Objective: Heart failure (HF) has become an increasingly frequent cause of hospital admission and carries a poor prognosis. There is a paucity of data in Indo-Asians particularly in Bangladesh on characteristics of heart failure patients. The purpose of this study was to determine the etiological factors and co-morbidity of hospitalized heart failure patients. Method: A hospital based cross sectional study was done at a tertiary cardiac hospital in Dhaka city. Hospital medical records of 14009 patients admitted between January 2005 and August 2006 were reviewed and 1970 patients with the diagnosis of HF were identified. Relevant etiological information and socio demographic data were abstracted from the hospital record files. Result: About one-seventh of total hospital admitted patient had HF. Mean age (SD) was 54.1 (15.3) years. Majority (35.79%) had ischaemic heart disease (IHD) as the principal etiological factor but this frequently coexisted with a history of hypertension (46.8%). Hypertension was considered the primary risk factor of HF in 29.14% of cases. Hypertension alone and in coexistence with other etiology was found in 48.07% (947) cases. Diabetes Mellitus (DM) co-existed with IHD in 41.4% (292) and it (32.64%) was found more prevalent in Dilated Cardiomyopathy (DCM) patient with HF. Conclusions: The mean age of hospitalized HF patients is remarkably lower than other related studies done abroad. The single most common etiology for HF is ischemic heart disease in this population. Hypertension is the most common risk factor. Measures to prevent ischaemic heart disease and control of risk factors are essential to prevent premature onset of HF. DOI: 10.3329/jbcps.v28i1.4640 J Bangladesh Coll Phys Surg 2010; 28: 24-29

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ObjectivesLeft ventricular dysfunction and remodeling can occur as a result of aortic valve stenosis (AS). Three‐dimensional speckle tracking echocardiography (3D‐STE) can detect early left ventricular myocardial dysfunction even before ejection fraction declines. The purpose of this study was to look at the relationship between various myocardial strain parameters measured by 3D‐STE in asymptomatic severe AS patients from Bangladesh.MethodsThis study included 46 patients with asymptomatic severe AS but preserved LV systolic function (mean age 50.11 ± 12.66 years, LVEF 63.78 ± 3.95%, AS group) and 33 healthy subjects with no cardiovascular disease (mean age 48.21 ± 4.53 years, LVEF 65.15 ± 3.13%, control group). 3D‐STE was used to measure left ventricular global myocardial strain parameters such as peak systolic longitudinal strain (PSLS), circumferential strain, radial strain, and area strain.ResultsThe AS group had significantly thicker interventricular septum and posterior ventricular wall than the control group (1.49 ± .19 cm vs. .81 ± .09 cm, p < .001; 1.73 ± 1.71 cm vs. .81 ± .10 cm, p = .003, respectively.) In the AS group, the Indexed Aortic Valve Area (AVA) was significantly lower than in the control group. (.29 ± .10 vs. 2.03 ± .18, p < .001, respectively). In terms of LVEF (p = .102), left ventricular end diastolic volume (p = .075), or left ventricular end systolic volume (p = .092), no significant inter‐group difference was found. However, global PSLS (−10.75 ± 2.27 vs. −16.42 ± 2.76, p < .001), circumferential strain (−14.26 ± 3.40 vs. −16.64 ± 2.56, p = .001), area strain (−22.70 ± 4.19 vs. −26.45 ± 9.90, p = .024) and radial strain (32.20 ± 8.77 vs. 41.00 ± 7.52, p < .001) in the AS group were significantly lower than in the control group.ConclusionOur findings showed reductions in left ventricular global myocardial strains, particularly PSLS in patients suffering from asymptomatic severe AS in Bangladesh; this is consistent with other studies. Reduced area strain, detectable with 3D‐STE, is also consistent with that pattern.

Acute myocardial infarction may occur in adolescent with angiographically normal or near normal coronary arteries but the pathophysiology remain unclear. This mechanism includes in situ thrombosis or embolization with subsequent clot lysis and recanalization and vascular endothelial dysfunction, per se or combined. An one adolescent male having acute myocardial infarction (inferior with posterior with right ventricular infarction) was reported with no anomalous coronary artery nor history of risk factors for coronary artery disease and no history of drug abuse. He was thrombolysed in addition to per oral clopidegrol (600mg) and aspirin (300 mg) and other conventional anti-ischemic treatment. Two hours later the patient was pain free and there was complete resolution of ST segment. Five days later he was scheduled for coronary angiography. Key words: Adolescent myocardial infarction, coronary artery. DOI: 10.3329/jafmc.v5i2.4583 JAFMC Bangladesh Vol.5(2) (December) 2009, pp.40-43

<p>A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9^th post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.</p>