Faisal Qadir - Academia.edu (original) (raw)

Papers by Faisal Qadir

Journal of Ayub Medical College Abbottabad

There is increasing popularity in the use of herbal medicine for different ailments as these natu... more There is increasing popularity in the use of herbal medicine for different ailments as these natural products are considered safer than conventional medicines; however, their use in dosage exceeding prescribed limits can result in serious toxic side effects. We present a case of a 63-year-old male who presented with complaints of restlessness, nausea, vomiting and tingling sensation on his body and ECG evidence of bi-directional ventricular tachycardia. On interrogation, it was revealed that the patient had self-prepared and consumed large quantity of an herbal medication (containing toxic aconite roots) as therapy for erectile dysfunction resulting in a fatal outcome.

Pakistan Heart Journal

Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using seco... more Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan. Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up. Results: We enrolled all 5...

Pakistan Heart Journal, Apr 1, 2023

Objectives: The objective of this study was to determine the frequency of loss of radial artery p... more Objectives: The objective of this study was to determine the frequency of loss of radial artery pulse after one month of the coronary catheterization through trans-radial route in patients diagnosed with acute coronary syndrome (ACS). Methodology: A sample of consecutive patients diagnosed with ACS who undergo coronary catheterization through trans-radial route were evaluated for the loss of radial pulse through color Doppler ultrasound and clinical examination (palpatory) after one month of the intervention. Results: A total of 115 patients were included, 107 (93%) of which were male patients, and mean age was 57.1 ± 9.9 years. Among these, 99 (86.1%) were diagnosed with ST elevation myocardial infarction (STEMI) and remaining 16 (13.9%) had non-ST elevation ACS. Only left heart catheterization was performed in 9 (7.8%) and 106 (92.2%) underdone percutaneous coronary intervention (PCI). The most commonly observed co-morbid condition was hypertension (47%) followed by diabetes (38.3%). A total of 72 (62.6%) were categori zed as overweight/obese with body mass index of ≥ 25 kg/m2. The loss of radial artery pulse was noted in three (2.6%) patients at one month follow-up through both palpatory method and color Doppler ultrasound. Conclusion: The loss of radial artery pulse was noted in a significant proportion of patients after one month of coronary catheterization in patients with ACS. Both palpatory assessment method and color Doppler ultrasound showed full concordance in the identification of patients with radial artery occlusion.

PubMed, May 17, 2019

Background: This study was conducted to establish the accuracy of R/S ratios in localizing access... more Background: This study was conducted to establish the accuracy of R/S ratios in localizing accessory pathways in Wolff Parkinson White Syndrome on surface ECGs. Methods: This was a retrospective cross-sectional study from January 2002 till December 2016 conducted at National Institute of Cardiovascular diseases in Karachi, Pakistan. The sample included 157 patients with manifesting Wolff Parkinson White (WPW) Syndrome on a 12-lead surface ECG. As per the inclusion criteria, patients who had persistent or intermittent pre-excitation on surface ECG and had undergone electrophysiological study (EP) were included in the sample. Individuals with both successful and unsuccessful ablation procedures were included. Results: The sample consisted of 62.4% males (n=98) and 37.6% females (n=59) with mean age being 35.36±12.44. Accessory pathways (APs) were identified on the left side in majority of the patients with 54.1% (n=85) while right sided pathways were seen in 42.1% (n=66). Moreover, the most common accessory pathway amongst the males was Left Anterior (LA) and Left Lateral (LL) with a percentage of 48%, followed by Right Posteroseptal (RPS) at 20.4%. As opposed to this, the most common pathways amongst the females turned out to be RPS at 33.9% followed by LL and LA at 32.2%. Furthermore, the test using ratios were most effective in identifying left sided APs with sensitivity 74.1% and was least sensitive in identifying right sided pathways (sensitivity=40.7%). However, it was highly specific in locating right sided pathways with specificity of 94.6% as opposed to 83.3% in the left side. Furthermore, mid-septum regions had a sensitivity and specificity of 66.7% and 69.6% respectively. Conclusions: This establishes the effectiveness of R/S ratios in determining the location of accessory pathway based on the surface ECG prior to the ablation procedure. Since the younger population is affected more commonly, prolonged exposure to ionizing radiation can cause long term complications therefore, by this means, the duration of exposure can be reduced.

Pakistan Heart Journal

Objectives: Among the common complications of coronary artery disease (CAD) is the ischemic mitra... more Objectives: Among the common complications of coronary artery disease (CAD) is the ischemic mitral regurgitation (IMR). Identifying IMR and assessing its severity is pertinent owing to its significance in post- myocardial infarction (MI) risk stratification. It is associated with a higher risk of heart failure and mortality. This study aimed to determine the frequency of IMR after the first acute ST-elevation MI (STEMI) in the Pakistani population. Methodology: A cross-sectional observational study was conducted at NICVD, Karachi between January and July 2021. One hundred and ninety-five consecutive participants of first acute ST elevation MI who fulfilled the diagnostic criteria of IMR were included in the study. Demographic and clinical profile was recorded. All patients underwent echocardiography to grade the severity of IMR. Data was entered and analyzed using SPSS version 20. Results: Of 195 patients, 141 (72.3%) were males. 77 (39.5%) were diabetic, 92 (47.2%) were hypertensiv...

Pakistan Heart Journal

Cardiac Electrophysiology Study (EPS) and Ablation procedures are definitive treatment for multip... more Cardiac Electrophysiology Study (EPS) and Ablation procedures are definitive treatment for multiple common arrhythmias the major component of the cost of the procedure is the expense of the catheters. Many centres around the world used to reuse these catheters but few years ago started noticing Single Use Device (SUD) labelling appearing on them without any change in the catheters (1). This SUD labelling certifies that this can be safely used once but does not mean that it cannot be used again. Based on this the Federal Drug Authority of the United States shifted the liability of the reused device on the entity reprocessing it. Despite this, due to their high cost these catheters are reused not just in low income countries but also in many European and North American centres (1) (2). This reuse is supported by extensive literature showing safety in reusing these catheters. Currently there are no specific regulatory guidelines either at the federal or provincial levels for reuse of ...

JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2010

To determine the safety and success of transradial coronary angiography and angioplasty in a Paki... more To determine the safety and success of transradial coronary angiography and angioplasty in a Pakistani population. This was a prospective study on 264 consecutive patients undergoing transradial coronary angiography (TRCAG) and angioplasty (TRCAP) at Tabba Heart Institute, Karachi between November to December 2008. All patients enrolled in the study underwent Allen's test to ensure dual arterial supply to the hand. Modified Allen's test was performed only when Allen's test was abnormal. Patients were excluded from the study if they had abnormal Allen's and modified Allen's test, were on haemodialysis or had abnormal serum creatinine level. The main outcome measures were success rate and complications of TRAG and TRCAP. The mean age was 57 +/- 11.08 years with 199 (75.4%) males and 64 (24.6%) females. A total of 182 (76.3%) coronary angiographies and 82 (76.8%) coronary angioplasties were preformed from the trans-radial route in the study period. Overall procedura...

Pakistan Heart Journal, 2020

Objectives : Misconceptions regarding various physical activities after pacemaker implantation ca... more Objectives : Misconceptions regarding various physical activities after pacemaker implantation can severely limit a patient's lifestyle and very little in terms of patient education has been done to correct it. This study; by means of both verbal, and provision of brochure for education of patients; at the time of discharge and then reinforcing by questioning again at subsequent visit, aims to correct it. Methodology: A Quasi- experimental design of study carried out on consecutive patients implanted permanent pacemaker at electrophysiology department NICVD Karachi. Patients were discharged with an educational brochure and practical application of various daily life activities after assessment of related knowledge at baseline with reassessment at 1st visit. A questionnaire of 25 daily activities was developed and tested. Patients perception of safety of various daily activities both at baseline and at 1 week follow up were noted along with socio- demographic data of the patient....

JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2010

To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) an... more To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis > or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. Out of 230 patients, in 111 patients with cTnI levels < or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels > 10 folds ULN, 23 (19.3%) had sing...

JPMA. The Journal of the Pakistan Medical Association, 2010

OBJECTIVE To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of norma... more OBJECTIVE To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). METHODS A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis > or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. RESULTS Out of 230 patients, in 111 patients with cTnI levels < or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels > 10 fold...

Pakistan Heart Journal, 2020

Background : Femoral vein access is the preferred approach for advancing multiple catheters via t... more Background : Femoral vein access is the preferred approach for advancing multiple catheters via the inferior vena cava (IVC) to the heart during routine cardiac electrophysiology study and catheter ablation. Compared to acquired venous abnormalities, congenital inferior vena cava anomalies are encountered rather infrequently in adult electrophysiology procedures and their presence may pose technical procedural challenges. Presentation: We describe 2 cases in which we were able to successfully perform cardiac electrophysiological procedures in the presence of a complex congenital venous anomaly, the left sided IVC. First case was 30 year old gentleman presented with history of recurrent episodes of supraventricular tachycardia terminated with AV nodal blocking agents. Second case was 21 year old boy with WPW syndrome and recurrent supra-ventricular tachycardia. Diagnosis and Management: We managed to pass the EP catheters in both cases with a bit difficulty and angulation, while give...

JPMA. The Journal of the Pakistan Medical Association, 2012

OBJECTIVE To determine factors affecting cardiac rehabilitation attendance after myocardial infar... more OBJECTIVE To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and coronary revascularization. METHODS A cross-sectional study was conducted on 416 patients admitted in Tabba Heart Institute, Karachi from December 2010 to May 2011. Patients admitted with diagnosis of acute myocardial infarction (AMI) or who underwent elective coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) procedures were offered cardiac rehabilitation (CR). Out of these, patients who enrolled in 6 weeks outpatient CR programme were followed for number of CR sessions and their socio-demographic and clinical data were collected. Data was analyzed by Statistical Package for Social Sciences (SPSS) software, version 15.0. Chi-square test was applied to test association between categorical variables and Student's t-test for continuous variables. RESULTS Out of 416 patients identified, only 151 patients (36.2%) enrolled and attended the CR...

JPMA. The Journal of the Pakistan Medical Association, 2005

We report a unique association of extra-pontine myelinolysis with severe hypophosphatemia develop... more We report a unique association of extra-pontine myelinolysis with severe hypophosphatemia developing in a young lady with a prolonged febrile illness and inadequate oral intake. The late identification of severe hypophosphatemia resulted in extra-pontine myelinolysis. Gradual improvement in clinical status was noticed with phosphate replacement and good supportive care.

Journal of Ayub Medical College, Abbottabad : JAMC, 2019

BACKGROUND This study was conducted to establish the accuracy of R/S ratios in localizing accesso... more BACKGROUND This study was conducted to establish the accuracy of R/S ratios in localizing accessory pathways in Wolff Parkinson White Syndrome on surface ECGs. METHODS This was a retrospective cross-sectional study from January 2002 till December 2016 conducted at National Institute of Cardiovascular diseases in Karachi, Pakistan. The sample included 157 patients with manifesting Wolff Parkinson White (WPW) Syndrome on a 12-lead surface ECG. As per the inclusion criteria, patients who had persistent or intermittent pre-excitation on surface ECG and had undergone electrophysiological study (EP) were included in the sample. Individuals with both successful and unsuccessful ablation procedures were included. RESULTS The sample consisted of 62.4% males (n=98) and 37.6% females (n=59) with mean age being 35.36±12.44. Accessory pathways (APs) were identified on the left side in majority of the patients with 54.1% (n=85) while right sided pathways were seen in 42.1% (n=66). Moreover, the m...

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004

A case of a young girl is described who presented in a state of intoxication and later developed ... more A case of a young girl is described who presented in a state of intoxication and later developed acute renal failure secondary to severe rhabdomyolysis. With vigorous fluid therapy she regained normal renal function. Biochemical testing finally confirmed over the counter drug overdose as the cause for this presentation.

JPMA. The Journal of the Pakistan Medical Association, 2010

OBJECTIVE To determine the correlation of thrombolysis in myocardial infarction (TIMI) risk score... more OBJECTIVE To determine the correlation of thrombolysis in myocardial infarction (TIMI) risk score with extent of coronary artery disease (CAD) in patients with acute coronary syndrome (ACS). METHODS We conducted a descriptive study among 200 consecutive patients admitted with ACS at Tabba Heart Institute, Karachi from June to December 2008. The TIMI risk score was stratified on seven standard variables. The extent of CAD was evaluated on angiography and significant CAD was defined as > or =70% stenosis in any one of the three major epicardial vessels. RESULTS The mean age of the sample was 58.53 +/- 10.64 years. Out of 200 patients, there were 142 (71%) patients with TIMI score < or =4 (low and intermediate TIMI risk score) and 58 (29%) patients with TIMI score >4 (high TIMI risk score). Patients with TIMI score >4 were more likely to have significant three vessel CAD (62%) versus those with TIMI risk score <4 (46.2%), (p < 0.04). CONCLUSION Patients with high TIMI...

Cureus, 2021

Background Hypothyroidism can be a cause of sinus bradycardia. However, thyroid laboratory evalua... more Background Hypothyroidism can be a cause of sinus bradycardia. However, thyroid laboratory evaluation is often performed routinely in patients with complete heart block (CHB) though there is little data to support this practice. This study aimed to assess the frequency of thyroid dysfunction in patients presenting with CHB without clinical features of hypothyroidism. Methodology All patients referred for permanent pacemaker implantation for CHB were included in this cross-sectional study. Patients with known thyroid disorder or clinical features of thyroid disorder were excluded. Demographic, electrocardiography (EKG), and routine thyroid stimulating hormone (TSH) screening results were recorded. Results A total of 102 patients with complete atrioventricular (AV) block were enrolled in the study of which 50.0% (51) were male. The mean age was 61.09 ± 11.74. Co-morbidities included diabetes mellitus 44.1% (45), smoking 36.3% (37), and hypertension 55.9% (57). Mean EKG atrial rate was...

BACKGROUND Medication non-adherence after acute myocardial infarction is a global problem causing... more BACKGROUND Medication non-adherence after acute myocardial infarction is a global problem causing increased morbidity and mortality. This multifaceted problem has not been well studied in our part of the world. Our study aimed to determine the burden of medication non-adherence in post myocardial infarction patients. METHODS This cross-sectional study was conducted at National Institute of Cardiovascular disease, Karachi, from December 2016 to June 2017. A total of 350 patients were included at the time of discharge after their first myocardial infarction (MI) of which follow up was completed for 315 patients. Baseline characteristics and discharged drug data were collected for each individual. Patients were called at 7th day, 1 and 3months post discharge and were assessed for the medication adherence using Morisky medication adherence scale. They were stratified accordingly into self-reported high, moderate and low groups. Chi- square test was used to determine significant relation...

Objective: The objective of the study is to determine frequency of history of hypertensive disord... more Objective: The objective of the study is to determine frequency of history of hypertensive disorders of pregnancy (HDP) in patients presenting with acute coronary syndromes (ACS) and secondly to evaluate for the prevalence and concomitant association with hypertension, diabetes mellitus, chronic kidney disease (CKD) and cerebrovascular disease (stroke/TIA) in the above said patients. Methods: A cross sectional comparative study was conducted on 654 consecutive female patients presenting with ACS admitted to National Institute of Cardiovascular Diseases, Karachi between May to September 2013. A comprehensive questionnaire including details of obstetric history, history of HDP, ACS, cardiovascular risk factors and existing hypertension (HTN), diabetes mellitus and CKD was obtained. Patients with history of HDP (group 1) were compared with patients without history of HDP (group 2). Results: 654 female patients with ACS with mean age 55.5 ± 10.34 were included. 184 (28%) patients report...

OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofre... more OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofrequency catheter ablation in the treatment of supraventricular tachycardia. METHODS The retrospective chart review was conducted at the National Institute of Cardiovascular Diseases, Karachi, and comprised records of all patients who underwent electrophysiological study and / or radiofrequency catheter ablation from January2007 to December 2016. SPSS 21 was used for data analysis. RESULTS Of the 627 patients, 335(53.4%) were females. The overall mean age was 40.99}13.59 years. The major indication for procedure was supraventricular tachycardia 376(59.97%). Final electrophysiological study diagnosis was typical slow fast atrioventricular nodal re-entrant tachycardia in 303(48.3%) patients. The overall success rate was 472(75.3%). Procedure-related complications were reported in 25(4%) patients, and there was 1(0.15%) mortality. CONCLUSIONS Cardiac electrophysiology studies and radiofreque...

Journal of Ayub Medical College Abbottabad

There is increasing popularity in the use of herbal medicine for different ailments as these natu... more There is increasing popularity in the use of herbal medicine for different ailments as these natural products are considered safer than conventional medicines; however, their use in dosage exceeding prescribed limits can result in serious toxic side effects. We present a case of a 63-year-old male who presented with complaints of restlessness, nausea, vomiting and tingling sensation on his body and ECG evidence of bi-directional ventricular tachycardia. On interrogation, it was revealed that the patient had self-prepared and consumed large quantity of an herbal medication (containing toxic aconite roots) as therapy for erectile dysfunction resulting in a fatal outcome.

Pakistan Heart Journal

Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using seco... more Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan. Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up. Results: We enrolled all 5...

Pakistan Heart Journal, Apr 1, 2023

Objectives: The objective of this study was to determine the frequency of loss of radial artery p... more Objectives: The objective of this study was to determine the frequency of loss of radial artery pulse after one month of the coronary catheterization through trans-radial route in patients diagnosed with acute coronary syndrome (ACS). Methodology: A sample of consecutive patients diagnosed with ACS who undergo coronary catheterization through trans-radial route were evaluated for the loss of radial pulse through color Doppler ultrasound and clinical examination (palpatory) after one month of the intervention. Results: A total of 115 patients were included, 107 (93%) of which were male patients, and mean age was 57.1 ± 9.9 years. Among these, 99 (86.1%) were diagnosed with ST elevation myocardial infarction (STEMI) and remaining 16 (13.9%) had non-ST elevation ACS. Only left heart catheterization was performed in 9 (7.8%) and 106 (92.2%) underdone percutaneous coronary intervention (PCI). The most commonly observed co-morbid condition was hypertension (47%) followed by diabetes (38.3%). A total of 72 (62.6%) were categori zed as overweight/obese with body mass index of ≥ 25 kg/m2. The loss of radial artery pulse was noted in three (2.6%) patients at one month follow-up through both palpatory method and color Doppler ultrasound. Conclusion: The loss of radial artery pulse was noted in a significant proportion of patients after one month of coronary catheterization in patients with ACS. Both palpatory assessment method and color Doppler ultrasound showed full concordance in the identification of patients with radial artery occlusion.

PubMed, May 17, 2019

Background: This study was conducted to establish the accuracy of R/S ratios in localizing access... more Background: This study was conducted to establish the accuracy of R/S ratios in localizing accessory pathways in Wolff Parkinson White Syndrome on surface ECGs. Methods: This was a retrospective cross-sectional study from January 2002 till December 2016 conducted at National Institute of Cardiovascular diseases in Karachi, Pakistan. The sample included 157 patients with manifesting Wolff Parkinson White (WPW) Syndrome on a 12-lead surface ECG. As per the inclusion criteria, patients who had persistent or intermittent pre-excitation on surface ECG and had undergone electrophysiological study (EP) were included in the sample. Individuals with both successful and unsuccessful ablation procedures were included. Results: The sample consisted of 62.4% males (n=98) and 37.6% females (n=59) with mean age being 35.36±12.44. Accessory pathways (APs) were identified on the left side in majority of the patients with 54.1% (n=85) while right sided pathways were seen in 42.1% (n=66). Moreover, the most common accessory pathway amongst the males was Left Anterior (LA) and Left Lateral (LL) with a percentage of 48%, followed by Right Posteroseptal (RPS) at 20.4%. As opposed to this, the most common pathways amongst the females turned out to be RPS at 33.9% followed by LL and LA at 32.2%. Furthermore, the test using ratios were most effective in identifying left sided APs with sensitivity 74.1% and was least sensitive in identifying right sided pathways (sensitivity=40.7%). However, it was highly specific in locating right sided pathways with specificity of 94.6% as opposed to 83.3% in the left side. Furthermore, mid-septum regions had a sensitivity and specificity of 66.7% and 69.6% respectively. Conclusions: This establishes the effectiveness of R/S ratios in determining the location of accessory pathway based on the surface ECG prior to the ablation procedure. Since the younger population is affected more commonly, prolonged exposure to ionizing radiation can cause long term complications therefore, by this means, the duration of exposure can be reduced.

Pakistan Heart Journal

Objectives: Among the common complications of coronary artery disease (CAD) is the ischemic mitra... more Objectives: Among the common complications of coronary artery disease (CAD) is the ischemic mitral regurgitation (IMR). Identifying IMR and assessing its severity is pertinent owing to its significance in post- myocardial infarction (MI) risk stratification. It is associated with a higher risk of heart failure and mortality. This study aimed to determine the frequency of IMR after the first acute ST-elevation MI (STEMI) in the Pakistani population. Methodology: A cross-sectional observational study was conducted at NICVD, Karachi between January and July 2021. One hundred and ninety-five consecutive participants of first acute ST elevation MI who fulfilled the diagnostic criteria of IMR were included in the study. Demographic and clinical profile was recorded. All patients underwent echocardiography to grade the severity of IMR. Data was entered and analyzed using SPSS version 20. Results: Of 195 patients, 141 (72.3%) were males. 77 (39.5%) were diabetic, 92 (47.2%) were hypertensiv...

Pakistan Heart Journal

Cardiac Electrophysiology Study (EPS) and Ablation procedures are definitive treatment for multip... more Cardiac Electrophysiology Study (EPS) and Ablation procedures are definitive treatment for multiple common arrhythmias the major component of the cost of the procedure is the expense of the catheters. Many centres around the world used to reuse these catheters but few years ago started noticing Single Use Device (SUD) labelling appearing on them without any change in the catheters (1). This SUD labelling certifies that this can be safely used once but does not mean that it cannot be used again. Based on this the Federal Drug Authority of the United States shifted the liability of the reused device on the entity reprocessing it. Despite this, due to their high cost these catheters are reused not just in low income countries but also in many European and North American centres (1) (2). This reuse is supported by extensive literature showing safety in reusing these catheters. Currently there are no specific regulatory guidelines either at the federal or provincial levels for reuse of ...

JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2010

To determine the safety and success of transradial coronary angiography and angioplasty in a Paki... more To determine the safety and success of transradial coronary angiography and angioplasty in a Pakistani population. This was a prospective study on 264 consecutive patients undergoing transradial coronary angiography (TRCAG) and angioplasty (TRCAP) at Tabba Heart Institute, Karachi between November to December 2008. All patients enrolled in the study underwent Allen's test to ensure dual arterial supply to the hand. Modified Allen's test was performed only when Allen's test was abnormal. Patients were excluded from the study if they had abnormal Allen's and modified Allen's test, were on haemodialysis or had abnormal serum creatinine level. The main outcome measures were success rate and complications of TRAG and TRCAP. The mean age was 57 +/- 11.08 years with 199 (75.4%) males and 64 (24.6%) females. A total of 182 (76.3%) coronary angiographies and 82 (76.8%) coronary angioplasties were preformed from the trans-radial route in the study period. Overall procedura...

Pakistan Heart Journal, 2020

Objectives : Misconceptions regarding various physical activities after pacemaker implantation ca... more Objectives : Misconceptions regarding various physical activities after pacemaker implantation can severely limit a patient's lifestyle and very little in terms of patient education has been done to correct it. This study; by means of both verbal, and provision of brochure for education of patients; at the time of discharge and then reinforcing by questioning again at subsequent visit, aims to correct it. Methodology: A Quasi- experimental design of study carried out on consecutive patients implanted permanent pacemaker at electrophysiology department NICVD Karachi. Patients were discharged with an educational brochure and practical application of various daily life activities after assessment of related knowledge at baseline with reassessment at 1st visit. A questionnaire of 25 daily activities was developed and tested. Patients perception of safety of various daily activities both at baseline and at 1 week follow up were noted along with socio- demographic data of the patient....

JOURNAL OF PAKISTAN MEDICAL ASSOCIATION, 2010

To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) an... more To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis > or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. Out of 230 patients, in 111 patients with cTnI levels < or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels > 10 folds ULN, 23 (19.3%) had sing...

JPMA. The Journal of the Pakistan Medical Association, 2010

OBJECTIVE To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of norma... more OBJECTIVE To determine the correlation of cardiac troponin I (cTnI) 10 folds upper limit of normal (ULN) and extent of coronary artery disease (CAD) in Non-ST-elevation myocardial infarction (NSTEMI). METHODS A cross-sectional study was conducted on 230 consecutive NSTEMI patients admitted in Tabba Heart Institute, Karachi between April to December 2008. cTnI was measured using MEIA method. All patients underwent coronary angiography in the index hospitalization. Stenosis > or = 70% in any of the three major epicardial vessels was considered significant CAD. Extent of CAD was defined as significant single, two or three vessel CAD. Chi-square test was applied to test the association between cTnI levels and CAD extent. RESULTS Out of 230 patients, in 111 patients with cTnI levels < or = 10 folds upper limit of normal (ULN), 25 (22.52%) had single vessel, 40 (36%) had two vessel and 34 (30.6%) had three vessel significant CAD, whereas in 119 patients with cTnI levels > 10 fold...

Pakistan Heart Journal, 2020

Background : Femoral vein access is the preferred approach for advancing multiple catheters via t... more Background : Femoral vein access is the preferred approach for advancing multiple catheters via the inferior vena cava (IVC) to the heart during routine cardiac electrophysiology study and catheter ablation. Compared to acquired venous abnormalities, congenital inferior vena cava anomalies are encountered rather infrequently in adult electrophysiology procedures and their presence may pose technical procedural challenges. Presentation: We describe 2 cases in which we were able to successfully perform cardiac electrophysiological procedures in the presence of a complex congenital venous anomaly, the left sided IVC. First case was 30 year old gentleman presented with history of recurrent episodes of supraventricular tachycardia terminated with AV nodal blocking agents. Second case was 21 year old boy with WPW syndrome and recurrent supra-ventricular tachycardia. Diagnosis and Management: We managed to pass the EP catheters in both cases with a bit difficulty and angulation, while give...

JPMA. The Journal of the Pakistan Medical Association, 2012

OBJECTIVE To determine factors affecting cardiac rehabilitation attendance after myocardial infar... more OBJECTIVE To determine factors affecting cardiac rehabilitation attendance after myocardial infarction and coronary revascularization. METHODS A cross-sectional study was conducted on 416 patients admitted in Tabba Heart Institute, Karachi from December 2010 to May 2011. Patients admitted with diagnosis of acute myocardial infarction (AMI) or who underwent elective coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) procedures were offered cardiac rehabilitation (CR). Out of these, patients who enrolled in 6 weeks outpatient CR programme were followed for number of CR sessions and their socio-demographic and clinical data were collected. Data was analyzed by Statistical Package for Social Sciences (SPSS) software, version 15.0. Chi-square test was applied to test association between categorical variables and Student's t-test for continuous variables. RESULTS Out of 416 patients identified, only 151 patients (36.2%) enrolled and attended the CR...

JPMA. The Journal of the Pakistan Medical Association, 2005

We report a unique association of extra-pontine myelinolysis with severe hypophosphatemia develop... more We report a unique association of extra-pontine myelinolysis with severe hypophosphatemia developing in a young lady with a prolonged febrile illness and inadequate oral intake. The late identification of severe hypophosphatemia resulted in extra-pontine myelinolysis. Gradual improvement in clinical status was noticed with phosphate replacement and good supportive care.

Journal of Ayub Medical College, Abbottabad : JAMC, 2019

BACKGROUND This study was conducted to establish the accuracy of R/S ratios in localizing accesso... more BACKGROUND This study was conducted to establish the accuracy of R/S ratios in localizing accessory pathways in Wolff Parkinson White Syndrome on surface ECGs. METHODS This was a retrospective cross-sectional study from January 2002 till December 2016 conducted at National Institute of Cardiovascular diseases in Karachi, Pakistan. The sample included 157 patients with manifesting Wolff Parkinson White (WPW) Syndrome on a 12-lead surface ECG. As per the inclusion criteria, patients who had persistent or intermittent pre-excitation on surface ECG and had undergone electrophysiological study (EP) were included in the sample. Individuals with both successful and unsuccessful ablation procedures were included. RESULTS The sample consisted of 62.4% males (n=98) and 37.6% females (n=59) with mean age being 35.36±12.44. Accessory pathways (APs) were identified on the left side in majority of the patients with 54.1% (n=85) while right sided pathways were seen in 42.1% (n=66). Moreover, the m...

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004

A case of a young girl is described who presented in a state of intoxication and later developed ... more A case of a young girl is described who presented in a state of intoxication and later developed acute renal failure secondary to severe rhabdomyolysis. With vigorous fluid therapy she regained normal renal function. Biochemical testing finally confirmed over the counter drug overdose as the cause for this presentation.

JPMA. The Journal of the Pakistan Medical Association, 2010

OBJECTIVE To determine the correlation of thrombolysis in myocardial infarction (TIMI) risk score... more OBJECTIVE To determine the correlation of thrombolysis in myocardial infarction (TIMI) risk score with extent of coronary artery disease (CAD) in patients with acute coronary syndrome (ACS). METHODS We conducted a descriptive study among 200 consecutive patients admitted with ACS at Tabba Heart Institute, Karachi from June to December 2008. The TIMI risk score was stratified on seven standard variables. The extent of CAD was evaluated on angiography and significant CAD was defined as > or =70% stenosis in any one of the three major epicardial vessels. RESULTS The mean age of the sample was 58.53 +/- 10.64 years. Out of 200 patients, there were 142 (71%) patients with TIMI score < or =4 (low and intermediate TIMI risk score) and 58 (29%) patients with TIMI score >4 (high TIMI risk score). Patients with TIMI score >4 were more likely to have significant three vessel CAD (62%) versus those with TIMI risk score <4 (46.2%), (p < 0.04). CONCLUSION Patients with high TIMI...

Cureus, 2021

Background Hypothyroidism can be a cause of sinus bradycardia. However, thyroid laboratory evalua... more Background Hypothyroidism can be a cause of sinus bradycardia. However, thyroid laboratory evaluation is often performed routinely in patients with complete heart block (CHB) though there is little data to support this practice. This study aimed to assess the frequency of thyroid dysfunction in patients presenting with CHB without clinical features of hypothyroidism. Methodology All patients referred for permanent pacemaker implantation for CHB were included in this cross-sectional study. Patients with known thyroid disorder or clinical features of thyroid disorder were excluded. Demographic, electrocardiography (EKG), and routine thyroid stimulating hormone (TSH) screening results were recorded. Results A total of 102 patients with complete atrioventricular (AV) block were enrolled in the study of which 50.0% (51) were male. The mean age was 61.09 ± 11.74. Co-morbidities included diabetes mellitus 44.1% (45), smoking 36.3% (37), and hypertension 55.9% (57). Mean EKG atrial rate was...

BACKGROUND Medication non-adherence after acute myocardial infarction is a global problem causing... more BACKGROUND Medication non-adherence after acute myocardial infarction is a global problem causing increased morbidity and mortality. This multifaceted problem has not been well studied in our part of the world. Our study aimed to determine the burden of medication non-adherence in post myocardial infarction patients. METHODS This cross-sectional study was conducted at National Institute of Cardiovascular disease, Karachi, from December 2016 to June 2017. A total of 350 patients were included at the time of discharge after their first myocardial infarction (MI) of which follow up was completed for 315 patients. Baseline characteristics and discharged drug data were collected for each individual. Patients were called at 7th day, 1 and 3months post discharge and were assessed for the medication adherence using Morisky medication adherence scale. They were stratified accordingly into self-reported high, moderate and low groups. Chi- square test was used to determine significant relation...

Objective: The objective of the study is to determine frequency of history of hypertensive disord... more Objective: The objective of the study is to determine frequency of history of hypertensive disorders of pregnancy (HDP) in patients presenting with acute coronary syndromes (ACS) and secondly to evaluate for the prevalence and concomitant association with hypertension, diabetes mellitus, chronic kidney disease (CKD) and cerebrovascular disease (stroke/TIA) in the above said patients. Methods: A cross sectional comparative study was conducted on 654 consecutive female patients presenting with ACS admitted to National Institute of Cardiovascular Diseases, Karachi between May to September 2013. A comprehensive questionnaire including details of obstetric history, history of HDP, ACS, cardiovascular risk factors and existing hypertension (HTN), diabetes mellitus and CKD was obtained. Patients with history of HDP (group 1) were compared with patients without history of HDP (group 2). Results: 654 female patients with ACS with mean age 55.5 ± 10.34 were included. 184 (28%) patients report...

OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofre... more OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofrequency catheter ablation in the treatment of supraventricular tachycardia. METHODS The retrospective chart review was conducted at the National Institute of Cardiovascular Diseases, Karachi, and comprised records of all patients who underwent electrophysiological study and / or radiofrequency catheter ablation from January2007 to December 2016. SPSS 21 was used for data analysis. RESULTS Of the 627 patients, 335(53.4%) were females. The overall mean age was 40.99}13.59 years. The major indication for procedure was supraventricular tachycardia 376(59.97%). Final electrophysiological study diagnosis was typical slow fast atrioventricular nodal re-entrant tachycardia in 303(48.3%) patients. The overall success rate was 472(75.3%). Procedure-related complications were reported in 25(4%) patients, and there was 1(0.15%) mortality. CONCLUSIONS Cardiac electrophysiology studies and radiofreque...