Global Summit On Heart Congress October 19-20, 2020 London, UK

Biography:

Dr Ayuna is a cardiology registrar in Salford Royal NHS foundation trust, UK, he is intereseted in intervential cardiology, he completed PGDip, MSc and MD in cardiology.Dr Sultan consultant intervential cardiologist at Wrightington  Wigan and Leigh NHS Foundation Trust ,UK.

Abstract:

Early diagnosis and treatment of ACS can reduce the risk of complications and death. Delay calling for help can increase morbidity and mortality. Method: Single-centre observational retrospective study. Patients’ admissions identified using data from local Myocardial Ischemia National Audit Project (MINAP) over a period of 30 months. 1603 patients were involved (919 male, 684 female) (mean age 70.4, mode 77 years). They were classified into nine different age groups (18-20 years, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89, 90-102). Participants were admitted to the hospital, diagnosed and treated for STEMI, and NSTE-ACS. Time from symptoms onset to call for help was collected in minutes. Results: Men and women in their 50s and 40s respectively tend to delay their call for help from symptoms onset. For the former it was 590 min on average, range 23029 min, median 102 and mode 25, whereas for the latter it was 1084 min, median 277, and range of 7230. Additionally those groups tend to have longer time delay between symptoms onset and arrival to hospital. Among deaths, it is observed that death is proportional to the time delay. Conclusion: middle age group of both genders tend to delay their call for help when they experience symptoms of ACS; moreover, regardless of the age, the longer the delay, the higher the mortality rate. Phase 2 of our study will include distributing questionnaires to all patients admitted to the hospital with acute coronary syndrome particularly this age group to find the reason behind this delay.

Biography:

Dr Ahmed Ayuna is a cardiology registrar in Salford Royal NHS foundation trust, UK, he is intereseted in intervential cardiology, he completed MBChB, MD and PGDip in cardiology MRCP(UK).Dr Lobna Al-Sodani is a junior clinical fellow in Salford Royal NHS Foundation Trust MBChB.

Abstract:

Background and aims: GIT bleeding is the most common serious complication results from the use of long term antiplatelets. ESC DAPT guidelines 2017 recommend the use of proton pump inhibitors (PPI) with dual antiplatelet (DAPT) as a class 1B recommendation. Our audit aims to ensure that our practice is parallel to the international standard.

Methods: We prospectively audited 18 patients admitted to NHS hospital in England with ACS (STEMI, NSTE-ACS) for six weeks from 05/02/2018-12/03/2018. As a result, we introduce our new ACS patient's safety discharge summary checklist, team education; developed a reminder message appears on the electronic prescription system to consider PPI whenever DAPT are prescribed. One year after implementing the changes, we re-audit our action plan. We used the same methodology; we prospectively audited 26 patients admitted with ACS 04/02/2019-01/03/2019. Results: Total number of patients 18 (N=18), Males 9, females 9, 3 of 18 no PPI prescribed (16.66 %). 83.33% (15/18) patients with DAPT had a PPI prescribed on discharge. On re-auditing, the total number of patients 26 (N=26). Only 1 of 26 no PPI prescribed (3.85%). So the compliance rose to 96.15% (25/26). There were no clear contraindications for PPI prescription for those who did not have their PPI prescribed.

Conclusion: Our steps to minimise the number of patients discharged without having PPI prescribed were successful in improving compliance significantly. Therefore we would recommend to our colleagues over the globe to consider similar steps to ensure patients safety; they are simple, easy to use, and useful.

Biography:

Dr Ahmed Ayuna is a cardiology registrar in Salford Royal NHS foundation trust, UK, he is intereseted in intervential cardiology, he completed MBChB, MD and PGDip in cardiology MRCP(UK).Dr Lobna Al-Sodani is a junior clinical fellow in Salford Royal NHS Foundation Trust MBChB.

Abstract:

Aims: Anthracycline-induced cardiotoxicity has been classified based on its onset into acute, early, and late. It may have a significant burden on the quality and quantity of life of those exposed to this class of medication. Currently, there are several ongoing debates on the role of different measures in the primary prevention of cardiotoxicity in cancer survivors. Our review article aims to focus on the role of ACEI and beta-blockers in the primary prevention of anthracycline-induced cardiotoxicity, whether it is acute, early, or late-onset.

Methods: PubMed, Cochrane library search, and Google scholar database were searched for the relevant articles; we reviewed and appraised 9 RCTs.

Results: [N=1456; ACEI (n=399).B-blockers (n=511), placebo or no treatment (n=546)]. Cardiotoxicity was higher on the placebo group [n=156(28.6%)], compared with B-blockers [n=79(15.4%)], and ACEIs [n=79(19.8%)]. Total cardiotoxicity sample was 314 (21.6%). Echocardiogram used to assess LVEF using Simpson’s biplane method. Follow up range in all RCTs was one week to 3 years; (mode six months).

Conclusion: Beta-blockers, especially carvedilol and ACEI, especially enalapril, should be considered for the primary prevention of acute and early onset cardiotoxicity. We recommend further studies to explore and establish the role of these neurohormonal blockers’ role in the primary prevention of late-onset cardiotoxicity. 

Biography:

Prof. Dr. Fatih Yalçın was born in Ankara in 1967, became a Cardiology specialist in 1997. In 1996, Prof. Dr. Fatih Yalçın conducted research in the "Cleveland Clinic", which has been selected as the best heart center in America for the last 20 years with the support of "NASA Grant NCC9-60" (NASA scholarship) in 1998-1999, and published 5 international publications supported by NASA scholarship.

Abstract:

Heart failure (HF) is a progressive process and gradually remodels heart tissue. In this course, we previously documented “predominant myocardial LV base and diminished regional LV basal cavity volume in LVH using real-time three dimensional imaging and predominant septal wall with blunted systolic regional function in myocardial performance analysis compared to free wall documenting that the importance of regional morphologic as well as functional features in remodeling process of heart failure. We also used exercise in hypertensive individuals as the external stressor using combined tissue analysis and exercise stress test to evaluate their adaptation and determine blood pressure and heart rate increase under stress for rate-pressure product representing hyperfunctional myocardial energetics in the early stage disease.

To test and validate our clinical findings, we have planned microimaging studies. Therefore, we have detected ”focal hypertrophy of LV septal base (basal septal hypertrophy, BSH) is the early imaging biomarker of pressure-overload stress leading to heart failure.”  Very recently, we have validated BSH with HYPERFUNCTION by a small animal study using 3 ^rd generation microscopic ultrasound. ^1,2  As the conclusion, early imaging biomarker, “BSH may support to early diagnosis of remodeling and effective medical therapy in a timely fashion.”

Biography:

Dr Naveed has completed his MBBS at the age of 25 years from Liaquat University of Medical Health Sciences,Jamshoro Hyderabad, Pakistan and postdgraduate studies from National Institute of Cardiovascular Diseases Karachi. He is the Clinical Fellow of Adult Cardiology. He is also certified BLS and ACLS Instructor from AHA in College of Physicians and Surgeons in Pakistan.        

Abstract:

Introduction: Increased ratio of Triglyceride (TG)/ High-density Lipoprotein (HDL) has been known as an accompanying finding in conditions like obesity and metabolic syndrome. Therefore, the aim of this study was to assess the utility of TG/HDL ratio as a diagnostic tool for the assessment of coronary artery disease (CAD).

Methods: This study was conducted at a semi-private hospital Karachi; patients above 15 years of age and undergone angiography or PCI were included. Patients with Congenital Heart Disease and familial hyperlipidmeia were excluded. TG/HDL ratio was obtained for all patients, severity of the disease was classified as normal, mild to moderate, moderate to severe, and very severe based on coronary angiography. Analysis of variance was applied to assess significant differences in mean TG/HDL ratio among severity of disease. P-value<0.05 was considered significant.

Results:  A total of 2,212 CAD patients were reviewed out of which 1613 (72.9%) were male and 599 (27.1%) were female. Average age of the patients was 55.12 years (±SD=9.93). Of these 2212 patients, 533 (24.1%) had very severe disease, 1213 (54.8%) had moderate to severe disease, 258 (11.7%) had mild to moderate disease, and 208 (9.4%) were normal. A Significant and an increasing trend was observed in TG/HDL ratio with the severity of disease (p=0.0001) Statistically significant difference was observed in the TG/HDL ratio of patients with mild to moderate, moderate to severe and very severe disease from normal patients. However, no statistically significant difference was seen in the TG/HDL ratio between the patients with moderate to severe and very severe disease.

Conclusions: A positive relationship between Triglyceride to HDL Ratio and severity of coronary artery disease was observed. Therefore, TG/HDL ratio can be used as an indicator of severity of coronary artery disease in addition to other parameters of lipid profile.

Biography:

Dr. Sheikh Jan is an consultant cardiologist at Florence Hospital J & K, India

Abstract:

Background: An early diagnosis of myocardial infarction is highly important in the emergency department (ED). It facilitates rapid decision making and treatment and therefore improves the outcome in patients presenting with symptoms of chest pain.

Aims and Objectives: To study diagnostic utility of new point of care high sensitive troponin-I assay in early diagnosis of acute myocardial infarction in patients presenting with acute chest pain.

Material and Methods: Forty six consecutive patients of acute onset chest pain who presented to our cardiac emergency department within three hours of symptom onset were enrolled for study.POC Hs Trop-I test was done on admission (0 hour), and after 3 hours if initial test result was negative. Quantitative troponin I (Q-Trop I) lab assay was done on admission (0 hour), 3 hours and 6 hours after admission. Six hour Q-Trop I assay was taken as gold standard for the initial diagnosis of AMI. The final adjudicated diagnosis of AMI was based on a composite of ECG changes (new ST segment or T wave changes, new onset LBBB), Troponin results, Echocardiography (new wall motion abnormality), angiographic findings (detection of a culprit lesion) and final chart review of observations made.

Results: Comparing the results of POC Hs Trop I results at 0 hour with the gold standard test we found the sensitivity of 97%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 92.3%. Sensitivity of POC Hs Trop I at 3 hours was better than POC Hs Trop I at 0 hour (97 vs. 100%) and equal to gold standard i.e. 100 %.Specificity, PPV and NPV are 100% for POC Hs Trop I at 1 hour.

Conclusion: High sensitive Trop I test is rapid and reliable method to diagnose and exclude acute myocardial infarction in patients presenting with acute onset chest pain to our Emergency Departments.

Biography:

Dr Abdulazeez is a senior house-officer doctor currently work at Medway Maritime Hospital, Kent, UK. Dr Abdulazeez has special interest in surgery, and he had experience working in different specialities including general surgery, orhtopaedics, acute and general medicine.

Abstract:

Ogilvie’s syndrome is a non-mechanical, acute pseudo-obstruction of the colon, causing massive colonic dilation. Medical or surgical conditions can predispose patients to Ogilvie’s syndrome; however, the pathogenesis and clinical findings are still not well understood. Here, we present a case of a 48-year-old male patient who presented to the Emergency Department with intermittent self-resolved left-sided lower chest pain on a background of ischaemic heart disease and positive risk factors for acute coronary syndrome. Troponin testing was negative and an electrocardiogram showed no acute changes. Chest radiography showed a dilated bowel under the left hemidiaphragm and a computed tomography (CT) scan of the abdomen-pelvis confirmed the diagnosis of Ogilvie’s syndrome. The patient was treated conservatively with a short period of nil by mouth and intravenous fluids. From this case there are many learning points as non-cardiac causes of chest pain should be always considered even in patients with previous cardiac history, especially those patients for whom there is no evidence to support recurrent cardiac ischaemia. Acute colonic pseudo-obstruction (Ogilvie’s syndrome) can be presented as chest pain that mimics angina pectoris. Chest radiography is of great value in cases of acute chest pain; a dilated bowel segment can be the only finding of Ogilvie’s syndrome in the initial assessment.

Biography:

Thongxay CHANVISOUTH has completed his internal medicine residency training at the age of 27 years from University of Health Science, Vientiane, Lao PDR support by Health Frontier and post residency training in Can Tho Stroke International Service General Hospital, South Vietnam. He is a Physician in the Cardiology Department, Savannaket Hospital. Now he is the consultant of cardiology in Savanakhet Hospital (Cardiac Care Unit) and also a lecturer at Savannaket Collage of Health Science. He is the member of Lao Internal Medicine Association (LIMA), and Lao Society of Cardiovascular Diseases. He has been a chief of resident in Mahosot Hospital and has been serving as assist editorial for junior resident thesis and Topics at that time he has been in six months Clinical Elective at Srinacarinnd Hospital, KonKaen University, Thailand support by Global Health Education, Department of Internal Medicine, University of Minnesota, USA.

Abstract:

Background: Heart failure places a significant burden on the patients and the health system worldwide. However, information about its burden in Low-income countries is scant. Witnessing a lack of adherence to heart failure guidelines amongst physicians in our environment prompted this study. The main objective is to determine physician adherence to ESC pharmacotherapy guidelines in heart failure in an economically resource-poor tertiary health facility.

Method: Review the prescription pattern of Neurohormonal blocker agent of 102 confirmed heart failure with reducing LVEF was carried out. Data from adherence evaluation were obtained from follow up information form outpatient clinic notes, while data on acute care medication and precipitating factors were from inpatient hospitalization notes.

Result: Heart failure (HFrEF) patients aged 59.03 ± 15.15 years, had NYHA III/IV symptoms (44.1%) and remain hypertension (21.5%), mean LVEF was 30.60± 7.14. hypertension and diabetes were predominant comorbidities, Etiology of heart failure was ICM (50%), Pharmacotherapy average three drug classes and consisted of ACEI/ARB (86.3%), Beta-blocker (50%), and MRA (32.24%) respectively. The use of Beta-blocker and MRA tents to be suboptimal. Combination pharmacotherapy: ACEI/ARB+BB (42.1%), ACEI/ARB+MRA (23.5%), BB+MRA (15.7%), three classes combination (18.7%). Target dose achievement ACEI (1.5%), beta-blockers, and MRA were not. the prescribing dosages were lower than the doses recommended by the guideline Most of the patients were prescribed starting doses in accordance with the guidelines: ACEI- 5mg/d (62.1%), BB-6,25mg/d (72.5%), MRA-25mg/d (97%). However, the maximum dose in this study was low: ACEI (40 mg/d), Beta-blocker (25mg/d), MRA (25mg/d).

Conclusion: As in the other country of the world nonadherence to guideline substantial problem in Laos. Our data confirm the need for a dedicated heart failure treatment program to optimize heart failure outcomes in a low resource environment. Our physicians will benefit from a structured heart failure education and feedback program. Better strategies for heart failure surveillance and management in Laos are need