Coronary Artery Disease (CAD) imposes physical, social, and economic burden. It is amongst the leading causes of mortality and morbidity. Exercise-induced ST segment depression is considered  reliable ECG finding for the diagnosis of obstructive coronary atherosclerosis. Exercise testing has an excellent safety record. The aim of the study is to determine the frequency of significant coronary artery  disease  in  cases  with  ST-segment depression during recovery phase of exercise tolerance test. This descriptive case series was carried out at the Department of Cardiology,   Rehmatul-Lil-Alamin Institute of Cardiology, Lahore, from 11-01-2021 to 10-07-2021. A total of 89 patients were taken in this study. Conventional coronary angiography via femoral or radial route was performed. Lesions were quantified by QCA technique in addition to visual assessment. Significant CAD was labelled as per operational definition. Patients ranged between 30-70 years of age with mean age of 51.8±10.8 years. There were 56 males (62.9%) while remaining 33 (37.1%) were females. History of diabetes mellitus was reported in 31 patients (34.8%), hypertension in 38 patients (42.7%) and smoking 51 (57.3%). Family history of CAD found in 46 patients (51.7%). Hyperlipidemia reported in 38 patients (42.7%). Significant CAD was observed in 76 patients (85.4%).   Stratification   for   age,   gender,   diabetes mellitus, hypertension and smoking were carried out and found no association with significant CAD. In conclusion, 85.4% frequency rate of significant coronary artery disease in cases with ST segment depression during recovery phase of exercise tolerance test   was   observed.   Thus,   careful   evaluation   of   ST segment depression occurring in recovery phase may add significantly to the clinical information derived from the results of ETT.

Congestive heart failure is among the most common presentations in Cardiology inpatient and outpatient departments. It is associated with several long- and short-term complications and among these patients hypo and hyperthyroidism is found frequently. This study aims to determine the frequency of subclinical hypo or hyperthyroidism in cases with congestive heart failure. This cross-sectional study was conducted at the Rehmatul-Lol-Alameen institute of cardiology, PESSI, from 23-08-2020 to 22-02-2021. This study included cases of both genders aged 30-70 years suffering from congestive heart failure. Hypothyroidism was labeled when the TSH level was between 4.6 to 10 mIU/L, and hyperthyroidism was labeled when the TSH level was between 0.01 to 0.02 mIU/L. In this study, there were 91 cases of congestive HF. There were 61 (67.03%) males and 30 (32.97%) females. The mean age of the subjects was 2 51.53±9.23 years, and the mean weight was 75.71±15.18 kg. There were 20 (21.98%) cases with a history of DM. Hypothyroidism was observed in 19 (20.88%) of the cases, and hyperthyroidism in 08 (8.79%) of the cases. There was no significant difference in gender, age, BMI, duration of HF, and DM with hypo and hyperthyroidism. We can conclude from the study results that hypo and hyperthyroidism are common in cases with congestive heart failure, though hypothyroidism cases were found to be double than the hyperthyroidism.

Atrioventricular (AV) block is an AV conduction disorder that can manifest in various settings, with varying symptomaticity and severity. Complications of acute ST-elevation myocardial infarction (STEMI) as AV blocks are often observed. The first degree of atrioventricular block is the most common and requires no treatment. The second-degree block is sub-classified in Mobitz type I and Mobitz type II. This study aimed to determine the frequency of high-degree atrioventricular block in acute anterior wall myocardial infarction cases. The current cross-sectional analysis was conducted at the Department of Cardiology, Rehmat-ul-Lil-Alameen Institute of Cardiology, Lahore, from 19-02-2021 to 18-08-2021. A total of 311 patients were enrolled in the study. Cases underwent an electrocardiogram, and high degree AV Block was labeled per operational definitions. The results were noted and recorded on the same proforma. The overall mean age of the patients was 55.6±8.4 years. Gender distribution of patients shows a higher frequency of 57.9% males compared to 42.1% females with a female-to-male ratio of 1:1.4.  High degree of atrioventricular block was found among 5.8% of the total patients. Around 5.8% of AWMI patients presented with high-grade AV block in this study are in-concomitant with other studies. No association of risk factors (p-value >0.05) was presented regarding age, gender, DM, hypertension, dyslipidemia, family history of CAD, and smoking in this study.

Acute myocardial infarction (AMI) can be fatal and, if not, can result in many short- and long-term complications. Left ventricular thrombus (LVT) is an underrated complication that can lead to systemic embolization and, ultimately, stroke or end-organ damage. The current cross-sectional study is designed to determine the frequency of left ventricular thrombus after acute anterior wall myocardial infarction at the Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, Lahore, from 12-09-2020 to 11-03-2021. All patients of 20 to 60 years of either gender meeting the operational definition of the acute anterior wall were included. LV thrombus was diagnosed on echocardiography as an amorphous echogenic structure with variable shape and adherent to the endocardium. In this study, there were 87 cases; out of these, there were 57 (65.52%) males, and 30 (34.48%) females. The mean age of the subjects was 49.90±6.27 years. Out of 87 cases, 37 (42.53%) had a history of DM, 30 (45.98%) were hypertensive, and 31 (35.63%) were smokers. Left ventricular thrombus (LVT) was found in 16 (18.39%) cases. LVT was seen in 9 (15.79%) males vs. 7 (23.33%) females with p= 0.39. LVT was seen in 5 (13.51%) cases with DM and 11 (22%) with no DM, 7 (17.50%) cases with HTN, and 9 (19.15%) normotensives with p= 0.41 and 1.0. LVT was found in 5 (22.72%) cases with ejection fraction (EF) up to 40% and 11 (16.92%) cases with EF more than this with p= 0.18. Based on the results, the left ventricular thrombus is not uncommon after acute anterior wall MI and is nearly seen in every one out of five cases and is more common in cases with ejection fraction up to 40%.

Objectives:  We aimed to see the results of conservative management of CSF rhinorrhea in post-traumatic patients. Material and Methods:  An observational study was conducted on 50 patients for 3 months from 1st November 2021 to 31th Jan 2022. Patients presented to neurosurgery unit II, PINS. All patients had a history of road traffic accidents (RTA). Results:  The age range was 10 – 50 years. The mean age was 25 years. All patients were managed conservatively for one week. We advised complete bed rest to all patients for 2 weeks. Head ends of all patients were slightly inclined from 15 – 30 degrees to reduce pressure in basal cisterns. We gave acetazolamide, mannitol, antibiotics, and anti-epileptic medication to all patients. CSF rhinorrhea in our 43 (86%) patients was stopped completely. In our 5 (10%) patients, CSF rhinorrhea was cured completely after doing a lumbar puncture with drainage of CSF and with the placement of a lumbar drain at a rate of 10 ml per hour. In our 2 (4%) patients, CSF rhinorrhea was not cured. We have to do surgery either by trans cranial or endoscopic repair of CSF rhinorrhea. Conclusion:  CSF rhinorrhea is best cured by conservative management except in 4% of cases.