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Aim: The aim of the study was to determine if the tissue Doppler imaging (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) of tricuspid lateral annulus could be used in early detection of RV systolic dysfunction in patients with mitral stenosis (MS), before the clinical signs of systemic venous congestion occur and to compare between IVA and conventional echocardiographic parameters in detecting early RV systolic dysfunction in patients with MS . Methods: Ninety-six patients with severe rheumatic MS without relevant regurgitation were enrolled in the study. Conventional echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional area change, pulmonary flow acceleration time, tricuspid annular plane systolic excursion) and TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration: IVA, peak myocardial velocity during isovolumic contraction: IVV, peak systolic velocity during ejection period: Sa and RV MPI) were recorded from all patients. Results: TDI-derived IVA, IVV, Sa were significantly decreased in patients with MS and RV MPI is increased in patients with MS. IVA was the only parameter which had a significant negative correlation with the traditional echocardiographic parameters and RV Tei index in patients with MS. Conclusion: TDI-derived right ventricular IVA may be used as an adjunctive, reliable, noninvasive parameter for the early detection of right ventricular systolic dysfunction in patients with MS but without signs of systemic venous congestion. RV IVA negatively correlate with RV MPI, positively correlate with IVV and Sa. RV IVA shows positive correlation with RVFAC and negative correlation with PAP, LA size. IVA shows no correlation with TAPSE. University Heart Journal 2022; 18(2): 80-86

Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. Subjects and Methods: This prospective observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period between July’2012 to June’2013. A total of 200 patients studied who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hs-CRP level and the preprocedural hs-CRP level . We divided the patients according to the median value of hs- CRP: Group I 3 mg/L. Results: Postprocedural TnI elevation was were observed in 72 (36%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnI elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p

Background: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA. Methods: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area

Background: Coronary heart disease is a global health problem and a major cause of death in both developed and developing countries. Clinical importance of hyponatremia in ST-elevated acute myocardial infarction (STEMI) is an important topic of study among present researchers. Objective: To assess the outcomes and prognostic implications of early development of hyponatremia inhospitalized acute ST-elevated myocardial infarction patients. Methods: This is a prospective observational study performed in the department of Cardiology, Combined Military Hospital (CMH), Dhaka from July 2018 to June 2019. A purposive sampling technique was used on 82 patients with ST-elevated acute myocardial infarction admitted in CCU and treated with thrombolysis. They were evaluated for serum sodium level at admission and at 48 hours after admission. Here sodium concentration

Background: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Identification and management of arrhythmias at an early period of acute MI has both short term and long term significance. Objective: The aim of the study is to evaluate the pattern of arrhythmias in acute STEMI in the first 48 hours of hospitalization and their inhospital outcome. Methods: A total of 50 patients with acute STEMI were included in the study after considering the inclusion and exclusion criteria. The patients were observed for the first 48 hours of hospitalization for detection of arrhythmia with baseline ECG at admission and continuous cardiac monitoring in the CCU. The pattern of the arrhythmias during this period & their in-hospital outcome were recorded in predesigned structured data collection sheet. Result: The mean age was 53.38 ± 10.22 years ranging from 29 to 70 years. Most of the patients were male 42(84%). Majority of the patients had anterior wall ( anterior, antero-septal & extensive anterior) myocardial infarction (54%). Sinus tachycardia in isolation was the most common arrhythmia observed in 36.8% of patients followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%),first degree AV block (5.3%), complete heart block and atrial ectopic 1.7% each. Tachyarrhythmias were more common in anterior wall myocardial infarction, whereas bradyarrhythmias were more common in inferior wall myocardial infarction. Among studied patients, 72% had favourable outcome , followed by acute left ventricular failure 10%, cardiogenic shock & lengthening of hospital stay 8% each and death 2%. Conclusion: The commonest arrhythmias encountered were sinus tachycardia followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block and atrial ectopic. The incidence of mortality was 2%. University Heart Journal Vol. 16, No. 1, Jan 2020; 16-21

not available University Heart Journal 2022; 18(2): 71

Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76

not available University Heart Journal Vol. 17, No. 2, Jul 2021; 79-80

Stress echocardiography (SE) is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. In recent years, SE has become an established method for the assessment of a wide spectrum of challenging clinical conditions, including systolic or diastolic heart failure, non-ischaemic cardiomyopathy, valvular heart disease, pulmonary hypertension (PH), athletes’ hearts, congenital heart disease (CHD) and heart transplantation. Advantages of SE include the ubiquitous availability of echocardiography, lack of ionising radiation, choice of physiological or pharmacological stressors, good diagnostic accuracy and robust supporting evidence base. SE has evolved significantly as a technique over the past three decades and has benefitted considerably from improvements in overall image quality (superior resolution), machine technology (e.g. digital cine-loop acquisition and side-by-side image display) and development of second-generation ultrasound contrast agents that have improved reader confidence and diagnostic accuracy. SE provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. A paradigm shift will occur when from a highly expertise qualitative reading SE will move to a quantitative approach that would make it easier also for less skilled readers. Technological premises are there at hand but they have not reached a full-blown status to be used on a routine clinical basis. Society recommendations and guidelines are mostly based on consensus and level of evidence C. The gap of knowledge should be filled with prospective large scale studies to support evidence-based treatment strategies. The purpose of this article is to review the breadth of SE in contemporary clinical cardiology.University Heart Journal Vol. 14, No. 1, Jan 2018; 31-37

Holt-Oram syndrome (HOS) is a heart-upper limb malformation complex , is a rare autosomal dominant disorder, caused by a mutation in the TBX5 gene located on chromosome 12 and near complete penetrance but variable expression. Holt and Oram first described this syndrome in 1960. Approximately 40% of cases represent new mutations. The syndrome is associated with defective development of cardiac structures that results in atrial septal defect(ASD), most commonly the secundum type; heart block of varying degree or both.The syndrome is characterized by cardiac malformations and aplasia or hypoplasia of the thumb. The incidence of HOS is estimated at 1:100,000 live births. In the literature, it is also known as atriodigital syndrome, heart-hand syndrome, upper limb-cardiovascular syndrome, cardiac-limb syndrome, or cardiomelic syndrome. Herein, we report a 45-year-old female case of HOS presenting a large ostium secundum type ASD along with congenitally fusion of carpal bones in both hands and absence of right first metacarpal bone with triphalagial thumb where as hypoplastic proximal phalange. In left hand, hypoplastic first metacarpal bone and hypoplastic thumb with syndactyly of both thumb with index finger.University Heart Journal Vol. 13, No. 2, July 2017; 67-71

Marfan syndrome (MS) is a dominantly inherited connective tissue disorder characterized by arachnodactyly, tall stature, the presence of aortic aneurysm, and lens dislocation. Takayasu’s arteritis(TA) is an inflammatory disease often affecting the ascending aorta and aortic arch, causing obstruction of the aorta and its major arteries. The disease commonly presents in the 2nd or 3rd decade of life, often with a delayed diagnosis. The disease is progressive and there is no definitive therapy. We report an unusual case of concomitant Takayasu’s arteritis and Marfan syndrome manifesting bilateral renal artery stenosis and aortic root dilatation. The patient had severe hypertension. The simultaneous presence of TA and MS could be a coincidence, however; the pathogenesis of TA might be linked with autoimmunity induced by abnormal extracellular matrix protein derived from the genetic mutations in MS.University Heart Journal Vol. 13, No. 1, January 2017; 29-32

Patent ductus arteriosus(PDA) is a congenital cardiac disorder which is not so uncommon but it becomes rare when associated with aortic stenosis. In our case clinical finding was consistent with PDA and aortic stenosis. Echocardiographic finding showed that patient also has moderate aortic regurgitation which makes this case one of the rarest. University Heart Journal Vol. 15, No. 2, Jul 2019; 86-88

Background: Ischemic heart disease remains the leading cause of death in both developed and under developed countries. The use of antiplatelet drugs specifically the thienopyridine has become a standard for the treatment of acute coronary syndrome. These drugs irreversibly inhibit the platelet aggregation by blocking the P2Y12 receptor. But currently this therapeutic choice has become limited due to potential interaction with other drugs, slow hepatic conversion, genetic resistance and narrow therapeutic safety margin. Ticagrerol, a reversible P2Y12 receptor inhibitor may represent a significant advancement over currently available oral antiplatelet drugs.Objectives: The study was intended to compare the effect of Ticagrelor and Clopidogrel on oxidative stress markers in patients of chronic stable angina (CSA) following percutaneous coronary intervention (PCI).Materials & Methods: The present prospective observational study was carried out in the Department of Pharmacology, Cardiology and Microbiology, BSMMU, Dhaka from September 2014 to February 2016. The study included a total of 100 CSA patients. Patients were divided into two groups, Ticagrelor and Clopidogrel treated groups (each having 50 patients). The baseline laboratory parameters-Malondihyde (MDA), Reduced glutathione (GSH), bleeding time, clotting time and platelet count, were measured and then patients of both groups underwent PCI. The same parameters were again assessed at follow up after 4 weeks of intervention. Total 12 patients from Ticagrelor and 14 patients from Clopidogrel groups were dropped out. Comparisons of the laboratory parameters were made between two groups at baseline and at follow up and also within group before and after intervention.Result: In the present study at baseline characteristics of patients treated with ticagrelor and clopidogrel were almost identical in terms of age, sex, diabetes and hypertension. The level of plasma MDA in ticagrelor group was significantly reduced from baseline to follow up(4.5 ± 1.8 to 1.4 ± 0.7, p

Back Ground: Hypertrophic cardiomyopathy is genetically transmitted primary cardiac disease and an important cause of morbidity and sudden death in young people, including competitive athletes.Objectives: The study was designed to compare the CAG findings between normal subject and hypertrophic cardiomyopathy patients who required CAG.Methods: HCM was diagnosed by using diagnostic criteria (clinical, electrocardiography and echocardiography) defined by Western Working group. The study was carried out on 60 subjects of which 30 had hypertrophic cardiomyopathy, 30 age and sex control (normal subjects).Results: In comparison of control it was observed that HCM cases had significantly larger proximal left anterior descending (3.81+-0.64 vs 2.49+-0.61 P < 0.001), proximal left circumflex (3.29+-0.46 Vs 2.39+-0.60, p < 0.001) and proximal right coronary artery (3.15+-0.47 vs 2.49+-0.42, P < 0.001). Coronary artery stenosis were found in 5 cases of HCM and among them, single vessel disease was present in 3, double vessel disease in I and triple vessel disease in I cases.Conclusion: Coronary artery disease (CAD) associated with hypertrophic cadiomyopathy (HCM) is a complex clinical syndrome, difficult to diagnose clinically, that can reliably be recognized by coronary arteriography.University Heart Journal Vol. 11, No. 2, July 2015; 71-78

Back ground: Malignancy related pericardial effusion (PE) may represent a terminal event in patients with therapeutically unresponsive disease. Pericardial tamponade (PT) is a co morbid condition in many diagnosed malignant cases. Selection of patients with malignancies who are responsive to available treatment may achieve significant improvement in palliation. Early detection of pericardial tamponade and appropriate intervention (Pericardiocentesis) or Subxyphoid pericardiotomy may result long term survival benefit.Objective: Early detection and management of PE and tamponade in malignant cases.Methods: Color Doppler (C-D) echocardiography was done in 260 patients with underlying malignancies on chemo or radiotherapy from oncology department of Delta Medical college and hospital from May 2016 to December 2016. These cases were reviewed retrospectively for clinical features, diagnosis and therapy for their malignancy.Results: 81% have shortness of breath, sign of pulsus paradoxus and pericardial tamponade were found in 22% and 5% patients respectively. During echocardiography, pericardial effusion was found in 102 patients. 65% have mild pericardial effusion, whereas 27% have moderate and 8% have severe PE. Effusions with malignancy comprising of 40% adenocarcinomas of lung, 15% carcinoma (Ca) of pharynx, 10% Ca breast, 10% lymphoma, 10% is Carcinoma of unknown primary, 8% Ca esophagus and 7% others (Renal, Hepatic, ovary & cheek).University Heart Journal Vol. 12, No. 1, January 2016; 23-25

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

The risk of bleeding events that occur during the course of randomized clinical trials on various anti thrombotic medication is still an important issue. The existing guidelines for classifying bleeding events often presents variable results in the reported incidence of bleeding events within the same clinical trial. We analyzed data from 128 ACS patients treated with Enoxaparin in a randomized clinical trial to compare the association between the different degrees of in-hospital TIMI and GUSTO bleeding. In TIMI bleeding group, no TIMI bleeding, TIMI minimal bleed, TIMI minor bleed and TIMI major bleed were 92.9%, 4.7%, 1.6% and 0.8%, respectively. Patients with a TIMI minor bleed were younger (60.8±1.6 yrs; p 0.001) and those with TIMI major bleed had higher mean weight (61.08±1.25 kg; p 0.001), diabetes mellitus (100%; p 0.001) and hyperlipidemia (100%; p 0.001). In GUSTO bleeding group no bleeding, mild, moderate and severe bleeding was 89.84%, 4.68%, 3.91% and 1.56% respectively. Worsening GUSTO bleeding severity was associated with a gradient of increasing age (p 0.001), mean weight (p 0.002), with hypertension (p 0.001), diabetes mellitus ( p 0.001), and hyperlipidemia ( p 0.001). DOI: http://dx.doi.org/10.3329/uhj.v8i2.16080 University Heart Journal Vol. 8, No. 2, July 2012

Background: Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. Aim & objectives: This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TIMI risk score. Methods: This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & complete physical examinations were done. ST changes in electrocardiogram & CKMB/Troponin value were noted in data sheet. TIMI risk score was calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Results: In patient with UA/NSTEMI major adverse cardiac events were 0%, 4.2%, 6.9%, 12.5%, 13.6% and 33.3% with TIMI score 0/ 1, 2, 3, 4, 5 and 6/7 respectively. . In patients with STEMI group major adverse cardiac events were 0%, 0%, 0%, 0%, 7.1%, 9.5%, 10%, 17.6%, 19% and 38.5% with TIMI score 0, 1, 2, 3, 4, 5, 6, 7, 8 and more than 8 respectively. Conclusions: Increasing TIMI risk score was associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16063 University Heart Journal Vol. 8, No. 2, July 2012

No abstract available DOI: http://dx.doi.org/10.3329/uhj.v7i2.10848 University Heart. Journal Vol. 7, No. 2, July 2011

The initial ECG in patients with acute inferior MI may have a great value to identify the subgroup of patients who are at high risk by predicting multivessel coronary artery disease (CAD). These patients, therefore, may benefit from a more invasive approach. ST segment depression in leads V4 to V6 but not V1 to V3 confers a greater likelihood of multivessel CAD. The aim of the study to correlate between ST-depression in ECG on admission & severity of coronary lesion in angiogram in acute inferior MI. This study was undertaken in the department of cardiology of Bangabandhu Sheikh Mujib Medical University and in Ibrahim Cardiac Hospital & Research Institute from March 2009 to October 2010. Patients (total 93) of acute inferior MI, who were presented within 12hrs of onset of symptoms and got intravenous thrombolytics were divided into three groups after initial ECG, group A-without precordial ST-segment depression, group B- maximal precordial STsegment depression in leads V1–V3 and group C- maximal precordial ST-segment depression in leads V4– V6.CAG was done within six weeks of MI and findings of CAG were compared among the groups. Age, sex, distribution of risk factors were identical among the groups. Significant number (53.8%) of patients in group C had a lower ejection fraction (LVEF< 50%) than group B (30%) and group A (10.8%) (p=0.001). Patients of group C more often had double vessel disease (38.5% p=0.007) and triple vessel disease (30.8%) (p=0.014). In contrast, single vessel disease was more common in group B (80%) (p=0.001). Involvement of LAD was also significantly higher in group-C (73.1% p= 0.001). Left precordial ST depression (lead V4-V6) correlates with multivessel CAD, a trend toward a higher rate of LAD artery disease and is associate with LV dysfunction. DOI: http://dx.doi.org/10.3329/uhj.v7i2.10839 University Heart. Journal Vol. 7, No. 2, July 2011

The early prediction of Coronary artery disease (CAD) is a major goal of healthcare through out the world. Aortic stiffness reflecting impaired elasticity of the aorta is shown to be an independent predictor of coronary artery disease which can be measured noninvasively. The aim of the study was to establish the noninvasive markers of Aortic stiffness as the predictor of CAD. In this prospective, observational study, total 100 patients were examined who were clinically suspected of having CAD and were scheduled to undergo CAG. Then the markers of aortic stiffness like Aortic strain, aortic distensibility and aortic propagation velocity were measured by transthoracic echocardiography. Other markers of aortic stiffness like Male sex, aging, systolic blood pressure and pulse pressure were significantly higher in the CAD group. Here it is showed that CAD can be significantly determined by aortic propagation velocity (AVP) cut off value d”41cm/sec. 82% patients were found CAD by AVP who had truly CAD on the basis of CAG and 96% patients were found no CAD by AVP who had no CAD by CAG. Thus an AVP value < 41 cm/sec predicted CAD with 82% sensitivity, 96% specificity (positive predictive value 95.35%, negative predictive value 84.21% and accuracy were 89%). In conclusion, bedside risk stratification of CAD is feasible by echcardiographic determination of Aortic propagation velocity(AVP). DOI: http://dx.doi.org/10.3329/uhj.v7i2.10838 University Heart. Journal Vol. 7, No. 2, July 2011

Myocardial infarction is an imbalance between pro-oxidants and antioxidants. Increase oxidative stress leads lipid peroxidation and malondialdehyde (MDA) is the stable end product of lipid peroxidation. But erythrocyte glutathione (GSH) plays an important role in auto-oxidation of oxygen free radicals (OFR), this study was conducted to determine erythrocyte antioxidant level by measuring erythrocyte glutathione (GSH) in patients of acute myocardial infarction (AMI). GSH level was measured by Ellmann method, plasma malondialdehyde (MDA) level was estimated by Yagi method 25 AMI patients and 25 healthy controls of 40- 70 years in both sexes were included according to inclusion and exclusion criteria. Erythrocyte glutathione level was significantly decreased (p < 0.001) and plasma MDA level was significantly increased (p < 0.001) in AMI patients in comparison to healthy control. On the other hand, total cholesterol, triglyceride and LDL-C were significantly higher (p < 0.001) and HDL-C was significantly lower (p < 0.01) in "I patients as compared to control. This study was found a significant correlation between MDA and GSH levels (r =-0.94, p < 0.001). In AMI GSH level is reduced to scavenge the. ROS. As reduced antioxidant level may be associated with enhanced protective mechanism agtainst oxidative stress, erythrocyte GSH level may be use as an important cardiac marker in AMI.DOI: http://dx.doi.org/10.3329/uhj.v7i2.10750 University Heart. Journal Vol. 7, No. 2, July 2011

Coronary artery ectasia is a relatively common entity characterized by inappropriate dilatation of the coronary vasculature. The exact mechanism of its development is unknown, but evidence suggests a combination of genetic predisposition, common risk factors for coronary artery disease and abnormal vessel wall metabolism. It frequently coexists with aneurysms elsewhere, mostly involving the aorta. In this review, the flow disturbances that are associated with this condition and the imaging modalities, which can be used for diagnosis and prospective follow-up are described. The prognosis of coronary ectasias is controversialand prospective studies focusing on conservative or invasive strategies to prevent cardiac complications are needed. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10210 UHJ 2011; 7(1): 42-47

Acute heart failure is a major health problem responsible for several million hospitalizations worldwide each year. Standard therapy has not changed for long time and includes diuretics and variable use of vasodilators or inotropes. Recently Nesiritide and Levosimendan are two drugs for the treatment of acute heart failure which have been approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMEA), respectively. There was little concern that Nesiritide can worsen the renal failure but recent trials had abolished this concern. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10208 UHJ 2011; 7(1): 35-38

Blood pressure is a vital parameter. Stephen Hales first measured BP and Scipione Riva-Rocci developed the prototype of the present day sphygmomanometer. Both directly and indirectly BP can be measured. The indirect method Includes sphygmomanometric method, ultrasound doppler method, oscillometric method, self measurement and ambulatory BP monitoring. For proper measurement of BP by auscultatory method, one should have adequate knowledge of equipment and cuff size, proper technique and Korotkoff sounds. In different situations like arrhythmias, shock, hyperkinetic circulatory states and aortic regurgitation, BP should be measured carefully. In recent years home BP monitoring and ambulatory BP monitoring are becoming popular. Care must be taken to avoid both underestimation and overestimation of BP recording. doi: 10.3329/uhj.v5i1.3438 University Heart Journal Vol. 5, No. 1, January 2009 28-31

Diabetes mellitus adversely influences the outcome of acute coronary syndrome. This study evaluated the in-hospital outcome of acute coronary syndrome in patients with diabetes mellitus. In this prospective observation study 130 patients with acute coronary syndrome were enrolled. They were divided into diabetic and nondiabetic group. Diabetic patients were taken as case and nondiabetic patients as control. Outcome parameter studied were in-hospital mortality, cardiogenic shock, congestive heart failure, different arrhythmias and recurrent angina. In this study, one third (32%) of the patients were diabetic with mean age 58±10.0 years vs. 53.0±13.6 years in diabetic and nondiabetic group, respectively. Majority of the patients in both groups were male. Congestive heart failure and arrhythmias were more common in case group compared to those in control group (19% vs. 13.6% p=0.424; 23.8% vs. 13.6%, p= 0.148, respectively). Cardiogenic shock developed in 7.1% of diabetic patients and 8% of nondiabetic patients. In hospital mortality was 7.1% and 5.7% in diabetic and nondiabetic group, respectively. Recurrent angina developed only in diabetic patients. Therefore, diabetic patients with acute coronary syndrome encountered more in- hospital adverse outcome. doi: 10.3329/uhj.v5i1.3437 University Heart Journal Vol. 5, No. 1, January 2009 24-27

Permanent pace maker (PPM) lead vegetation is a rare condition. Diagnosis is made by persistent fever after PPM lead implantation, blood culture,2D & M-mode Echocardiography and confirmed by Transoesophageal echocardiography. Many literatures showed that Staphylococcus epidermidis is the most responsible organism as it can grow on plastic material. In this case, we confirmed the vegetations in PPM lead and Tricuspid valve (TV) leaflets by Transoesophageal echocardiography. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16088 University Heart Journal Vol. 8, No. 2, July 2012

A one and half year old child presented with lethargy and unwilling to take food for 2 days. He had history of unusual cry with a history of pneumonia 2 month back. After getting high heart rate on auscultation, a 12 – lead ECG was done and diagnosed as a case of supra ventricular tachycardia (SVT). He was managed by using injection adenosine intravenously by which he was reverted to sinus rhythm. In this case, the treatment strategies of SVT in children will be discussed with other option also. DOI: http://dx.doi.org/10.3329/uhj.v7i2.10851 University Heart. Journal Vol. 7, No. 2, July 2011

The aim of the stuey is to evaluate the association of periodontal condition of patients with Ischemic Heart disease at a university hospital in Bangladesh. This study was done at Bangabandhu Sheikh Mujib Medical University. Two group of patients was selected. Case group of 25 patients with history ischemic heart disease was selected at OPD of cardiology department another control group 25 patient was selected at dental OPD of BSMMU. Data were analyzed by SPSS, Version 10. In this study, The mean age (±SD) of patients was 50.4±8.49 years in the case group and 49.6±10.9 years in the control group. 50 patients consisting of 26 males (52%) and 24 females (48%) were examined. Study showed that probing depth, plaque index, gingival index, bleeding index, gingival recession and clinical attachment level is more in patient with ischemic heart diseases. This study showed higher incidence and more severe periodontal diseases in patients with ischemic heart diseases. DOI: http://dx.doi.org/10.3329/uhj.v7i2.10842 University Heart. Journal Vol. 7, No. 2, July 2011

Ventricular noncompaction is a kind of cardiomyopathy which is called Noncompaction Cardiomyopathy (NCC). In this condition in which the muscular wall of the main pumping chamber of the heart -the left ventricle (LV) appears to be spongy and “non-compacted”, consisting of a meshwork of numerous muscle bands called trabeculations. Here, anatomically LV wall has deep trabeculations. This condition is associated major clinical problems like systolic and diastolic dysfunction, arrhythmia and even systemic embolism. Sudden cardiac death may occur in this group. Early detection of this condition may help to plan the management. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10209 UHJ 2011; 7(1): 39-41

Pulmonary artery pressure is one of the most important parameter for evaluating the status of pulmonary vascular bed for patients of PDA, which helps in formulating treatment strategy. This study was carried out in National Institute of Cardiovascular Diseases and Hospital (NICVD) and National Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh. Pulmonary artery pressure was recorded noninvasively using Doppler echocardiography and the it was correlated with those obtained from haemodynamic studies done at cardiac catheterization. Estimation of pulmonary artery pressure using Doppler derived measurement of pressure gradient across patent ductus arteriosus correlated well with that of simultaneous catheterization measured values. Doppler echocardiography is a cheap, simple, noninvasive bedside test for measuring pulmonary artery systolic and diastolic pressure in patient with PDA. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10202 UHJ 2011; 7(1): 10-12

He was mildly anemic, Pulse was 50/min, regular, high volume; BP was normal & Cannon wave was present in JVP. His apex beat was normal, palpable P2 and Left parasternal heave present with variable S1, loud P2 in pulmonary area and 3/6 Pansystolic murmur all over the A Rare Case of Congenitally Corrected Transposition of Great Arteries with Complete Heart Block MUHAMMED MUSTAFIZUR RAHMAN1, MD. ARIFUR RAHMAN2, MD. ABU SIDDIQUE1, MD. KHURSHED AHMED1, MD. ASHRAF UDDIN SULTAN1 1Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka. 2Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Shahbag, Dhaka. Address for Correspondence: Muhammed Mostafizur Rahman, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Stem cells are one of the most fascinating areas of biology today. Stem cells have two important characteristics that distinguish them from other types of cells. First, they are unspecialized cells that renew themselves for long periods through cell division. The second is that under certain physiologic or experimental conditions, they can be induced to become cells with special functions. Stem cells can be obtained from several sources including spare embryos, special purposes embryos, aborted fetus, umbilical cords, adult tissue or organs, cadavers. The procedure of adult stem cell therapy involves several steps including extraction of cells from various sources, separation by surface markers using FACS, growth in specific culture media and injection into target organs. This modern aspect of regenerative or reparative medicine can be applied for cardiac diseases (coronary artery diseases, heart failure, non ischaemic cardiomyopathies), skin replacement, Diabetes, spinal cord injury, neurodegenerative disease like Parkinsonism, stroke. In future, it may become possible the use of stem cells in organ transplantation. Â Â doi:10.3329/uhj.v4i2.2076 University Heart Journal Vol. 4 No. 2 July 2008 p.46-48

Background: Coronary heart disease (CHD) is a major health problem which imposes a significant burden on health care systems because of high morbidity and mortality. Objectives: To compare the risk factors profile for coronary heart disease in young and old subjects. Methods: Total 100 patients (50 subjects less than 40 years of age and 50 subjects more than 40 years of age) with acute coronary syndrome or stable angina who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University Dhaka, from July 2006 to June 2008 were evaluated for the presence coronary artery disease risk factors e.g. hypertension, dyslipidemia and smoking. Results: The mean age of the study population in younger group was (33.0 ± 6.4) years and in older group (52.0±8.6). The male to female ratio in both groups was 4:1. Smokers were more in younger group (70.0% vs. 46.0%) (p = 0.032). Hypertension was less in the younger group (38.0% vs. 58.0%) (p = 0.045). Presence of diabetes was higher in the older age group (34.0% vs. 4.0%) (p = 0.001). Higher incidence of family history of coronary heart disease was in the younger age group. The total cholesterol was higher in older group (182.9 ± 33.1) vs. (171.1 ± 24.8 mg/dl) (p = 0.047). 68% of patients of older group and 38% of younger group had stenosis in left anterior descending artery (p = 0.003). The involvement of left circumflex and right coronary artery in older age group were higher (56% and 66% respectively) than those in younger group (36% and 40% respectively) (p = 0.045 and p = 0.009). Conclusion: Ischemic heart disease in younger adults < 40 years had different risk profile characteristics than older patients. Key words: Coronary heart disease; acute coronary syndrome; stable angina; risk factors. DOI: 10.3329/bsmmuj.v3i1.5508 BSMMU J 2010; 3(1): 13-17

The prevalence of metabolic syndrome was determined in clinic-based 1,517 hypertensive patients. All traits were present in 1.1% men and 12.8% women. Combination of different three traits were present as follows: hypertension with high triglyceride and low HDL (men 29.4% vs. women 51.8%), hypertensio with high blood glucose and low HDL (men 13.5% vs. women 29.8%), hypertension with high glucose and high triglyceride (men 18.1% vs. women 18.1%), hypertension with high blood glucose and large waist (men 2.7% vs. women 25.7%), hypertension with high triglyceride and large waist (men 3.4% vs. women 39.3%) and hypertension with low HDL and large waist (men 2.5% vs. women 70.6%). The study shows that the metabolic syndrome is highly prevalent among hypertensive patients especially women.

 A thirty years old lady presented with uncontrolled hypertension and dizziness during working for last 5 years. She had history of termination of pregnancy due to treatment-resistant hypertension. Even in the post-partum period her blood pressure remains uncontrolled with more than three antihypertensive drugs. Her serum K+ level was low and USG of KUB & adrenal glands showed slightly increased right renal cortical echotexture; CT scan of abdomen revealed right Adrenal adenoma. She underwent unilateral adrenalectomy. Now, she has no complaints and her blood pressure is normal without any antihypertensive drugs. There is no target organ damage. Key words: Primary hyperaldosteronism, unilateral adrenal adenoma, resistant endocrine hypertension  doi:10.3329/uhj.v4i2.2077 University Heart Journal Vol. 4 No. 2 July 2008 p.49-50

The diagnosis of the metabolic syndrome holds promise for enhanced prevention of diabetes and cardiovascular diseases. However, its magnitude in Bangladeshi population is not precisely known.

Heart is supplied mostly by two coronary arteries-right and left. Only inner 75-100mm of endothelial surface gets nutrition directly from the blood in the cardiac chamber. Anatomically coronary arteries are not end-arteries because they anastomosis with each other by their trunk branches and sub-branches- mostly at the pre-capillary level. So they are functional end arteries. Right coronary artery supplies whole of the right atrium, most of the right ventricle except a strip along the anterior inter ventricular groove, post-inferior one third of ventricular septum and S-A node and A.V. node in the majority of subjects, left coronary artery supplies most of the left atrium and left ventricle except a strip along the posterior and inferior surface of the heart and also supplies anterior–superior two third of the ventricular septum. The most common cause of death in affluent society across the world is ischemic heart disease which results from occlusion of coronary artery or its major branches; clinically the occlusion of coronary arteries and their major branches may be within the fast 2-5 cm of left anterior descending and circumflex branches and proximal and distal third of right coronary artery. Average frequencies of critical narrowing of the three major arterial trunk areanterior interventricular( LAD)-40-50%, right coronary artery (RCA), 30-40% and circumflex branch of left coronary artery (LCX),15-20%.

The prevalence of metabolic syndrome was determined in clinic–based 1,517 hypertensive patients. All traits were present in 1.1% men and 12.8% women. Combination of different three traits were present as follows; hypertension with high triglyceride and low HDL (men   29.4% vs. women 51.8%), hypertension with high blood glucose and low HDL (men 13.5% vs. women 29.8%), hypertension with high glucose and high triglyceride (men 18.1% vs. women 18.1%), hypertension with high blood glucose and large waist (men 2.7% vs. women 25.7%), hypertension with high triglyceride and large waist (men 3.4% vs. women 39.3%) and hypertension with low HDL and large waist (men 2.5% vs. women 70.6%). This study shows that the metabolic syndrome is highly prevalent among hypertensive patients especially women. Keywords: essential hypertension; metabolic factor Online 29-1-2009 DOI: 10.3329/bmrcb.v34i3.1856 Bangladesh Med Res Counc Bull 2008; 34: 71-75

A 59 years old gentleman with hypertension, type-2 DM, dyslipidemia and atheroschlerotic stenosing coronary artery disease had the rare blood group Oh ((Bombay phenotype). After prophylactic conservation of two units of predeposit autologous blood, myocardial revascularization was successfully accomplished with off pump coronary artery bypass surgery (OPCAB). Postoperative recovery was uneventful.Key words: Bombay phenotype; OPCAB DOI: 10.3329/uhj.v6i2.7258University Heart Journal Vol. 6, No. 2, July 2010 pp.110-113

Background: Coronary collateral circulation is an alternative source of blood supply to the myocardium in coronary atherosclerotic disease. They provide adequate flow to the major epicardial branches of the coronary artery. Indicator of cardiac ischemia like stable angina pectoris may determine the presence of coronary collateral circulation.Methods and results: In this prospective observational cross sectional study, 150 patients with stable angina pectoris with or without MI (myocardial infarction) and or coronary intervention were enrolled. Presence of coronary collaterals in coronary angiogram was defined as Rentrop grade > 1. Patients were divided into two groups. Group A patients having Rentrop grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3. Patients are compared in these groups. Total (63%) patients with stable angina were in Group B with coronary collateral circulation and only (37%) patients with stable angina pectoris were in Group A without collaterals.Conclusions: The incidence of development of coronary collaterals was significantly higher in patients with stable angina pectoris. DOI: 10.3329/uhj.v6i2.7245University Heart Journal Vol. 6, No. 2, July 2010 pp.61-64

Diabetes mellitus (DM) itself increases the risk of Coronary Artery Disease (CAD) by 2-4 fold and in out country we are treating a good number of patients having CAD with DM. On the other hand several studies have reported increased risk of adverse outcomes following balloon angioplasty in diabetic cases. In this situation this study had been carried out at National Institute of Cardiovascular Diseases (NICVD) cath lab to determine the immediate procedural success & in-hospital adverse outcomes in this population. In our study 100 cases were enrolled. Out of which, 40 patients had type II DM & rest were non-diabetic.Diabetic patients were compared with non- diabetic and found no major difference between the two patient group except for a higher number of LCX (Left Circumflex) lesion in the non-diabetic (25% VS 35%, P value 0.038). The lone case of renal complication came from the diabetic group. No MACE (Major Adverse Cardiovascular or Cerebrovascular Events) or death was occur in this series. Angiographic, procedural and clinical success in diabetic was 97.5%, 97.5% & 95% respectively whereas 100% found in non-diabetic group at its all segment. But this results are statistically insignificant and P value is 0.4000 for angiographic success, 0.4000 for procedural success and 0.158 for clinical success. P value for hospital stays is also insignificant i.e. 0.250 (while p value of < 0.05 was considered significant). Therefore in the setting of diabetes mellitus the outcomes of the stenting procedure are quite encouraging. Key words: Coronary Stenting; Diabetic; Outcomes DOI: 10.3329/uhj.v6i1.7181University Heart Journal Vol.6(1) 2010 pp.3-8

The purpose of this study was to assess the value of MA in the prediction of PE and also to compare urinary collagen IV with MA in this prediction. A total of 200 subjects (age 25±4 years, M±SC), were selected in their early pregnancy (10 to 14 weeks). Blood glucose, serum lipids, serum and urinary creatinine, urinary albumin and urinary collagen IV were measured in these subjects and they were followed up to the term for the possible development of PE, MA was defined by albumin creatinine ratio (ACR) above 32mg/g and high urinary collagen IV was defined by values above the cut-off point 2.54 ng/ml determined by the median value of the controls. The data were analyzed by grouping the subjects who developed PE in later stages of pregnancy (the PE group) and those who did not develop PE in later stages (the control group). Out of 200 subjects 94 were primigravida and 106 were multigravida. From the total subjects 16 developed PE, which shows a prevalence of about 8.4%. The PE group showed a relatively higher value of ACR as compared to control group. 106 subjects had MA out of which 13 developed PE. The sensitivity of ACR in predicting the development of PE was 80%, specificity 49.54%, PPV 12.69% and NPV 96.42%. Regarding urinary collagen IV the PE group showed no significant difference with the value of the control group. 103 subjects had high urinary collagen IV and out of them 11 developed PE. The sensitivity of high urinary collagen IV in prediction PE was found to have no significant difference with ACR in this respect. The data suggest the following conclusions:Early pregnancy levels of microalbuminuria and urinary collagen IV can be used as predictors of PE with high negative value.Urinary collagen IV has no added advantage over MA in this respect. Keywords : MA-Micro DOI: 10.3329/uhj.v5i2.4555 University Heart Journal Vol.5(2) July 2009 pp.59-62

A forty years widow having four children presented with palpitation, shortness of breath on exertion and chest pain. Her sufferings progressively increase in course of time. Her ECG shows complete Right Bundle Branch Block. Transthoracic echocardiography showed atrial septal defect of secundum type. Both the leaflets of the mitral valve were thickened with mild degree of diastolic doming. Key Words: Lutembacher Syndrome; Mitral Stenosis. DOI: 10.3329/uhj.v6i1.7198University Heart Journal Vol.6(1) 2010 pp.51-54

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

Nebivolol is a vasodilating β-blocker, which can be distinguished from other β-blockers by its haemodynamic profile. It combines β-adrenergic blocking activity with a vasodilating effect mediated by the endothelial Larginine nitric oxide (NO) pathway. The blood pressure lowering effect of nebivolol is linked to a reduction in peripheral resistance and an increase in stroke volume and preservation of cardiac output. Clinical trials have demonstrated that nebivolol reduces blood pressure similarly to atenolol, bisoprolol, amlodipine, nifedipine, lisinopril, and hydrochlorothiazide. The tolerability of nebivolol is similar to or better than that of these agents. In general, response rates to treatment are higher and the frequency and severity of adverse events are either comparable or lower with nebivolol. Endothelium-derived NO is important in the regulation of large arterial stiffness, which in turn is a major risk factor for cardiovascular disease. Therefore, antihypertensive drugs, such as nebivolol, that also improve endothelial function and decrease arterial stiffness, may contribute to a reduction in cardiovascular risk.Key words: Vasodilating β-blocker; nitric oxide (NO); peripheral resistance; arterial stiffness DOI: 10.3329/uhj.v6i2.7254University Heart Journal Vol. 6, No. 2, July 2010 pp.93-96

Diabetes mellitus (DM) increases the risk of cardiovascular events in patients with cardiovascular disease as well as in patients without any previous history of ischemic heart disease (IHD). This inordinate increase in the risk of coronary events in diabetic patients is attributed to multiple factors, including glycation and oxidation of proteins and increased prevalence of classic risk factors of coronary disease, such as hypertension, obesity, and dyslipidemia. Despite advances in the management of cardiovascular disease, a large proportion of diabetic subjects continue to have uncontrolled hyperglycemia, hypertension, and dyslipidemia. Patients with CAD and pre-diabetic states should undergo lifestyle modifications aimed at preventing DM. In patients with CAD and DM, routine use of aspirin and an angiotensin-converting en zyme inhibitor (ACE I) - unless contraindicated or not tolerated - and strict glycemic, blood pressure, and lipid control are strongly suggested. The results after revascularization in diabetic patients are usually worse compared with non-diabetic patients. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as GpIIbIIIa antagonists. Glycemic control is an important determinant of outcome after revascularization in diabetic patients. In this review, some of these landmark studies are reviewed and some practical guidelines of management are suggested. Key words: Angiotensin-converting enzyme inhibitor; Coronary artery disease; diabetes mellitus; dyslipidemia. DOI: 10.3329/uhj.v5i2.4559 University Heart Journal Vol.5(2) July 2009 pp.75-78