Afzalur Rahman

Recurrent Deep Vein Thrombosis due to Thrombophilia

Deep vein thrombosis (DVT) is a common condition that is often under-diagnosed. Acquired or hereditary defects of coagulation or a combination of these defects may facilitate the development of DVT. Recurrent DVT, a positive family history or unusual presentation may warrant investigation for hereditary thrombophilia. Investigations are best when conducted at least one month after completion of a course of anticoagulant therapy. Most patients are managed with heparin in the acute stage overlapped by warfarin. The case presented here describes a 40-year old man undergoing three episodes of DVT. Investigations revealed protein C and protein S deficiency. Protein C, protein S and antithrombin deficiency either singly or in combination, are relatively common causes of hereditary thrombophilia. The case presented here serves as a reminder of the need to look into the underlying cause of venous thromboembolism.

Rheumatic Fever and Rheumatic Heart Diseases in Bangladesh: Challenges and Remedies

In the 21 st century, Rheumatic fever (RF) and Rheumatic heart disease (RHD) are neglected diseases of marginalized communities. Globally, RHD remains the most-common cardiovascular disease in young people aged <25 years. Although RF and RHD have been almost eradicated in areas with established economies, migration from low-income to high-income settings might be responsible for a new burden of RHD in high-income countries. Globally, the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD) has declined sharply but, in developing countries, RF is still aleading cause of heart disease and, consequently, death in children and young adults. In 2005, it was estimated that over 2.4 million children aged 5-14 years were having RHD globally and 79% of all these cases were from lessdeveloped countries. Cardiovasc. j. 2018; 10(2): 206-211

Prediction of Reperfusion and Infarct Related Artery Patency after Thrombolysis in Acute Anterior Myocardial Infarction by Degree of P Wave Dispersion on ECG

Background: Early detection IRA patency following thrombolytic therapy is of great importance in terms of prognosis and identification of candidates for rescue percutaneous coronary intervention (PCI). P wave dispersion (PWD), a new parameter measured before and after thrombolytic therapy is supposed to predict successful reperfusion in patients with anterior acute myocardial infarction (AMI). Methods: 132 patients were selected and divided into two groups on the basis of ST Segment resolution (STR) after 120 minutes of thrombolysis. Group I: patients with STR >70%; Group II: patients with STR < 70%. P wave dispersion was measured in both groups before and after thrombolysis. All patients underwent coronary angiography (CAG). IRA was considered patent if TIMI flow grade was e”2. Results: It was observed that diabetes mellitus and dyslipidemia were significantly higher in group II patients (p=0.04 and p=0.03, respectively). PWD before thrombolysis (PWD0) and 90 minutes after thrombolysis (PWD90) in both groups were statistically insignificant (p=0.45 and p=0.19, respectively). The mean level of PWD120 was statistically significant (p=0.001). After multivariate regression analysis PWD120 was found to be the significant predictor of IRA patency (OR = 1.101; 95% CI = 1.012 – 1.240; p = 0.01). Conclusion : P wave dispersion in patients receiving thrombolytic therapy can be a predictor of successful reperfusion and patent IRA. PWD values, in combination with other reperfusion parameters, can contribute to the identification of rescue PCI candidates. Cardiovasc. j. 2018; 10(2): 158-163

Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

Background: Acute coronary syndrome (ACS) is increasingly prevalent among young patients, particularly in South Asia, where young patients are known to present with multiple risk factors and gender-based differences in angiographic profiles. This study aimed to compare gender differences in clinical, angiographic and procedural profiles between young patients with ACS undergoing percutaneous coronary intervention (PCI). Methods: This prospective observational study was done at the National Institute of Cardiovascular Diseases (NICVD) from April 2016 to March 2017. 190 young patients with ACS undergoing PCI were included. Clinical, angiographic and procedural variables were compared and statistically analyzed. Results: The mean age of young females and males was 43.8±6.9 years and 40.1±4.3 years respectively (p<<0.001). Young women had significantly more risk factors of hypertension (62.1% vs 33.7%, p<0.001) and diabetes (57.9% vs 31.6%, p<0.001) in comparison to young men. Smoking was significantly greater among young males (70.5% vs 0%, p<0.001). Young females had significantly better mean ejection fraction (EF) (48.4±9.3% vs 45.1±10.4%, p=0. 02). Left main coronary artery (3.2% vs. 1.1%, p=0.61) and left anterior descending artery (51.6% vs. 45.3%, p=0.38) were more frequently involved among young females. Young males showed angiographically more severe CAD and greater frequency of multivessel CAD with higher DVD (22.1%vs 18.9%, p=0.58) and TVD (18.9%vs 11.6%, p=0.15). Conclusion: Significantly more young women with ACS presented with hypertension and diabetes than young males. However, they had better ejection fraction and less severe angiographic profiles. Cardiovasc. j. 2018; 10(2): 113-120

Prediction of Reperfusion and Infarct-Related Artery Patency after Thrombolysis in Acute Anterior Myocardial Infarction by Degree of P Wave Dispersion on ECG

Background : The prognosis of patients with persistent occlusion of the infarct related artery (IRA), despite lytic therapy is poor. Early detection of successful reperfusion and IRA patency is of great importance in terms of prognosis and identification of candidates for rescue percutaneous coronary intervention (PCI). P wave dispersion (PWD), a new parameter measured before and after fibrinolytic therapy (FT) is supposed to predict successful reperfusion in patients with anterior acute myocardial infarction (AMI). Objectives : To examine the prediction of successful reperfusion and infarct related artery (IRA) patency by measuring P wave dispersion in 12-lead surface ECG. Method :132 patients were selected and divided into two groups on the basis of ST segment resolution (STR) after 120 minutes of thrombolysis. Group I: patients with STR >70%; Group II: patients with STR 2. Results : Mean age of the successfully thrombolysed group was 49.12±9.54 and mean age of failedthrombolysis group was 52.08±8.23 years. Though higher age was associated with failed thrombolysis and it was statistically insignificant (p=0.06). Patients with higher BMI showed no significant difference in thrombolysis. It was observed that diabetes mellitus and dyslipidemia were significantly higher in group II patients (p=0.04 and p=0.03, respectively). The mean level of PWD after 120 minutes of thrombolysis (PWD120) was statistically significant (p=0.001) between two groups. After multivariate regression analysis PWD120 was found to be the significant predictor of ST segment resolution as well as IRA patency (OR = 1.101; 95% CI = 1.012 – 1.240; p = 0.01). Conclusion : P wave dispersion (PWD) in patients receiving thrombolytic therapy can be a predictor of successful reperfusion and patent infarct related artery (IRA). PWD values, in combination with other reperfusion parameters, can contribute to the identification of rescue PCI candidates. Bangladesh Heart Journal 2017; 32(2) : 100-105

TCTAP A-028 Predictors of Short Term Outcomes of Primary Percutaneous Coronary Intervention (PCI)

Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in

TCTAP A-182 Immediate In-Hospital Complications of Percutaneous Transvenous Mitral Commissurotomy in Patients with Mitral Stenosis

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach.