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Objective: To determine the hospital outcome of acute myocardial infarction patients with COVID-19 and compare it with patients without COVID-19. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi Pakistan, from Mar to Oct 2021. Methodology: The study included PCR-positive patients with COVID-19 infection who had acute myocardial infarction diagnosed by a consultant cardiologist. The hospital recorded clinical outcomes within two days of acute myocardial infarction. Data regarding outcome was compared with patients who had acute myocardial infarction but did not have COVID-19. Results: Fifty cases of COVID-19 and myocardial infarction were included in the study. An equal number of patients with no evidence of COVID-19 but having myocardial infarction were also included. The mean age of the study participants was 49.96±897 years. Out of 100 patients, 79(79%) were male, while 21(21%) were female. Statistical analysis showed that all the outcome parameters studied had no significant difference in both the acute myocardial infarction patients with and without COVID-19 (p-value>0.05). Conclusion: Our study results revealed no statistically significant difference in the hospital outcome of patients with acute myocardial infarction who were suffering from COVID-19 and those who were not. [ABSTRACT FROM AUTHOR]

Objective: To compare the complications between closure device and manual compression in patients after percutaneous coronary intervention through femoral access site. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology, from Mar to Nov 2021. Methodology: Eighty patients who underwent percutaneous coronary intervention through the femoral access site during the study period were recruited in this analysis. Patients were randomly divided into two groups for the procedure adopted for hemostasis after percutaneous coronary intervention. Group-A underwent manual compression of the femoral access site, while hemostasis in Group-B was achieved with the help of a closure device. Hematoma formation, pseudo-aneurysm, AV fistula and bleeding were compared in both groups. Results: Eighty patients participated in this analysis. Of them, 50(62.5%) were male and 30(37.5%) were female. The mean age of patients was 48.85±8.93 years. In 35(43.75%) patients, hemostasis was achieved by manual compression (Group-A), while in 45(56.25%) patients, by vascular compression device (Group-B). Both groups did not differ statistically significantly in Hematoma formation, AV fistula formation, bleeding, and pseudo-aneurysm formation (p-value: 0.05). Conclusion: There was no statistically significant difference in the complications studied among the closure device method and manual compression of hemostasis in PCI through femoral vein access. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of vein graft occlusion after bypass surgery in patients undergoing coronary computerized tomography angiography with anginal symptoms. Study Design: A retrospective longitudinal study. Place and Duration of Study: Computerized Tomography Angiography department, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi Pakistan, from Jan to Jun 2021. Methodology: A total of 109 patients having angina symptoms after coronary artery bypass graft. For this purpose, we performed computerized tomography angiography for graft study to assess the patency/occlusion of bypass grafts and to rule out possible cause of anginal symptoms. Along with that, we also assessed the co-morbids, i.e. DM, HTN, Gender and age factor which could be the possible risk factors in occlusion of the grafts. Results: A total of 109 patients according to the inclusion criteria were enrolled in the study. The mean age of the patient population was 61.55 ± 9.53. Among which 92 (84.4%) were males and 17 (15.5%) were females. Fifty (45.8%) patients were hypertensive while 55 (50.4%) were diabetic. Forty one (37.6%) had past history of coronary artery bypass graft with duration of 1-5 years followed by 29 (26.6%) patients with duration of 6-10 years and 21 (19.3%) patients had duration in 11-15 years. Among the study population 39 (35.8%) had left internal mammary artery-LAD, SVG-OM, SVG-RCA grafts followed by 13 (11.9%) patients who had left internal mammary artery to LAD and SVG to OM while only 5 patients had left internal mammary artery to LAD as lone graft. Out of 105 patients out of 109 (96.3%) received mammary graft. Two patients also received right internal mammary graft. Graft occlusion occurred in SVG-RCA among 34 (31.2%) patients followed by 17 (15.6%) patients who had graft occlusion in SVG-OM. As far as the number of grafts is concerned, 66 (60.6%) had three grafts while 26 (23.93%) had two grafts and 12 (11%) had four grafts and only 5 (4.58%) had one graft. Sixty six (60.5%) patients had symptoms of angina CCS class I and II while 27 (24.7%) patients had presented with acute coronary syndrome (both STEMI and NSTEMI). Conclusion: Less than ideal patency rate of saphenous vein grafts associated with adverse outcome reminds the necessity of performing technically perfect coronary artery bypass surgery alongwith special emphasis on secondary prevention. Further progress must be made in preventing intimal injury during harvesting and exposure to arterial pressure and platelet adherence resulting in development of intimal hyperplasia to improve graft patency. [ABSTRACT FROM AUTHOR]

Objective: To assess the carotid artery disease spectrum in patients with coronary artery stenosis who underwent Carotid Doppler studies. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Radiology department, AFIC/NIHD, Rawalpindi Pakistan from Jan 2018 to Jul 2019. Methodology: Doppler ultrasound study of both carotid arteries was done in consecutive patients. All participants regardless of age and gender underwent carotid doppler assessment for the site of carotid plaque and percentage of stenosis. Data was grouped into two categories based upon Carotid Doppler outcomes such as; insignificant findings and significant findings. Insignificant findings comprised of no plaque or insignificant plaque with intima-media thickness (≤1.1mm), peak systolic velocity (<125cm/s), end-diastolic velocity (<40cm/s) and <50% narrowing of carotid arteries. Findings in which intima-media thickness was >1.1mm, peak systolic velocity (>125cm/s), end-diastolic velocity (>40cm/s) and >50% carotid stenosis were represented as significant Doppler outcomes. Pearson Chi-square test was applied by using SPSS-26:00. Results: Total n=654 patients were included. Normal carotid doppler outcome was seen in 290(43.4%) patients, while 350(53.5%) had insignificant findings and 20(3.1%) had significant findings. The commonest lesion found was the atherosclerotic plaque and most frequently present in the left carotid system 392(60.0%) while most common site of plaque presence was at carotid bifurcation 218(33.3%). Significant association of plaque site and plaque type with carotid doppler outcomes was found (p<0.001). Conclusion: Carotid artery disease is common on routine ultrasonic assessment. Carotid bifurcation was the most common site of plaque while the left internal carotid artery was the commonest site of both critical and significant stenosis. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of percutaneous trans-catheter aortic valve implantation in patients with severe symptomatic aortic stenosis. Study Design: A retrospective cross sectional study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from Mar 2015 to Feb 2020. Methodology: Retrospective analysis of all consecutive patients who underwent percutaneous trans-catheter aortic valve implantation was done to assess its immediate, short and long term outcome and safety. Twenty patients have undergone trans-catheter aortic valve implantation since 2015 in the institute. Base line blood chemistry including creatinine clearance, ultra-sonography abdomen, carotid Doppler, chest X-ray, High-Resolution Computed Tomography chest was done in all cases as part of the protocol. Mean age of the patients was 73 ± 7.91. There were sixteen males (80.0%) and four females (20.0%). All patients under went procedure through transfemoral route. Valve structure and peripheral vasculature for suitability of the procedure was assessed by computerized coronary tomographic angiography with TAVI protocol. In eleven patients aortic valve was trileaflet (55.0%) and in remaining nine it was bicuspid (45.0%). Mean gradient across the valve pre-procedure was 56.37 ± 9.14. Thirteen patients (65.0%) presented with angina/dysnoea NYHA III, 6 patients with syncope (30.0%) and one (5.0%) had heart failure. Two patients had undergone previous coronary artery bypass surgery. Procedure was carried out under general anesthesia in all patients except one. Balloon expandable Edwards Sapienvalve was implanted in two patients and self-expandable Core Valve/Evolut R in eighteen patients. Results: Seventeen patients underwent the procedure successfully with reduction of the mean gradients immediately after valve implantation to less than 15 mmHg recorded in the cath labangiographically subsequently complemented by transthoracic echocardiography. There were 3 deaths during the index hospitalization. Two occurred in the catheterization laboratory, one death was due to development of severe acute aortic regurgitation and second was due to acute coronary obstruction. Third death occurred due to acute kidney injury after seven days. Five patients died in next three months during follow up. One patient required permanent pacemaker because of development of left bundle branch block and second degree atrio-ventricular block post procedure. Conclusion: Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis is a very effective and procedurally safe option and reasonable alternative to surgical valve replacement in high operative risk individuals. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of acute kidney injury among patients undergoing coronary angiography. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Cardiology, Hayatabad Medical Complex, Peshawar, from Jan 2018 to Jul 2018. Methodology: This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22nd Jan 2018 to 22nd Jul 2018. Through a descriptive cross-sectional study design, a total of 116 patients scheduled for coronary angiography were included in the study in a consecutive manner and baseline / follow up serum creatinine was recorded to detect acute kidney injury. Results: In this study 116 patients were included, 61.2% males and 38.8% females. Mean age of the patients was 55.6 years with a standard deviation of 6.6 years. Mean baseline serum creatinine level was 0.9 ± 0.11mg/dl which was 1.5 ± 0.11 48 hours after coronary angiography (p 0.000). AKI was recorded in 19.8% of patients. Conclusion: Acute kidney injury after coronary angiography is not uncommon in our population. More studies are recommended on its risk factors and complications to draw future directions for its control and prevention. [ABSTRACT FROM AUTHOR]

Objective: To assess the left ventricular function three months after the primary percutaneous coronary intervention versus Streptokinase in ST elevation myocardial infarction. Study Design: Prospective comparative study. Place and Duration of Study: Cardiac Catheterization Lab, in-patients and out patients departments of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from Jun 2018 to Jun 2019. Methodology: Patients included in the study were with first acute MI treated with primary PCI/SK, having systolic blood pressure >90 mmhg, pre-infarction EF >40% and with no previous history of coronary artery bypass grafting or angioplasty. All patients undergoing primary percutaneous coronary intervention/Streptokinase injection were assessed for left ventricular function at day one by transthoracic echocardiography and then three months later by transthoracic echocardiography. Two-dimensional echocardiography was being performed immediately after primary percutaneous coronary intervention on day one and at three months follow-up. Results: There were 80 patients recruited in the study. Mean age of the patients was 55.5 ± 11.6 years with range 36-81 years. Sixty nine (86.3%) patients were male while 11 (13.48%) were female patients. Most common comorbid was smoking 37 (46.3%) followed by diabetes mellitus 25 (31.3%). Most common culprit artery was left anterior descending 38 (47.5%) followed by left circumflex 15 (18.8%) and then right coronary artery 14 (17.5%). Independent sample t-test was applied to find out the statistical significance between two groups (Streptokinase group vs PPCI group). Ejection fraction of the patients was checked at the time of discharge and after three months follow-up and result showed the statistical significance with p-value <0.05. Conclusion: Based on this comparative analysis of improvement of left ventricular function between streptokinase and primary percutaneous coronary intervention, we concluded that after three months satisfactory ejection fraction is seen in patients treated with primary percutaneous coronary intervention as compared to patients treated with streptokinase. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation between thrombolytic in Myocardial Infarction risk score with the severity of coronary lesions found by coronary angiography during hospitalization in patients with non-ST elevation Acute coronary syndrome. Study Design: Cross sectional study. Place and Duration of Study: Adult Cardiology department, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi from Jul to Dec 2018. Methodology: Patients who had chest pain suggestive of angina or anginal equivalent symptoms and diagnosis of Acute Coronary Syndrome (ACS) were included in the study. Patients with Acute Coronary Syndrome were risk stratified with Thrombolysis In Myocardial Infarction risk scores and were further evaluated with coronary angiograms to assess the extent of coronary artery disease. Results: Total 115 patients were recruited in the study with mean age 57.08 ± 10.2 years. There were 87 (75.7%) male patients while 28 (24.3%) female patients. The most common co-morbidity was hypertension 66 (57.4%) followed by diabetes mellitus 39 (33.9%) and smoking 25 (21.7%). 71 (61.7%) patients had one angina episode in the last 2 hours while 34 patients had two angina episodes in the last 2 hours. Cardiac biomarkers were raised in 36 (31.3%) patients. 60 (52.2%) used aspirin in the last 7 days. Chi-square test was applied between Thrombolysis In Myocardial Infarction Score and Coronaries lesions, which showed statistically significant results (p<0.001). Conclusion: Our study demonstrates that among patients presenting with Non-STE Acute coronary syndrome i.e. unstable angina /NSTEMI who are referred for coronary angiography, clinical risk stratification according to the Thrombolysis in Myocardial Infarction risk score correlates with the angiographic extent of Coronary Artery Disease. Patients with high thrombolysis in Myocardial Infarction risk scores were more likely to have severe multi vessel Coronary Artery Disease compared with those who have low scores. A routine invasive strategy in high Thrombolysis in Myocardial Infarction risk score patients should be considered as the preferred strategy. [ABSTRACT FROM AUTHOR]

Corneal thickness is an important indicator of corneal health. Its alteration may be indicative of diff erent pathologies. Central Corneal Th ickness (CCT) is an essential tool in the assessment and management of corneal disease. Myopia is one of the most common eye disorders worldwide. Some studies concluded that eyes with myopia have more fl att ened corneas, deeper anterior chambers and major white-to-white corneal diameters when compared with low-myopic, emmetropic and hyperopic eyes. Corneal thickness is also implicated in the measurement of intraocular pressure (IOP). A thin CCT might be a risk factor for the progression of Primary Open Angle Glaucoma. Objective: Th is study aims to compare the CCT in Myopic and Emmetropic patients aged between 18-55 years, seen in an ophthalmology out-patient department in an urban area of Pakistan Material and Methods: Th is was a cross-sectional, observational study of 205 patients aged between 18-55 years, presenting to the Ophthalmology Department of Liaquat National Hospital, Karachi from August 2016 till Feburary 2017. Results: Of 205 patients 61% were males and 39% were females. 55.1% were myopic patients and 44.9% were emmetropic patients. Mean CCT in Myopic patients were 538.45 μm and 529.06 μm in emmetropic patients with P-value of 0.047 that is statistically signifi cant. Conclusion: In contrast to studies conducted before, our study showed a high value of mean CCT in Myopic as compared to Emmetropic patients. More studies are needed to further investigate this relationship. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of percutaneous trans-catheter aortic valve implantation TAVI in patients with severe symptomatic aortic stenosis. Study Design: A retrospective cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from Mar 2015 to Aug 2019. Methodology: Sixteen patients have undergone transcatheter aortic valve implantation since 2015 in the institute. Base line blood chemistry including creatinine clearance, ultrasonography abdomen, carotid Doppler, CXR, HRCT chest was done in all cases as part of the protocol. All patients under went procedure through transfemoral route. Valve structure and peripheral vasculature for suitability of the procedure was assessed by computerized coronary tomographic angiography (CCTA) with TAVI protocol. Procedure was carried out under general anesthesia in all patients except one. Results: Sixteen patients underwent the procedure successfully with reduction of the mean gradients immediately after valve implantation to less than 15mmHg recorded in the cath lab angiographically subsequently complemented by echocardiography. There were 2 deaths during the index hospitalization. Both occurred in the cath lab, one death was due to development of severe acute aortic regurgitation and second was due to acute coronary obstruction. Four patients died in next three months during follow up. One patient required permanent pacemaker because of development of left bundle branch block and second degree atrioventricular (AV) block post procedure. Conclusion: Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis is a very effective and safe procedure and reasonable alternative to surgical valve replacement in high operative risk individuals. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical characteristics and outcomes of 57 cases of Pulmonary embolism in relation to use of thrombolytics and anticoagulants. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Adult cardiology department of AFIC & NIHD from Oct 2017 till Dec 2018. Material and Methods: Fifty seven patients with pulmonary embolism were included in the study using consecutive sampling technique. Clinical characteristics and outcomes of the patients were noted and analyzed. SPSS-23 was used for data analysis. Results: Fifty Seven cases of acute pulmonary embolism were included in our study and were admitted to the coronary care unit of hospital during the study period. Mean age of patients was 43.6 ± 17.88 years with minimum age 20 years and maximum 83 years. There were 47 (82.5%) male patients while 10 (17.50%) female patients. Most common NYHA class with which patients presented was, class III 27 (47.5%) followed by class IV 15 (26.3%), class II 9 (15.7) and class I 6 (10.5). The most common CT Pulmonary Angiogram finding of the patients was bilateral segmental embolism 30 (52.6%) followed by bilateral massive in 17 (29.8). Out of 57 patients, 22 (38.60%) patients received streptokinase and ten (17.5%) received tissue plasminogen activator (TPA). Nine patients were found to have deep venous thrombosis. Mortality was 12.30% (n=7). Conclusion: Acute pulmonary embolism is a relatively common medical emergency and accurate diagnosis in early period can help institute appropriate thrombolytic therapy to maximally benefit the patients. [ABSTRACT FROM AUTHOR]

Objective: To assess right ventricular function by echocardiography in 57 cases of hospitalized patients with Pulmonary Embolism. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Adult Cardiology Department of AFIC & NIHD from 1st October 2017 till 31st December, 2019. Material and Methods: 57 patients with pulmonary embolism were included in the study using consecutive sampling technique. Clinical characteristics and outcomes of the patients were noted and analyzed. SPSS-23 was used for data analysis. Results: Fifty Seven (57) cases of acute pulmonary embolism (based on CT pulmonary angiography) were included in our study and were admitted to the coronary care unit of hospital during the study period. Mean age of patients was 43.64 ± 17.8 years with minimum age 20 years and maximum 83 years. There were 47 (82.5%) male while 10 (17.5%) female patients. Most common New York Heart Association (NYHA) class with which patients presented was, class IIIin 27 (47.5%) followed by class IV in 15 patients (26.3%). The most common CT Pulmonary Angiogram finding of the patients was bilateral segmental embolism seen in 34 patients (59.64%). Out of 57 patients, 22 (38.6%) patients received streptokinase and ten (17.5%) received tissue plasminogen activator. Four patients were found to have deep venous thrombosis. Mortality was 12.3% (n=7). On 2D echocardiography, mean Pulmonary Artery Pressure (PAP) was 27.88 ± 19, mean RV size 41.56 ± 7 and mean RV/LV size ratio was 0.97 ± 0.15. Mean Tricuspid annular plane systolic excursion (TAPSE) as measure of right ventricular systolic function was 17.37 ±. Mortality was higher in patients with TAPSE less than 18. Conclusion: Acute pulmonary embolism is a relatively common medical emergency and accurate diagnosis in early period can help institute appropriate thrombolytic therapy to maximally benefit the patients. Right ventricular function can be assessed by echocardiography at bed side and its dysfunction correlates with prognosis and mortality in pulmonary embolism. [ABSTRACT FROM AUTHOR]

Necrolytic acral erythema is a relatively recently described psoriasis-like skin eruption seen in people infected with hepatitis C virus. Hepatitis C virus infection is endemic in many parts of the world with a steady increase of incidence in Pakistan. Recognition of this disorder is crucial to an early treatment of the underlying liver disease. Herein, we report the first case of necrolytic acral erythema from Asia and also describe good therapeutic response to topical tacrolimus ointment. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of left ventricular (LV) systolic and diastolic function on Echocardiography (ECHO) in patients presented with liver cirrhosis. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, Pakistan, from Apr 2023 to May 2023. Methodology: Total of n=131 liver cirrhotic patients were recruited by non-probability consecutive sampling technique. All these patients presented and diagnosed with liver cirrhosis on ultrasound, were selected. Their echocardiographic assessment was done by an experienced operator. Gathered data specially the LV diastolic and systolic function, was entered and analyzed in SPSS version-24:00. Chi-square and analysis of variance was applied to find the p-values for study variables in relation with severity of liver cirrhosis. p-value <0.05 was taken statistically significant. Results: Out of 131 Patients, 85(64.9%) patients had liver cirrhosis for less than 5-years, 32(24.4%) had for 5-10 years and 14(10.68%) for more than 10-years. There was almost similar frequency of males and females [67(51.1%) and 64(48.9%) respectively] with mean age of 57.14±9.84 years. Statistically significant association of demographics and clinical parameters with liver cirrhosis was found (p<0.05) except left ventricular systolic diameter (p>0.05). LV diastolic dysfunction was reported in 94(71.8%) while systolic function was normal in all participants. LV diastolic dysfunction was found in 56(42.7%) as grade-I, 31(23.7%) as grade-II and 7(5.3%) cases as grade-III which was statistically significant (p<0.001). Conclusion: Diastolic dysfunction is relatively more common in liver cirrhosis patients as compared to systolic function. There was significant disturbance of hemodynamic parameters in these patients. [ABSTRACT FROM AUTHOR]

Introduction: According to American Heart Association standards, hypertension is classified into three stages based on blood pressure measurements: essential hypertension, stage 1 hypertension, and stage 2 hypertension. The global target is to reduce the prevalence of high blood pressure by 25% by the year 2025. Worldwide, the prevalence of high blood pressure among men and women aged 18 and above reported to be 24% and 20%, respectively. Aim: The aim of this study was to overall reduce high blood pressure of hypertensive patients to the recommended level of 140/90 mm of Hg through implementing a non-pharmacological and multi-component intervention based on Disease Control Priorities (3rd edition). Methods: A randomized controlled trial in which a multi-component intervention for lowering high blood pressure was tested. This was pilot-tested for its acceptance, appropriateness, and relevance, explored through an earlier formative research and desk review conducted from the available evidence. A total of 240 study participants were enrolled after obtaining informed consent. Ethical approval was obtained from the Institutional Review Board of Health Services Academy and the trial was registered in clinicaltrials.gov number NCT04336631. SPSS software version 21 was used to enter and analyze the data. Results: High blood pressure of hypertensive patients in a hospital setting during 03 months yielded –23.9 mm Hg of systolic blood pressure reduction (95% confidence interval, p ≤ 0.005). A significant reduction was observed in intervention group after delivering the intervention. Compared to patients in the usual care group, improved health outcomes were achieved for diet control, reducing salt intake and increased physical exercise. In the intervention group, the mean blood pressure among male hypertensive patients was 145/90 mm Hg and in female hypertensive patients, the mean blood pressure was recorded as 140/100 mm Hg. Conclusion: High blood pressure was significantly reduced in hypertensive patients who adhered to a low salt diet, weight loss measures, and increased physical activity. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of disorders leading to sudden cardiac death (SCD). Study Design: Cross-sectional study. Place and duration of study: Pathology Lab in collaboration with the Cardiology Department, AFIC & NIHD, Rawalpindi Pakistan, from Jan 2017 to Dec 2018. Methodology: A total of 305 cases of sudden cardiac death reported within the last 24 hours of a death to AFIC Rawalpindi were included consecutively. Cases with a history of extracardiac diseases leading to sudden death were excluded. Most of the included cases were diagnosed phenotypically based on clinical examination, biochemistry, ECG, echocardiography, angiography, thallium scan, electro-physiological studies, cardiac CT scan, MRI and routine autopsy whenever recommended. Results: Out of 305 cases, 197 (65%) were males and 108 (35%) females. Disorders leading to SCD were found in 178 (58.3%) cases due to ischemic heart disease (IHD), aortic dissection (0.7%), hypertrophic cardiomyopathy (HCM) (0.3%), dilated cardiomyopathy (DCM) (10.5%), congenital heart disease (12.1%) and valvular heart disease (7.9%). While in cardiac channelopathies, catecholaminergic polymorphic ventricular tachycardia (CPVT) in 5 (1.6%) and congenital long QT syndrome (LQTS) in 2 (0.7%) cases. However, 24 (7.9%) cases remained as sudden unexplained deaths (SUD). Conclusion: In our setup, ischemic heart disease and dilated cardiomyopathy were the commonest causes of sudden cardiac death, followed by congenital heart disease and valvular heart diseases. [ABSTRACT FROM AUTHOR]

Objective: To study the differences in characteristics of Chronic Totally Occluded coronary artery lesions on computed tomography angiography in patients with and without prior Coronary Artery Bypass Graft. Study Design: Comparative cross-sectional Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb to Jul 2023. Methodology: The study included ninety six patients, with 48 patients in each group (prior CABG and non-CABG). Patients presenting with chest pain and having Chronic Totally Occluded lesions on Computed Tomography Angiography were selected using non-probability consecutive sampling. Data was analyzed using SPSS-23:00. Chi-square test was applied to find the association of lesion characteristics in study groups and level of significance was taken 0.05. Results: This study analyzed the characteristics of lesions in different target vessels among n= 96 patients, with 74(77.1%) being males and 22(22.9%) females. The mean age was 61.98±8.04 years. No statistically significant distinctions in the distribution of target vessels were observed when comparing the two groups. (p=0.48). However, osteal lesions had higher prevalence in the CABG group 20(41.7%) (p=0.04). The presence of blunt stump [21(43.8) vs 18(37.5); p=0.67] and calcification [(20(41.7%) vs 21(43.8%), p=1.00)] had no significant divergence between CABG and non-CABG groups. Bending was more common in the CABG group 17(35.4%) (p=0.002). In the CABG group, a higher occurrence of a side branch at the proximal cap 22(45.8%) (p=0.01) as well as a distal cap at the bifurcation 20(41.7%) (p<0.001), was noted. Conclusion: Chronic Totally Occluded lesions were more intricate in prior CABG patients, posing greater challenges for recanalization. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of Peri-Procedural Myocardial Injury (PMI) after elective, successful Percutaneous Transluminal Coronary Angioplasty (PTCA) as assessed by High Sensitivity troponin-I (HS-Trop-I) levels, and to find out association between PMI and clinical, angiographic and procedural variables. Study Design: Analytical cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Paki-stan, from Dec 2022 to Jun 2023. Methodology: Total one hundred and thirty-one cases were included using consecutive sampling technique. Patients with stable angina and having at least one positive stress test, baseline pre-PCI cardiac troponin level below the 99th percentile up-per reference limit (normal baseline troponin), and a target lesion with a stenosis of >70% on qualitative angiography were included in study. Patients were divided into two groups; (Group-I=HS-Trop-I>40ng/L and Group-II=HS-Trop-I≤40 ng/L). Independent samples t-test and Pearson's Chi-square test were applied to compare the study variables among study groups and p<0.05 was considered as statistically significant. Results: PMI was reported in 60(45.8%) out of 131 patients. Hypertension and previous myocardial infarction demonstrated slightly higher prevalence in group-I but there was insignificant difference in frequencies of demographics and comorbid in study groups (p>0.05). Total stent length and max balloon time, were significantly higher in the group-I (50.73±25.19mm vs 31.13±17.83mm; 26.80±7.51sec vs 22.42±5.94sec respectively) (p<0.001). There was also statistically significant difference in frequency of AHA classification, number of diseased vessels and multi-vessel PCI in study groups (p<0.001). Conclusion: PMI is a common complication of elective PCI, especially when patients present with high-risk features for PCI as demonstrated by increased complexity and severity of angiographic findings and procedural parameters (number of diseased vessels, total length of implanted stents and amount of contrast used). [ABSTRACT FROM AUTHOR]

Objective: To determine the association of Systolic Blood Pressure to Left Ventricular End-Diastolic Pressure ratio with in-hospital mortality in ST-Elevation Myocardial Infarction patients undergoing Primary Percutaneous Coronary Intervention. Study Design: Analytical, cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi Pakistan, from Apr-Jun 2023. Methodology: One hundred and ninety-eight patients who underwent Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction patients presenting within 12-hours were included using non-probability consecutive sampling technique. Patients were divided into two groups (Group-I= SBP/LVEDP ratio ≤4; Group-II= SBP/LVEDP ratio >4). SBP and LVEDP were measured during Primary Percutaneous Coronary Intervention. Demographic and clinical data, including risk factors and laboratory findings, were collected and SBP/LVEDP ratio was calculated. Study variables were compared among groups by applying independent t-test and Chi-square test. p-value<0.05 was kept as significant. Results: Among the study sample of 198, 126(63.6%) were males and females were 72(36.3%), mean age was 61.31±9.16 years. 21(10.6%) patients had SBP/LVEDP ratio≤4 (Group-I), while 177(89.3%) patients had SBP/LVEDP ratio>4 (Group-II). Group-I showed a higher prevalence of heart failure 5(23.8%), lower ejection fraction (35.48±7.56%), longer duration of in-hospital stay (8.76±2.48 days) (p<0.05), and higher TIMI scores (9.28±1.10) compared to Group-II. In-hospital mortality was also higher in Group-I (33.3%), compared to Group-II (6.2%) (p<0.05). Conclusion: The SBP/LVEDP ratio≤4 has significantly predicted increased risk of adverse outcomes and in-hospital mortality in STEMI patients who underwent Primary Percutaneous Coronary Intervention. This ratio may serve as a marker of compromised cardiac function and disease severity. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of daily oil, butter and ghee consumption in general population. Study Design: Descriptive cross-sectional study. Place and Duration of Study: A multi-center community-based survey conducted at AFIC, AFIO, AFIRI and PEMH hospital of Rawalpindi, Pakistan. Methodology: It was a descriptive cross-sectional study using a self-administered questionnaire. Non-probability consecutive sampling technique was used. Healthy individuals (attendants of patients visiting these hospitals) of both genders and willing to participate were included and participants having any disability, bed ridden and seriously ill were excluded. Participants underwent a physical examination, anthropometry and blood pressure determination. Lab investigations were performed by hospital laboratory which included blood sugar fasting/random, blood pressure and lipid profile. Results: A total of 700 respondents participated in the study; the mean age of our study population was 43.62 ± 14.80. The gender distribution consisted of 259 (40.4%) males and 382 (59.6%) females. Majority of the participants were from Punjab (74%). Family history of the co-morbids was found higher for HTN (28%), diabetes (19.50%), CHD (17.1%), Obesity (9.70%) and for hypercholestremia (5.70%). Trigycerides were measured to be out of range i.e., 183.19 ± 93.38 while it should be less than 150mg/dL and Blood Sugar Fasting was 109.51 ± 54.68 mg/dl. According to our finding, average family members per house hold were found to be 7. Monthly mean consumption of oil per house hold was found 5.49 ± 5.39 ltr while monthly mean consumption of ghee per house hold was found to be 1.830 ± 4.87 Kg. Conclusion: The findings facilitate quantitative assessment of consumption of dietary fats attributable to dietary factors and in future can be used to inform national and global efforts to alter diet, reduce disease, and improve population health. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a planned 2-stent double kissing crush technique is superior to provisional stenting patients presenting with true distal LM bifurcation lesions. Study Design: Cross-sectional comparative study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: A total of 70 patients enrolled in the study presented with true distal LM bifurcation lesions (Medina 1, 1, 1 or 0, 1, 1). Patients were randomized to PS or DK crush technique. The primary end-point was peri hospital and 1 month composite rate target lesion failure (TLF): target vessel myocardial infarction (TVMI), cardiac death, stent thrombosis (ST), target vessel revascularization (TVR). Routine clinical follow up done at 2 weeks and 4 weeks followed by 3 and 6 months thereafter. Results: A total of 70 patients fulfilling the inclusion criteria were enrolled in the study. The patient population was divided into two groups. Group A participants underwent DK crush technique while group B participants underwent provisional stenting. In group A [DK crush technique] 16 (45.7%) patients presented with Non-ST elevation MI followed by 14 (40%) who presented with chronic coronary syndrome (CCS) while in group B [Provisional stenting] 13 (37.1%) presented with chronic coronary syndrome followed by 9 (25.7%) who presented with non-ST elevation MI. Conclusion: LM-PCI is an acceptable procedure in patients with true distal LM bifurcation lesions who are candidates for PCI. This study also showed that DK-Crush has good periprocedural and angiographic outcomes and superior to PS in complex LMCAD lesions. PS is an acceptable option in simple distal LMCAD. [ABSTRACT FROM AUTHOR]

Objective: In-hospital outcome of percutaneous coronary intervention after thrombolysis as part of invasive strategy in anterior ST-elevation myocardial infarction. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, from Dec 2020 to Apr 2021. Methodology: Permission was sought from hospital ethics committee. Written informed consent was taken from participants of study. Charges of the tests and procedures were borne by hospital administration and not by the patient. Particulars of all the patients who meet the inclusion and exclusion criteria were recorded. Patients who present in ED after thrombolysis with streptokinase after anterior wall ST elevation myocardial infarction from any other non-percutaneous coronary intervention capable/percutaneous coronary intervention capable center were acknowledged. If the patient qualifies for facilitated percutaneous coronary intervention i.e. within 3-24 hours of fibrinolytic therapy, pathway for coronary angiogram with intent to perform percutaneous coronary intervention was initiated. Results: Total 234 patients were included according to the inclusion criteria of the study. Mean age (years) in the study was 56.71 ± 15.83 with ranges from 18-70 years. There were 164 (70.1%) male and 70 (29.9%) female patients who were included in the study according to the inclusion criteria. Out of 234 cases, 21 (8.9%) cases presented with non-fatal MI (acute stent thrombosis), 16.23% died and 4 (1.7%) stroke patients noted in patients after thrombolysis with streptokinase suffering from anterior ST-elevation myocardial infarction. Conclusion: The study concluded that those areas where percutaneous coronary intervention centers are not readily available, a pharmaco-invasive strategy can be proposed. As, this strategy comprises the use of fibrinolysis with subsequent transfer to a PCI-capable facility for angiography within 24 hours of presentation. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of myocarditis in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi and Pak Emirates Military Hospital (PEMH), Rawalpindi, from Dec 2020 to May 2021. Methodology: A total of 143 hospitalized patients who had tested positive for COVID-19 infection via RT-PCR were included in the study. Patients with pre-existing cardiac conditions were excluded. All patients underwent transthoracic echocardiography and their ejection fractions were recorded. Meticulous testing for the inflammatory markers including CRP, serum ferritin, procalcitonin and interleukin-6 (IL-6) and cardiac biomarker (NT-pro-BNP) was carried out. The data was recorded on a specially designed questionnaire and later transferred to SPSS-23 for analysis. Myocarditis was diagnosed on the basis of reduced Ejection Fraction or raised NT pro BNP or both in a person without any known cardiac pathologies before getting COVID-19. Results: Out of total 143 COVID-19 patients included in the study, 24 patients (16.8%) developed myocarditis. The frequency of myocarditis in COVID-19 positive male population was 14.6% (10.5% of all myocarditis cases) and that of female population was 22.5% (6.3% of all myocarditis cases). The raised pro-inflammatory markers IL-6 and CRP were significantly associated with development of myocarditis while ferritin was not significantly associated. Only 28% of the study population recovered and got discharged from the hospital, however, there were no survivors among those who developed myocarditis. Conclusion: Myocarditis is a serious complication of COVID-19 and directly linked to increased mortality risk. There is an increasing need to perform serial assays for the inflammatory as well as cardiac biomarkers including IL-6, Trop-I and NTpro-BNP for early detection and prompt treatment of this not so uncommon complication. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of anxiety and depression in young patients presenting with atypical chest pain and normal coronary arteries. Study Design: Analytical, Cross-Sectional Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, Pakistan, from Jul to Dec 2021. Methodology: This study was carried out on 750 participants (having normal coronaries) of both gender and age<40years divided into study group (presented with atypical chest pain; n=375) and comparison group (no chest pain; n=375). Consecutive sampling technique was applied to collect data. Hospital Anxiety and Depression Scale (HADS) Questionnaire was used. Patients scoring 11 or more out of 21 points in Depression and Anxiety scale were identified as positive. Data was analyzed using SPSS version 24:00. Chi Square test was applied to find association between variables and p-value <0.05 was taken as significant value. Results: Out of n=750 patients 619(82.4%) were males and 131(17.6%) were females. Mean age at presentation was 33.54±5.54 years and 30.93±5.68 years in study and comparison group respectively. About 230(61.3%) participants had anxiety in the study group compared with 189(50.4%) in the comparison group, which was statistically significant (p=0.003). 221(58.9%) participants in study group and 132(35.2%) in comparison group had depression (p<0.001). Conclusion: Non cardiac chest pain is a common manifestation of depression and anxiety. Early recognition and prompt referral of these patients should be ensured to improve quality of life and prevent future unnecessary hospital visits. [ABSTRACT FROM AUTHOR]

Objective: To determine in hospital early complications in diabetics' vs non diabetics with acute ST elevation myocardial infarction. Study Design: Comparative cross-sectional study. Place and Duration of Study: The study was conducted in emergency departments and adult cardiology wards of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Aug to Nov 2019. Methodology: A comparative cross sectional study was conducted on 380 patients (190 patients with diabetes and 190 patients without diabetes) who presented with acute ST-Elevation MI in age group 30 to 70 years to emergency department of Armed Forces Institute of Cardiology/National Institute of Heart Disease during specified period. Patients with rescue PCI and new onset of LBBB were also included. Patients with age group lesser than 30 years or greater than 70 years with STEMI were excluded. Sampled with consecutive non probability technique in patients was assessed with ECG, cardiac enzymes, transthoracic echocardiography, renal Doppler and RFTs. All patients were admitted in wards and were followed up during hospital stay. Patients were evaluated and their record of Primary PCI and thrombolysis was also noted. Data was entered and analyzed with SPSS-23. Results: A total of 380 patients with STEMI were included in this study consisting of 292 (76.8%) male and 88 (23.1%) female from 30 to 70 years. The patients were divided in two groups i.e. diabetic and non-diabetic, 190 patients were included in each group. It was found that frequency of ST-Elevation MI was higher in diabetic group as compared to non-diabetic group. All the patients were analyzed for complications occurred after STElevation MI. LV failure, Brady arrhythmias, atrial fibrillation, post MI angina and cardiogenic shock were the main complications noted. It was found that all these complications are more in diabetic group post MI angina which occurred most frequently in non-diabetic group. Conclusion: In our study we observed that left ventricular failure and arrhythmias were the major complications. Mortality was higher in diabetic patients than non-diabetic patients. In both groups PPCI and SK reduced mortality. Post MI angina were found more frequent in non-diabetic group. [ABSTRACT FROM AUTHOR]

Objective: To study the frequency of In-Stent Restenosis and its treatment in patients undergoing Percutaneous Coronary Intervention for coronary artery disease. Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Cardiology, Armed Forces Institute of Cardiology & National Institute of Heart disease (AFIC/NIHD) Rawalpindi, from Jul 2017 to Jul 2019. Methodology: All the patients who underwent Percutaneous Coronary Intervention for Coronary Artery Disease at our institute were considered for this study. A consecutive sampling method was used and inclusion/exclusion criteria was applied. Following data was obtained; 1) Demographic information and clinical risk factors like history of hypertension, hyperlipidemia, diabetes mellitus, smoking, coronary artery disease characteristics (number of diseased arteries, bifurcation lesions, calcification, chronic total occlusions-CTO and tortuosity) 3), Stent factors (under expansion, fracture, longitudinal miss, stent gap). Data recording, storage, assessment and analysis was done by using SPSS software version 21. Results: Among 1332 cases, 50 had In-Stent Restenosis with overall prevalence of 3.75%. Mean age of the patients with In-Stent Restenosis was 58.76 (± 9.97), with 45 (90%) male and 5 (10%) female. Diabetes Mellitus was the commonest risk factor (22.9%) followed by Hypertension (18%). Sixty four percent of the patients (n=32) had Single Vessel Coronary Artery Disease, 14 (28%) had Double Vessel Coronary Artery Disease and 4 (8%) had Tripple Vessel Coronary Artery Disease. Left Anterior Descending was the commonest coronary artery that developed In-Stent Restenosis, followed by Right Coronary Artery and Left Circumflex respectively. Previously deployed stents which developed In-Stent Restenosis showed longitudinal geographical miss in 16%, stent under expansion in 6% and stent gap in 4%. There was statistically significant association (p-value=0.02) between stent length and frequency of In-Stent Restenosis and it was commonest in stents longer than 30 mm. Eighty six percent (n=43) of In-Stent Restenosis cases in our study group was treated with Drug Eluting Stent followed by Drug Eluting Balloon in 32% and Plain Old Balloon Angioplasty in 22%. Conclusion: History of diabetes mellitus and greater stent length were major risk factors in developing In-Stent Restenosis in our study. DES was the commonest treatment modality used. [ABSTRACT FROM AUTHOR]

Objective: To identify the risk factor profile of Atrial Fibrillation applying CHA2DS2-VASC scoring system Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in outdoor patient and emergency departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases in 4 months duration after approval of synopsis, from Sep 2019 to Dec 2019. Methodology: All patients with symptoms of palpitation and dyspnea were evaluated with detailed history, physical examination, electrocardiogram and 2-D echocardiography for collection of data. Patients who were found with Atrial Fibrillation on electrocardiogram and non-valvular on 2-D echocardiography were enrolled. Detailed History regarding CHA2DS2-VASC scoring system was taken. Patients with age <18 years, those with moderate rheumatic stenos is, hypertrophic cardiomyopathy and Atrial Fibrillation with prosthetic valves were excluded. Data was entered and analyzed with SPSS-23. Results: Out of 100 patients enrolled, frequencies of male and female patients were 60 (60%) and 40 (40%) respectively. The age varied from 25 years to 89 years with a mean age of 64.27 ± 12 years. Maximum number of patients was between 65-74 years (31%). Hypertension (57%) was the most common risk factor after gender followed by age. Frequencies of other risk factors were congestive heart failure (33%), diabetes mellitus (18%), vascular disease (14%) and stroke/TIA/thrombo-embolism (13%). Paroxysmal atrial fibrillation was the most common type of atrial fibrillation observed (67%) followed by persistent atrial fibrillation (31%). The number of patients having CHA2DS2-VASC score 2 and greater than 2 were 76 (76%) and less than 2 were 24%. Conclusion: Our findings highlighted the prevalence of non-modifiable as well as modifiable predictors of thromboembolic phenomena in atrial fibrillation using CHA2DS2-VASC scoring system in our population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and compare the impact of COVID-19 pandemic on admission rates and mortality in patients presenting with ST elevation myocardial infarction (STEMI) to a tertiary care cardiac setup in Pakistan. Study Design: Comparative cross-sectional study Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD) Rawalpindi, from Apr to May 2020. Methodology: All ST elevation myocardial infarction patients presenting to our hospital for two months (April, May) during COVID-19 pandemic were studied. Similar patients were also analyzed from pre-COVID era for an equivalent period. Parameters compared include total number of ST elevation myocardial infarction patients, age, gender, door to balloon (DTB) time, MI type (anterior versus non-anterior) and prognosis in terms of mortality. Categorical variables are presented as absolute numbers and percentages and compared by chi-square test. Odds ratio was determined to study the impact of COVID-19 pandemic on ST elevation myocardial infarction mortality. SPSS-23 was used for all the analysis. Results: We observed a significant 43% reduction in the total numbers of ST elevation myocardial infarction admissions compared to equivalent time before pandemic. There was a decrease in patients >75 years of age (4.1%, p-value 0.007), decrease in female patients (21.7%, p-value 0.001), mild improvement in door to balloon (1.3%, p-value 0.4), increase in anterior MI (1.2%, p-value 0.7). The ST elevation myocardial infarction case fatality rate during the pandemic increased from 4-7.1% (Odds ratio 1.81, confidence interval 1.01 to 3.24, p-value 0.04). Conclusion: Although ST elevation myocardial infarction admissions decreased after COVID-19 but there was a paradoxical increase in mortality. Late presentation to hospital due to contagion fear, various lockdown measures, unavailability of public transport, economic instability may be some of the contributing factors, in addition to the COVID-19 infection itself, that need to be studied further. [ABSTRACT FROM AUTHOR]

Background: Acute myocardial infarction remains a time-sensitive medical emergency associated with significant morbidity and mortality. Research supports the superiority of PPCI over fibrinolytic therapy that can improve outcomes when delivered within a specified timeframe, however; effectiveness of treatment options in the terms of survival over the period of time has not been tested in our setup. Objective: To compare the survival times in patients with acute myocardial infarction treated with PPCI, PI and streptokinase. Material and Methods: A prospective study was conducted in Armed Forces Institute of Cardiology, Rawalpindi from Jan 2016 to July 2018 using consecutive sampling. Total 294 patients fulfilling the inclusion criteria were stratified into three groups i..e group I patients who underwent PPCI and group II who underwent parmacoinvasive therapy and group III who were administered streptokinase. All the groups were followed for 30 months. In this study the probability of the patients to survive after PPCI at the end of 6 months duration was found to be 96% for PPCI, 93% for PI and 75% for SK. Similarly, probability of the patients to survive at the end of 30 months in case of PPCI was 91%, 89% in case of PI and 64% for SK. Conclusions: This study will help determine the benefits of PPCI over fibrinolysisin terms of survival and will play a pivotal role in policy decisions for sustainability of a 24/7 PPCI reperfusion strategy to decrease overall mortality related to acutemyocardial infarction. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To find out how common subclinical atherosclerosis is in psoriasis patients. Study Design: Descriptive crosssectional study Place and Duration of Study: Dermatology unit of Fauji Foundation, Rawalpindi Pakistan, from Jan 2020 to Jun 2020. Methodology: After receiving informed consent, 314 cases that met the selection criteria were enrolled. Psoriasis was diagnosed depending on physical examination the family history of patients. Ultrasonography highresolution B mode was opted to assess carotid atherosclerosis (Xario color Doppler probe frequency 5 to 7mHZ.). If the (IMT) was less than 0.9mm, it was regarded normal; values greater than 0.9mm were termed thickened intima, while digits greater than 1.5mm were considered atherosclerotic plaque. SPSS version 21.0 was used for data analysis. Results: Age of patients was from 18 to 70 years old, with a Mean±SD (44.00 ±12.12) years. Males made up 47(15%) of the population, while females made up 267(85%). There were 33(10.5%) smokers and 281(89.5%) nonsmokers. The mean IMT was 0.84±0.61, with 0.1mm and 2.05mm as the minimum and maximum, respectively. Subclinical atherosclerosis was found in 96 patients (30.6%) (p<0.05). SPSS 21 was used to enter and evaluate the data. Age, BMI, IMT, and disease duration were all expressed as a Mean±SD. Other parameters like gender, smoking, subclinical atherosclerosis be measured by frequency and percentage. Conclusion: Subclinical atherosclerosis is significantly higher in patients of psoriasis. Early detection and management can help to reduce risks of cardiovascular complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine the frequency of myocarditis in patients recovered from COVID-19 infection. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Cardiac Magnetic Resonance Imaging Department, Armed Forces Institute of Cardiology/ National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from Jul 2020 till Apr 2022. Methodology: All patients who underwent Cardiac Magnetic Resonance Imaging after recovery from COVID-19 were enrolled. Non-probability consecutive sampling technique was used for sample selection and was calculated on the basis of G-power. Data of patients fulfilling the inclusion criteria was selected. All PCR positive cases of COVID-19 who recovered from COVID-19 and completed their 12 days of isolation not exceeding 60 days of 1st Polymerase chain reaction positive, and who have any symptoms of shortness of breath, fatigue and chest pain with reduced left ventricular ejection fraction (LVEF) on 2D-echocardiogram were included in the study. Data was recorded, stored, and analyzed by using SPSS version-21. Quantitative data was reported as Mean±SD. Categorical variables were reported as frequency and percentage. To determine the association between different variables Chi square test was used. Results: A total 83 patients were included in this study who recovered from COVID-19 and underwent Cardiovascular magnetic resonance. Mean age of the patients was 39.17±12.9 years. 67(80.72%) were male while 16(19.28%) were females. 50(60%) had myocarditis after recovery from COVID-19. This study showed statistically significant association of all the Cardiovascular magnetic resonance imaging findings with Myocarditis (p<0.05) at 95% confidence interval and 5% margin of error. Conclusion: Early detection of COVID-19 related myocarditis will help in better management of patient. In such patients, cardiac Magnetic Resonance Imaging is the modality of choice, since it allows for noninvasive assessment of myocardial edema and fibrosis, as well as therapeutic guidance and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of disorders leading to sudden cardiac death (SCD). Study Design: Cross-sectional study. Place and duration of study: Pathology Lab in collaboration with the Cardiology Department, AFIC and NIHD, Rawalpindi Pakistan, from Jan 2017 to Dec 2018. Methodology: A total of 305 cases of sudden cardiac death reported within the last 24 hours of a death to AFIC Rawalpindi were included consecutively. Cases with a history of extracardiac diseases leading to sudden death were excluded. Most of the included cases were diagnosed phenotypically based on clinical examination, biochemistry, ECG, echocardiography, angiography, thallium scan, electro-physiological studies, cardiac CT scan, MRI and routine autopsy whenever recommended. Results: Out of 305 cases, 197 (65%) were males and 108 (35%) females. Disorders leading to SCD were found in 178 (58.3%) cases due to ischemic heart disease (IHD), aortic dissection (0.7%), hypertrophic cardiomyopathy (HCM) (0.3%), dilated cardiomyopathy (DCM) (10.5%), congenital heart disease (12.1%) and valvular heart disease (7.9%). While in cardiac channelopathies, catecholaminergic polymorphic ventricular tachycardia (CPVT) in 5 (1.6%) and congenital long QT syndrome (LQTS) in 2 (0.7%) cases. However, 24 (7.9%) cases remained as sudden unexplained deaths (SUD). Conclusion: In our setup, ischemic heart disease and dilated cardiomyopathy were the commonest causes of sudden cardiac death, followed by congenital heart disease and valvular heart diseases. [ABSTRACT FROM AUTHOR]