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In the recent era of medicine, Novel Oral Anticoagulants (Apixaban, Dabigatran, Edoxaban, and Rivaroxaban) have become the preferred drugs for long-term anticoagulation therapy in the majority of cardiovascular conditions, along with non-cardiac co-morbid conditions with few necessary exceptions. This preference is based on their easy availability, therapeutic efficacy, all-cost effectiveness, safety profile, and more convenient usage for both patients and clinicians. Novel Oral Anticoagulants (NOACs) have different pharmacokinetics and pharmacodynamics than oral vitamin K antagonists. This article highlights the basic pharmacology, common complications, available antidotes, and the util ity of NOACs in different common cardiovascular diseases requiring long-term oral anticoagulation, including stroke prevention in valvular and non-valvular atrial fibrillation, coronary artery disease, myocardial infarction, left ventricular thrombus and cerebrovascular attacks. NOACs are still underutilized in cardiovascular practice because the concomitant co -morbid conditions hinder a clinician from prescribing these drugs confidently. This manuscript will provide a brief critical overview to help clinicians prescribe NOACs more conveniently. [ABSTRACT FROM AUTHOR]

Temporary cardiac pacing via trans-venous approach is a treatment technique of choice in case of life threatening arrhythmias. This approach is used to re-establish the hemodynamics that are acutely compromised by a fast or slow heart rate. Inadvertent lead placement into abnormal locations is an uncommon but serious complication of temporary cardiac pacing in emergency departments. These can easily be detected and managed, even in emergencies, with the help of readily available modalities including 12-lead ECG and chest x-rays, as well as transthoracic echocardiography. Here, we report 2 cases of mal-placement of temporary pacing lead and their timely management to highlight the signifcance of simple yet necessary post procedure investigation techniques. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is one of the leading causes of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission among patients in Pakistan and worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients themselves can identify the underlying factors that contribute to their readmissions. Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission in stabilized discharged HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way. Methods: This qualitative study, using indepth semi-structured patient interviews, was conducted among patients readmitted to National Institute of Cardiovascular Diseases, through emergency in Karachi, Pakistan for a period of 3 months from June 2019 till august 2019. Patients readmitted within 6 months of their discharge after primary HF were included in the study. Patients were approached, consented, and interviewed within the next 24 hours of readmission. Results: During the readmission, median length of stay was 6 days. Among the 500 patients included in the study, 375 (75%) were males, the commonest cause of heart failure was ischemic cardiomyopathy in 400 (80%) cases. Common reason for readmission was lack of counseling (40%), followed by under dose (15%), non-compliance (12%), and volume over load (10%), hypertension (10%) and secondary infection (7%). No deaths were recorded. Conclusion: We conclude that, along with patient compliance of medication, appropriate fluid intake, self-care and life style modification, psychotherapies and proper counseling sessions can help reduce the readmissions due to HF. Detailed case records must be maintained by the physicians at the time of diagnosis of such patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patients with unexplained syncope. Methodology: This quasi experimental study was done at National Institute of Cardiovascular diseases Karachi and Chaudhry Pervaiz Elahi Institute of Cardiology Multan Pakistan from January to December 2018. Patients presented with unexplained syncope were included. 64 syncope patients were included and HUTT was done. Outcome including positive HUTT, response to HUTT, phase of HUTT and the effect of age and gender in patients with unexplained syncope undergoing HUTT. Results: The mean age of patients was 63.39±6.94 years. There were 51 (79.7%) male while 13 (20.3%) were females. HUTT was found to be positive in 37 (57.8%) patients while 27 (42.2%) patients had negative HUTT. Mixed HUTT response was observed in 18 (48.6%) patients, cardio-inhibitory reposes in 8 (21.6%) patients while vaso depressive response in 11 (17.2%) patients. Active HUTT phase was observed in 30 (81.1%) patients while 7 (18.9%) patients had passive HUTT phase. The age and gender were found to have insignificant impact on HUTT findings (p>0.05). Conclusion: Thus the frequency of positive HUTT is high in unexplained syncope patients. No significant difference was found in the frequency of responses to HUTT between the gender groups. The trend of the HUTT result significantly changed with age. [ABSTRACT FROM AUTHOR]