Genes and Cardiovascular Disease : Where do we go from here?

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Management of elderly patients with troponin positive chest pain in a District General Hospital

Background: The number of elderly patients that present with an acute coronary syndrome (ACS) is increasing, reflecting the growing number of people in the general population in this age group. The various guidelines do not generally specify a management strategy in this elderly group and the management is often at the discretion of the treating physician. We conducted an audit within our Cardiology Department to compare our practice of management of ACS in the elderly population based on the European Society of Cardiology guidelines. Methods: We conducted a retrospective analysis of the management of patients aged 80 and above that were admitted with troponin positive chest pain from 1st January to 31st December 2010. Patient information was primarily obtained from our computer data base system that includes blood results, ECHOs, diagnostic angiograms, discharge and clinic letters. If the information was inadequate we obtained patient files or contacted the relevant general practitioner. Results: Octo-nonagenarians represented just over a third (35%) of all patients that were admitted with a troponin positive event during the study period. We noted a 10% mortality rate observed in our study population over a 12 month period. Atrial fibrillation was an incidental finding in 22% of patients. Nearly half of these patients (49%) were managed by the cardiologists. 68% of these patients underwent diagnostic coronary angiography, of which 32% went on to have percutaneous coronary intervention and 7% underwent surgical intervention. Majority (80%) of patients that underwent angioplasty had more than 1 stent and 74% of patients required more than one coronary vessel to be stented. The length of stay in hospital was double for patients who were under the care of the general medical teams rather than the cardiology team. This group also had a higher number of other comorbidities such as dementia, malignancy, a history of gastro intestinal bleeds and chronic renal impairment. Conclusions: Octo and nonagenarians represent a significant proportion of our ACS patients. They have high mortality, greater number of comorbidities, diseased coronary vessels and if intervention was undertaken required more than one stent. Therefore, octo-nonagenarians represent a very complex group of patients. Guidelines and risk stratification are of limited value in this group as clinical trial data is currently lacking. Quality of life and risk to benefit assessments are of paramount importance in this group

Biomarkers in Routine Heart Failure Clinical Care

Heart failure is a clinical condition with complex pathophysiology that involves many different processes. Diagnosis is often difficult in patients presenting for the first time with breathlessness. Many biomarkers have been identified that are elevated in heart failure and their role in assessing prognosis has also been investigated. However, at present the natriuretic peptides appear to be the gold standard biomarker against which the other biomarkers are compared. In this review we will examine the evidence behind the other biomarkers for use in heart failure patients and the current guidelines for their use

Knowledge, Attitudes and Practices Regarding Traditional and Complimentary Medicine in Oman

Objectives: The aim of the study was to assess the knowledge, attitudes and practices with regards to traditional medicine in Oman and to assess the factors that lead to its use. Methods: This was a cross sectional questionnaire-based study. All Omani nationals above the age of 18 were eligible to be enrolled. The questionnaire consisted of questions regarding the knowledge, attitudes and use of traditional medicine. Results: There were 598 (out of 700) responses to the questionnaire (response rate of 85.4%) of which 552 (mean age 33.6±7.7 years; 345 or 62.5% male) were complete. Majority of the respondents (90%) are aware of the different types of traditional medicine(TM). A high percentage (81.5%) feel that it is effective.  67.8% had tried at least one method. These were older (34.5±7.8 years vs 31.8±7.2 years, p<0.001) and mostly male (72.1% vs 42.1%, p<0.001) and in full time employment (73% vs 27%). Herbal medications (65.7%) and traditional massage (60.4%) were the most common form of TM that was practiced. Women tended to go more for herbal medications (69.2%) and massage (63.4%), while, for men cupping was the most popular (65.1%) followed by herbal medications (64.4%) and massage (59.2%).  Back pain was the most common condition for which TM was used with only a small percentage reporting any side effects. Conclusion: There is widespread use of TM among the urban population in Oman. Better understanding of their benefits will help incorporate them into modern health care services. Keywords: Traditional and complementary medicine; knowledge and attitude

Successful use of intra-aortic counter pulsation therapy for intractable ventricular arrhythmia in patient with severe left ventricular dysfunction and normal coronary arteries

Intra-aortic balloon pumps (IABP) are commonly used in the setting of an acute myocardial infarction that is complicated by cardiogenic shock or mechanical complications such as a ventricular septal defect or papillary muscle rupture. IABP has also been shown to be useful in patients with refractory and hemodynamically unstable ventricular arrhythmias and refractory post-myocardial infarction angina. We report a case in which IABP was used in a patient with dilated cardiomyopathy and normal coronary arteries, who presented with persistent, recurrent and refractory ventricular tachycardia. His ventricular tachycardia settled immediately with the use of IABP therapy. He subsequently had an implantable defibrillator. The use of IABP is associated with favorable changes in the left ventricular wall tension and reduction in afterload, which could reduce the excitability of the myocardium, thus making it less prone to arrhythmias. The use of IABP is relatively safe and should be considered in patients with refractory ventricular arrhythmias, even if it is not associated with ischemia. (Cardiol J 2010; 17, 4: 401-403

Percutaneous Septal Reduction Therapy in a Patient with Severely Symptomatic Hypertrophic Obstructive Cardiomyopathy: An experience from a tertiary care center

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Angiographic Predictors of Viability During Intervention for a ST Elevation Myocardial Infarction

Objectives: This study aimed to identify angiographic features that would predict myocardial viability after coronary intervention for ST elevation myocardial infarction (STEMI). Methods: This retrospective study included patients who attended Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 with a STEMI. Results: A total of 72 patients (61 male; mean age = 54.9 ± 12.7 years) were included in the study; 11 patients had evidence of non-viability on echocardiography. There were 13 patients with viable myocardium and 3 with non-viable myocardium who had a myocardial blush grade (MBG) of 2 or lower. Similarly, 10 patients with viability and 1 with non-viable myocardium had thrombolysis in myocardial infarction (TIMI) flow of 2 or lower in the infarct related artery (IRA). However, none of these were statistically significant. The TIMI flow in the IRA at the end of the procedure correlated with the MBG. Conclusion: There were no clear angiographic features during primary angioplasty that could predict myocardial viability. Keywords: Myocardial infarction; Coronary Angiography; Viability; Oman

Adherence to Medications in Patients with Ischemic Heart Disease in Oman

Objectives: The aim of this study was to evaluate the level of adherence to medications in patients with IHD in Oman and assess the factors influencing it. Methods: This was a cross sectional questionnaire-based study among patients with IHD. Results: A total of 105 patients (Mean age 49.9+11.1 years; 78.1% male) were recruited. Most of the patients take the medications by themselves (84 or 80%). 77 patients (73.3%) said that over the preceding two weeks, they missed at least three doses. The reasons for missing included forgetting (100%), too many tablets (57%), not effective (48%) and too many times a day (23%). There were no factors that could be identified that made patients prone to not taking medications. Conclusion: Medication adherence was low among patients with IHD in Oman with high pill burden the most common reason for non-adherence. Physicians must keep this in mind when patients are reviewed. Keywords: Cardiovascular disease, adherence, myocardial infarction