Open Access Original Article

Introduction Non-ST segment elevation myocardial infarction (NSTEMI) is becoming more common than ST segment elevation myocardial infarction (STEMI) and data regarding presence of underlying multivessel coronary artery disease (MVCAD) in these patients is consistent in locoregional population that leads to lethal delays in proper management. Therefore, in the current study, we aimed to evaluate the frequency of MVCAD in NSTEMI with markedly raised troponin T levels. This will help to identify patients that should be labeled as high risk and must be referred for coronary revascularization on priority basis, so that clinical outcomes can be improved in these patients. Methods This cross-sectional research study was carried out at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan over a period of one year. A total of 326 patients with history of chest discomfort within past 48 hours of presentation or angina equivalent symptoms and cardiac troponin T more than 500 ng/l were included in the study. Coronary angiography was done within 72 hours of same hospital admission. The outcome variable i.e. MVCAD was determined. Results Mean age of patients was 50.74 ± 7.75 years with range of 30 to 60 years. MVCAD was found in 107 (32.82%) patients, whilst there was no MVCAD in 219 (67.18%) patients. Moreover, no significant association of MVCAD was noted with age or smoking.

Background: Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function. Material and Methods: This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic. Results: Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient. Conclusions: Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six months

Background: Coronary artery disease (CAD) is associated with the highest mortality in women around the world. The objective of this study was to compare the clinical risk factors and angiographic pattern of coronary artery disease in young versus old age females having CAD.Material and Methods: This cross-sectional study was conducted at the Department of Cardiology, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology Multan, Pakistan from April 2018 to December 2018. All females with diagnosis of angina and consistent ischemic changes on ECG were enrolled in the study. A total of 230 females were included with 123 patients aged <45 years and 107 patients aged >45 years. Comparison of patient characteristics, clinical risk factors and angiographic pattern in young and old age females was done by using SPSS version 21 statistical software.Results: Prevalence of hypertension (P=0.001), dyslipidemia (P=0.06) and diabetes mellitus (P=0.007) was significantly higher in females of older age group (>45 years). Similarly, a larger number of older age females (32; 29.9%) presented with ST-Elevation Myocardial Infarction (STEMI) as compared to young female patients (22; 17.88%) (P=0.03). Regarding angiographic patterns of CAD, there was no difference in the prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) between the groups. Normal angiogram was found in 13 (12.3%) old age females versus 35 (28.8%) young females, respectively (P=0.002).Conclusions: The risk factors profile and clinical presentation of CAD is different in young female patients with CAD. There is an essential need to determine the coronary atherosclerosis factors in young females and these women should be treated more aggressively to prevent adverse cardio-vascular outcomes.Key words: Angiographic Pattern, Coronary Artery Disease, Clinical Pattern, Young Females

Objective: To determine the prevalence of metabolic syndrome (MetS) in patients of acute coronary syndrome. Methodology: This cross-sectional study was conducted in department of cardiology, CPE institute of cardiology Multan. A total of 150 patients of ACS who were admitted in the hospital from Oct-2018 to March-2019 were included. Patients demographics, reason for admission in hospital were noted. Waist circumference, body mass index (BMI), serum lipid profile, and fasting blood sugar was measured in all patients. Results: Metabolic syndrome (MetS) was diagnosed in 53 (35.3%). Frequency of heart failure was lower in Non-MetS group; 17 (17.5%) versus 15 (28.3%) in MetS group (p-value 0.12). STEMI was 10 (18.8%) in MetS group whereas it was 28 (28.8%) in Non-MetS group (p-value 0.18). Arrhythmias occurred in 5 (9.4%) in MetS group; as compared to 5 (5.15%) in Non-MetS group (p-value 0.32). Conclusion: The prevalence of MetS in present study was 35.3% and these patients were mostly female and obese. These were more likely admitted because of heart failure and arrhythmias. Key Words: Metabolic syndrome, Acute coronary syndrome, heart failure, myocardial infarction