This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Worldwide, the major cause of mortality and morbidity is coronary artery disease (CAD). In the pa... more Worldwide, the major cause of mortality and morbidity is coronary artery disease (CAD). In the pathogenesis and progression of atherosclerosis, lipid and its metabolites play an important role. The aim of the study was to find out the association of triglyceride (TG) level on the severity of coronary artery disease (CAD) in patients with ischemic heart disease (IHD). In this cross-sectional study, 431 patients with ischemic heart disease were enrolled after taking informed written consent. TG level were categorized into normal (< 150 mg/dl), borderline (150-199 mg/dl) and high (³200 mg/dl). Patients with ischemic heart disease (IHD) were stratified according to TG level. Severity of CAD was assessed by the Gensini score. Most of the patients (33.4%) belonged to the age group 51–60 years. The mean age was 51.31±10.30 years. The majority (74.5%) of patients were male. Among risk factors, 205 (47.6%) patients were smokers, followed by hypertension 190 (44.1%) and diabetes mellitus 1...
Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized ... more Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized by left ventricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but there is still uncertainty regarding its incidence, pathogenesis, and optimum management protocol. Retrospective analysis of twenty cases of PPCM admitted, within July 20016 to June 2018 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka is done here. Mean age of study population was 25 (6.3). Majority of the patients were multi-paras 12 (60%). 80% of the patients were diagnosed after delivery. Breathlessness was the most common symptom. Bibasal lung base crepitations was most frequent sign, which was found in 95% cases. Sinus tachycardia was most frequent electrocardiographic change which was found in 80% cases. Mean left ventricular ejection fraction (LVEF) was 35.2(2.8). All the patients had different extent of ...
Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Alt... more Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Although it predominantly affects young women in the peripartum period, it can also occur in men. The left coronary artery is most frequently involved. The usual presentation is ST segment elevation myocardial infarction. Although several treatment modalities have been proposed, the optimal treatment options still remain to be established. This current case report focuses on a 40- year-old male presented with acute coronary syndrome and subsequently was found to have coronary artery dissection. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21498 J Enam Med Col 2015; 5(1): 52-57
Background: Ventricular arrhythmias (VA) are among the most feared complications of coronary arte... more Background: Ventricular arrhythmias (VA) are among the most feared complications of coronary artery disease (CAD) and one of the major contributors of death in CAD patients. Antiarrhythmic drug (AAD) therapy is required for recurrent significant VA in the absence of need for further revascularization. But all AADs do not have the same efficacy against life threatening VA and supraventricular arrhythmias (SVAs). Methodology: All (50) patients admitted in the department of Cardiology, BSMMU with ventricular arrhythmias with CAD fulfilling the inclusion and exclusion criteria were included in the study. Informed written consent was taken from each patient before enrollment. Detailed history was taken and relevant physical examinations were done. Loading dose followed by maintenance dose of amiodarone was given and recorded. Relevant lab investigations were performed and recorded in predesigned semi-structured data collection sheet. Symptomatic improvement was assessed, relevant physica...
Background: Corona virus disease (COVID-19) has been associated with different cardiac complicati... more Background: Corona virus disease (COVID-19) has been associated with different cardiac complications including cardiac arrhythmias. Arrhythmias carries a great influence on the outcomes. The pathophysiology of these manifestations remain elusive. This study was aimed to observe the incidence and outcome of cardiac arrhythmia in patients with COVID-19 infection from July 2020 to May 2021. Method: We conducted an observational study of patients ³18 years of age with a clinical diagnosis of COVID -19 infection attending Bangabandhu sheikh Mujib Medical University (BSMMU) with and without cardiac arrhythmias from July 2020 to May 2021. Patients were labeled as having arrhythmia if they had sinus bradycardia (heart rate <40 bpm), A-V block, Atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), nonsustained VT, sustained VT, ventricular fibrillation (VF). We excluded those patients presented with Acute Coronary syndrome & cardiogenic shock. Different clini...
Background: Amiodarone is the most effective antiarrhythmic medications available today for the t... more Background: Amiodarone is the most effective antiarrhythmic medications available today for the treatment of both atrial and ventricular arrhythmias. It is an iodinated benzofuran derivative with demonstrated efficacy against a range of cardiac arrhythmias, including atrial fibrillation, paroxysmal supraventricular tachycardias, and life-threatening ventricular arrhythmias. Objective: To evaluation the status of amiodarone with therapeutic dose in Bangladeshi population. Materials and Methods: The quasi experimental study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka during April, 2019 to March, 2020 Patients got admitted in the Department of Cardiology, BSMMU, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Results: Th...
Objective: The present research aimed at the careful evaluation of the different patterns, clinic... more Objective: The present research aimed at the careful evaluation of the different patterns, clinical presentation and establishment echocardiography as an authentic tool for diagnosis of Hypertrophic Cardiomyopathy (HCM) at an earlier stage. Methods: In this cross sectional study 20 patients were enrolled after taking informed consent. Initially all patients had presented with atypical chest pain where 10 patients presented with exertional shortness of breath and 4 patients presented with acute breathlessness. Initial ECG revealed T inversion in anterior-inferior leads and upright T wave in aVR. Patients were initially diagnosed accordingly as Chronic stable angina, Heart failure with preserve Ejection fraction (HFpEF), hypertesion and they underwent coronary angiogram (CAG) but CAG was normal in all patients. So, final evaluation of all patients done by repeat transthorasic echocardiography to find out the presence of any features of hypertrophic cardiomyopathy. Results: Among 20 pa...
Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome ... more Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center. Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced...
Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with ven... more Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with venous thrombosis, pulmonary embolism, atrial fibrilation, cardiac valve replacement, stroke and acute myocardial infarction. It is a vitamin K antagonist composed of S- and R- isomers. The more potent S-warfarin is metabolized by cytochrome 450 isoenzyme 2C9 (CYP2C9), encoded by CYP2C9 gene. Warfarin exerts its anticoagulants effect by inhibitingits target enzyme vitamin K epoxide reductase (VKOR), encoded by vitamin K epoxide reductase subunit 1 (VKOR1) gene. Genetic variation in the CYP2C9 and VKOR1 gene can affect warfarin efficacy and dose required to achieve stable International Normalization Ratio (INR). Specifically two variants in the CYP2CP gene (CYP2C9*2 and CYP2C9*3) result in an enzyme with reduced activity, leading to increased active warfarin levels. A variant in the VKORC1 gene (VKORC1-1639 G>A) can lead to reduced gene expression resulting in decresed level of VKOR. Toge...
Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the pre... more Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the predominant form of heart failure in the western world. We aimed to estimate the frequency and clinical characteristics of HFpEF cohort in Bangladesh as limited data are available about this extremely heterogeneous syndrome. Methods: This cross sectional study was conducted at the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from December, 2017 to December, 2018. A total of 124 heart failure patients were enrolled in the study for the estimation of frequency of HFpEF. Comorbidities and presentation of 30 HFpEF patients were assessed. HFpEF diagnosis was made according to the 2016 European Society of Cardiology (ESC) Guidelines. Results: The frequency of HFpEF was 30 (24.1%) (95% confidence interval 16.6% to 31.7%). The mean (SD) age of was 65.0 (10.1) years. Majority of the patients (73.3 %) were between 60 to 79 years of age. Majority of the patients (60%) w...
Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million... more Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients...
Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left... more Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left entricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but till now its incidence, pathogenesis, optimum management protocol are not known. Oxidative stress-prolactin hypothesis , anti-angiogenic-signalling excess hypothesis, viral myocarditis and genetic predisposition are some attractive etiologic explanation but nothing is proven comprehensively. Novel biomarkers and role of new imaging modalities are being investigated. As benefit by targeted therapy like bromocriptine or pentoxifylline are inconsistent, so controlling volume status, neutralizing maladaptive neurohormonal response and treatment of complications are required.prognosis is reasonably good. The aim of this review to highlight its pathophysiology, emerging investigatios modalities, and updated management protocol.
T wave on ECG is the positive deflection after QRS complex which reflect the ventricular repolari... more T wave on ECG is the positive deflection after QRS complex which reflect the ventricular repolarization. The amplitude of T wave is 5mm in limb lead and 10mm in chest leads. T wave is upright in all leads except a VR and V1, but it may be inverted in V1-V3 in pediatric age group. Triple T pattern is the negative T waves in inferior leads, anterior leads and on a VR. Triple T pattern is a very common finding in Apical hypertrophic cardiomyopathy (AHCM). Apical hypertrophic cardiomyopathy is a rare form of cardiomyopathy that affects LV apex and rarely RV apex or both. Patients with AHCM has a wide range of presentations, ranging from asymptomatic to palpitation, nonspecific chest discomfort, chest pain etc. It does not present with features which are common in other type of obstructive hypertrophic cardiomyopathy like presyncope, syncope, and it has less chance of sudden cardiac death. First clue of diagnosis of AHCM is widespread negative T wave in ECG. Although negative T-waves may...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Worldwide, the major cause of mortality and morbidity is coronary artery disease (CAD). In the pa... more Worldwide, the major cause of mortality and morbidity is coronary artery disease (CAD). In the pathogenesis and progression of atherosclerosis, lipid and its metabolites play an important role. The aim of the study was to find out the association of triglyceride (TG) level on the severity of coronary artery disease (CAD) in patients with ischemic heart disease (IHD). In this cross-sectional study, 431 patients with ischemic heart disease were enrolled after taking informed written consent. TG level were categorized into normal (< 150 mg/dl), borderline (150-199 mg/dl) and high (³200 mg/dl). Patients with ischemic heart disease (IHD) were stratified according to TG level. Severity of CAD was assessed by the Gensini score. Most of the patients (33.4%) belonged to the age group 51–60 years. The mean age was 51.31±10.30 years. The majority (74.5%) of patients were male. Among risk factors, 205 (47.6%) patients were smokers, followed by hypertension 190 (44.1%) and diabetes mellitus 1...
Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized ... more Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized by left ventricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but there is still uncertainty regarding its incidence, pathogenesis, and optimum management protocol. Retrospective analysis of twenty cases of PPCM admitted, within July 20016 to June 2018 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka is done here. Mean age of study population was 25 (6.3). Majority of the patients were multi-paras 12 (60%). 80% of the patients were diagnosed after delivery. Breathlessness was the most common symptom. Bibasal lung base crepitations was most frequent sign, which was found in 95% cases. Sinus tachycardia was most frequent electrocardiographic change which was found in 80% cases. Mean left ventricular ejection fraction (LVEF) was 35.2(2.8). All the patients had different extent of ...
Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Alt... more Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Although it predominantly affects young women in the peripartum period, it can also occur in men. The left coronary artery is most frequently involved. The usual presentation is ST segment elevation myocardial infarction. Although several treatment modalities have been proposed, the optimal treatment options still remain to be established. This current case report focuses on a 40- year-old male presented with acute coronary syndrome and subsequently was found to have coronary artery dissection. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21498 J Enam Med Col 2015; 5(1): 52-57
Background: Ventricular arrhythmias (VA) are among the most feared complications of coronary arte... more Background: Ventricular arrhythmias (VA) are among the most feared complications of coronary artery disease (CAD) and one of the major contributors of death in CAD patients. Antiarrhythmic drug (AAD) therapy is required for recurrent significant VA in the absence of need for further revascularization. But all AADs do not have the same efficacy against life threatening VA and supraventricular arrhythmias (SVAs). Methodology: All (50) patients admitted in the department of Cardiology, BSMMU with ventricular arrhythmias with CAD fulfilling the inclusion and exclusion criteria were included in the study. Informed written consent was taken from each patient before enrollment. Detailed history was taken and relevant physical examinations were done. Loading dose followed by maintenance dose of amiodarone was given and recorded. Relevant lab investigations were performed and recorded in predesigned semi-structured data collection sheet. Symptomatic improvement was assessed, relevant physica...
Background: Corona virus disease (COVID-19) has been associated with different cardiac complicati... more Background: Corona virus disease (COVID-19) has been associated with different cardiac complications including cardiac arrhythmias. Arrhythmias carries a great influence on the outcomes. The pathophysiology of these manifestations remain elusive. This study was aimed to observe the incidence and outcome of cardiac arrhythmia in patients with COVID-19 infection from July 2020 to May 2021. Method: We conducted an observational study of patients ³18 years of age with a clinical diagnosis of COVID -19 infection attending Bangabandhu sheikh Mujib Medical University (BSMMU) with and without cardiac arrhythmias from July 2020 to May 2021. Patients were labeled as having arrhythmia if they had sinus bradycardia (heart rate <40 bpm), A-V block, Atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), nonsustained VT, sustained VT, ventricular fibrillation (VF). We excluded those patients presented with Acute Coronary syndrome & cardiogenic shock. Different clini...
Background: Amiodarone is the most effective antiarrhythmic medications available today for the t... more Background: Amiodarone is the most effective antiarrhythmic medications available today for the treatment of both atrial and ventricular arrhythmias. It is an iodinated benzofuran derivative with demonstrated efficacy against a range of cardiac arrhythmias, including atrial fibrillation, paroxysmal supraventricular tachycardias, and life-threatening ventricular arrhythmias. Objective: To evaluation the status of amiodarone with therapeutic dose in Bangladeshi population. Materials and Methods: The quasi experimental study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka during April, 2019 to March, 2020 Patients got admitted in the Department of Cardiology, BSMMU, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Results: Th...
Objective: The present research aimed at the careful evaluation of the different patterns, clinic... more Objective: The present research aimed at the careful evaluation of the different patterns, clinical presentation and establishment echocardiography as an authentic tool for diagnosis of Hypertrophic Cardiomyopathy (HCM) at an earlier stage. Methods: In this cross sectional study 20 patients were enrolled after taking informed consent. Initially all patients had presented with atypical chest pain where 10 patients presented with exertional shortness of breath and 4 patients presented with acute breathlessness. Initial ECG revealed T inversion in anterior-inferior leads and upright T wave in aVR. Patients were initially diagnosed accordingly as Chronic stable angina, Heart failure with preserve Ejection fraction (HFpEF), hypertesion and they underwent coronary angiogram (CAG) but CAG was normal in all patients. So, final evaluation of all patients done by repeat transthorasic echocardiography to find out the presence of any features of hypertrophic cardiomyopathy. Results: Among 20 pa...
Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome ... more Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center. Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced...
Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with ven... more Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with venous thrombosis, pulmonary embolism, atrial fibrilation, cardiac valve replacement, stroke and acute myocardial infarction. It is a vitamin K antagonist composed of S- and R- isomers. The more potent S-warfarin is metabolized by cytochrome 450 isoenzyme 2C9 (CYP2C9), encoded by CYP2C9 gene. Warfarin exerts its anticoagulants effect by inhibitingits target enzyme vitamin K epoxide reductase (VKOR), encoded by vitamin K epoxide reductase subunit 1 (VKOR1) gene. Genetic variation in the CYP2C9 and VKOR1 gene can affect warfarin efficacy and dose required to achieve stable International Normalization Ratio (INR). Specifically two variants in the CYP2CP gene (CYP2C9*2 and CYP2C9*3) result in an enzyme with reduced activity, leading to increased active warfarin levels. A variant in the VKORC1 gene (VKORC1-1639 G>A) can lead to reduced gene expression resulting in decresed level of VKOR. Toge...
Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the pre... more Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the predominant form of heart failure in the western world. We aimed to estimate the frequency and clinical characteristics of HFpEF cohort in Bangladesh as limited data are available about this extremely heterogeneous syndrome. Methods: This cross sectional study was conducted at the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from December, 2017 to December, 2018. A total of 124 heart failure patients were enrolled in the study for the estimation of frequency of HFpEF. Comorbidities and presentation of 30 HFpEF patients were assessed. HFpEF diagnosis was made according to the 2016 European Society of Cardiology (ESC) Guidelines. Results: The frequency of HFpEF was 30 (24.1%) (95% confidence interval 16.6% to 31.7%). The mean (SD) age of was 65.0 (10.1) years. Majority of the patients (73.3 %) were between 60 to 79 years of age. Majority of the patients (60%) w...
Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million... more Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients...
Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left... more Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left entricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but till now its incidence, pathogenesis, optimum management protocol are not known. Oxidative stress-prolactin hypothesis , anti-angiogenic-signalling excess hypothesis, viral myocarditis and genetic predisposition are some attractive etiologic explanation but nothing is proven comprehensively. Novel biomarkers and role of new imaging modalities are being investigated. As benefit by targeted therapy like bromocriptine or pentoxifylline are inconsistent, so controlling volume status, neutralizing maladaptive neurohormonal response and treatment of complications are required.prognosis is reasonably good. The aim of this review to highlight its pathophysiology, emerging investigatios modalities, and updated management protocol.
T wave on ECG is the positive deflection after QRS complex which reflect the ventricular repolari... more T wave on ECG is the positive deflection after QRS complex which reflect the ventricular repolarization. The amplitude of T wave is 5mm in limb lead and 10mm in chest leads. T wave is upright in all leads except a VR and V1, but it may be inverted in V1-V3 in pediatric age group. Triple T pattern is the negative T waves in inferior leads, anterior leads and on a VR. Triple T pattern is a very common finding in Apical hypertrophic cardiomyopathy (AHCM). Apical hypertrophic cardiomyopathy is a rare form of cardiomyopathy that affects LV apex and rarely RV apex or both. Patients with AHCM has a wide range of presentations, ranging from asymptomatic to palpitation, nonspecific chest discomfort, chest pain etc. It does not present with features which are common in other type of obstructive hypertrophic cardiomyopathy like presyncope, syncope, and it has less chance of sudden cardiac death. First clue of diagnosis of AHCM is widespread negative T wave in ECG. Although negative T-waves may...
Uploads
Papers by Walidur Rahman