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Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is well known for causing an acute respiratory disease, a number of patients after they get recovered from acute infection, subsequently experience a constellation of symptoms and events that lasts for more than 3 months. Adequate clinical data are now accumulating on the subacute and long-term effects of Covid-19 and can involve multiple organ systems. This spectrum of symptoms and late manifestations are thought to have a possible link with the covid-19 and this condition is named LONG COVID or POST-COVID. Some of the patients may show the ongoing evidence of cardiovascular damage on long term without having symptoms which may be picked up by different imaging modalities like CMR. There has been an increase in the number of COVID-19 patients in an exponential fashion so as to cause a collapse in the healthcare system in many countries across the world, with an effect not only on public health, but also on social and economic activities. University Heart Journal 2022; 18(2): 118-124

Clinicians have long recognized that acute myocardial infarction (MI) can occur in the absence of atherothrombosis . The Universal Definition of MI Global Taskforce introduced a classification system in 2007 (and reaffirmed in 2012) that defined type 2 MI (following standard diagnostic criteria) as MI occurring due to an imbalance in myocardial oxygen supply and/or demand not caused by atherosclerotic plaque disruption. Nevertheless, ambiguity remains regarding how to diagnose type 2 MI and how to distinguish it from both type 1 MI and myocardial injury. Here we report a case of a 23 year old young woman attended to emergency department, with typical chest pain and shortness of breath for 6 hours, Diarrhoea for 2 days, and single time loss of consciousness for 5 minutes, 6 hours before attending to hospital. Cardiac enzymes were rising titres in subsequent samples, Serum Creatinine was also high. Echocardiography performed 36 hour later, showed no regional wall motion abnormality, coronary angiogram showed normal coronary arteries. So, a diagnosis of Myocardial Infarction (Type 2 MI) with Non Obstructive Coronary Artery (MINOCA) was made, and MINOCA was attributed to hypovolemic shock (resulting from Dirrrahoea), manifested as MI, Syncope and AKI. University Heart Journal 2022; 18(2): 128-131

Background: Corona virus disease (COVID-19) has been associated with different cardiac complications including cardiac arrhythmias. Arrhythmias carries a great influence on the outcomes. The pathophysiology of these manifestations remain elusive. This study was aimed to observe the incidence and outcome of cardiac arrhythmia in patients with COVID-19 infection from July 2020 to May 2021. Method: We conducted an observational study of patients ³18 years of age with a clinical diagnosis of COVID -19 infection attending Bangabandhu sheikh Mujib Medical University (BSMMU) with and without cardiac arrhythmias from July 2020 to May 2021. Patients were labeled as having arrhythmia if they had sinus bradycardia (heart rate

Background: Heart failure (HF) is one of the most important health problems in terms of prevalence, morbidity, mortality and health service use. It affects around 2 to 3 % of the population. NYHA class can be used for the prioritization, triage and tailoring the HF management which is the foundation for the selection of therapies. The patient with higher NYHA class may need Mechanical Circulatory Support therapy or palliative care or hospice care. The identification of the patients with lower NYHA class helps to tailor vigorous drug therapy and close follow up program, the prognosis of these low risk patients maybe further improved. It is a simple tool for risk stratification in clinical practice. Objective: The principal objective of this study was to determine frequency of transition of NYHA class III / IV to NYHA class I / II / III of stage C & D HF with drugs in a tertiary level hospital. Methods: This was a crosssectional study. A total of 45 patients with stage C and D HF were enrolled in the study by consecutive sampling from October 2019 to September 2020. Detailed history including NYHA functional class of stage C and D HF, physical examination, relevant investigations and Echocardiography were done in all the subjects. The subjects were treated accordingly. The treatment response was assessed again with NYHA functional class on discharge. Result: Patients had mean age of 62 &60 and 54 & 54 years for NYHA class III & IV of stage C and D HF. Majority of the patients were male. Primary cause of HF for both stage were IHD followed by DCM and valvular heart disease. The clinical presentation of stage C & D HF was improved significantly on discharge. Haematological, biochemical, radiological and echocardiographic findings of NYHA class IV of stage C & D HF was more worst. Conclusion: There is statistically significant transition of NYHA class III of stage C and D HF to lower NYHA class but there is no statistically significant transition of NYHA class IV of stage C and D HF with pharmacotherapy in a tertiary level hospital. Higher NYHA class is associated with poor outcome of stage C & D HF patients. University Heart Journal 2022; 18(1): 14-21

Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized by left ventricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but there is still uncertainty regarding its incidence, pathogenesis, and optimum management protocol. Retrospective analysis of twenty cases of PPCM admitted, within July 20016 to June 2018 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka is done here. Mean age of study population was 25 (6.3). Majority of the patients were multi-paras 12 (60%). 80% of the patients were diagnosed after delivery. Breathlessness was the most common symptom. Bibasal lung base crepitations was most frequent sign, which was found in 95% cases. Sinus tachycardia was most frequent electrocardiographic change which was found in 80% cases. Mean left ventricular ejection fraction (LVEF) was 35.2(2.8). All the patients had different extent of global hypokinesia of left ventricle (LV) at rest. The patients were treated with bed rest, water and salt restriction, loop diuretic, digitalis, selective Beta-blocker, vitamin B complex and an anticoagulant in relevant cases in antepartum period, Angiotensin converting enzyme inhibitor (ACEI) or Angiotensin receptor blocker (ARB) was added in postpartum period.70% patients were clinically improved and in 45% the left ventricular functional status returned to normal. 30% developed persistent cardiomyopathy beyond six months of presentation. Maternal mortality was 1 (5%). Among all live births three had intra uterine growth retardation. The pathophysiology, emerging investigations modalities, updated management protocol, and prognosis of PPCM are also discussed in this review. University Heart Journal Vol. 17, No. 1, Jan 2021; 71-75

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

Antiplatelet therapy is the cornerstone in the treatment of acute coronary syndrome. Aspirin is the most widely used antiplatelet agent followed by P2Y12 inhibitors. Glycoprotein (GP) IIb-IIIa antagonists are also gaining popularity as an antiplatelet agents during peri-PCI period. This review article summarizes the indications, duration of dual antiplatelet therapy (DAPT) in ACS setting. Antiplatelet therapy in special situations like atrial fibrillation and thrombocytopenia are discussed here. Issues like switching between P2Y12 inhibitors and genetic testing of antiplatelet agents are also mentioned in this article University Heart Journal Vol. 17, No. 1, Jan 2021; 66-70

Background: The use of Warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulant effects than Warfarin. Methods: In this Open comparison trial, the researchers compared Rivaroxaban (at a daily dose of 20 mg or 15 mg daily in patient with a creatinine clearance of 30-49 ml/min ) with dose adjusted Warfarin (target INR 2.0 to3.0) in 2,846 patients with nonvalvular atrial fibrillation and CHA2DS2-VASc Score 2 or more. The primary efficacy outcome was stroke or systemic embolism and primary safety outcome was major or minor bleeding. This research was designed to determine whether Rivaroxaban have more efficacy and safety than Warfarin for the primary outcomes. Results: Total follow-up period was 6 months. Risk factors and co-morbidities were similar in both groups. Baseline investigations were also similar. Age and sex of both groups were matched. The rate of ischaemic stroke was 1.8% in Rivaroxaban group, as compared with 2.18% in the Warfarin group (p 0.479, nonsignificant). The rate of haemorrhagic stroke was 0.53% in Rivaroxaban group, as compared with 1.36 % in the Warfarin group (p 0.026, significant). Systemic embolism was 0.08% in Rivaroxaban group, as compared with 0.15 % in the Warfarin group (p 0.561, non-significant). The rate of major bleeding was 0.4% in Rivaroxaban group and 0.53 % in the Warfarin group (p 0.361, non-significant). The rate of minor bleeding was 2.10% in Rivaroxaban group, as compared with 2.33% in the Warfarin group (p 0.681, non-significant). Conclusions: Rivaroxaban have similar efficacy and better safety profile than Warfarin in patients with nonvalvular atrial fibrillation in Bangladeshi population. University Heart Journal Vol. 16, No. 2, Jul 2020; 99-105

Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that affects the arteries in your lungs and the right side of your heart. In this study, hepatic venous duplex will be done to diagnose and quantify the PH. So that Patients can avoid unnecessary invasive right heart catheterization. This practical demonstration is the key to enrich our experience and knowledge in the field of PH. Objectives of this study was to assess PH status by Hepatic venous Duplex (HVD) as well by right heart catheterization and to compare them. This study was conducted in the Department of Cardiology, BSMMU, Shahbagh, Dhaka extending from July 2018 to December 2019. Total 100 (One hundred) subjects were enrolled in this study. It was an Observational study and includes the subjects between 18 years to 45 years of age. Results of this study shows very close proximity to that of Right heart catheterization. Hemodynamic changes in Hepatic venous duplex study could be used as an alternative diagnostic tool for evaluating moderate to severe pulmonary hypertension. This method could counteract the weakness of the currently used diagnostic methods and improve the accuracy of assessing pulmonary hypertension when combined with other methods. University Heart Journal Vol. 16, No. 2, Jul 2020; 86-91

Background: Chronic heart failure (CHF) causes multiple lung complications and lung functions are reduced in CHF patients. Objective: To observe FVC, FEV1, FEV1/FVC% and their relationship with EF% in patients with chronic heart failure. Methods: This cross sectional study was conducted in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, during 2016. For this, 60 diagnosed stable male, aged 35-65 years CHF patients were randomly selected from the Cardiology Department of BSMMU, Dhaka. On the basis of staging of the disease (Stage C) and New York Heart Association (NYHA) functional classification, the study subjects were divided into two groups, 30 patients of NYHA Class- I and 30 patients of NYHA class –II. Thirty (30) apparently healthy Age, Sex and BMI matched subjects were taken as control. To assess the ventilatory function, Forced vital capacity (FVC), Forced expiratory volume in 1st second (FEV1), Forced expiratory ratio (FEV1/FVC%) of all subjects were measured by a portable Digital Spirometer. Again, Ejection fraction (EF%) ranged (≥35% to ≤50%) were measured by Echocardiogram to observe left ventricular function of the heart. For statistical analysis, Independent sample‘t’ test and Pearson’s correlation co-efficient test was performed by using SPSS for windows version-16 & p≤0.05 was accepted as level of significance. Results: The mean percentage of predicted values of FVC and FEV1 were significantly lower but FEV1/FVC% was significantly higher in CHF patients comparison to the healthy control. All the study variables were significantly lower in patients of NYHA class–II as compared to patients of NYHA class–I. 73.33% CHF patients had restrictive, 10.00% small airway obstruction and 16.67% combined restrictive and small airway obstruction feature. In addition, FVC and FEV1 (p

Introduction: Chronic heart failure with reduced ejection fraction is a major complication of diseases involving myocardium. Despite numerous pharmacological interventions and invasive therapeutic techniques, therapeutic options for end stage heart failure remain limited to left ventricular assist device & organ transplantation. Regenerative medicine may bring hope here. Method: This pilot study was carried out at the Department of cardiology in collaboration with department of haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from October 2017 to March 2018. Considering inclusion & exclusion crieteria ten (10) patients were taken in stem cell group and ten (10) patients in control group. Patients in the control arm received standard of care in accordance with practice guidelines for heart failure management (GDMT). Patients in the cell therapy arm received, in addition to standard of care, bone marrow–derived cardiopoietic stem cells (G-CSF) meeting quality release criteria. Baseline clinical and echocardiographic data were obtained and recorded in pre-formed data sheet. Close liaison was maintained with all patients and followed up after 30 days & after 3 months and for any complication. The absolute change in 6 MWD from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But significant improvement was found at 6 months follow up of 6MWD between the two groups (300±28 vs 375±25, p= 0.04). Baseline BORG scale was similar in the control group and the SCT group (8.1±0.56 and 8.3±0.67 respectively, P= 0.45). The absolute change in BORG scale from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But improvement was not statistically significant in between the two groups (p= 0.32, 0.45, 0.23 respectively). Echocardiographic observation also revealed a similar baseline LVIDd, LVEF level in the control group and the SCT group which was not statistically significant (p = 0.45, 0.52 respectively). Gradual improvement in LVIDd were found at 30 days, 3 months, 6 months follow up observation but statistically significant absolute change was found only at 6 months follow up in between groups (62.4±1.8 vs 56±2.4, p=0.03). Baseline LVEF were less than 30% in both control & SCT group (29.5±0.8% & 28.7±1.3% respectively). The echocardiographic evaluation also revealed a significant increase in LVEF at 6 months (34% ±1.6 and 40% ± 2.5%, p = 0.04) of follow-up in between group but not at 30 days & 3 months follow up. University Heart Journal Vol. 16, No. 2, Jul 2020; 52-58

Acute coronary syndrome may leads to heart failure. Severity of heart failure is identified by NYHA classification clinically. Color Doppler echocardiography is the key investigation to identify the acute systolic heart failure. For the quantification of systolic heart failure diagnosis, Ejection fraction (EF) can be measured by Simpson method. EF > 30% is defined as severe systolic heart failure. Pulsus alternans is found in severe heart failure patients. Pulsus alternans is a poor prognostic sign of severe heart failure patients in acute MI setting. This cross sectional observation study was aimed to identify the objective evidence of Pulsus alternance noninvasively by Echocardiography. Color Doppler echocardiography was done 100 acute coronary syndrome with heart failure NYHA III and IV patients in department of Cardiology, BSMMU, from July 2018 to June 2019. Age 18 to 70 yrs, male is 79 and female is 21. Pulsus alternans was found in 32 patients, 39 had low volume and 29 had normal volume pulse. 50% patients had ST depression and T inversion and diagnosed as case of Unstable Agina or Non STEMI, 44 had STEMI and 7 had developed new onset of LBBB. 87 Patients who have EF < 30 % was marked as Severe LV systolic dysfunction. Among them, 3 had mild, 14 had moderate and rest 70 had severe Mitral regurgitation. 38 (43.67%) patients had Doppler alternans in severe LV systolic dysfunction group. P value for Doppler alternans is 0.039 which is significant. Doppler alternans by Echocardiography in Severe LV systolic dysfunction patients showed 49% sensitivity and 78% specificity. 38 patients had Severe RV systolic dysfunction by M- mode echo measurement of TAPSE

Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center. Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV were selected by random sampling, from July 2017 to June 2018. Each patient was randomly allocated into either of the two arms, and was continued receiving treatment with either spironolactone (Arm-I) or eplerenone(Arm-II). Each patient was evaluated clinically, biochemically and echocardiographically at the beginning of treatment (baseline) at 1 month and at the end of 6th month. Echocardiography was performed to find out change in left ventricular systolic function. Result: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 6.2% in eplerenone group and 4.1% in spironolactonearm. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P0.05). Conclusion: In this study, the improvement in systolic function was more in eplerenone arm, which also had fewer adverse side effects when compared to spironolactone arm. So, it can be concluded that eplerenone can be advised in patient with chronic heart failure in addition to other drugs that are used to treat heart failure. University Heart Journal Vol. 16, No. 2, Jul 2020; 65-70

Acute coronary syndrome (ACS) is the public health issue as it is the single most common cause of death in the world. Role of vitamin D in cardiovascular health is of much interest at present. Experimental, as well as, some observational studies suggest that vitamin D and its metabolites are integrally related to blood pressure and the rennin-angiotensin system. Vitamin D insufficiency affects almost 50% of the population worldwide. Few studies have been carried out to determine the prevalence of hypovitaminosis D in Bangladesh . 30 Patient with ACS were included in this study who had admitted in the department of Cardiology of Bangabandhu Sheikh Mujib Medical University (BSMMU) patient with in first 48 hours of the onset of chest pain. This study was conducted from 1st July’18 to 30th June’19 (One year) by Purposive sampling. Data analysis was carried out by using the statistical package for Social Science (SPSS) version 20.0 windows software. Baseline characteristics have been compared using the independent sample student t-test test where appropriate. The student t-test was used to assess the correlation between PTH levels. p-value

not available University Heart Journal Vol. 17, No. 1, Jan 2021; 1-2

Abstract not available University Heart Journal Vol. 16, No. 2, Jul 2020; 50-51

The sinus of valsalva aneurysm (SVA) is a small dilatation caused by a separation between the aortic media and annulus fibrosus. It may be either acquired or congenital. The right coronary sinus is most frequently affected, with the most common complication being rupture of the sinus. Cardiac failure and sudden auscultation changes suggest the possibility of SVA rupture. Echocardiography is sufficient to diagnose SVA, its complications, repercussions and to determine surgical options. SVA, even if asymptomatic, has potential risks of expansion, rupture, cardiac failure, endocarditis, embolism and sudden death. This justifies surgical correction which has a low mortality rate in both the short and long-term.Bangladesh Med J. 2015 Sep; 44 (3): 175-177

Electronic cardiac pacemakers are the definitive treatment of sinoatrial node (SAN) dysfunction and high degree atrioventricular block. But they have limitations like limited battery life, need for lead implantation into heart and lack of response to autonomic and physiologic demands on the heart. Genetically engineered biological pacemakers could be a possible alternative to electronic pacemakers. The strategies include upregulation of β-1 adrenergic receptors, conversion of cardiomyocyte into pacemaker cells and stem cell therapy. Investigators created biological pacemakers in animal models by gene therapy targeting If current (HCN) and inward rectifier current (IkI) (Kir 2.1). They delivered pacemaker current gene into animal heart by using viral vectors and human mesenchymal stem cells (hMSC). The limitations noted are longevity and stability of pacemaker genes and the chance of migration and tumour formation after stem cells therapy. Key words: Sinoatrial node (SAN); HCN-2 gene; If current; inward rectifier current (Ikl); human embryonic stem cells. DOI: 10.3329/uhj.v6i1.7189University Heart Journal Vol.6(1) 2010 pp.35-36