Day 2 :
(MD. DNB – CARDIOLOGY)Consultant Cardiologist,Batra Hospital and Medical Research centre, New Delhi, India
Keynote: Save Heart Study Diagnostic Utility Of Point Of Care High Sensitive Troponin-I Assay For Early Diagnosis Of Acute Myocardial Infarction In Patients Presenting With Acute Onset Chest Pain In Emergency Departments
Time : 09:00-9:30am
Sheikh Jan M is the Consultant Cardiologist (MD. DNB –Senior Resident Cardiology,Batra Hospital and Medical Research centre, New Delhi, India.
Background: An early diagnosis of myocardial infarction is highly important in the emergency department (ED). It facilitates rapid decision making and treatment and therefore improves the outcome in patients presenting with symptoms of chest pain.
Aims and Objectives: To study diagnostic utility of new point of care high sensitive troponin-I assay in early diagnosis of acute myocardial infarction in patients presenting with acute chest pain.
Materials and methods: Forty six consecutive patients of acute onset chest pain who presented to our cardiac emergency department within three hours of symptom onset were enrolled for study.POC Hs Trop-I test was done on admission (0 hour), and after 3 hours if initial test result was negative. Quantitative troponin I (Q-Trop I) lab assay was done on admission (0 hour), 3 hours and 6 hours after admission. Six hour Q-Trop I assay was taken as gold standard for the initial diagnosis of AMI. The final adjudicated diagnosis of AMI was based on a composite of ECG changes (new ST segment or T wave changes, new onset LBBB), Troponin results, Echocardiography (new wall motion abnormality), angiographic findings (detection of a culprit lesion) and final chart review of observations made.
Results: Comparing the results of POC Hs Trop I results at 0 hour with the gold standard test we found the sensitivity of 97%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 92.3%. Sensitivity of POC Hs Trop I at 3 hours was better than POC Hs Trop I at 0 hour (97 vs. 100%) and equal to gold standard i.e. 100 %.Specificity, PPV and NPV are 100% for POC Hs Trop I at 1 hour.
Conclusion: High sensitive Trop I test is rapid and reliable method to diagnose and exclude acute myocardial infarction in patients presenting with acute onset chest pain to our EmergencyDepartments.
Resident physician,Hamad Medical Corporation, Internal Medicine, Doha, Qatar
Time : 9:30-10:00am
Dr.Phool Iqbal is the resident physician in internal medicine department PGY-2 in Hamad Medical Corporation which is accredited with ACGMEI and JCI and provide handsome opportunities for research and quality projects.
Cardiac tamponade is a life-threatening condition characterized by slow or rapid compression of the heart due to the accumulation of fluid in the pericardial space and rarely presents mainly as a headache.
We report an unusual presentation of cardiac tamponade associated mainly with severe headache from 3 days and mild shortness of breath in a 60-year-old male not known to have any previous heart disease. Immediate CT scan of the head ruled out intracranial hemorrhage. Chest XR showed cardiomegaly and further echocardiography revealed large pericardial effusion on a transthoracic echocardiogram compromising right ventricular output. Urgent pericardiocentesis was performed and removed 800ml of hemorrhagic fluid that led to a complete resolution of severe headache. All the work up for hemorrhagic pericardial effusion, including Tuberculosis, malignancy and autoimmune screening was negative. PET scan was also unremarkable for any foci of increased uptake. We labelled our case as idiopathic myocarditis complicated with hemorrhagic pericardial effusion, based on Cardiac MRI which revealed features suggestive of Myocarditis or cardiomyopathy.
Headache as the main presentation of a fatal condition like cardiac tamponade without any underlying secondary cause is quite uncommon to find in the literature. Therefore makes it an important reportable case.
MD, MPH, CES in Cardiology Unit, National Institute of Public Health, Abidjan, Côte d’Ivoire
Time : 10:00-10:30am
MALIK Koussoh Simone is associated with MD, MPH, CES Cardiology Unit, National Institute of Public Health, Abidjan, Côte d’Ivoire
Background: Worldwide, 10 % of all pregnancies are complicated by hypertension. Hypertensive disorders in pregnancy are public health problems. Women with Hypertensive disorders of pregnancy are five times more likely to have perinatal death compared with women who have no hypertensive disorders of pregnancy. The risk that a woman in a developing country die of the complications of hypertensive disorders of pregnancy is approximately 300 times higher than that for a woman in a developed country.
Objectives: The aim of this review is to determine associated factors of hypertension disorders in pregnancy in africa south of the sahara.
Methods: We did a comprehensive literature review using the databases PubMed/Medline, and search engine google scholar. We selected sources of publications and conducted an analysis of articles. The search consisted of a literature review of databases PubMed/ Medline and search engines Google scholar. Keywords in english were: hypertension, pregnancy, africa south of the sahara. Keywords in french were: hypertension artérielle, grossesse, afrique au sud du sahara. Mesh terms were: hypertension, pregnancy, africa south of the sahara.
Results: Prevalence of hypertensive disorders in pregnancy ranges from 1.2% to 18.25% Several factors were associated with hypertension disorders in pregnancy. These factors included, age of women ; parity, level of education, residence area and lifestyle. Women with hypertensive disorders in pregnancy were older than those without hypertensive disorders in pregnancy ; they have multiparity, low education level and live mostly in rural areas.
Conclusion: This review shows that there are several risk factors for hypertensive disorders of pregnancy
Liaquat University of Medical Health Sciences,MBBS, FCPS, NICVD Pakistan
Keynote: Assessment of Triglyceride to High-density Lipoprotein Ratio as an Indicator of Coronary Artery Disease
Time : 10:30-11:00am
Dr. Naveed has completed his MBBS at the age of 25 years from Liaquat University of Medical Health Sciences,Jamshoro Hyderabad, Pakistan and post graduate studies from National Institute of Cardiovascular Diseases Karachi. He is the Clinical Fellow of Adult Cardiology. He is also certified BLS and ACLS Instructor from AHA in College of Physicians and Surgeons in Pakistan.
Increased ratio of Triglyceride (TG)/ High-density Lipoprotein (HDL) has been known as an accompanying finding in conditions like obesity and metabolic syndrome. Therefore, the aim of this study was to assess the utility of TG/HDL ratio as a diagnostic tool for the assessment of coronary artery disease (CAD).
Methods: This study was conducted at a semi-private hospital Karachi; patients above 15 years of age and undergone angiography or PCI were included. Patients with Congenital Heart Disease and familial hyperlipidmeia were excluded. TG/HDL ratio was obtained for all patients, severity of the disease was classified as normal, mild to moderate, moderate to severe, and very severe based on coronary angiography. Analysis of variance was applied to assess significant differences in mean TG/HDL ratio among severity of disease. P-value<0.05 was considered significant.
Results: A total of 2,212 CAD patients were reviewed out of which 1613 (72.9%) were male and 599 (27.1%) were female. Average age of the patients was 55.12 years (±SD=9.93). Of these 2212 patients, 533 (24.1%) had very severe disease, 1213 (54.8%) had moderate to severe disease, 258 (11.7%) had mild to moderate disease, and 208 (9.4%) were normal. A Significant and an increasing trend was observed in TG/HDL ratio with the severity of disease (p=0.0001) Statistically significant difference was observed in the TG/HDL ratio of patients with mild to moderate, moderate to severe and very severe disease from normal patients. However, no statistically significant difference was seen in the TG/HDL ratio between the patients with moderate to severe and very severe disease.
Conclusion: A positive relationship between Triglyceride to HDL Ratio and severity of coronary artery disease was observed. Therefore, TG/HDL ratio can be used as an indicator of severity of coronary artery disease in addition to other parameters of lipid profile.
MBBS, MD (Internal Medicine),Chitwan Medical College, Bharatpur, Chitwan, Nepal
Keynote: Evaluation Of The Pulmonary Artery Pressure During Percutaneous Transvenous Mitral Commissurotomy in Rheumatic Mitral Stenosis
Time : 11:00-11:30am
Dr. Ananda G.C. MBBS, MD (Internal Medicine) Training in Non-Invasive Cardiology & Diabetes Consultant Physician, Doctor Of Medicine at chitwan medical college.
Rheumatic heart disease is one of the most common heart diseases in developing country. One of the most common complications of Rheumatic Heart Disease is Mitral Stenosis which ultimately lead to pulmonary hypertension and heart failure and death. So, PTMC (Percutaneous Transluminal Mitral Commissurotomy) is a well established simple, effective and safe therapeutic intervention for mitral stenosis.
While many literatures reviewed till date have shown that it takes 3-6 months time period for the reduction of pulmonary artery pressure after PTMC, this study is designed to see the result in pulmonary artery pressure immediately after procedure.
Methods: Total 42 patients with Rheumatic Mitral Stenosis in Cath Lab under Department of Cardiology of Chitwan Medical College from October 1 2018 to August 30 2019 were included in the study. Pulmonary artery pressure was assessed by Right heart catheterization by using multipurpose /pigtail catheter under conscious sedation.
Results: It is a prospective observational study on a total of 42 patients who underwent PTMC, 30 were female and 12 were male. Age ranged from 30 to 61 years with the mean age of 45.36±10 years. The mean mitral valve area increased from 0.87±0.2 cm2 to 1.74±0.17 cm2 whereas Mean Pressure Gradient decreased from 13.59± 7.30 mmHg to 5.15±30 mmHg. Mean Pulmonary Artery Pressure decreased from 41.50 ±16.00 mmHg to 33.50±12.00 mmHg. Similarly, the mean left atrial pressure decreased from 26.57±8.62 mmHg to 15.50±5.95 mmHg whereas, the mean Aortic Pressure increased from 91.43 ±23.02 mmHg to 98.29±24.92 mmHg . Eighteen (42.85%) patients had an increase in MR by 2 grades but there is no need of immediate mitral valve replacement. During procedure, paroxysmal PSVT was noted in six (14.285%) patients and also local hematoma was observed in five (11.90%) patients.
Conclusion: There is reduction in pulmonary artery pressure immediately post PTMC which is directly correlated with left atrial pressure without significant MR and tachycardia.
This study is limited in terms of single center with small sample size.