Han Naung Tun
University of Zurich, Switzerland, Cardiology, Department Member
- University of Vermont, Medicine, Faculty Memberadd
- noneedit
- Han Naung Tun, MBBS, MD is a cardiologist and researcher affiliated with the University of Vermont’s Larner College o... moreHan Naung Tun, MBBS, MD is a cardiologist and researcher affiliated with the University of Vermont’s Larner College of Medicine and a fellow of both the American College of Cardiology and the European Society of Cardiology. Dr Han has authored and co-authored more than 50 scientific publications. He is a member of the Web & Communication Committee of the European Association of Cardiovascular Imaging (EACVI), where he also served as an Ambassador of Echocardiography for Myanmar as a “Heart Imager of Tomorrow.” His research interests lie in both clinical and translational cardiology, focusing on heart failure, cardiac imaging, and preventive cardiology.edit
Aims It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients,... more
Aims
It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.
Methods and results
We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.
Conclusion
Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.
It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.
Methods and results
We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.
Conclusion
Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.
Full text is available on the Publisher's website Aims It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of... more
Full text is available on the Publisher's website
Aims
It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.
Methods and results
We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.
Conclusion
Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.
Aims
It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.
Methods and results
We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.
Conclusion
Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.
Research Interests:
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area... more
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used ...
Research Interests:
Hypertension is one of the most common disorders encountered, yet pharmacotherapy for resistant hypertension has limited effective options. Aprocitentan is postulated to be a novel anti-hypertensive. The main goal was to determine the... more
Hypertension is one of the most common disorders encountered, yet pharmacotherapy for resistant hypertension has limited effective options. Aprocitentan is postulated to be a novel anti-hypertensive. The main goal was to determine the effect of aprocitentan on blood pressure among patients with hypertension. A thorough search of five electronic databases, including PubMed Central, PubMed, EMBASE, Springer, and Google Scholar, was carried out. The study included nine articles with a total of 2024 participants. With doses exceeding 25 mg, plasma ET-1(endothelin-1) concentrations, which show ETB (Endothelin receptor type B) receptor antagonism, significantly rose. Aprocitentan significantly reduced systolic and diastolic blood pressure with both doses of 10mg and 25mg in patients with hypertension. Further research is warranted to evaluate the efficacy, safety, and long-term outcomes of aprocitentan and its synergistic effect with other anti-hypertensives
Research Interests:
Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when compared to left-sided failure. However,... more
Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when compared to left-sided failure. However, there are more emerging data in recent years, and several studies have emphasized the unique features of the right ventricle regarding its anatomy, pathophysiology, clinical consequences, diagnostic modalities, and treatment options. Despite that, management of acute right ventricular failure is still challenging. This article summarizes an overview of acute right heart failure including pathophysiology, causes, clinical features, and diagnostic work-up with emphasis on the role of echocardiography
Research Interests:
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area... more
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used instead of conventional pacemakers. Both HBP and LBBP are being investigated as alternatives to conventional CRT
Research Interests:
Introduction: Myocardial bridging (MB) is an inborn abnormality of coronary vessel. It occurs when a segment of a coronary artery or its major branch travels through the myocardium instead of on th...
Research Interests:
Contrast echocardiography Second generation contrast agents allows improved visualisation of the endocardium, which is useful in the assessment of: • LV systolic function in patients with poor endocardial border delineation • LV... more
Contrast echocardiography Second generation contrast agents allows improved visualisation of the endocardium, which is useful in the assessment of: • LV systolic function in patients with poor endocardial border delineation • LV pseudoaneurysms • Intracardiac masses They may also be used to facilitate the diagnosis of aortic dissection. Despite some earlier safety concerns regarding the use of contrast agents, recently published data revealed no increase in mortality in patients who underwent contrast-enhanced echocardiography examinations, including critically ill patients. Agitated saline may be useful to: • Differentiate between intracardiac and intrapulmonary shunting • Confirm correct placement of the cannula/drain during echocardiographic-guided pericardiocentesis Click here for a review of the use of contrast echocardiography in the intensive care, and here for the EACVI recommendations on the use of contrast echocardiography. Focused echocardiography Several focused echo pro...
Research Interests:
Introduction: There is alarming problem in increasing incidence of hypertension and its complications in Myanmar. The genetic background of hypertension is not known well in Myanmar population. The present study aimed to find out the... more
Introduction: There is alarming problem in increasing incidence of hypertension and its complications in Myanmar. The genetic background of hypertension is not known well in Myanmar population. The present study aimed to find out the association with angiotensinogen gene M235T polymorphism, plasma angiotensinogen level, BMI and essential hypertension in local area.
Research Interests:
Citation: Han Naung Tun. “Trends in Interventional Cardiology: What 2019 Left Promising Hopes in Interventional Cardiology Practice?”. EC Cardiology 7.3 (2020): 01-03. *Corresponding Author: Han Naung Tun, Council on Clinical Practice,... more
Citation: Han Naung Tun. “Trends in Interventional Cardiology: What 2019 Left Promising Hopes in Interventional Cardiology Practice?”. EC Cardiology 7.3 (2020): 01-03. *Corresponding Author: Han Naung Tun, Council on Clinical Practice, Clinical and Research Working Groups, European Society of Cardiology and National Representative of Heart Failure Specialist of Tomorrow for Myanmar in European Heart Failure Association, European Society of Cardiology, France.
Research Interests:
Ventricular septal rupture (VSR) definitive treatment, but it remains challenging and associated with high morbidity and mortality. We present a 58-year-old patient with AMI who developed VSR 72 h after primary revascularization, the... more
Ventricular septal rupture (VSR) definitive treatment, but it remains challenging and associated with high morbidity and mortality. We present a 58-year-old patient with AMI who developed VSR 72 h after primary revascularization, the patient was complicated by cardiogenic shock managed with mechanical circulatory support and an attempt at VSR closure was performed by percutaneous closure procedure under transoesophageal echocardiographic guidance. As the defect was extensive and large for percutaneous closure, the procedure failed and was aborted. The patient died of cardiogenic shock with severe acute pulmonary edema one week post PCI, while awaiting the surgical repair procedure.
Research Interests:
Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D... more
Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D < 10 ng/mL (n = 59); 2: 25(OH)D 10–20 ng/mL (n = 82), and 3: 25(OH)D > 20 ng/mL (n = 28). Based on a cut-off GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT ≤19 (n = 66) and GGT >19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = −0.23; p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of >19 U/L in predicting vitamin D deficiency...
Research Interests:
Since the beginning of the COVID-19 pandemic, healthcare workers (HCWs) have been under immense physical and psychological stress as they face the pandemic sequelae of being the frontline workers. Unfortunately, mental health consequences... more
Since the beginning of the COVID-19 pandemic, healthcare workers (HCWs) have been under immense physical and psychological stress as they face the pandemic sequelae of being the frontline workers. Unfortunately, mental health consequences could affect HCWs during and even after the pandemic. Hence, we aimed through this survey to study the prevalence of anxiety among HCWs during the COVID-19 pandemic.
Research Interests:
Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D... more
Background: No previous study has investigated the association between gamma glutamyltransferase (GGT) and vitamin D in patients with stable coronary artery disease (CAD). We investigated the cross-sectional associations between vitamin D status as assessed by serum 25(OH)D and GGT. Methods: 169 patients were enrolled. Study population was divided into three groups: 1: 25(OH)D < 10 ng/mL (n = 59); 2: 25(OH)D 10-20 ng/mL (n = 82), and 3: 25(OH)D > 20 ng/mL (n = 28). Based on a cutoff GGT value identified in ROC analysis, we also divided the study population to compare the following groups: GGT ≤19 (n = 66) and GGT >19 (n = 103). Results: GGT activity was the highest in vitamin D severely deficient patients and the lowest in vitamin D insufficient patients. GGT was inversely correlated with 25(OH)D concentrations (R = −0.23; p = 0.002). The receiver operating characteristics curve identified the discrimination threshold of GGT of >19 U/L in predicting vitamin D deficiency. Higher leukocyte and neutrophil counts and lower 25(OH)D concentration were found in patients with GGT > 19 U/L. Conclusions: We identified an interaction between declining 25(OH)D levels and rising GGT levels with increasing age, which resulted in an unfavorable 25(OH)D-to-GGT ratio in stable CAD patients. These results suggest that these changes might further contribute to a high cardiovascular risk in the elderly.
THE European Society of Cardiology (ESC) Congress 2020 presented several promising clinical trials that may potentially change our practice in heart failure management. Among the trials and studies reported on, I am going to evaluate the... more
THE European Society of Cardiology (ESC) Congress 2020 presented several promising clinical trials that may potentially change our practice in heart failure management. Among the trials and studies reported on, I am going to evaluate the most important heart failure studies that may change our practice. What does the future look like for heart failure management?
Research Interests:
Bradycardia is commonly encountered in emergency department. Hyperkalemia may sometime cause bradycardia with block and also synergize with AV node blockers to cause bradycardia and hypoperfusion. We report a 53 years old male with... more
Bradycardia is commonly encountered in emergency department. Hyperkalemia may sometime cause bradycardia with block and also synergize with AV node blockers to cause bradycardia and hypoperfusion. We report a 53 years old male with history of hypertension, congestive heart failure and coronary artery disease was admitted to hospital for sudden onset of breathlessness. He underwent percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery and left circumflex (LCx) artery one year ago and taking Aspilet 80 mg for daily, Clopidogrel 75 mg daily, Ramipril 5 mg daily, Atorvastatin 20 mg daily, Metoprolol 25 mg daily, Spironolactone 25 mg daily and Frusemide 40 mg daily. Significant physical examination was remarkable for a temperature 97.5'F, blood pressure of 110/70 mmHg, heart rate of 40 beats per minute, oxygen saturation was 99% on air and both lung were full with audible crepitation by auscultation. He was given atropine 0.6 mg bolus and transcutanaeous pacing with unimproved heart rate and then a transvenous pacing was immediately placed before the blood investigation results were returned. His relevant laboratory values were significant for a potassium of 7.99 mmol/L(ref range : 3.5-5.2 mmo/l) , creatinine of 458 micmol/L (ref range : 59-104 micmol/L) , Urea of 33.9 mmol/L (ref range : 2.7-8.0 mmol/l), random blood glucose of 233mg/dl , sodium 126.8 mmol/L (ref range 135-145 mmol/L) , anion gap of 13.5 mmol/? (ref range : 3.6-11.0 mmo/L) and bicarbonate of 15.6 mmil/L (ref range: 22-29 mmol/L). He was given calcium glucoronate , insulin with dextrose , kaexylate , nebulizer salbutamol with significant improvement in his potassium levels to 4.6 in 24 hours. In Cardiac intensive care unit his heart rate was improved and the transvenous pacemaker was turned off the next day.
Research Interests:
Background: Heart failure (HF) is one of the leading causes of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission among patients in Pakistan and worldwide. Despite this... more
Background: Heart failure (HF) is one of the leading causes of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission among patients in Pakistan and worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients themselves can identify the underlying factors that contribute to their readmissions.
Research Interests:
Coronaviruses are a group of related viruses, cause respiratory tract infections in human that can be mild as common cold and can be lethal, such as SARS, MERS, and COVID-19. Coronavirus disease 2019 (COVID-19) is caused by severe acute... more
Coronaviruses are a group of related viruses, cause respiratory
tract infections in human that can be mild as common cold and can
be lethal, such as SARS, MERS, and COVID-19. Coronavirus disease
2019 (COVID-19) is caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). The disease was first identified in November 2019 in Wuhan, the capital of China's Hubei province, and
has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic Worldwide, total numbers of cases have reached up to 1,188,486with recovered cases 244,280 and deaths 64,091. To begin with China was having the most diagnosed cases but currently USA is
leading by 302,919 and Spain following by 124,736. This data has
been changing dramatically everyday
tract infections in human that can be mild as common cold and can
be lethal, such as SARS, MERS, and COVID-19. Coronavirus disease
2019 (COVID-19) is caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). The disease was first identified in November 2019 in Wuhan, the capital of China's Hubei province, and
has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic Worldwide, total numbers of cases have reached up to 1,188,486with recovered cases 244,280 and deaths 64,091. To begin with China was having the most diagnosed cases but currently USA is
leading by 302,919 and Spain following by 124,736. This data has
been changing dramatically everyday
Research Interests:
Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during... more
Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention.Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique.PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle
Research Interests:
In the end of last decade, 2019 left us with some promising trials that potentially may change our interventional practice. Among the numbers of trials and studies were published in 2019, I am going to cull some interesting clinical... more
In the end of last decade, 2019 left us with some promising trials that potentially may change our interventional practice. Among the numbers of trials and studies were published in 2019, I am going to cull some interesting clinical trials that may have changed our practice. What was ahead in 2019 for interventional cardiovascular medicine? They are modifying use of antiplatelet in acute coronary syndrome (ACS) and other conditions; new paradigms in the management of revascularization strategy; increased use of transcatheter aortic valve replacement (TAVR) and emerging of new generation stents and its effective outcomes. Revascularization in acute coronary syndrome (ACS) In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. COMPLETE (Complete Revascularization with Multivessel PCI for Myo-cardial Infarction) Trial funded by the Canadian Institutes of Health Research has given interesting results that may change our practice in revascularization of coronary arteries. The COMPLETE trial was presented at European Society of Cardiology (ESC) Congress 2019 and studied patients presented with STEMI and multivessel disease. The study was concluded that among patients with STEMI and multives-sel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization [1]. Antiplatelet therapy Another interesting trial that was conducted in Acute Coronary Syndrome (ACS) is ISAR-REACT 5 (The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5) trial. German Center for Cardiovascular Research and Deutsches Herzzentrum München supported this phase 4, multicenter, randomized, open-label trial was conducted in patients who presented with acute coronary syndromes with or without ST-segment elevation. The trial has given hope for patients who presented with acute coronary syndromes with or without ST-segment elevation, the incidence of death, myocardial infarction, or stroke was significantly lower among those who received prasugrel than among those who received ticagrelor and the incidence of major bleeding was not significantly different between the two groups [2]. When it comes to dual antiplatelet therapy (DAPT), Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT) study was one of the biggest highlights. In this double-blind trial, the trialists examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding
Research Interests:
Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries , whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments,... more
Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries , whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). CTCA uses computed tomography (CT) scanning to take images (angiograms) of the coronary arteries. It requires the use of rapid CT scanning techniques and can only be carried out in centers where the equipment is suitable and the medical/technology staffs are trained appropriately. Computed Tomography Coronary Angiography is the preferred test in patients with a lower range of clinical likelihood of CAD, no previous diagnosis of CAD, and characteristics associated with a high likelihood of good image quality. It detects subclinical coronary ath-erosclerosis but can also accurately rule out both anatomically and functionally significant CAD. Its higher accuracy values of CTCA when low clinical likelihood populations are subjected to examination [1]. Trials evaluating outcomes after coronary CTA to date have mostly included patients with a low clinical likelihood [2,3]. The non-invasive functional tests for ischaemia typically have better rule-in power. In outcome trials, functional imaging tests have been associated with fewer referrals for downstream ICA compared with a strategy relying on anatomical imaging [4,5]. Functional evaluation of ischaemia (either non-invasive or invasive) is required in most patients before revascularization decisions can be made. Therefore , non-invasive functional testing has now come to be preferred in patients at the higher end of the range of clinical likelihood if revas-cularization is likely or the patient has previously diagnosed CAD. If CAD is suspected in patients, but who have a very low clinical likelihood (≤ 5%) of CAD, should have other cardiac causes of chest pain excluded and their cardiovascular risk factors adjusted, based on a risk-score assessment. In patients with repeated, unprovoked attacks of anginal symptoms mainly at rest, vasospastic angina should be considered, diagnosed, and treated appropriately In addition to diagnostic accuracy and clinical likelihood, the selection of a non-invasive test depends on other patient characteristics, local expertise, and the availability of tests. Some diagnostic tests may perform better in some patients than others. For example, irregular heart rate and the presence of extensive coronary calcification are associated with increased likelihood of non-diagnostic image quality of CTCA and it is not recommended in such patients [1]. Stress echocardiography or SPECT perfusion imaging can be combined with
Research Interests:
Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patients with unexplained syncope. Methodology: This quasi experimental study was done at National Institute of Cardiovascular diseases Karachi... more
Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patients with unexplained syncope. Methodology: This quasi experimental study was done at National Institute of Cardiovascular diseases Karachi and Chaudhry Pervaiz Elahi Institute of Cardiology Multan Pakistan from January to December 2018. Patients presented with unexplained syncope 64 syncope patients were included and HUTT was done. were included. Outcome including positive HUTT, response to HUTT, phase of HUTT and the effect of age and gender in patients with unexplained syncope undergoing HUTT. Results: The mean age of patients was 63.39±6.94 years. There were 51 (79.7%) male while 13 (20.3%) were females. HUTT was found to be positive in 37 (57.8%) patients while 27 (42.2%) patients had negative HUTT. Mixed HUTT response was observed in 18 (48.6%) patients, cardio-inhibitory reposes in 8 (21.6%) patients while vaso depressive response in 11 (17.2%) patients. Active HUTT phase was observed in 30 (81.1%) patients while 7 (18.9%) patients had passive HUTT phase. The age and gender were found to have insignificant impact on HUTT findings (p>0.05). Conclusion: Thus the frequency of positive HUTT is high in unexplained syncope patients. No significant difference was found in the frequency of responses to HUTT between the gender groups. The trend of the HUTT result significantly changed with age.
Research Interests:
Temporary cardiac pacing via trans-venous approach is a treatment technique of choice in case of life threatening arrhythmias. This approach is used to re-establish the hemodynamics that are acutely compromised by a fast or slow heart... more
Temporary cardiac pacing via trans-venous approach is a treatment technique of choice in case of life threatening arrhythmias. This approach is used to re-establish the hemodynamics that are acutely compromised by a fast or slow heart rate. Inadvertent lead placement into abnormal locations is an uncommon but serious complication of temporary cardiac pacing in emergency departments. These can easily be detected and managed, even in emergencies, with the help of readily available modalities including 12-lead ECG and chest x-rays, as well as transthoracic echocardiography. Here, we report 2 cases of mal-placement of temporary pacing lead and their timely management to highlight the significance of simple yet necessary post procedure investigation techniques.
Research Interests:
Introduction: An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardio-vascular (CV) events; however, it is unknown whether this association is true in patients with associated diabetes mellitus (DM).
Research Interests:
Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classical ischemic electrocardiographic (ECG) changes and unremarkable cardiac biomarkers. This syndrome shouldn't be missed by the clinicians as... more
Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classical ischemic electrocardiographic (ECG) changes and unremarkable cardiac biomarkers. This syndrome shouldn't be missed by the clinicians as delay in urgent coronary intervention can result in anterior wall myocardial infarction (MI), arrhythmias, left ventricular dysfunction and death. It can be predicted by patient's history and ECG changes. Thus, physicians and health care providers should be familiar with the electrocardiographic manifestations about Wellens' Syndrome in clinical care. Here, we are describing a case of middle aged male patient presented with history of typical chest pain with slightly elevated blood pressure (BP) with an initial ECG showing Brugada pattern, patient was admitted and started with antiplatelets, anti-ischemics and anticoagulants followed by serial ECGs but after 3 hours ECG done showed wellenoid pattern for which he underwent a coronary angiography and it came out to be severe lesion in proximal left anterior descending (LAD) artery.
Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due... more
Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a significant risk of death.
Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction.
Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients.
Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%.
Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.
Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction.
Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients.
Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%.
Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.
Research Interests:
Research Interests:
Research Interests:
Infective endocarditis is the most common cause of heart infections. The epidemiology, pathophysiology, clinical presentation, diagnosis, management and prevention have evolved in the past several years due to the increasingly-recognized... more
Infective endocarditis is the most common cause of heart infections. The epidemiology, pathophysiology, clinical presentation, diagnosis, management and prevention have evolved in the past several years due to the increasingly-recognized healthcare associated infective endocarditis and advancements in cardiac devices. Prevention of infective endocarditis has been an important issue for the cardiovascular societies across the world, leading to updates in the guidelines of infective endocarditis prevention. The effective use of antibiotics prophylaxis in IE is still been a challenge as there is a threat of antibiotic resistance by widespread use of antibiotics , an important issue today, as well as needlessly exposing patients to antibiotic side effects. In this article, we are discussing the medical literature on infective endocarditis, mainly addressing its burden, the evolving causative microorganisms and endocarditis prevention guidelines.
Research Interests:
Cardiovascular disease (CVD) is one of the most global threatened diseases; particularly coronary artery disease (CAD) is a major deadly attack around the world. Diabetes mellitus (DM) is associated with a 2 to 4-fold increased mortality... more
Cardiovascular disease (CVD) is one of the most global threatened diseases; particularly coronary artery disease (CAD) is a major deadly attack around the world. Diabetes mellitus (DM) is associated with a 2 to 4-fold increased mortality risk from heart disease. Diabetes related microvascular complication is seemed to be a hazardous factor for cardiovascular system and likely to cause coronary arteries disease, hypertension, peripheral arteries, and carotid vessels, especially seen in the type 2 DM populations. The severity of cardiovascular complications are related to prolong hyperglycemia and the control of dysglycemia. Thus, effective glycemic control is one of the imperative aspects of the management for the prevention of CVD in diabetes. In addition, different kinds of antidiabetes agents have different mechanism of actions that has impacted to cardiovascular outcome. The benefi t and risk of current anti-diabetic agents are needed to defi ne clearly and that is needed to promote effective clinical care between cardiology and diabetology. There are multiple complications and sequelae of diabetes that requires the involvement of cardiologic expertise in the diabetes care setting in heart disease population. Therefore, the close cooperation between the cardiologist and the diabetologist is new perceptive way of care to defeat diabetes related cardiovascular complications.
Research Interests:
Infective endocarditis is a preventable infectious heart disease that invades to endocardial part of heart. The occurrence of IE is still seen and has impacted to high risk morbidity patients. Despite it can easily be prevented, it is... more
Infective endocarditis is a preventable infectious heart disease that invades to endocardial part of heart. The occurrence of IE is still seen and has impacted to high risk morbidity patients. Despite it can easily be prevented, it is still been a challenge to prevent especially in low economic and developing countries. Antibiotic prophylaxis alone is not recommended to prevent infective endocarditis because there is no strong association between having an interventional procedures and development of IE. Preventive antibiotics are no longer recommended for any other congenital heart disease but may be considered in high-risk cardiac conditions. According to recent NICE and ESC guideline, prevention IE with antibiotic is needed to give clear information about the benefits and risks of antibiotics prophylaxis. Thus, it is very important to know how to give effective antibiotics prophylaxis in high risk patients.
Research Interests:
Heart failure (HF) is a complex clinical syndrome and it is one of the common cardiovascular complication seen in diabetes mellitus (DM). The coexistence of heart failure and diabetes is not rare and affects vice versa between severity... more
Heart failure (HF) is a complex clinical syndrome and it is one of the common cardiovascular complication seen in diabetes mellitus (DM). The coexistence of heart failure and diabetes is not rare and affects vice versa between severity of Diabetes and Heart Failure in complex pathophysiology. The management of diabetes in heart failure patients is carefully tackled in clinical setting due to different adverse reaction of oral hypoglycemic agents that may affect and worsen the condition of heart failure. So, the selection of the use of effective oral hypoglycemic agents in heart failure especially in patients with heart failure reduced ejection fraction (HFrEF) is very important to control the cardio-endocrinological benefit. Metformin is a biguanide class of antidiabetic medications, was first described in the scientific literature in 1922, as a product in the synthesis of N,N-dimethyl guanidine. Generally, the suppressive action of metformin on liver glucose production (hepatic gluconeogenesis) decreases blood glucose level. Recent multicenter observational studies show metformin is associated with lower mortality rate and reduced the hospitalization in heart failure. This article focuses the metabolic disturbances of Type 2 DM in heart failure and the safely usefulness metformin of in Type 2 diabetes with heart failure.
Research Interests:
Cardiovascular disease is the number one killer of death around the world. Most of the cardiovascular diseases are caused by sedentary life style, bad eating habit, tobacco smoking, high alcohol intake, dyslipidemia and genetic factors... more
Cardiovascular disease is the number one killer of death around the world. Most of the cardiovascular diseases are caused by sedentary life style, bad eating habit, tobacco smoking, high alcohol intake, dyslipidemia and genetic factors .Recently the idea of human microbiome science has emerged in diseases pathogenesis .The human gut is a house of trillions of microbial fl oral. Since a couple of decades ago, there has been interesting insights into the human gut microbiota and have highlighted its increasingly association to cardiovascular (CV) and metabolic diseases. Trimethylamine N-oxide (TMAO), which is a metabolic product from gut microbiota plays a central role in cardiovascular disease pathogenesis. Nature of microbial inhabitants within the host has been noticed by the numbers of scientists and researchers to understand more about the hidden mechanism of diseases pathogenesis including cardiovascular disease, metabolic and autoimmune diseases and it has become a good hope to develop new drug designs to prevent metabolic and cardiovascular disease in near future.
Research Interests:
Introduction: Radial artery occlusion is a usually silent complication of transradial approach that may prevent future transradial procedures.TR Band provides quick, effective, comfortable hemostasis and reduces arterial occlusion. The... more
Introduction: Radial artery occlusion is a usually silent complication of transradial approach that may prevent future transradial procedures.TR Band provides quick, effective, comfortable hemostasis and reduces arterial occlusion. The purposive significance of this study was to evaluate the usefulness of TR band after coronary angiogram in decreasing the frequency of radial artery occlusion.
Materials and Methods: A total of 180 patients with undergoing coronary angiogram through transradial access of any gender between age 18 - 70 years were included. Patients with history of previous coronary angiogram through transradial access, undergoing PCI and h/o peripheral arterial disease were excluded. Full demographic informations including age, gender were included in the study. The radial artery occlusion (RAO) was assessed by Barbeau test after 24 hours of coronary angiography.
Results: Mean age was 54.19 ± 12.30 years. Out of the 180 patients, 123 (68.33%) were male and 57 (31.67%) were females with male to female ratio of 2.16:1. Radial artery occlusion was found in 14 (7.78%) patients. It was also found that presence of confounding variables i.e. diabetes mellitus, hypertension and smoking, increased the risk of radial artery occlusion though this difference was found to be only statistically significant for diabetes mellitus.
Conclusions: This study concluded that TR pneumatic compression band is a very useful and safe method with frequency of radial artery occlusion is only 7.78% after transradial cardiac catheterization.
Keywords: Cardiac Catheterization; Radial Artery; Thrombosis; Compression
Materials and Methods: A total of 180 patients with undergoing coronary angiogram through transradial access of any gender between age 18 - 70 years were included. Patients with history of previous coronary angiogram through transradial access, undergoing PCI and h/o peripheral arterial disease were excluded. Full demographic informations including age, gender were included in the study. The radial artery occlusion (RAO) was assessed by Barbeau test after 24 hours of coronary angiography.
Results: Mean age was 54.19 ± 12.30 years. Out of the 180 patients, 123 (68.33%) were male and 57 (31.67%) were females with male to female ratio of 2.16:1. Radial artery occlusion was found in 14 (7.78%) patients. It was also found that presence of confounding variables i.e. diabetes mellitus, hypertension and smoking, increased the risk of radial artery occlusion though this difference was found to be only statistically significant for diabetes mellitus.
Conclusions: This study concluded that TR pneumatic compression band is a very useful and safe method with frequency of radial artery occlusion is only 7.78% after transradial cardiac catheterization.
Keywords: Cardiac Catheterization; Radial Artery; Thrombosis; Compression
Research Interests:
Standard 12-lead electrocardiography (ECG) is a widely available technology that is routinely applied in the setting of chest pain to identify patients with ST-elevation myocardial infarction (STEMI) who would benefit from primary PCI... more
Standard 12-lead electrocardiography (ECG) is a widely available
technology that is routinely applied in the setting of chest pain to
identify patients with ST-elevation myocardial infarction (STEMI)
who would benefit from primary PCI [1]. The use of ECG to predict
the location of the culprit coronary lesion within the infarct-related
artery (IRA) could provide additional valuable information to
augment clinical decision making and expedite reperfusion therapy.
Previous studies in patients with acute coronary syndromes have
correlated ECG findings to the results of coronary angiography,
leading to the formulation of ECG criteria capable of identifying
the coronary artery housing the culprit lesion and the site of the
culprit lesion within that artery [2-5].
The culprit artery of anterior STEMI is nearly always the left anterior
descending
artery
(LAD),
but
inferior
STEMI
can
be
caused
by
an
occlusion
of
either
the
right
coronary
artery
(RCA)
or
left
circumflex
(LCX)
artery.
Various
ECG
criteria
have
been
suggested
to
predict
the
culprit
artery
based
on
the
analysis
of
ST-segment
elevation
and
ST-segment
depression
in different
leads
[6].
More recently, ST-segment depression in lead aVR has been
suggested as a predictor of LCX artery involvement [7], aVR
depression was also shown to be associated with significantly
impaired myocardial perfusion [8].
Prediction of the culprit artery in inferior STEMI can be challenging
because the dominance of the RCA and LCX can vary significantly
among patients [
technology that is routinely applied in the setting of chest pain to
identify patients with ST-elevation myocardial infarction (STEMI)
who would benefit from primary PCI [1]. The use of ECG to predict
the location of the culprit coronary lesion within the infarct-related
artery (IRA) could provide additional valuable information to
augment clinical decision making and expedite reperfusion therapy.
Previous studies in patients with acute coronary syndromes have
correlated ECG findings to the results of coronary angiography,
leading to the formulation of ECG criteria capable of identifying
the coronary artery housing the culprit lesion and the site of the
culprit lesion within that artery [2-5].
The culprit artery of anterior STEMI is nearly always the left anterior
descending
artery
(LAD),
but
inferior
STEMI
can
be
caused
by
an
occlusion
of
either
the
right
coronary
artery
(RCA)
or
left
circumflex
(LCX)
artery.
Various
ECG
criteria
have
been
suggested
to
predict
the
culprit
artery
based
on
the
analysis
of
ST-segment
elevation
and
ST-segment
depression
in different
leads
[6].
More recently, ST-segment depression in lead aVR has been
suggested as a predictor of LCX artery involvement [7], aVR
depression was also shown to be associated with significantly
impaired myocardial perfusion [8].
Prediction of the culprit artery in inferior STEMI can be challenging
because the dominance of the RCA and LCX can vary significantly
among patients [
Research Interests:
Citation: Han Naung Tun. " Severe Hypokalemia with Premature Ventricular Contraction ". EC Cardiology 5.4 (2018): 224-228. Abstract Electrolytes imbalance caused by potassium disorders are commonly seen in many clinical conditions due to... more
Citation: Han Naung Tun. " Severe Hypokalemia with Premature Ventricular Contraction ". EC Cardiology 5.4 (2018): 224-228. Abstract Electrolytes imbalance caused by potassium disorders are commonly seen in many clinical conditions due to alterations in potassium intake, changes in excretion or transcellular shifts. Hypokalemia is a common electrolyte disorder in clinical practice and that can lead to serious arrhythmias. Most of the arrhythmias caused by electrolytes imbalance can be usually noticed by electrocardio-gram changes. Despite the underlying causes of arrhythmia can be predicted by history taking from patients and ECG changes, sometime it can be missed to provide optimal care and effective medication in time. Thus, physicians and health care providers should be familiar with ECG changes and of electrocardiogram manifestations about electrolyte imbalance in clinical care. Typically, the first ECG manifestation of hypokalemia is decreased T-wave amplitude but arrhythmias associated with hypokalemia include sinus brady-cardia, premature ventricular contractions, ventricular tachycardia, or fibrillation, and torsade de pointes can lead to life threatening condition. The present case report article shows the association between the premature ventricular contraction and severe hypoka-lemia caused by electrolyte imbalance due to chronic diarrhea.
Introduction: Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide. Despite this recent... more
Introduction: Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmission.
Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way.
Method and Materials: Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital.
Result: For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%).
Conclusion: We concluded that hypertension is not largely associated with heart failure hospitalization in our study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure
Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way.
Method and Materials: Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital.
Result: For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%).
Conclusion: We concluded that hypertension is not largely associated with heart failure hospitalization in our study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure
Research Interests:
Introduction: An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardio-vascular (CV) events. ABI is an inexpensive and reliable method for detection of peripheral artery disease (PAD), and it has also been... more
Introduction: An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardio-vascular (CV) events. ABI is an inexpensive and reliable method for detection of peripheral artery disease (PAD), and it has also been proposed as a marker of subclinical atherosclerosis and cardiovascular prognosis.
Objectives: The objective of this study was to determine frequency of coronary artery disease in terms of number of vessels involved using angiography in Type II diabetic patients with abnormal ankle brachial index.
Subjects and methods: This Cross Sectional Study was done at Department of Adult Cardiology, CPE institute of Cardiology Multan. ABI was measured using the standard method. After measuring the ABI, angiography was done on patients with abnormal ABI and pattern of Coronary Artery Disease (CAD) was recorded noting the number of vessels involved.
Result: A total of 115 patients were included in the study. The mean age of patients was 62.40 years with standard deviation of 2.78 years. Majority of the patients in the study were male (68.7%). Mean ABI was of study participants was 1.2 with standard deviation of 0.58 while mean duration of disease was 3.2 years with standard deviation of 0.7 years. 97 of the study participants were hypertensive and 18 were smokers. A total of 28 patients (24.3%) did not have CAD as per angiography while the rest had 1 vessel disease (33.4%), 2 vessel disease (29.5%), and 3 vessel disease (20.9%). Stratification of patients by age, gender, duration of disease, hypertension and low/high ABI showed p value > 0.05 in all cases showing statistically insignificant difference between various subgroups.
Conclusion: It is concluded that there is high frequency of CAD in diabetic patients with abnormal ABI. Further studies are needed to determine the risk conferred by this high prevalence of CAD in this age group and steps taken to decrease the associated morbidity and mortality.
Objectives: The objective of this study was to determine frequency of coronary artery disease in terms of number of vessels involved using angiography in Type II diabetic patients with abnormal ankle brachial index.
Subjects and methods: This Cross Sectional Study was done at Department of Adult Cardiology, CPE institute of Cardiology Multan. ABI was measured using the standard method. After measuring the ABI, angiography was done on patients with abnormal ABI and pattern of Coronary Artery Disease (CAD) was recorded noting the number of vessels involved.
Result: A total of 115 patients were included in the study. The mean age of patients was 62.40 years with standard deviation of 2.78 years. Majority of the patients in the study were male (68.7%). Mean ABI was of study participants was 1.2 with standard deviation of 0.58 while mean duration of disease was 3.2 years with standard deviation of 0.7 years. 97 of the study participants were hypertensive and 18 were smokers. A total of 28 patients (24.3%) did not have CAD as per angiography while the rest had 1 vessel disease (33.4%), 2 vessel disease (29.5%), and 3 vessel disease (20.9%). Stratification of patients by age, gender, duration of disease, hypertension and low/high ABI showed p value > 0.05 in all cases showing statistically insignificant difference between various subgroups.
Conclusion: It is concluded that there is high frequency of CAD in diabetic patients with abnormal ABI. Further studies are needed to determine the risk conferred by this high prevalence of CAD in this age group and steps taken to decrease the associated morbidity and mortality.
Research Interests:
This abstract is to review the demographic results, complication and treatment outcomes of CMV eye program. A retrospective review of patients’ register based on our under-care patients at HIV clinic and the period of treatment was... more
This abstract is to review the demographic results, complication and treatment outcomes of CMV eye program. A
retrospective review of patients’ register based on our under-care patients at HIV clinic and the period of treatment was
started from March 2016 to December 2017. 914 patients whose CD4 is less than 100 were eligible for the study. Mean age was
30.37 +/- 10.7 year. Among those patients with active CMV lesion, 50% of them were already on any kind of first line ART
(NNRTI and NRTI) but 38.9% of the newly diagnosed patients with HIV infection were also co-infected with active CMV
lesion. Only 5.6% of the patients were already on second line ART (with PI) or another special regimen of ART. On one month
after the treatment according to our WHO CMV protocol, 73.3% of the lesions became improved with appropriate treatment
and 26.7% of the lesions became inactive. Here, 16.7% of the patients did not reach to one month. On three months, 53.8% of
the lesions became inactive and 23.1% of the lesions become improved well on the treatment but another 23.1% of the patients
suffered again with relapsed. The reason of relapse was not due to inefficiency of the treatment but mainly due to loss of follow
up for weeks or months. Here also 27.8% of the patients did not reach to three months. On six months, 60% of the lesions
became inactive and 40% of the lesions improved well. There was low incidence of complications (5 cases in 914). The cause of
death was due to occurrence of new OIs who were also loss to follow up. The cause of death is not totally associated with side
effect of injection (Ganciclovir) and oral (Valganciclovir). The study showed that even low CD4 (<100) with CMV retinitis was
effectively cured with very low side effect and achieved better outcome with least of adverse reaction.
retrospective review of patients’ register based on our under-care patients at HIV clinic and the period of treatment was
started from March 2016 to December 2017. 914 patients whose CD4 is less than 100 were eligible for the study. Mean age was
30.37 +/- 10.7 year. Among those patients with active CMV lesion, 50% of them were already on any kind of first line ART
(NNRTI and NRTI) but 38.9% of the newly diagnosed patients with HIV infection were also co-infected with active CMV
lesion. Only 5.6% of the patients were already on second line ART (with PI) or another special regimen of ART. On one month
after the treatment according to our WHO CMV protocol, 73.3% of the lesions became improved with appropriate treatment
and 26.7% of the lesions became inactive. Here, 16.7% of the patients did not reach to one month. On three months, 53.8% of
the lesions became inactive and 23.1% of the lesions become improved well on the treatment but another 23.1% of the patients
suffered again with relapsed. The reason of relapse was not due to inefficiency of the treatment but mainly due to loss of follow
up for weeks or months. Here also 27.8% of the patients did not reach to three months. On six months, 60% of the lesions
became inactive and 40% of the lesions improved well. There was low incidence of complications (5 cases in 914). The cause of
death was due to occurrence of new OIs who were also loss to follow up. The cause of death is not totally associated with side
effect of injection (Ganciclovir) and oral (Valganciclovir). The study showed that even low CD4 (<100) with CMV retinitis was
effectively cured with very low side effect and achieved better outcome with least of adverse reaction.
Research Interests:
Introduction: Myocardial bridging (MB) is an inborn abnormality of coronary vessel. It occurs when a segment of a coronary artery or its major branch travels through the myocardium instead of on the surface of the myocardium, resulting in... more
Introduction: Myocardial bridging (MB) is an inborn abnormality of coronary vessel. It occurs when a segment of a coronary artery or its major branch travels through the myocardium instead of on the surface of the myocardium, resulting in a tunnelled arterial segment. The reported frequency of MB varies greatly in the exiting literature which might be attributable to hardware and population differences.
Objective: To determine the frequency of myocardial bridging on computed tomographic coronary angiography in patients with coronary artery disease (CAD).
Materials and Methods: Two hundred and nineteen (219) patients having age 40-70 years suffering from coronary artery disease were included in this study from Chaudhry Pervaiz Elahi Institute of Cardiology, Multan . All these patients with CAD underwent CT angiography. Presence of myocardial bridge was recorded. Data regarding age, gender, factors i.e. positive family history, smoking, controlled and uncontrolled hypertension, controlled and uncontrolled diabetes mellitus and hyperlipidemia and duration of CAD was also collected.
Results: Mean age of the patients was 51.53+7.05 years. There were 175 (79.9%) male patients and 44 (20.1%) females. There were 55 (25.1%) patients who were having a positive family history of coronary artery disease, 86 (39.3%) were smokers, Dyslipidemia was diagnosed in 25 (11.4%) patients, 93 (42.5%) patients were hypertensive, 82 (37.6%) patients were suffering from diabetes mellitus. Myocardial bridging (MB) was diagnosed in only 18 (8.2%) patients. There was no effect of confounder variables on the frequency of MB.
Conclusion: Frequency of myocardial bridging in our study was 8.2% using computed tomography angiography in coronary artery disease patients. CCTA is an emerging noninvasive alternative test for the diagnosis of myocardial bridging.
Objective: To determine the frequency of myocardial bridging on computed tomographic coronary angiography in patients with coronary artery disease (CAD).
Materials and Methods: Two hundred and nineteen (219) patients having age 40-70 years suffering from coronary artery disease were included in this study from Chaudhry Pervaiz Elahi Institute of Cardiology, Multan . All these patients with CAD underwent CT angiography. Presence of myocardial bridge was recorded. Data regarding age, gender, factors i.e. positive family history, smoking, controlled and uncontrolled hypertension, controlled and uncontrolled diabetes mellitus and hyperlipidemia and duration of CAD was also collected.
Results: Mean age of the patients was 51.53+7.05 years. There were 175 (79.9%) male patients and 44 (20.1%) females. There were 55 (25.1%) patients who were having a positive family history of coronary artery disease, 86 (39.3%) were smokers, Dyslipidemia was diagnosed in 25 (11.4%) patients, 93 (42.5%) patients were hypertensive, 82 (37.6%) patients were suffering from diabetes mellitus. Myocardial bridging (MB) was diagnosed in only 18 (8.2%) patients. There was no effect of confounder variables on the frequency of MB.
Conclusion: Frequency of myocardial bridging in our study was 8.2% using computed tomography angiography in coronary artery disease patients. CCTA is an emerging noninvasive alternative test for the diagnosis of myocardial bridging.
Research Interests:
Contrast echocardiography Second generation contrast agents allows improved visualisation of the endocardium, which is useful in the assessment of: • LV systolic function in patients with poor endocardial border delineation • LV... more
Contrast echocardiography Second generation contrast agents allows improved visualisation of the endocardium, which is useful in the assessment of: • LV systolic function in patients with poor endocardial border delineation • LV pseudoaneurysms • Intracardiac masses They may also be used to facilitate the diagnosis of aortic dissection. Despite some earlier safety concerns regarding the use of contrast agents, recently published data revealed no increase in mortality in patients who underwent contrast-enhanced echocardiography examinations, including critically ill patients. Agitated saline may be useful to: • Differentiate between intracardiac and intrapulmonary shunting • Confirm correct placement of the cannula/drain during echocardiographic-guided pericardiocentesis Click here for a review of the use of contrast echocardiography in the intensive care, and here for the EACVI recommendations on the use of contrast echocardiography. Focused echocardiography Several focused echo protocols have been proposed for the acute/emergency setting. These include (but are not limited to):
Research Interests:
BEST PRACTICES IN CARDIOLOGY:
TOP CONSENSUS REPORTS
& POSITION PAPERS
TOP CONSENSUS REPORTS
& POSITION PAPERS
Research Interests:
ECG Clinical Case Library By Dr Han Naung Tun : Emergency , Clinical ECG and Interpretation by cases
Research Interests:
Emerging infectious diseases are communicable diseases that have newly appeared in a population or have existed for years, and it also may be outbreak of previously unknown diseases. Emerging diseases that are also seemed to be rapidly... more
Emerging infectious diseases are communicable diseases that have newly appeared in a population or have existed for years, and it also may be outbreak of previously unknown diseases. Emerging diseases that are also seemed to be rapidly increasing in incidence or geographically range in the last few decades (1). We have been fighting with many emerging infectious diseases as a public health crisis for several decades. Some of them are HIV infections, SARS, Lyme disease, Dengue virus, E. coli infection, hantavirus and very recently COVID19 (2). For example, travelling abroad can put us at risk for infectious disease that are not normally widespread in a country.