results: In this study, analysis of the baseline parameters revealed no statistically significant   difference among the three groups of patients (p>0.05). Mean sum of the ST-segment depression analysis was done and all mean values were more in group III patients. 41.0% patients developed  complications during the study period. Acute LVF (22.9%) was the most common complication   followed by arrhythmia (11.5%), cardiogenic shock (4.4%) and STEMI (2.2%). All the complications were more in group III patients. During this period 6% patients died and more death (12.3%) was observed in group III patients.   Conclusion: The amount of ST-segment depression is a powerful predictor of adverse in-hospital   outcome in patients with non ST-segment elevation acute coronary syndrome DOI: http://dx.doi.org/10.3329/cardio.v5i1.12275 Cardiovasc. j. 2012; 5(1): 62-66

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An enhanced method for determining cardiac output using Doppler color flow imaging techniques to measure mitral orifice diameter was developed and validated in an experimental model and in clinical patients. In an in vitro circuit model, color jet width correlated well with actual orifice dimension from 12 to 24 mm (r = 0.99). In the clinical application, mitral valve area was calculated as a X b X pi/4 where a and b represent the width of the color flow stream in the mitral orifice just distal to the annulus in apical long-axis (short-diameter) and 4-chamber (90 degrees rotated, long-diameter) views, respectively. Cardiac output was then computed as the product of mitral valve area and time-velocity integral of transmitral flow from the same site. Cardiac output was also measured by thermodilution and conventional echocardiographic methods using diameters and time-velocity integrals from the left ventricular outflow tract. In 30 patients with nonvalvular heart disease, cardiac output measured by thermodilution ranged from 3.40 to 8.40 L/min. Cardiac output was determined in 28 of 30 patients (93%) by the Doppler color flow imaging technique; it ranged from 3.00 to 8.36 L/min and correlated well with thermodilution: y = 0.90x + 0.63, r = 0.91. Cardiac output was determined in 24 of 30 patients by the conventional left ventricular outflow method (80%). The cardiac output measured by the conventional method correlated less closely with thermodilution (r = 0.84), although there was no statistical difference in correlation coefficiencies between the 2 methods. These results indicate that the Doppler color flow imaging technique can be used to enhance the determination of cardiac output by echocardiography, particularly when the conventional method has resulted in technically inadequate recordings.