Syed HR Naqvi - Academia.edu (original) (raw)

Papers by Syed HR Naqvi

Vol. 52 (04) : 376 - 380, 2019

Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patie... more Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patients with unexplained syncope. Methodology: This quasi experimental study was done at National Institute of Cardiovascular diseases Karachi and Chaudhry Pervaiz Elahi Institute of Cardiology Multan Pakistan from January to December 2018. Patients presented with unexplained syncope 64 syncope patients were included and HUTT was done. were included. Outcome including positive HUTT, response to HUTT, phase of HUTT and the effect of age and gender in patients with unexplained syncope undergoing HUTT. Results: The mean age of patients was 63.39±6.94 years. There were 51 (79.7%) male while 13 (20.3%) were females. HUTT was found to be positive in 37 (57.8%) patients while 27 (42.2%) patients had negative HUTT. Mixed HUTT response was observed in 18 (48.6%) patients, cardio-inhibitory reposes in 8 (21.6%) patients while vaso depressive response in 11 (17.2%) patients. Active HUTT phase was observed in 30 (81.1%) patients while 7 (18.9%) patients had passive HUTT phase. The age and gender were found to have insignificant impact on HUTT findings (p>0.05). Conclusion: Thus the frequency of positive HUTT is high in unexplained syncope patients. No significant difference was found in the frequency of responses to HUTT between the gender groups. The trend of the HUTT result significantly changed with age.

”. EC Cardiology 6.11 (2019): 49-50., 2019

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque a... more Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries , whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). CTCA uses computed tomography (CT) scanning to take images (angiograms) of the coronary arteries. It requires the use of rapid CT scanning techniques and can only be carried out in centers where the equipment is suitable and the medical/technology staffs are trained appropriately. Computed Tomography Coronary Angiography is the preferred test in patients with a lower range of clinical likelihood of CAD, no previous diagnosis of CAD, and characteristics associated with a high likelihood of good image quality. It detects subclinical coronary ath-erosclerosis but can also accurately rule out both anatomically and functionally significant CAD. Its higher accuracy values of CTCA when low clinical likelihood populations are subjected to examination [1]. Trials evaluating outcomes after coronary CTA to date have mostly included patients with a low clinical likelihood [2,3]. The non-invasive functional tests for ischaemia typically have better rule-in power. In outcome trials, functional imaging tests have been associated with fewer referrals for downstream ICA compared with a strategy relying on anatomical imaging [4,5]. Functional evaluation of ischaemia (either non-invasive or invasive) is required in most patients before revascularization decisions can be made. Therefore , non-invasive functional testing has now come to be preferred in patients at the higher end of the range of clinical likelihood if revas-cularization is likely or the patient has previously diagnosed CAD. If CAD is suspected in patients, but who have a very low clinical likelihood (≤ 5%) of CAD, should have other cardiac causes of chest pain excluded and their cardiovascular risk factors adjusted, based on a risk-score assessment. In patients with repeated, unprovoked attacks of anginal symptoms mainly at rest, vasospastic angina should be considered, diagnosed, and treated appropriately In addition to diagnostic accuracy and clinical likelihood, the selection of a non-invasive test depends on other patient characteristics, local expertise, and the availability of tests. Some diagnostic tests may perform better in some patients than others. For example, irregular heart rate and the presence of extensive coronary calcification are associated with increased likelihood of non-diagnostic image quality of CTCA and it is not recommended in such patients [1]. Stress echocardiography or SPECT perfusion imaging can be combined with

Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classic... more Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classical ischemic electrocardiographic (ECG) changes and unremarkable cardiac biomarkers. This syndrome shouldn't be missed by the clinicians as delay in urgent coronary intervention can result in anterior wall myocardial infarction (MI), arrhythmias, left ventricular dysfunction and death. It can be predicted by patient's history and ECG changes. Thus, physicians and health care providers should be familiar with the electrocardiographic manifestations about Wellens' Syndrome in clinical care. Here, we are describing a case of middle aged male patient presented with history of typical chest pain with slightly elevated blood pressure (BP) with an initial ECG showing Brugada pattern, patient was admitted and started with antiplatelets, anti-ischemics and anticoagulants followed by serial ECGs but after 3 hours ECG done showed wellenoid pattern for which he underwent a coronary angiography and it came out to be severe lesion in proximal left anterior descending (LAD) artery.

Vol. 52 (04) : 376 - 380, 2019

Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patie... more Objective: To determine the impact of age and gender on the outcome of head-up tilt test in patients with unexplained syncope. Methodology: This quasi experimental study was done at National Institute of Cardiovascular diseases Karachi and Chaudhry Pervaiz Elahi Institute of Cardiology Multan Pakistan from January to December 2018. Patients presented with unexplained syncope 64 syncope patients were included and HUTT was done. were included. Outcome including positive HUTT, response to HUTT, phase of HUTT and the effect of age and gender in patients with unexplained syncope undergoing HUTT. Results: The mean age of patients was 63.39±6.94 years. There were 51 (79.7%) male while 13 (20.3%) were females. HUTT was found to be positive in 37 (57.8%) patients while 27 (42.2%) patients had negative HUTT. Mixed HUTT response was observed in 18 (48.6%) patients, cardio-inhibitory reposes in 8 (21.6%) patients while vaso depressive response in 11 (17.2%) patients. Active HUTT phase was observed in 30 (81.1%) patients while 7 (18.9%) patients had passive HUTT phase. The age and gender were found to have insignificant impact on HUTT findings (p>0.05). Conclusion: Thus the frequency of positive HUTT is high in unexplained syncope patients. No significant difference was found in the frequency of responses to HUTT between the gender groups. The trend of the HUTT result significantly changed with age.

”. EC Cardiology 6.11 (2019): 49-50., 2019

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque a... more Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries , whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). CTCA uses computed tomography (CT) scanning to take images (angiograms) of the coronary arteries. It requires the use of rapid CT scanning techniques and can only be carried out in centers where the equipment is suitable and the medical/technology staffs are trained appropriately. Computed Tomography Coronary Angiography is the preferred test in patients with a lower range of clinical likelihood of CAD, no previous diagnosis of CAD, and characteristics associated with a high likelihood of good image quality. It detects subclinical coronary ath-erosclerosis but can also accurately rule out both anatomically and functionally significant CAD. Its higher accuracy values of CTCA when low clinical likelihood populations are subjected to examination [1]. Trials evaluating outcomes after coronary CTA to date have mostly included patients with a low clinical likelihood [2,3]. The non-invasive functional tests for ischaemia typically have better rule-in power. In outcome trials, functional imaging tests have been associated with fewer referrals for downstream ICA compared with a strategy relying on anatomical imaging [4,5]. Functional evaluation of ischaemia (either non-invasive or invasive) is required in most patients before revascularization decisions can be made. Therefore , non-invasive functional testing has now come to be preferred in patients at the higher end of the range of clinical likelihood if revas-cularization is likely or the patient has previously diagnosed CAD. If CAD is suspected in patients, but who have a very low clinical likelihood (≤ 5%) of CAD, should have other cardiac causes of chest pain excluded and their cardiovascular risk factors adjusted, based on a risk-score assessment. In patients with repeated, unprovoked attacks of anginal symptoms mainly at rest, vasospastic angina should be considered, diagnosed, and treated appropriately In addition to diagnostic accuracy and clinical likelihood, the selection of a non-invasive test depends on other patient characteristics, local expertise, and the availability of tests. Some diagnostic tests may perform better in some patients than others. For example, irregular heart rate and the presence of extensive coronary calcification are associated with increased likelihood of non-diagnostic image quality of CTCA and it is not recommended in such patients [1]. Stress echocardiography or SPECT perfusion imaging can be combined with

Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classic... more Wellens' syndrome, or "Widow Maker", is referred to as a pre-infarction syndrome with non-classical ischemic electrocardiographic (ECG) changes and unremarkable cardiac biomarkers. This syndrome shouldn't be missed by the clinicians as delay in urgent coronary intervention can result in anterior wall myocardial infarction (MI), arrhythmias, left ventricular dysfunction and death. It can be predicted by patient's history and ECG changes. Thus, physicians and health care providers should be familiar with the electrocardiographic manifestations about Wellens' Syndrome in clinical care. Here, we are describing a case of middle aged male patient presented with history of typical chest pain with slightly elevated blood pressure (BP) with an initial ECG showing Brugada pattern, patient was admitted and started with antiplatelets, anti-ischemics and anticoagulants followed by serial ECGs but after 3 hours ECG done showed wellenoid pattern for which he underwent a coronary angiography and it came out to be severe lesion in proximal left anterior descending (LAD) artery.