Antidromic Atrioventricular Reentrant Tachycardia Dependent on a Unidirectional Left Anterior Accessory Pathway Mimicking Peri-mitral Ventricular Tachycardia: Successful Ablation via a Transseptal Approach

Antidromic atrioventricular reentrant tachycardia (aAVRT) is rare compared to orthodromic atrioventricular reentrant tachycardia (oAVRT). An aAVRT that is dependent on a unidirectional, decremental accessory pathway (AP) is even rarer. Idiopathic ventricular tachycardias (iVT) that have benign prognoses and respond well to medical therapy can be confused with aAVRTs dependent on APs having ventricular insertion sites close to the iVT focus and have a real risk of sudden death. The preferred approach of ablation for such tachycardias with anterograde conduction only is a retrograde aortic approach, which facilitates the mapping of the earliest ventricular activation during atrial pacing or tachycardia from the ventricular side. This, however, necessitates access to the arterial system with accompanying complications. We describe herein the case of a wide complex tachycardia, which was treated initially as VT with intravenous lidocaine. The baseline electrocardiogram (ECG) did not show preexcitation. An electrophysiology study (EPS) revealed a left anterior AP that conducted anterograde only. AVRT was easily inducible at a cycle length of 290 ms. Successful ablation was undertaken via the transseptal approach without recurrence

Syncope: experience at a tertiary care hospital in Karachi, Pakistan

Introduction:Our aim was to determine the characteristics of Patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.Methods: A review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi. Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending physician were included.Results:A total of 269 Patients were included (75% males, mean age: 57.4 years). Neurogenic (vasovagal) syncope was the most common cause (47%), followed by cardiogenic syncope (18%) and orthostatic syncope (9%). A total of 24% were discharged undiagnosed. Twenty Patients (7.4%) did not have any prodrome. Common prodromal symptoms included dizziness (61%), sweating (25%), palpitations (19%), nausea/vomiting (19%) and visual symptoms (17%). The distribution of symptoms according to cause of syncope revealed only breathlessness to be significantly associated with cardiogenic syncope (p = 0.002). Most Patients with cardiogenic syncope were aged above 40 (98%, p \u3c 0.001), had coronary artery disease (72%, p \u3c 0.001) and abnormal electrocardiogram at presentation (92%, p \u3c 0.001).Conclusion:Despite differences in burden of diseases, our findings were similar to those of published syncope literature. Further studies are needed to develop a protocol to expedite the evaluation and limit the work-up and admission in low-risk Patients

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan. METHODS: Hospital charts of 95 patients (mean age 58.8 (± 10.4) years; 78.9% male) undergoing IABC between 2000–2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality. RESULTS: The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01–1.11] for every year increase in age); diabetes (OR 3.68 [1.51–8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92–12.2]). Furthermore, prior CABG (OR 0.12 [0.04–0.34]), and in-hospital revascularization (OR 0.05 [0.01–0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05–1.22] for every year increase in age); diabetes (OR 6.35 [1.61–24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33–42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003–0.12]) conferred a protective effect. The overall complication rate was low (8.5%). CONCLUSIONS: Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country

Spectrum of antihypertensive therapy in South Asians at a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Despite available guidelines on hypertension (HTN), use of antihypertensives is variable. This study was designed to ascertain frequency of patients on monotherapy and > 1 antihypertensive therapy and also to ascertain proportion of patients on diuretic therapy.</p> <p>Methods</p> <p>It was a crossectional study conducted on 1191 adults(age > 18 yrs)hypertensive patients selected by computerized International Classification of Diseases -9-coordination and maintenance (ICD-9-CM) presenting to a tertiary care hospital in Pakistan. Data on demographics, comorbids, type of antihypertensive drug, number of antihypertensive drug and mean duration of antihypertensive drug was recorded over 1.5 year period (2008-09). Blood pressure was recorded on admission. Primary outcome was use of combination therapy and secondary outcome was use of diuretic therapy.</p> <p>Results</p> <p>A total of 1191 participants were included. Mean age(SD) was 62.55(12.47) years, 45.3%(540) were males. Diabetes was the most common comorbid; 46.3%(551). Approximately 85% of patients had controlled hypertension. On categorization of anti hypertensive use into 3 categories;41.2%(491) were on monotherapy,32.2%(384) were on 2 drug therapy,26.5%(316) were on ≥3 drug therapy. Among those who were on monotherapy for HTN;34%(167) were on calcium channel blockers,30.10%(148) were on beta blockers, 22.80%(112) were on Angiotensin converting enzyme (ACE) inhibitors,12%(59) were on diuretics and 2.20%(11) were on Angiotensin receptor blockers(ARB). Use of combination antihypertensive therapy was significantly high in patients with ischemic heart disease(IHD)(p < 0.001). Use of diuretics was in 31% (369) patients. Use of diuretics was significantly less in patients with comorbids of diabetes (p 0.02), Chronic kidney disease(CKD)(p 0.003), IHD (p 0.001) respectively</p> <p>Conclusion</p> <p>Most patients presenting to our tertiary care center were on combination therapy. Calcium channel blocker is the most common anti hypertensive drug used as monotherapy and betablockers are used as the most common antihypertensive in combination. Only a third of patients were on diuretic as an antihypertensive therapy.</p

Sex disparity in left ventricular hypertrophy in South Asians with hypertension: Influence of central obesity and high blood pressure

Women have been reported to be at greater risk of left ventricular hypertrophy (LVH) than men in South Asia, but whether the sex disparity is affected by central obesity and blood pressure has not been well studied. We examined prospectively the interaction of sex with waist circumference and systolic blood pressure at baseline on LVH measured after a median of 8-year follow-up among 539 individuals with hypertension in Karachi, Pakistan, and found that the risk of LVH for women vs men increased with higher baseline waist circumference and systolic blood pressure. Our results underscore the urgency for public health programs to prevent obesity and control hypertension in women in South Asi

<雜錄>新たに発見された玄奘三藏の遺骨

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Consortium between Groundwater Quality and Lint Yield in Cotton Belt Areas

The agriculture sector of Pakistan mainly depends on freshwater from groundwater resources. Deterioration of these resources adversely affected crop yields due to climate change and human activities. A comprehensive study was conducted to evaluate the groundwater quality of varying boring depths and the possible effects on the crop yield of cotton in Tehsil Fort Abbas, District Bahawalnagar, Punjab, Pakistan. A total of 347 samples were collected from the investigated areas. Results revealed that 86% of samples were declared unfit for irrigation purposes, 6% of samples were fit, and 8% of samples were marginally fit for irrigation. The ranges for the electrical conductivity (EC), sodium absorption ratio (SAR), and residual sodium carbonate (RSC) were 0.61&ndash;10.49 dS m&minus;1, 0.65 to 5.44 meq L&minus;1, and 0.02 to 5.44 meq L&minus;1, respectively. Regarding the EC of water samples, the southwestern side of the study area where the lower values were observed was in an acceptable range in terms of water quality. Differential response to metal contamination was observed in the study area. Lower contamination of metals was observed in the water samples collected from some regions on the eastern and western sides of the study area. Principal component analysis (PCA) showed that by increasing the depth of the bore, the value of EC was also increased. Similarly, for the cotton lint yield maximum yield (1040 kg acre&minus;1) was observed in the sampling point located in the southwestern part of the study area due to better quality of irrigation water, while the minimum cotton lint yield (520 kg acre&minus;1) was noticed in sampling point located in the western side of the study area. Overall groundwater quality of Tehsil Fort Abbas was unfit for irrigation due to the high EC values and metal concentrations. The yield showed a negative correlation among all parameters of water. It was suggested that using the recommended dose of gypsum powder/stone and dilution of groundwater with canal water reduced the hazards of anions and cations of groundwater for the accumulation of salts in crops

Consortium between Groundwater Quality and Lint Yield in Cotton Belt Areas

The agriculture sector of Pakistan mainly depends on freshwater from groundwater resources. Deterioration of these resources adversely affected crop yields due to climate change and human activities. A comprehensive study was conducted to evaluate the groundwater quality of varying boring depths and the possible effects on the crop yield of cotton in Tehsil Fort Abbas, District Bahawalnagar, Punjab, Pakistan. A total of 347 samples were collected from the investigated areas. Results revealed that 86% of samples were declared unfit for irrigation purposes, 6% of samples were fit, and 8% of samples were marginally fit for irrigation. The ranges for the electrical conductivity (EC), sodium absorption ratio (SAR), and residual sodium carbonate (RSC) were 0.61–10.49 dS m−1, 0.65 to 5.44 meq L−1, and 0.02 to 5.44 meq L−1, respectively. Regarding the EC of water samples, the southwestern side of the study area where the lower values were observed was in an acceptable range in terms of water quality. Differential response to metal contamination was observed in the study area. Lower contamination of metals was observed in the water samples collected from some regions on the eastern and western sides of the study area. Principal component analysis (PCA) showed that by increasing the depth of the bore, the value of EC was also increased. Similarly, for the cotton lint yield maximum yield (1040 kg acre−1) was observed in the sampling point located in the southwestern part of the study area due to better quality of irrigation water, while the minimum cotton lint yield (520 kg acre−1) was noticed in sampling point located in the western side of the study area. Overall groundwater quality of Tehsil Fort Abbas was unfit for irrigation due to the high EC values and metal concentrations. The yield showed a negative correlation among all parameters of water. It was suggested that using the recommended dose of gypsum powder/stone and dilution of groundwater with canal water reduced the hazards of anions and cations of groundwater for the accumulation of salts in crops