Shah Mohd Shah Azarisman

Institutional hypertension control in Malaysia: a multicenter study focusing on gender and cardiovascular risk factor profile difference

The prevalence of hypertension in Malaysia is alarmingly high. The National Survey in 2006 showed 43% of people aged ⩾30 had hypertension and among treated patients, only 26% reached the target blood pressure (BP) of <140/90 mm Hg. We evaluated BP control in tertiary institutions in Malaysia and the difference in hypertension control between genders and within specific cardiovascular risk factor groups. This cross-sectional study aimed at determining BP control among hypertensive patients attending three specialist institutions in Malaysia, located in Kuala Lumpur, Kuantan and Kota Bharu. A total of 950 patients with known hypertension for at least 6 months were recruited between January 2007 and July 2008. There were more males (n=548, 57.7%) with a mean age of 60.3±10.5 (±s.d.) years. The mean systolic BP (SBP) and diastolic BP were 138.8±20.3 mm Hg and 79.6±11.3 mm Hg, respectively. In total, 48.5% of all the patients had good BP control (<140/90 mm Hg). Males had better SBP control compared with female (SBP: 135.9±18.7 vs. 142.8±21.7 mm Hg, P<0.001). Overall, 54.6% of the patients had ischemic heart disease (IHD), 24.2% had undergone coronary revascularization, 50.1% were diabetic, 68.6% hyperlipidemic, 17.3% smokers and 27.5% had renal impairment. Males and small numbers of antihypertensives used were independently associated with better treatment outcome. In summary, our data reveal a poorer BP control, secondary to higher SBP levels in women. Moreover, the gender difference is more pronounced in patients with concomitant diabetes mellitus, renal impairment and IHD.

Immediate postpartum cardiorespiratory collapse:a management quandary

A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.

An Ideal Image: Effusive Constrictive Pericarditis

Presentation Cardiac magnetic resonance imaging (MRI), which provides incremental information on cardiac physiology and tissue characterization, represents the gold-standard tool for assessment of cardiac function. The technology proved most helpful when a 38-year-old Asian man presented with exertional dyspnea, pleuritic chest pain, and fever, symptoms that had been afflicting him for several months. During this time, he took multiple courses of antibiotics but had no improvement.

Emergent Caesarean section in parturient with congenital complete atrioventricular block

Maternal complete atrioventricular block undergoing emergent operative procedure under general anaesthesia should always be managed with intraoperative temporary pacing.

The Innocent Bystander: Papillary Fibroelastoma

The Innocent Bystander: Papillary Fibroelastoma Andrew Li, MBBS, FHKCP, Shah M. Azarisman, MBBS, MMED, Karen S. L. Teo, MBBS, PhD, Matthew I. Worthley, MBBS PhD, Samuel Sidharta, MBBS, Timothy Glenie, MBBS, FRACP, Luay Samaraie, MBBS, FRACP, SK Chua, MBBS, MMED, Timothy J. Bailie, MBBS, FRACP, Robert Stuklis, FRACS, Stephen G. Worthley, MBBS, PhD Cardiovascular Research Centre and the Department of Medicine and the Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia, Department of Internal Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia, and the Department of Medicine, Ruttonjee Hospital, Wan Chai, Hong Kong.