Md. Fakhrul Islam Khaled | Bangabandhu Sheikh Mujib Medical University (original) (raw)

Papers by Md. Fakhrul Islam Khaled

Acute coronary syndromes (ACS) remain a source of high morbidity and mortality among adults, desp... more Acute coronary syndromes (ACS) remain a source of high morbidity and mortality among adults, despite advances in treatment. Treatment, modality, and success of ACS mainly depend on the time yielded since the onset of symptoms. Pre-hospital delay (PHD) is the time between the start of myocardial infarction (MI) symptoms and arrival at the hospital where either pharmacological or interventional revascularization is available. This delay remains unacceptably long worldwide, including in Bangladesh. The current study investigates several sociodemographic characteristics, clinical, social, and treatment-seeking behavior to discover the factors associated with decision time to be hospitalized and home-to-hospital delay. A crosssectional study was conducted between July 2019 to June 2020 in 21 district hospitals and six medical college hospitals where cardiac care facilities were available. The patients with ACS who visited the studied hospitals during the study period were selected in this study. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and analyzed. This study evaluated 678 patients of ACS from 30 districts of Bangladesh. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40-60 years age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients got their first medical care after 12 hours of first appearing the symptom. The study found that the patients' age, residence, education, and employment status are the significant factors for the PHD of ACS patients in Bangladesh. The patients with previous MI and chest pain were significantly early to arrive at the hospital with ACS. In addition, place of symptoms, first medical contact with private doctors, distance from symptoms to first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transport are significantly associated with PHD of the patients. The findings of this study may help the national health management system to identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity & mortality.

University Heart Journal, Oct 9, 2018

Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left... more Peripartum cardiomyopathy is a life threatening entity of peripartum period characterized by left entricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but till now its incidence, pathogenesis, optimum management protocol are not known. Oxidative stress-prolactin hypothesis , anti-angiogenic-signalling excess hypothesis, viral myocarditis and genetic predisposition are some attractive etiologic explanation but nothing is proven comprehensively. Novel biomarkers and role of new imaging modalities are being investigated. As benefit by targeted therapy like bromocriptine or pentoxifylline are inconsistent, so controlling volume status, neutralizing maladaptive neurohormonal response and treatment of complications are required.prognosis is reasonably good. The aim of this review to highlight its pathophysiology, emerging investigatios modalities, and updated management protocol.

Saudi Journal of Medicine

Background: Hypertension and dyslipidemia are well-established and partially overlapping risk fac... more Background: Hypertension and dyslipidemia are well-established and partially overlapping risk factors for cardiovascular disease. Hypertension affects nearly 26% of the adult population worldwide and is an important independent predictor of cardiovascular disease, cerebrovascular accidents and death. The prevalence of cardiovascular diseases and Hypertension is rapidly increasing in developing countries. Hypertension has been reported to be responsible for 57% of all stroke deaths and 24% of all cardiovascular deaths in East Asians. Objective: To compare the lipid profile of hypertensive patients with normotensive individuals and socio-demographic and dyslipidemia patterns in hypertensive and normotensive individuals. Methodology: A total of 167 hypertensive patients. This is a descriptive cross-sectional study. An equal number of normotensive individuals were selected at Hypertension & Research Center, Rangpur and the Department of Medicine, Rangpur medical college hospital, Rangpu...

University Heart Journal

Clinicians have long recognized that acute myocardial infarction (MI) can occur in the absence of... more 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, c...

University Heart Journal, Nov 8, 2022

Background: Left atrial appendage (LAA) is considered the "most lethal human appendage" as it cau... more Background: Left atrial appendage (LAA) is considered the "most lethal human appendage" as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) < 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality & morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention. Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective. Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab. Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion & exclusion criteria. The purpose of the study was explained to each subject & informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared. Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,

University Heart Journal

Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with ven... more Warfarin is an oral anticoagulant used to prevent or treat clotting disorders associated with venous thrombosis, pulmonary embolism, atrial fibrilation, cardiac valve replacement, stroke and acute myocardial infarction. It is a vitamin K antagonist composed of S- and R- isomers. The more potent S-warfarin is metabolized by cytochrome 450 isoenzyme 2C9 (CYP2C9), encoded by CYP2C9 gene. Warfarin exerts its anticoagulants effect by inhibitingits target enzyme vitamin K epoxide reductase (VKOR), encoded by vitamin K epoxide reductase subunit 1 (VKOR1) gene. Genetic variation in the CYP2C9 and VKOR1 gene can affect warfarin efficacy and dose required to achieve stable International Normalization Ratio (INR). Specifically two variants in the CYP2CP gene (CYP2C9*2 and CYP2C9*3) result in an enzyme with reduced activity, leading to increased active warfarin levels. A variant in the VKORC1 gene (VKORC1-1639 G>A) can lead to reduced gene expression resulting in decresed level of VKOR. Toge...

University Heart Journal

Patent ductus arteriosus(PDA) is a congenital cardiac disorder which is not so uncommon but it be... more 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

University Heart Journal

Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the pre... more Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the predominant form of heart failure in the western world. We aimed to estimate the frequency and clinical characteristics of HFpEF cohort in Bangladesh as limited data are available about this extremely heterogeneous syndrome. Methods: This cross sectional study was conducted at the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from December, 2017 to December, 2018. A total of 124 heart failure patients were enrolled in the study for the estimation of frequency of HFpEF. Comorbidities and presentation of 30 HFpEF patients were assessed. HFpEF diagnosis was made according to the 2016 European Society of Cardiology (ESC) Guidelines. Results: The frequency of HFpEF was 30 (24.1%) (95% confidence interval 16.6% to 31.7%). The mean (SD) age of was 65.0 (10.1) years. Majority of the patients (73.3 %) were between 60 to 79 years of age. Majority of the patients (60%) w...

University Heart Journal

Background: ST-elevation myocardial infarction (STEMI) is a major cause of mortality worldwide. P... more Background: ST-elevation myocardial infarction (STEMI) is a major cause of mortality worldwide. PCI remain gold standard management of STEMI. An Angiographic Perfusion Score (APS) is a combination of TIMI Flow Grades (TFG) and myocardial perfusion (TMPG) grades before and after PCI. So it can accurately measure both epicardailand myocardial perfusion and predict major adverse cardiac events (MACE). The aim of the study is to evaluate the association of APS for determining the short term clinical outcomes after PCI in ST-segment elevation myocardial infarction without thrombolytic therapy. Methodology: This cross sectional observational study carried out among adult patients presenting STsegment elevation myocardial infarction without thrombolytic pretreatment to the cardiology department of BSMMU who underwent Percutaneous Coronary Intervention and met inclusion and exclusion criteria. This study was conducted from April 2017 to March 2018. After informed written consent data collec...

University Heart Journal

Background: Long term mortality is higher in patients with Non-ST-segment elevated myocardial inf... more Background: Long term mortality is higher in patients with Non-ST-segment elevated myocardial infarction (NSTEMI) than those with STEMI. In diabetic patients with NSTEMI are at high risk for subsequent cardiovascular events. But, the widespread use of drug eluting stents(DES) will further improve outcomes in patients with diabetes undergoing early percutaneous coronary intervention(PCI). Objective: The aim of the study was to determine the changes in left ventricular (LV) systolic function after successful PCI in NSTEMI diabetic patients compared with non-diabetic patients. Methods: From April 2017 to March 2018, this comparative clinical study was carried out in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. 30 diabetic and 34 nondiabetic patients with NSTEMI undergoing Percutaneous coronary intervention were included in the study. Successful PCI with drug eluting stent was performed for all patients....

Bangladesh Heart Journal

Background: The effect of late percutaneous coronary intervention on left ventricular function is... more Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood. Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction. Methods: A total of 60 patients, > 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period. Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 m...

University Heart Journal

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. S... more Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. Statin therapy is the cornerstone for prevention and treatment of cardiovascular diseases (CVDs), and is generally safe and well tolerated. 1 According to ASCVD Primary Prevention Guideline 2016, atherosclerotic cardiovascular diseases refer to the following conditions: a) Coronary heart disease (CHD), such as myocardial infarction (MI), angina, and coronary artery stenosis > 50%. b)

University Heart Journal

Holt-Oram syndrome (HOS) is a heart-upper limb malformation complex , is a rare autosomal dominan... more 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

Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the differe... more Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the different etiologies may result in differences in management and outcome. Multiple trails and epidemiologic surveys have demonstrated that patients with ICM have decreased survival compared to patients with non-ischemic dilated cardiomyopathy (NIDCM). Increased age, multivessel arteriopathy, potent neurohormonal stimulation and arrhythmias associated with sudden death predispose patients with ICM to greater morbidity and mortality compared to patients with NIDCM. 1 Discussion: LV may be enlarged and show dysfunctional in both ischemic heart disease and dilated cardiomyopathy (DCM). Patients with ICM may benefit from a revascularization treatment strategy. 2 In clinical practice distinguishing between two types of conditions can be very challenging. In some situations, a diagnosis can be inferred from history and physical examination(e.g. Postpartum or chemotherapy induced NICM).Definition of ICM requires the identification of significant coronary artery disease (stenosis of any epicardial vessels more than 75%) or a history of myocardial infarction or previous revascularization of the coronaries in the presence of depressed LV ejection fraction (LVEF<45%). 3

University Heart Journal

Stress echocardiography (SE) is the combination of 2D echocardiography with a physical, pharmacol... more Stress echocardiography (SE) is the combination of 2D echocardiography with a physical, pharmacological, or electrical stress with atrial pacing. Stress-induced ischemia generates new or worsening regional wall motion abnormalities in the segment supplied by the stenosed coronary artery.SE plays an important role in identifying these wall motion abnormalities in the assessment of ischemic heart disease. 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, nonischaemic cardiomyopathy, valvular heart disease, pulmonary hypertension (PH), athletes hearts, congenital heart disease(CHD)and heart transplantation. 1,2 Stress Echocardiography Methods: SE provides a dynamice valuation of myocardial structure and function under conditions of physiological (exercise) or pharmacological(inotrope, vasodilator) stress. SE can unmask structural/functional abnormalities, whichalthough occult in the resting or static state-may occur under conditions of activity or stress, and lead to wall motion abnormalities, valvular dysfunction, or other haemodynamic abnormalities. 3-6 Exercise is the test of choice as this preserves the integrity of the

University Heart Journal

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional ... more Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. 26 Chronic heart failure carries a major health burden, with significant morbidity and mortality. Accurate diagnosis, treatment of reversible causes and institution of proven medical and device therapies are key facets of management. 20 HF may be associated with a wide spectrum of LV functional abnormalities, which may range from patients with normal LV size and preserved ejection fraction (EF) to those with severe dilatation and/or markedly reduced EF. In most patients, abnormalities of systolic and diastolic dysfunction coexist, irrespective of EF. EF is considered important in classification of patients with HF because of differing patient demographics, comorbid conditions, prognosis, and response to therapies. 3

University Heart Journal

Isolated mitral regurgitation is a relatively uncommon presentation of chronic rheumatic heart di... more Isolated mitral regurgitation is a relatively uncommon presentation of chronic rheumatic heart disease 1. Chronic nature of rheumatic mitral regurgitation causes gradual dilatation of the left atrium with little increase in pressure and therefore relatively fewer symptoms. However, occasionally the dilatation of LA is so severe, it is termed giant LA. Giant left atrium is a rare condition, with a reported incidence of 0.3%, and occurs following mainly rheumatic mitral valve disease 2. Atrial fibrillation is almost always present 3 predisposing to thromboembolic complications. A subset of patients may develop severe dysphagia from esophageal compression or hoarseness from laryngeal nerve impingement 4. Here we are presenting a case of isolated mitral regurgitation with giant left atrium in sinus rhythm. Case Report|: A 30-year-old woman normotensive, non-diabetic presented with the complain of SOB and palpitation for 2 ½ months and leg swelling for 10 days. 2 ½ months back, after 10 days of delivery of her 3 rd child, she developed SOB which was initially present on exertion (NYHA-II) and relieved by rest, but since last 10 days, it was present on minimal exertion or rest (NYHA III-IV) with orthopnea but no PND. She also had dry cough but no hemoptysis or diurnal and seasonal variation. She also had palpitation which occurred with SOB during exertion and was relieved by rest. It was regular and not associated with dizziness or syncope. Since last 10 days, she also developed swelling of legs which was gradually increasing, associated with decreased urine output but no puffiness of face or abdominal swelling. She didn't have history of chest pain,

University Heart Journal, 2016

Chronic Kidney diseases and acute coronary syndrome (ACS) are wide spread diseases and they affec... more Chronic Kidney diseases and acute coronary syndrome (ACS) are wide spread diseases and they affect many individuals worldwide. Number one cause of death in patients with CKD is coronary artery diseases-1. Patients with STEMI and renal dysfunction had a six fold higher one eighty days mortality than the patients with normal renal function (16.2% vs 2.5%, p <0.001) in GUSTO-IIb 2. CKD is defined as kidney damage e" 3 months with or without decrease GFR 2. Presentation of patients with CKD and STEMI at admission is atypical specially patients on dialysis than nondialysis 2. Regarding management of these patients, fibrinolysis or primary PCI did not improve inhospital mortality 1. So there is great importance of primary prevention and risk factor modification to prevent the progression of CKD and cardiovascular diseases. On the other hand, the distortion of the terminal portion of QRS complex on initial electrocardiogram (ECG) in patients with STEMI has been found to be predictive of adverse outcome 3,4. The purpose of this study was to analyze the prevalence of this ECG pattern in patients with CKD with STEMI and its influence on their prognosis. Methods: Patients: This observational prospective study was conducted in BSMMU during the period of July 2014 to June 2015. We studied 60 patients of STEMI admitted within 12 hours of onset of chest pain which lasted for at least 30 minutes and receiving thrombolytic therapy. STEMI was diagnosed when ECG showing ST elevation of 1 mm or more in two or more consecutive leads often with reciprocal ST depression in the contralateral leads, except in leads V2-V3 where >2 mm of ST elevation in men with age >40 years, >2.5mm men with age <40 years and > 1.5 mm in women were required for accurate diagnosis 5 with positive T waves in leads with ST segment elevation

University Heart Journal, Oct 9, 2018

Saudi Journal of Medicine

University Heart Journal

University Heart Journal, Nov 8, 2022

University Heart Journal

Bangladesh Heart Journal

University Heart Journal

University Heart Journal, 2016