Objective: Supraventricular tachycardia (SVT) is the most common presentation of patients at cardiac emergency department. This study aims to determine the quality of life in patients with supraventricular tachycardia after they treated with medicines vs. ablation therapy. Methods: This prospective clinical comparative study was held at the National Institute of Cardiovascular Diseases (NICVD). Patients 18 years or older of either gender presenting with the two most common variants of SVT i.e. Atrioventricular nodal reentry tachycardia (AVNRT) and Atrioventricular reentry tachycardia (AVRT) were eligible to be included into the study. Once stabilized at the emergency department (ED) the patients were given the option to undergo electrophysiology study and radiofrequency ablation (EPS and RFA) (group A) or opt for medications only (group B). Quality of life (sense of personal well being, impact on social life, fear of mortality or anxiety about the disease, recurrence of episodes of arrhythmia, and visits to ED) was assessed through a questionnaire filled after six months of receiving treatment. Results: A total of 120 patients were included into our study. Group A and group B were evenly divided with 60 patients each. The overall mean age of the participants and duration of cardiac illness were 44.67±18.91 and 5.42±3.13 years, respectively. Patients who received EPS and RFA (group A) had superior and statistically significant scores (better QoL) for sense of personal well being, impact on social life, fear of mortality or anxiety levels, recurrence of arrhythmia, and visits to the ED as compared to those who received medications alone, p<0.05. Conclusion: EPS and RFA vastly improved the quality of life in patients with SVT post treatment. Medications alone are associated with a high number of post treatment sequels and adverse events; therefore they are best avoided in patients with SVT.

Introduction: Higher levels of troponins >10 folds of upper normal limits (UNL) are considered as high-risk patients on coronary angiography sufferers having high levels of troponin-I (>10 folds upper limit normal level) had extra three-vessel coronary artery disease involvement. Objectives: To determine the frequency of degree of cardiovascular disease with Troponin-I level >10 folds ULN in NSTEMI patients at tertiary care hospital. Methodology: It is a cross-sectional study comprising of a total 800 patients recruited from the Department of Cardiology, National Institute of Coronary Disease, Karachi Pakistan based on Exclusion/Inclusion criteria. Results: There are 678 male as well as 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. There have been 678 male and also 122 female patients. The mean troponin-I level was 15.00±6.82 ng/ml. Single vessel disease found in 25.25% cases, two vessel diseases were observed in 37.75% cases, and three vessel diseases were observed in 20% cases. 83% were found with extent of CAD findings on angiography. Conclusion: The higher troponin level found significantly associated with extent of CAD and three vessel disease. To understand the cardiovascular troponin condition of the sufferer as soon as feasible is crucial. Keywords: Extent of Coronary Artery Disease, NSTEMI, Troponin-I Level >10 Folds ULN

Objective: To determine the frequency of heart failure after thrombolysis in STEMI patients with diabetes mellitus. Methodology: Through a prospective study we have enrolled all the diabetic patients who presented with acute ST-Segment Elevation Myocardial Infarction (STEMI) having age more than 35 years and less than 70 years who underwent pharmacological revascularization both males and females were included in this study. Patients with previous history of revascularization, end stage kidney, liver or heart disease, known advanced valvular heart disease, pregnant women, and those who develop serious complication related to streptokinase were excluded from our study. Echocardiography was done immediately after thrombolysis then after 3 days and then before discharge of the patients to determine the frequency of heart failure. Baseline and clinical data were entered and analysed using SPSS and a chi square test and p-value ≤0.05 was considered as significant. Results: A total of 175 patients were finally analysed and most of them were males as compared to females, 63.42% (N = 111) vs. 36.57% (N = 64), respectively. Mean age and SD of the patients was 55.90±10.49 years and mean duration of DM was 12.95±8.40 years. The overall frequency of heart failure in patients with post-STEMI was 56% (N = 98) and their mean ejection fraction was 38.46±8.20%. Frequency of heart failure in diabetic post-STEMI thrombolysed patients was significantly observed higher with increased age, increased duration of diabetes mellitus, hypertension, and smoking (p≤0.05). Conclusion: High prevalence of heart failure was observed in diabetic patients admitted with acute STEMI and underwent thrombolysis. The burden is even higher in males having age more than 55 years.

Objective: The aim of the study to determine the frequency of cardiogenic shock and its associated factors in patients with inferior wall myocardial infarction in tertiary care hospital. Study Design: Observational Descriptive study. Setting: Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi. Period: January to July 2017. Material & Methods: A total of 241 patients with acute inferior wall MI presented with the complain of chest pain for more than 30 minutes and less than 24 hours were recruited in this study. A detailed history including age, sex, family history and co-morbidities status was taken. Patients undergone right sided ECG. Cardiac shock was assessed and recorded prospectively. Results: There were 144 male and 97 female patients. Mean age was 52.58±10.13 years. 44.8% were hypertensive, 14.5% were diabetic, 19.1% had family history of CAD, and 14.9% were smokers. In our study, 7.9% cases were found with cardiogenic shock. The association of cadiogenic shock was found significant with age, female gender, co-morbidities (P-values<0.05). Conclusion: Cardiogenic shock (CS) remain the leading cause of death in hospitalized patients with myocardial infarction. The present study concluded that there is increased risk of cardiogenic shock in patients having inferior myocardial infarction along with right ventricular infarction. The study shows prevalence of cardiogenic shock and factors that increases the risk. The factors such as age, female gender, patients with medical conditions such diabetes and hypertension, smoking status are risk factors of cardiogenic shock in patients with coronary heart disease.