Abdul Wadud Chowdhury

A simple time domain algorithm for the detection of ventricular fibrillation in electrocardiogram

Ventricular fibrillation (VF) is the most serious variety of arrhythmia which requires quick and accurate detection to save lives. In this paper, we propose a new time domain algorithm, called threshold crossing sample count (TCSC), which is an improved version of the threshold crossing interval (TCI) algorithm for VF detection. The algorithm is based on an important feature of the VF signal which relies on the random behavior of the electrical heart vector. By two simple operations: comparison and count, the technique calculates an effective measure which is used to separate life-threatening VF from other heart rhythms. For assessment of the performance of the algorithm, the method is applied on the complete MIT-BIH arrhythmia and CU databases, and a promising good performance is observed. Seven other classical and new VF detection algorithms, including TCI, have been simulated and comparative performance results in terms of different quality parameters are presented. The TCSC algorithm yields the highest value of the area under the receiver operating characteristic curve (AUC). The new algorithm shows strong potential to be applied in clinical applications for faster and accurate detection of VF.

A teenager with uncontrolled hypertension: a case report

BackgroundTakayasu Arteritis is a vasculitis occurring mostly in young females which may present in diverse ways. Here we report a teenager with Takayasu Arteritis who presented with uncontrolled hypertension. This case depicts an atypical presentation of this disease where the girl visited many physicians for controlling the level of hypertension and put a diagnostic dilemma about the underlying etiology of young hypertension.Case presentationA 13 year old girl presented with epistaxis, persistent headache and uncontrolled hypertension. Her clinical examination revealed normal radial, very feeble femoral and absent other lower limb pulses. There was a blood pressure discrepancy of 50/40 mm of Hg between two arms. There were bruits over multiple areas including the abdominal aorta. She had features of left ventricular hypertrophy. Her Arch aortogram showed hugely dilated arch of aorta which became abruptly normal just after origin of left subclavian artery. There was ostio-proximal stenosis of right bracheocephalic artery, left common carotid and left subclavian artery with post stenotic dilatation of all the vessels. Abdominal aortogram revealed critical stenosis of abdominal aorta above the origin of renal arteries with a pressure gradient of 80/11 mm of Hg.ConclusionTakayasu’s Arteritis should also be kept in mind while searching for the cause of uncontrolled hypertension in the young age group.

Cardiac cephalgia: A headache of the heart

Atypical presentations of common diseases are often difficult to identify in time, nonetheless necessary, especially in cases of diseases like ischemic heart disease (IHD) which otherwise may progress into irreversible stage and ultimately, fatality, in the absence of timely administered medical treatment. We report a case of a 51-year-old male, presenting initially with only headache as the sole symptom, who later was diagnosed with severe coronary artery disease, and the symptoms resolved completely after coronary angioplasty with stenting. <Learning objective: Atypical presentations, such as headache, can be more prevalent in ischemic heart disease (IHD) than was thought of, so awareness of the possibility of IHD while assessing headache and further study to see actually how commonly headache is associated with IHD are necessary.>.

Situs Inversus Totalis: A Rare Congenital Anomaly and the Presence of COPD Giving a Concept of Dextroposition with Limb Lead Reversal in ECG

Situs inversus totalis is the mirror-image of normal position of the thoracic and abdominal viscera. It may be detected incidentally when the patient seek medical attention for other medical illness. From medico-legal points of view, this rare disorder is important in many ways for a junior physician to prevent a big mishap, especially surgical. Here, we report a case, who was 55- year-old, seeking medical attention for infective exacerbation of chronic obstructive pulmonary disease incidentally diagnosed as a case of situs inversus totalis. Bangladesh Heart Journal 2016; 31(2) : 100-103

Admission Serum Uric Acid Levels and In-Hospital Outcomes in Patients with Acute Coronary Syndrome

Background : Uric acid is an independent risk factor for cardiovascular disease. Hospital admission for ischemic heart disease (IHD) is increasing rapidly in our country. Although studies were conducted abroad regarding association of serum uric acid with in-hospital outcomes in patients with acute coronary syndrome (ACS), no data is yet available to show the association in our country. Objective : The objective of this study was to assess the association of serum uric acid level on admission with in-hospital outcomes of the patients with ACS. Materials and Methods : This cross sectional comparative study was done in the Department of Cardiology, Dhaka Medical College Hospital (DMCH) from January to December 2012. After proper ethical consideration total 93 ACS patients were enrolled in the study by nonrandom sampling. Serum uric acid of all subjects was measured within 24 hours of admission. Then in-hospital outcomes were observed in all subjects. Results : The frequency of hyperuricemia among ACS patients was 24.7% (22.54% in male and 31.82% in female). Hyperuricemic patients significantly developed heart failure (30.4% vs 11.4%, p=0.032) and conduction defect (13.0% vs 1.4%, p=0.017) than normouricemic subjects. The mean ejection fraction was significantly lower in hyperuricemic patients than patients with normal uric acid level (50.87 ± 10.27% vs 55.94 ± 6.66%). The mean ± SD duration of hospital stay of hyperuricemic group was significantly longer in patients with ACS (8.26 ± 1.18 vs 7.51±1.18 days, p=0.010). Conclusion : The measurement of serum uric acid level, an easily available and inexpensive biochemical tool, might turn out as a valuable risk marker for prediction of in-hospital outcomes in patients with ACS. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21492 J Enam Med Col 2015; 5(1): 15-22

Graves’ disease presenting as bi - ventricular heart failure with severe pulmonary hypertension and pre-eclampsia in pregnancy – a case report and review of the literature

BackgroundGraves’ disease, a well-known cause of hyperthyroidism, is an autoimmune disease with multi-system involvement. More prevalent among young women, it appears as an uncommon cardiovascular complication during pregnancy, posing a diagnostic challenge, largely owing to difficulty in detecting the complication, as a result of a low index of suspicion of Graves’ disease presenting during pregnancy. Globally, cardiovascular disease is an important factor for pregnancy-related morbidity and mortality. Here, we report a case of Graves’ disease detected for the first time in pregnancy, in a patient presenting with bi- ventricular heart failure, severe pulmonary hypertension and pre- eclampsia. Emphasis is placed on the spectrum of clinical presentations of Graves’ disease, and the importance of considering this thyroid disorder as a possible aetiological factor for such a presentation in pregnancy.Case presentationA 30-year-old Bangladeshi-Bengali woman, in her 28th week of pregnancy presented with severe systemic hypertension, bi-ventricular heart failure and severe pulmonary hypertension with a moderately enlarged thyroid gland. She improved following the administration of high dose intravenous diuretics, and delivered a premature female baby of low birth weight per vaginally, twenty four hours later. Pre-eclampsia was diagnosed on the basis of hypertension first detected in the third trimester, 3+ oedema and mild proteinuria. Electrocardiography revealed sinus tachycardia with incomplete right bundle branch block and echocardiography showed severe pulmonary hypertension with an estimated pulmonary arterial systolic pressure of 73 mm Hg, septal and anterior wall hypokinesia with an ejection fraction of 51%, grade I mitral and tricuspid regurgitation. Thyroid function tests revealed a biochemically hyperthyroid state and positive anti- thyroid peroxidase antibodies was found. 99mTechnetium pertechnetate thyroid scans demonstrated diffuse toxic goiter as evidenced by an enlarged thyroid gland with intense radiotracer concentration all over the gland. The clinical and biochemical findings confirmed the diagnosis of Graves’ disease.ConclusionsGraves’ disease is an uncommon cause of bi-ventricular heart failure and severe pulmonary hypertension in pregnancy, and a high index of clinical suspicion is paramount to its effective diagnosis and treatment.