Objective: To determine the frequency of factors that cause potassium imbalance in patients with postoperative arrhythmias after cardiac Bypass surgery Material and methods: During the time period of 2 November 2018 through 10 January 2020, 100 patients with heart disease receiving open-heart surgery were enrolled in a prospective observational research conducted by the cardiac surgery department at the Punjab Institute of Cardiology in Lahore. Both genders of age 17-70 years were included and patients with cyanotic heart disease congenital heart disease, previous cardiac surgery and urgent CABG were excluded. Results: Our results showed that of 100 patients, 59 (59%) were male and 41 (41%) were female and the mean age was14.243 ± 50.12 years. 6 patients had preexisting renal failure and 9 had postoperative renal failure. Overall potassium imbalance was noted in 39 patients, 33 were hypokalemic and 6 were hyperkalemic and the mean potassium with S.D was 3.95±0.83 and 37 had postoperative arrhythmias out of which 18 (54.5%) were hypokalemic and 2 (33.3%) were hyperkalemic. Preoperative drugs, preexisting renal failure, CPB time, aortic cross clamp time, intraoperative potassium levels, time on ventilation, postoperative urine output, potassium infusion, postoperative renal failure, arrhythmias and total hospital stay were found to be statistically significant. Conclusion: Potassium imbalance post-cardiopulmonary bypass is major factor that may lead to increased risk of postoperative arrhythmias. Keywords: Potassium imbalance, cardiopulmonary bypass, postoperative arrhythmias, renal failure, hypokalemia

Objective: To assess the frequency of thrombus formation in LV post Anterior wall ST Segment elevation acute MI. Methodology: In this descriptive case series during the year 2018 we included 100 cases of age 40-70years of either gender presenting with STEMI planned to undergo Transthoracic echocardiography. Demographic information including name, age, gender, BMI, smoking and diabetes (BSR>186mg/dl) was also noted. Then patients were admitted in cardiology wards and were followed-up there. Then patients were discharged after 3days and were followed-up in OPD for one week. After one week, patients were evaluated on 2-D Transthoracic echocardiography and LV thrombus was labeled. The patients who had LV thrombus, were managed as per hospital protocol. Results: The mean age of patients was 56.68±8.59years. There were 90 (90%) males and 10 (10%) females. The mean BMI of patients was 24.54±3.49kg/m2. There were 43 (43%) smokers and 57 (57%) were non-smokers. There were 36 (36%) diabetics and 64 (64%) were non-diabetics. In this study, 63 (63%) underwent thrombolysis and 87 (87%) underwent primary PCI after STEMI. There were 7 (7%) cases who developed LV thrombus while 93 (93%) were remained free of LV thrombus. Concussion: Frequency of Left ventricular thrombus formation is low in our local population. Keywords: Left ventricular thrombus, anterior wall myocardial infarction, ST-segment elevation myocardial infarction, Transthoracic echocardiography

Aim: To assess the outcomes of primary percutaneous coronary intervention among patients of complete atrioventricular block with acute inferior ST-elevation myocardial infarction Methods: We conducted an observational study of patients with CAVB and STEMI who underwent Primary PCI at interventional cardiology department, national institute of cardiovascular diseases Karachi during the period from January 1, 2022 to July 31, 2022. The primary outcomes were in-hospital mortality and CAVB resolution. Results: A total of 100 patients were included in the study. The mean age was 60.63±5.63 years, and 61% were male. The median door-to-balloon time was 89.96±17.97 minutes. In hospital mortality rate was 4%. CAVB was resolved in 93%. Conclusion: For patients with CAVB and STEMI, Primary PCI is a safe and successful treatment with a low rate of in-hospital mortality. These findings support the use of primary PCI in this patient population. Keyword: Primary PCI, CAVB, STEMI

Objective: To determine the rate of adverse outcome in patients with at least five TIMI scores after primary percutaneous coronary intervention. Methods: We conducted this descriptive study at National Institute of Cardiovascular Diseases Karachi for six months. This study included 200 men and women with chest pain who presented to the emergency department with chest pain and ST-segment elevation myocardial infarction. PCI processes were executed by cardiologists, and any post-procedure adverse outcomes were noted throughout the hospital stay. Results: A total of 200 participants were involved, 167 (83.5%) being males, and 33 (16.5%) being females. There were 95 (47.5%) moderate risk cases and 105 (52.5%) high-risk cases based on the TIMI scores. In the survey of patient outcomes, death occurred in 18.5% of cases, heart failure was observed in 43 cases (21.5%), cardiogenic shock was observed in 27 cases (13.5%), and ventricular arrhythmia was observed in 44 (22%) cases. Practical Implication: This research on the outcomes of primary PCI in patients with a TIMI score of five or higher can provide valuable information for healthcare providers, leading to improved patient selection, enhanced treatment decision-making, tailored interventions, reduced morbidity and mortality rates, and increased cost-effectiveness in managing myocardial infarction cases. These practical implications can significantly benefit the community by improving patient outcomes and optimizing healthcare resource utilization. Conclusion: A TIMI risk score of five or higher can also identify patients who may have heart failure, cardiogenic shock, and ventricular arrhythmias. Keywords: Primaryipercutaneous coronary intervention, thrombolysis, myocardial infarction, score of five or higher.

Objective: The object of our research was to determine whether intra-aortic balloon pump-assisted PCI improved overall clinical outcomes during hospitalization, as well as to predict in-hospital mortality and cardiogenic shock. Methods: This retrospective study was carried out at National Institute of Cardiovascular Diseases Karachi. We enrolled 60 consecutive patients with a history of AMI complicated by cardiogenic shock. These patients underwent PCI with insertion of an IABP between 1st September 2019 and 28th February 2020. Patients with cardiogenic shock would have better survival if the IABP was inserted before PCI rather than after PCI was performed. The prospective study included 60 patients (33 patients received IABP before PCI, before and 27 after PCI) suffering from cardiogenic shock complicating acute myocardial infarction who underwent PCI with IABP. SPSS version 23.0 was used to analyze all the data. Results: Based on the type of treatment, we divided individuals into two groups in our study. The IABPs were inserted before PCI in 33 patients in group A, and the pumps were started after PCI in 27 participants in group B. It was significantly different regarding the 30-day mortality rate between IABP support after PCI and IABP-assisted PCI (59.2% versus 18.1%, respectively, p = 0.006). Among the entire study population, no reinfections or repeat PCI were reported. There was no significant difference between these two groups in the rates of emergency bypass surgery and cerebral vascular events. Practical Implication: This research study on in-hospital mortality among patients with acute coronary syndrome and cardiogenic shock treated with PCI and IABP has practical implications that benefit the community. It enhances patient outcomes, informs clinical decision-making, contributes to treatment guidelines and protocols, facilitates healthcare resource allocation, and inspires future research and innovation. Ultimately, the study aims to improve the quality of care provided to patients in this specific population, leading to reduced mortality rates and improved patient well-being Conclusion: This study concluded that PCI assisted by IABP results in a better outcome for patients with cardiogenic shock complicating acute myocardial infarction and a lower mortality rate compared to IABP after PCI. Keywords: In-hospital mortality, percutaneous coronary intervention, intra-aortic balloon pump.