scholarly journals Frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction: A single-center experience at a large tertiary care center in Lahore, Pakistan

2021 ◽  
Vol 15 (2) ◽  
pp. 87-90
Author(s):  
Sarmad Zahoor ◽  
Hafiz Mudabbar Mahboob ◽  
Hafiz Muhammad Sajid Jehangir ◽  
Bilal Mehmood ◽  
Aleena Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vision Loss ◽  
Care Center ◽  
Tertiary Care ◽  
Retinal Hemorrhage ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Cross Sectional ◽  
Female Ratio ◽  
St Elevation

Background: Thrombolytic therapy with streptokinase is the mainstay of pharmacological treatment in acute myocardial infarction in Pakistan. Retinal hemorrhage is a common complication of streptokinase-induced thrombolysis and is often overlooked which can lead to permanent vision loss. Therefore, this study was carried out to determine the frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction (STEMI). Patients and methods: It was an observational, cross-sectional study conducted at the Emergency Department of Mayo Hospital Lahore from 11-08-2015 to 10-02-2016. The patients underwent injection of streptokinase (1.5 million U) intravenously over 60 min and intravenous heparin 5,000 U bolus followed by 1,000 U/hour. Then patients were followed up for 24 hours followed by the ophthalmoscopy to confirm the presence of retinal hemorrhage. The data were entered and analyzed using SPSS version 20. Results: A total of 130 patients were included in this study. The mean age of patients was 62±9.86 years. The male to female ratio was 1.6:1. The retinal hemorrhage was present in 17 (13.08%) patients. About 80 (61.5%) were diabetics and 96 (73.8%) were hypertensive. Stratified variables like age, gender, hypertension, and diabetes were not found associated with retinal hemorrhage (p-value ≥0.05).   Conclusion: Retinal hemorrhage was found in 13.08% after streptokinase injection in patients presenting with STEMI. Although the association was statistically insignificant but still the proportion of retinal hemorrhage was substantially high in these patients. This higher percentage demands vigilant monitoring with the drug for timely diagnosis of this ignored complication which latter can be proved hazardous to the vision.  

THROMBOLYTIC EFFICACY OF STREPTOKINASE IN ELDERLY TYPE 2 DIABETES MELLITUS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION USING ELECTROCARDIOGRAPHIC ST-SEGMENT RESOLUTION

2021 ◽  
pp. 67-70
Author(s):  
Mahendra Pratap ◽  
Somil Verma ◽  
S. L. Mathur
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Thrombolytic Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
Common Location ◽  
St Segment ◽  
St Elevation

Background: Age and diabetes are important prognostic factors in patients with acute ST-elevation myocardial infarction (STEMI) undergoing thrombolysis. In our study we compared the post-thrombolytic effect of streptokinase in elderly diabetic and non-diabetic patients. Methods: A prospective observational study was conducted in tertiary care center of India in which 140 elderly patients diagnosed with STEMI and undergoing thrombolytic therapy with streptokinase were enrolled after making necessary exclusions and were divided into diabetic (n=70) and non-diabetic (n=70) as study and control groups respectively. ECG was done immediately before and at 60 minutes after thrombolytic therapy. ST-segment resolution was measured and patients were classied as failed (<30%), partial (30-70%) and successful (>70%) resolution of STsegment. Results: Failed thrombolysis was evident in 34.3% non-diabetic and 57.1% diabetic patients (p=0.010). The incidence of successful thrombolysis was present in 41.4% non-diabetic and 28.6% diabetic patients, whereas partial thrombolysis was seen in 24.3% non-diabetic and 14.3% diabetics. Anterior wall was the most common location of infarction in elderly population but the proportion was higher in diabetics than non-diabetics (p=0.025). Conclusion: Failed thrombolysis with streptokinase was higher in diabetics than in non-diabetics after 60 minutes of streptokinase infusion in elderly patients warranting the need of using another cost effective and easily available agent for elderly diabetic population.

scholarly journals Frequency of fragmented QRS in patients with acute Non ST elevation Myocardial Infarction (NSTEMI).

2021 ◽  
Vol 28 (01) ◽  
pp. 60-65
Author(s):  
Muhammad Yasir ◽  
Muhammad Usman ◽  
Munir Ahmed ◽  
Rehan Riaz ◽  
M Hamid Saeed
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Operational Definition ◽  
Cross Sectional Study ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Qrs Complex ◽  
Cross Sectional ◽  
Fragmented Qrs ◽  
St Elevation

Objective: To determine the frequency of fragmented QRS complex in patients with acute non-ST elevation myocardial infarction (NSTEMI). Study Design: Cross-Sectional Study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: July 15, 2019 to January 15, 2020. Material & Methods: One hundred and forty five diagnosed patients of NSTEMI on the basis of chest pain and positive troponin-I were included in this study. The electrocardiography (ECG) was performed to document the presence or absence of f QRS complex in these patients. A 12-lead ECG with paper speed of 25 or 50 mm per second and a voltage of 10 mm/mv was used. FQRS was labeled (as per operational definition). The collected data were entered and analyzed statistically by using SPSS v25.0. Data were stratified for age, gender, diabetes, smoking and hypertension. Post-stratification, f QRS complex was compared by Chi-Square test in stratified groups. A p-value ≤0.05 was taken as significant. Results: Total 145 patients presenting with NSTEMI were selected for this study. Mean age of the patients was 48.2±12.3 year. Among these patients, 90(62.1%) were males, while 55(37.9%) were females. Overall frequency of fQRS complex in patients with NSTEMI was 64(44.1%). Conclusion: There is an association of fQRS among patients with acute non-ST elevation myocardial infarction (NSTEMI). Further prospective studies are needed to determine the clinical significance of fQRS complex and identify its correlation with the incidence of possible complications.

scholarly journals Challenges in Timely Pharmacological Reperfusion Therapy of Acute ST-Elevation Myocardial Infarction Patients: A Cross-sectional Study

2021 ◽  
Author(s):  
Prakriti Snehil ◽  
Anwar Hussain Ansari ◽  
Praloy Chakraborty ◽  
Niveditha Devasenapathy
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Tertiary Care ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
System Level ◽  
Care Hospital ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
St Elevation

Introduction: Acute ST-Elevation Myocardial Infarction (STEMI) is the most severe presentation of an Acute Coronary Syndrome (ACS) resulting from sudden occlusion of one of the major epicardial coronary arteries resulting in myocardial injury and necrosis within minutes to few hours. Despite Primary Percutaneous Coronary Intervention (PPCI) being the gold standard, thrombolytic therapy is still the most common form of reperfusion therapy in eligible patients of acute STEMI even in large metropolitan cities in India. Aim: To find the proportion of STEMI patients receiving thrombolytic therapy within four hours of the onset of symptoms and within 30 minutes of reaching the hospital and to explore factors related to Pain-To-Door (P2D) delay. Materials and Methods: This was a single-centre cross-sectional observational study of 147 STEMI patients conducted at a tertiary care hospital in the National Capital Territory (India). from February to May 2017. Ethical clearance was obtained from the Institute’s Ethics Committee. All patients were interviewed and their medical records reviewed. Factors related to delay in reaching hospital and association of patient characteristics with those receiving thrombolytic therapy were explored using univariable and multivariable logistic regression. Results: Mean age of the study population was 52.1±13.1 years and 121 (82.3%) were men. Median P2D time was 4.7 hours (IQR- 2.2-17.0). Overall, 64 (43.5%) of 147 patients reached the hospital within four hours of chest pain. Only 5 (3.4%) patients availed ambulance to reach the hospital. Distance from the hospital, seeking care elsewhere and delay in reaction to symptom were reasons for the delay (>4 hours). Median Door-To-Needle (D2N) time was 45.9 minutes (IQR- 30.6-61.2). Patients who reached the hospital at night were more likely to be thrombolysed after adjusting for time to reach the hospital. Conclusion: Significant P2D and Door-To-Balloon (D2B) delays still exist in large metro cities in India. Action is needed both at the population level as well as system level to reduce these delays.

scholarly journals Upper Extremity Dysfunction after Trans-Radial Interventions- Experience from a Tertiary Care Center of North India

2020 ◽  
Author(s):  
Manazir Iqbal ◽  
Mohd Iqbal Dar ◽  
Aamir Rashid ◽  
Khursheed A Khan
Keyword(s):  
Myocardial Infarction ◽  
Upper Extremity ◽  
Care Center ◽  
Tertiary Care ◽  
Vascular Occlusion ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
North India ◽  
Post Procedure ◽  
St Elevation

Introduction: Coronary artery disease treatment by percutaneous intervention has revolutionised the management of this disease and the choice and safety of vascular access site has significantly contributed to the outcome of the overall procedure. Aim: To assess upper extremity dysfunction in patients undergoing Transradial Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Materials and Methods: This study involved patients planned for transradial coronary intervention. Patients were assessed for development of upper extremity dysfunction and other local complications post procedure at 24 hours, 2 weeks, 1 month and 6 months. Data analysis was done using SPSS Version 21. Results: A total of 165 patients were enrolled in the study. There were 123 (74.5%) males. Total 156 patients (94.5%) had stable angina as underlying diagnosis, 4 (2.4%) had unstable angina, 2 (1.2%) had Non ST Elevation Myocardial Infarction (NSTEMI), 1 (0.6%) had ST Elevation Myocardial Infarction (STEMI) and 2 (1.2%) required CAG before valve replacement. A 5F sheath was used in 110 (66.67%) and 6F sheath in 55 (33.33%) cases. Tiger catheter was used in all 165 patients initially for diagnostic angiography. Dynamometer testing showed reversible downgrading of hand grip in 49% of patients post-procedure. Local site haematoma was seen in 3 (1.8%) at 24 hours, reversible vascular occlusion in 2 (1.2%) at 24 hours and Thrombolysis in Myocardial Infarction (TIMI) Minor bleed in 1 (0.6%) at 24 hours. No significant correlation was seen between sheath or catheter size with dynamometer testing or local complication. Conclusion: There was no significant upper extremity dysfunction after trans-radial intervention in the study population.

scholarly journals ST ELEVATION MYOCARDIAL INFARCTION

2015 ◽  
Vol 22 (05) ◽  
pp. 536-540
Author(s):  
Syed Fasih Ahmed Hashmi ◽  
Mashooq Ali Dasti ◽  
Nisar Ahmed Shah ◽  
Syed Saad Hussain ◽  
Munaza Gohar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Care Hospital ◽  
Female Population ◽  
St Elevation

OBJECTIVE: To evaluate the frequency of hyponatremia and its prognosticimportance in ST elevation myocardial infarction. Period: Six months. Design: Case series.Setting: Tertiary care hospital Hyderabad. Methods: All the cases with ST elevation myocardialinfarction admitted in the CCU were recruited and evaluate for serum sodium level at admissionand then at 24, 48 and 72 hours. The data was analyzed in SPSS 16 and the frequency andpercentage was calculated. Results: One hundred patients with acute myocardial infarctionwere recruited and assessed for sodium level. The mean age ±SD of whole population was57.52±9.51 whereas in male and female population it was 58.72±7.53 and 53.84±7.93respectively. The sodium level was 130.21±3.42 and 127.41±4.21 in male and femalepopulation. The p-value was statistically significant (<0.01) in context to age and sex whereasthe age in context to hyponatremia is non significant (p=0.77). The hyponatremia and itsseverity was statistically significant in context to sex (p=0.04) and duration of the myocardialinfarction (p=0.03). The serum sodium level in context to duration of MI was also significant(p=0.03) whereas the mortality at the end of 30 days was 11% of which 02 patients had normalsodium level while the 09 had low sodium level (hyponatremia). Conclusion: Hyponatremia inpatients with acute STEMI is a important predictor of thirty days mortality.

scholarly journals Reperfusion times for ST elevation myocardial infarction: a prospective audit

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Kendeep S Kaila ◽  
Kapil M Bhagirath ◽  
Malek Kass ◽  
Lorraine Avery ◽  
Lillian Hall ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Response Times ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Strong Trend ◽  
St Elevation ◽  
Contact Response

Background: New published guidelines recommend treatment of ST elevation myocardial infarction (STEMI) within 30 minutes of first medical contact to thrombolysis and 90 minutes to primary percutaneous coronary intervention (PCI). Objectives: To determine how a tertiary care center compares to these new guidelines and to evaluate the success of measures directed to shorten delays. Methods: This was a prospectively designed audit loop using retrospective chart review. Specific time intervals were evaluated: 1) T2 (ER presentation to diagnostic EKG; 2) T ER (ER presentation to reperfusion); and 3) T AHA (first medical contact to reperfusion). Results of the initial 12-month data were conveyed to Emergency Room staff and a dedicated EKG machine was placed in the ER for the subsequent 12 months, and the results were then re-analyzed. Results: In 2003-4, 58 patients with STEMI were identified, with 41 (70.7%) receiving reperfusion. Of those receiving thrombolysis, median T AHA was 54 [37-72] minutes, with 12.0% <30 minutes, while those receiving PCI, median T AHA was 58 [43-78] minutes, with 25.0% <90 minutes. In 2004-5, 52 patients had STEMI, with 40 (76.9%) receiving reperfusion. The percentage of patients meeting the guidelines was 14.3% for the thrombolysis group and 11.1% for the PCI group. Introduction of a dedicated EKG machine led to a strong trend towards improvement in median T2 (22 vs 10 minutes; P=0.07), but other treatment times remained unchanged. Conclusions: Treatment times are longer than recommended guidelines. More comprehensive strategies and improved coordination of medical services are required to shorten pre-contact and post-contact response times.

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