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The prevalence of CAD in patients requiring valvular surgery is 20-40%. Clinically the patient is advised to receive surgery when the level of stenosis exceeds 50%. The aim of our study was to provide a complete picture of the prevalence and incidence of CAD in valvular surgery patients along with examining the mortality rates and causes of CAD within the same group of patients. A wide ranged literature search was conducted using PubMed, to find all the various published original articles comparing morbidity and mortality rates, along with the prevalence of CAD in valve surgery patients, as late as May 2015. Consequently, 3957 articles were found and then reviewed as part of the exclusion criteria, after which 10 studies were incorporated in our study. Out of which, 5 were based on incidence of CAD among AVR patients, 2 focused on CAD with MVR and remaining 3 indicated overall picture of CAD in DVR (dual valve replacement) patients. Our study suggests, an incident rate of CAD to be 30% in AVR patients, rates slightly higher in MVR patients but the least in DVR patients. However, the mortality rates for DVR patients were the greatest, the rates decreased among MVR patients and were the least among those receiving AVR. [ABSTRACT FROM AUTHOR]

Objective: To establish association of phosphorus levels with surgical outcome of patients in our setup. Methodology: This was an case control study conducted at Department of Cardiac Surgery, Civil Hospital Karachi from May 2015 to August 2015 . Phosphorus levels were measured at three points of hospital stay; a) preoperatively b) immediately post operatively and c) at first post operative day. Patients were divided in two groups according to immediate post operative phosphate levels; those with hypophosphatemia (<2.7 mg/dl) and a control group with normal phosphate levels (2.7-4.5 mg/dl). Pre and post operative management including duration of Heart Lung Machine, cross clamp, duration of ventilation, ICU Stay, cardio active support needed and amount of blood loss, use of IABP and mortality were recorded. Results: A total of 55 patients were included in the study .Hypophosphatemia was found in 27.3% patients immediately after surgery and 38.2% patients at first post operative day. No significant difference was found in intra operative management of patient. However, post operative course of both groups differed significantly in two groups in terms of duration of ventilation (11.9±11.6 versus 6.1±5.5 hours, p=0.002), duration of ICU stay (3.5±1.5 versus 2.4±0.7 days, p=0.01) and duration of inotropic support needed (45.5±31.2 versus 25.0 ±12.4 hours, p=0.001). Patients with hypophosphatemia had significantly more blood loss (998.7±1217.8 versus 526.8±322.0, p=0.001) and received more blood transfusions post operatively (1.80±2.09 versus 0.8±0.9, p=0.009). No significant difference of post operative mortality was found in both groups (15.3% versus 3.2%, p=0.07). Conclusion: Hypophosphatemia is documented in one third of postoperative cardiac surgery patients and is associated with prolonged ventilation, duration of ICU stay and inotropic support with more blood loss. [ABSTRACT FROM AUTHOR]

Objective: To determined the percentage of myocardial infarction (MI) patients in Karachi who mistook their MI pain with heartburn and to study which socioeconomic class had the highest misconception. Methodology: This cross sectional study was conducted from June 2014 to Feb 2016. Patients included in the study were divided in upper, middle and lower socioeconomic classes. Upper and middle class patients were taken from Liaquat National Hospital while lower class patients were chosen from Civil Hospital Karachi. There were no age or gender limitations. Informed consent was taken. Subjects diagnosed with MI were interviewed according to a pre-designed questionnaire. Result: Of total 375 patients , 71.5% were males. Hypertension, diabetes and smoking was present in 66.9%, 36.8% and 36% respectively. Misconception of MI pain with heartburn was reported in 59.5% cases in first attack and 3.3% in successive attacks. This misconception in lower, middle and upper class was 66.4%, 54.4% and 57.6% respectively. Gastric reflux disease was reported in 45.9% people. Gastric reflux diseases and epigastric pain showed association with this misconception (p<0.001). Among gastric diseases, indigestion was most commonly seen as a positive misconception (p<0.001). Conclusion: Misconception of MI pain with heartburn is very common, mostly prevalent in lower socio-economic class, followed by upper and middle classes. It was more common with gastric reflux diseases and epigastric pain. Among gastric diseases, indigestion and bloating showed significant association as a misconception. [ABSTRACT FROM AUTHOR]

Objective: A 60 years old male, bilaterally anophthalmic patient, presented to the out-patient department with the complaints of substernal chest pain at rest and exertional shortness of breath for the past one month. He had a past medical history of congestive cardiac failure with reduced ejection fraction and hypertension for an undocumented period. The patient underwent cardiac catheterization and coronary artery disease (CAD) was diagnosed. Coronary artery bypass grafting surgery (CABG) was planned. Two counselling sessions were called pre and post-operatively to educate the patient and his family about his condition and his visual status emphasizing the need of an individually tailored cardiac rehabilitation program. Aural and haptic modalities were used so that the patient could perceive better. Despite, a systematic approach the patient returned unstable on his second follow-up visit, which suggests that a more robust and supervised approach is needed for the rehabilitation of visually impaired patients as they have limited mobility and accessibility. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of low flow IMA, the effect of topical vasodilators, its use on LAD and immediate post-operative outcome. Methodology: This cross-sectional study was conducted at Dow University Health Sciences, Karachi, from 1st January 2012 to 31st December 2014. Data was collected of patients who underwent CABG. Free flow of IMA was measured immediately after harvesting with a syringe. Data was analysed on SPSS 15 with sample t test used for comparison. P-value of less than 0.05 was considered statistically significant Results: Total of 158 consecutive patients were included. Males were 81.6%, with mean age of 52 years The mean flow was 11.6±9.6ml/30 seconds.About 40 patients had IMA flow less than 5ml/30seconds (25.3%). The low flow IMA did not showed a good response to topical vasodilators and its use on LAD showed significantly higher need of inotropic support(p=0.004), more LCOS(p=0.022), more use of IABP(p=0.028), and higher incidence of atrial fibrillation. The mortality and readmission were also high but not reached to significant levels. Conclusion: Low flow IMA should be used cautiously on LAD. If low flow IMA after harvesting does not give good response to topical vasodilators it may be better to use the vein graft on LAD. If use of low flow IMA necessary than mechanical and pharmacological support should be consider early. [ABSTRACT FROM AUTHOR]

Objective: To identify the effect of duration of cardiopulmonary bypass as a risk factor in the incidence of stroke in elective conventional surgery for coronary artery bypass grafting (CABG). Methodology: It was a cross-sectional, descriptive, retrospective study conducted from 1st February 2014 to 31st January 2015 at Department of Cardiac Anaesthesia & Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi. All patients between 30-70 years of age undergoing elective isolated CABG surgery were included while emergency CABG, patients with history of TIA or stroke, patients with coronary stents, diagnosed case of atrial fibrillation, low ejection fraction, intraoperative hemodynamic instability and renal dysfunction were excluded. The effect of duration of cardiopulmonary bypass with emphasis on the occurrence of stroke was analyzed in consecutive patients who underwent conventional CABG. Variables included demographic data, clinical symptoms, risk factors for stroke and CABG, investigations and other surgical parameters. Chi square test was applied for comparison. Significant p value was set for <0.05. Results: The study included 80 (100%) patients who underwent conventional CABG. There were 30 (37.5%) female patients with mean age of 64.6±2.1 years. Postoperative stroke was found in 03 patients (3.75%). Out of these, stroke was found in patients in whom bypass time was more than 100 minutes. Conclusion: Prolonged cardiopulmonary bypass time is a common risk factor for post CABG stroke. [ABSTRACT FROM AUTHOR]

Objective: To determine the percentage prevalence of cardiovascular risk factors among males of Karachi aged above 40 years and to compare them between health and non-health professionals. Methodology: It was a descriptive cross-sectional study. The participants were males aged above 40 years and were divided in two equal groups, one comprising of health professionals and the other of non-health professionals. Data was collected by a questionnaire which contained variables including hypertension, diabetes, hypercholesterolemia, smoking, excessive alcohol consumption, type A personality, obesity, sedentary lifestyle, family history of CVD and past history of CVD. Frequencies were calculated for each variable and their association with the profession was determined by Chi-Sq test and p value. Results: Among male population of Karachi above 40 years of age, prevalence of hypertension, diabetes, hypercholesterolemia, smoking, alcoholism, Type A personality, obesity, physical inactivity, family history of CVD and past history of CVD were found to be 33.3%, 21%, 21.4%, 15.7%, 2.4%, 35.7% and 21.4%, 46.7%, 84.8% and 12.4% respectively. Except for physical inactivity, all the risk factors were found to be more common among non-health than health professionals. Conclusion: CVD risk factors are present but not very commonly among males of Karachi aged above 40 years. Non-health professionals have a higher prevalence of CVD risk factors. Physical inactivity was more common in health than nonhealth professionals. [ABSTRACT FROM AUTHOR]

Embolic occlusion of a coronary artery subsequent to mitral valve replacement is a rare condition with undocumented incidence. Here we present a case of 55- year-old female, ex-smoker, with complain of sudden onset of severe dyspnea, left sided chest pain and signs of decreased cardiac output within eighteen months after MVR. The patient discontinued her anti-coagulants, as a result she developed sub therapeutic International normalized ratio of 1.45. The angiogram revealed triple vessel disease with complete occlusion of Left Main Coronary Artery. Due to the deterioration of general condition, hemodynamic instability and extensive occlusion of multiple coronary arteries, plan was made to operate the patient for coronary artery bypass grafting surgery. This case report highlights the importance of continuation of anti-coagulant therapy and management of multi-vessel lesion by coronary artery bypass grafting surgery. [ABSTRACT FROM AUTHOR]