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Aim: This purpose of this study was to compare the effects of clopidogrel and ticagrelor in cases of antiplatelet therapy for treating acute coronary syndromes Study design: retrospective longitudinal comparative study Place and duration: This Study was conducted at Sandeman Provincial Hospital Quetta, Pakistan over a period of two years, from February 2019 to July 2021 Methodology: A study population of 1002 patients was taken, each diagnosed with acute coronary syndrome. The inclusion criteria for these patients included that they had been previously treated with antiplatelet therapy and had been subject to invasive therapy and management. The multiplate analyzer was used to measure the platelet count for each patient. Patient history was taken and the response of each patient to the medication was recorded throughout the interval of one year. The outcome after one year on the medication was also noted and analyzed. Results: Ticagrelor was given to patients who were young and possessed a lesser chance of having diabetes. These patients also presented with an elevated ST segment or had previously suffered from a myocardial infarction, the p value was recorded to be greater than 0.05. It was noted that patients who were treated with ticagrelor had a lower risk score of bleeding. Patients who were treated with ticagrelor also showed a lower risk score for the global registry of acute coronary events (grace) where the results showed that patients treated with ticagrelor had a score of 121 ± 27 versus 127± 31.5 and the p value was equated as 0.002. There were greatly reduced results for the high platelet reactivity in patients treated with ticagrelor. When patients treated with clopidogrel were compared with patients treated with ticagrelor the high platelet reactivity results showed that it was 37.5% versus 16.7% respectively with the p-value of less than 0.0001. Conclusion: The results from the study concluded that in case of patients who were categorized as lower risk, ticagrelor was prescribed more frequently, but it was not prescribed as frequently in the case of higher risk patients. Ticagrelor was also discontinued in case of side effects such as bleeding, trouble breathing or bradyarrythmia. However, these side effects were not common. Discontinuation rates were higher after most cases of coronary artery bypass graft surgery. These higher discontinuation rates were noted in patients who were treated without the use of revascularization. There is a need for more research to be done on this and educating surgeons on the benefits and pitfalls of the medication and its effects is also needed. Keywords: Ticagrelor, clopidogrel, acute coronary syndromes. comparison

Background: Gestational diabetes (GD) is identified as a risk factor for increasing the onset of cardiovascular disorders (CVD). However, it is not clear whether this risk is linked with the intercurrent pathogenesis of type 2 diabetes mellitus. Thus, it is essential to identify markers and risk factors responsible for the pathogenesis of CVD and develop therapeutic strategies to decrease the cardiovascular health burden in affected women. Objective: The present study aims to evaluate the effect of GD on the future onset of CVD and assess the impact of type 2 diabetes mellitus in this context. Study Design: A cohort study was conducted in Karachi Institute of Heart Diseases Karachi Pakistan from June 2017 to June 2018. A total of 227 females who give birth to at least one kid were included in this study. Females with previous history of cardiovascular disorders and any other chronic disorders were excluded from this study. Using a biennial questionnaire behavioral, life style characters and health outcomes were evaluated. Multivariable Cox model was used to measure hazardous risk and ratio for cardiovascular disorders with 95 % confidence interval. Results: In this study, 11.8% of participants were diagnosed with gestational diabetes with a mean age of 31.6 ± 2.6 years. 28% of women with GD were developed hypertension later on compared to the non-GD participants (8%), indicating a positive association between GD and hypertension. A multivariate Cox analysis revealed that women with GD had a 28% increased risk of incidence of hypertension as compared to the non-GD group (HR. 1.24 [95% CI 1.13 – 1.65); P

Background: Warfarin has long been established as the oral anticoagulant of choice. The benefits of warfarin depend on maintaining the International Normalized Ratio (INR). It has been shown that the optimal INR target range is 2-3 for AF patients. Very less number of patients had been reported to achieve and remain in that target INR range. The prevalence of AF in the general population is about 1.6% in women and 2.4% in men and is generally lower in Asian countries Aim: To determine the frequency of achieving target INR in patient on warfarin for atrial fibrillation. Methodology: This is cross sectional study conducted at national institute of cardio vascular disease, Karachi from 31st May 2016 30th November 2016.The sample size of the study were 111, and nonprobability convenience sampling technique was used. Results: Among study population 61 (54.9%) were male and 50(45%) female patients. Mean duration of atrial fibrillation was 3.44±0.97 years. The mean duration of warfarin taken was 11.34±3.96 months. INR (2-3) target achieved in 72(64.9%) patients. Significant association of achieved INR target was observed with duration of atrial fibrillation, duration of warfarin, hypertension, stroke, and Left ventricular dysfunction. Conclusion: Target of INR was achieved in 64.9% patients when these patients were given warfarin doses of 5.0 to 7.5 mg/day. Keywords: Achieving Target INR, Warfarin, Atrial Fibrillation.

Aim: Multiple studies have shown obesity to be related with augmented mortality and morbidity, as well as other cardiovascular risk factors such as diabetes, hyperlipidaemia and hypertension. Therefore, we are investigating the relationship between obesity and in-hospital mortality among patients planned for coronary intervention (PCI). Place and Duration: In the Cardiology department of Peoples University of Medical and Health Sciences For Women PUMHSW (SBA) Nawabshah, for one-year duration from July 2020 to July 2021. Methods: 138 patients (69 obese, 69 non-obese) aged 30-70 years were included in the research using a purposive, non-probability sampling technique from the cardiology department. The body mass index of all patients was recorded and patients with BMI above 30 kg / m2 were deliberated as obese, and individuals with BMI less than 30 kg / m2 were deliberated as non-obese. All patients who endured percutaneous coronary intervention were included in the study. Group I comprised of obese and non-obese patients in group II. Results: To determine the obesity relationship with in-hospital mortality among patients planned for coronary intervention (PCI), a total of 138 cases (69 obese and 69 non-obese) were included that met the inclusion / exclusion criteria. When the age grouping was performed, 17.4% (n = 12) of the obese group and 24.6% (n = 17) of the non-obese group were between the ages of 30 and 50, while 82.6% (n = 57) in the obese group and 75. 4% (n = 52) in the non-obese group were 51- 70 years of age, the mean ± SD was calculated as 55.25+8.10 years in the obese group and 57.97+7.52 years in the non-obese group. The mean BMI was calculated as 34.46±4.31 in the obese group and 28.91±5.37 in the non-obese group Conclusion: We concluded that there is no association between obesity and in-hospital mortality in patients enduring coronary intervention (PCI). Keywords: In-hospital mortality, Coronary intervention, non-obese, obese.

Aim: The purpose of this study was to predict the patient’s death due to sudden cardiac arrest with left ventricular dysfunction by analyzing the value of BNP Study design: Prospective longitudinal study Place and duration: This study was conducted at Karachi institute of heart diseases Karachi, Pakistan from Feb 2020 to Feb 2021 Methodology: This cross sectional study was conducted from Feb 2020 to Feb 2021 on 70 patients who were pin pointed with acute STEMI complicated by left ventricular systolic failure and hospitalized in our hospital. A total of 70 patients who were recognized with STEMI, 48 of whom got primary PCI, and 17 of whom received thrombolytic treatment. Results: The average age of the patients was 57.6 years and the range being from 35 to 80 years. Male patients constituted 73.3 percent of the study. It was discovered a mean of NYHA of 2.5, an average Killip classification of 2.8 and an average TIMI score of 8.1. A 90-day follow-up showed that 48 patients survived out of which 7 were reported to have a life-threatening arrhythmia and 12 had sickle cell disease. When ROC curve was shown, Pro-BNP indicated Sc.D. and unanticipated cardiac death was forecasted which also stipulated an AUC of 0.76, while the AUC was 69.6 percent of the ROC curve of the same neuropeptide in evaluating accuracy in prediction of VT, by. A Kaplan-Meier analysis reveals that an increase in pro-BNP over 3.2ng/ml has a significant predictive influence on SCD [OR 0.748 (CI 95 percent: 0.07-0.932), p-value .039] Conclusion: BNP levels in individuals with ischemic cardiomyopathy after an acute MI are a significant, independent predictor of sudden death. Keywords: BNP levels, ischemic cardiomyopathy, sudden death, myocardial infarction

Objective: To compare the relative effects of intravenous adenosine with verapamil in emergency treatment of supraventricular tachycardia (SVT) and to conclude which one is best suited for the treatment of SVT. Study Design: A prospective comparative study. Place and Duration: In the Cardiology Unit, Peoples Medical College and Hospital Nawabshah for one year duration from May 2018 to May 2019. Methods: In 90 patients of SVT, adenosine was given and also in 90 subject’s verapamil was given and comparison was recorded. In the adenosine group, the first bolus of 6 mg was administered for cardiovert and an additional 12 mg of bolus was given if cardioversion was not observed within 2 minutes into sinus rhythm. If SVT continued, that case was transferred to the group receiving Verapamil. On the further, intravenous 5mg verapamil was given in the verapamil group for 2 minutes in the bolus, and if SVT persisted, 5 additional mg was again given after ten mints of the first dose. In the case of cardiovascular insufficiency with verapamil, patients were included in the group of adenosine. The blood pressure and heart rate were continuously monitored while drug infusion and 30 minutes after conversion. Results: 180 total cases of spontaneous SVT in stable state were analysed. 54 (60%) cases of the adenosine group were changed to sinus rhythm after 6 mg bolus and with additional 12 mg adenosine bolus 17 (18.89%) patients maintained sinus rhythm. 78.9% was the total efficacy of adenosine. The sinus rhythm was maintained in 74 (82.22%) patients of verapamil group with 5 mg dose, and with 5 mg additional verapamil, sinus rhythm was maintained by 8 (8.89%) patients. 91.1% was the total efficacy of verapamil. A correlation test was performed and there was significant variation in the verapamil efficacy paralleled to adenosine (p = 0.02). Conclusion: This analysis demonstrates the verapamil efficacy over adenosine in order to transform spontaneous SVT into sinus rhythm. Thus, alternative of adenosine is verapamil in the immediate management of SVT. It is safe and profitable for health systems where adenosine is limited. Key words: Adenosine, Supraventricular tachycardia (SVT), efficacy, verapamil.