scholarly journals Clinical Profile and Outcome of COVID 19 Patients at Tertiary Cardiovascular Center of Nepal.

2021 ◽  
Vol 18 (1) ◽  
pp. 7-11
Author(s):  
Kunjang Sherpa ◽  
Reeju Manandhar ◽  
Chandra Mani Adhikari ◽  
Murari Dhungana ◽  
Dipanker Prajapati ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Disease ◽  
Past History ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Clinical Profile ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Study Population ◽  
Cardiovascular Diagnosis

Background and Aims: Cardiovascular comorbidities are common in patients with COVID-19 and these patients  are at higher risk of morbidity and mortality. It is not known if the presence of cardiovascular co-morbid conditions poses independent risk or whether this is mediated by other factors. Methods: This is a retrospective follow up study done at Shahid Gangalal National Heart Centre (SGNHC). The main objective of this study was to study the clinical profile, baseline comorbidities, and outcome of cardiac patients and health care worker diagnosed with COVID 19. This study retrospectively evaluated case records of all cardiovascular disease (CVD) patients admitted at SGNHC with COVID 19 cases from 1st case diagnosed on July at SGNHC till September 2020. Results: During this study period, 90 patients with COVID 19 with cardiovascular disease were admitted. The mean age of the study population was 52.3±19 years with 65.6% being male. Among the study population 52 (57.8%) had past history of cardiovascular disease, hypertension in 18 (20%) cases, diabetes in 8 (8.9%) cases. Among the patients with cardiovascular diagnosis, acute coronary syndrome was most common cardiovascular diagnosis in 23 (25.6% cases) followed by rheumatic heart disease in 21 (23.4%) cases, dilated cardiomyopathy in 7 (7.8% cases), ischemic cardiomyopathy with reduced ejection fraction (EF) in 7 (7.8%) cases, post coronary artery bypass graft (CABG) in 8 (8.9%), post valve replacement in 5 (5.5%), congenital heart disease in 3.3% cases and complete heart block in 3.3% cases. Most of the cases were symptomatic with moderate illness in 46.7% cases, mild illness in 41.4% cases and severe/critical illness in 11.1% cases. Among COVID patients with cardiovascular disease, the mortality was 11.1%. Conclusion: Patients with cardiovascular disease with COVID 19 have more severe COVID 19 symptoms and has higher COVID 19 related death, so strict vigilance and early intervention is needed to improve its outcome.

Resumption of Work After Acute Coronary Syndrome or Coronary Artery Bypass Graft Surgery

2014 ◽  
Vol 23 (5) ◽  
pp. 444-453 ◽  
Author(s):  
Marian U. Worcester ◽  
Peter C. Elliott ◽  
Alyna Turner ◽  
Jeremy J. Pereira ◽  
Barbara M. Murphy ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Coronary Syndrome

scholarly journals Large-scale phenome-wide association study of PCSK9 loss-of-function variants demonstrates protection against ischemic stroke

2017 ◽  
Author(s):  
Abhiram S. Rao ◽  
Daniel Lindholm ◽  
Manuel A. Rivas ◽  
Joshua W. Knowles ◽  
Stephen B. Montgomery ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Protective Effect ◽  
Large Scale ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Genetic Associations ◽  
Loss Of Function

AbstractPCSK9 inhibitors are a potent new therapy for hypercholesterolemia and have been shown to decrease risk of coronary heart disease. Although short-term clinical trial results have not demonstrated major adverse effects, long-term data will not be available for some time. Genetic studies in large well-phenotyped biobanks offer a unique opportunity to predict drug effects and provide context for the evaluation of future clinical trial outcomes. We tested association of the PCSK9 loss-of-function variant rsll591147 (R46L) in a hypothesis-driven 11 phenotype set and a hypothesis-generating 278 phenotype set in 337,536 individuals of British ancestry in the United Kingdom Biobank (UKB), with independent discovery (n = 225K) and replication (n = 112K). In addition to the known association with lipid levels (OR 0.63) and coronary heart disease (OR 0.73), the T allele of rs11591147 showed a protective effect on ischemic stroke (OR 0.61, p = 0.002) but not hemorrhagic stroke in the hypothesis-driven screen. We did not observe an association with type 2 diabetes, cataracts, heart failure, atrial fibrillation, and cognitive dysfunction. In the phenome-wide screen, the variant was associated with a reduction in metabolic disorders, ischemic heart disease, coronary artery bypass graft operations, percutaneous coronary interventions and history of angina. A single variant analysis of UKB data using TreeWAS, a Bayesian analysis framework to study genetic associations leveraging phenotype correlations, also showed evidence of association with cerebral infarction and vascular occlusion. This result represents the first genetic evidence in a large cohort for the protective effect of PCSK9 inhibition on ischemic stroke, and corroborates exploratory evidence from clinical trials. PCSK9 inhibition was not associated with variables other than those related to low density lipoprotein cholesterol and atherosclerosis, suggesting that other effects are either small or absent.

Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

2020 ◽  
Author(s):  
Ki Hong Choi ◽  
Young Bin Song ◽  
Dong Seop Jeong ◽  
Yong Ho Jang ◽  
David Hong ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Lower Risk ◽  
Dual Antiplatelet Therapy ◽  
Artery Bypass ◽  
Cardiovascular Death ◽  
Bypass Grafting ◽  
Coronary Syndrome

Abstract Aims The current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG). Methods and results Between January 2001 and December 2017, 3199 patients with ACS (55.3%) and 2583 with SIHD (44.7%) who underwent isolated CABG were enrolled. The study population was stratified using DAPT or SAPT in ACS patients and SIHD patients. The primary outcome was a cardiovascular death or myocardial infarction (MI) at 5 years. After CABG, DAPT was more frequently used in patients with ACS than in those with SIHD [n = 1960 (61.3%) vs. n = 1313 (50.8%), P < 0.001]. Among patients with ACS, the DAPT group showed a significantly lower risk of cardiovascular death or MI at 5 years than the SAPT group [DAPT vs. SAPT, 4.0% vs. 7.8%, hazard ratio (HR) 0.521, 95% confidence interval (CI) 0.339–0.799; P = 0.003]. In contrast, among patients with SIHD, there was no significant difference in the rate of cardiovascular death or MI at 5 years between the use of DAPT and SAPT (4.0% vs. 4.0%, HR 0.991, 95% CI 0.604–1.626; P = 0.971). These findings were robust to multiple sensitivity analyses and competing risk analysis. In the subgroup analysis, the use of DAPT was associated with a significantly lower risk of cardiovascular death or MI among SIHD patients with a previous percutaneous coronary intervention (PCI), with a significant interaction between the use of DAPT and PCI history (interaction P = 0.011). Conclusion Among ACS patients who underwent CABG, the use of DAPT was associated with lower cardiovascular death or MI than the use of SAPT, but this was not the case in SIHD patients. Trial registration ClinicalTrials.gov, NCT03870815.

scholarly journals Clinical Profile of Patients with Heart Failure in Eastern Part of Nepal: a Hospital based study

2019 ◽  
Vol 8 (1) ◽  
pp. 48-52
Author(s):  
Abdul Khaliq Monib ◽  
Sahadeb Prasad Dhungana ◽  
Rajesh Nepal ◽  
Rinku Ghimire
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Angiotensin Receptor Blockers ◽  
Hypertensive Heart Disease ◽  
College Teaching ◽  
Clinical Profile ◽  
Female Ratio ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Background: There is limited information on the clinical profile of patients with heart failure from the Nepalese population. Materials and Methods: This is a descriptive cross-sectional study on 120 consecutive patients with New York Heart Association class II or IV symptoms of heart failure admitted from June 2018 to January 2019 at Nobel Medical College Teaching hospital, Biratnagar, Nepal. Results: Mean age was 52.2 ± 20.6 years. The male and female ratio was 0.71. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, acute coronary syndrome, hypertensive heart disease, and peripartum cardiomyopathy were common etiologies constituting 22.5%, 19.1%,13.3%, 9.1%, 8.3 %, 5% of cases respectively. Among co-morbid conditions, anemia (91.6%),hypertension (31.6%), coronary artery disease (29.1%), diabetes (20.8%) and chronic kidney disease (11.6%) were common. Among various drugs used, 66.6% patients were prescribed diuretics, 60% mineral corticoid receptor blockers, 33.3% angiotensin-converting enzymeinhibitors, 33.3% beta-blockers, 29.1% digoxin and 8.3% angiotensin receptor blockers. Echocardiography revealed LV systolic and diastolic dysfunction in 75% and 25% respectively, mitral regurgitation in 52.5%, right ventricular dysfunction in 10.8 % and pulmonary artery hypertension in 66.6%. Conclusion: Appropriate use of evidence-based therapies, careful attention to the diagnosis and management of specific co-morbidities in patients with HF may help to improve outcomes.

Coronary artery bypass graft surgery

2017 ◽  
Author(s):  
Piroze M Davierwala ◽  
Friedrich W Mohr
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Artery Bypass Graft ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.

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