University Heart Journal 2020-12-21T11:12:03+00:00 Professor Harisul Hoque Open Journal Systems The University Heart Journal is the English Language, official “six-monthly peer reviewed” publication of the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. It provides a forum for exchange of information on all aspects of cardiovascular medicine including education. Viral Infections and the Heart 2020-12-21T11:11:38+00:00 Manzoor Mahmood Md Harisul Hoque <p>Abstract not available</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 1-2</p> 2020-12-21T09:54:55+00:00 ##submission.copyrightStatement## Correlation between Abnormal Signal-Averaged ECG and Left Ventricular Ejection Fraction in Patients of Acute Myocardial Infarction within Seven Days of Sustaining the Infarction. 2020-12-21T11:11:39+00:00 Mohammad Abdul Malek Sayed Asif Iqbal AFM Shamsul Haque Sayeda Aleya Sultana Md Waliur Rahman Md Mukhlesur Rahman <p><strong>Objective</strong>: This study sought to evaluate the correlation of left ventricular ejection fraction (LVEF) with Signal – Average Electrocardiogram (SAECG) in patient with acute myocardial infarction.</p> <p><strong>Background</strong>: Post MI risk stratification is still a debatable issue. Appropriate investigation to ascertain the patient at risk of sudden cardiac death is sometimes difficult. Abnormalities in the SAECG have been determined to be independent predictors of risk of developing ventricular arrhythmias in patients convalescing from myocardial infarction. Correlation of LVEF with SAECG will identify the small group of patient at risk of fatal arrhythmia.</p> <p><strong>Method</strong>: This observational study was carried out in the cardiology center, Combined Military Hospital, Dhaka cantonment during the period of January 2010 to January 2011. Patient with first acute myocardial infarction within 7 days of sustaining acute myocardial infarction were included in the study. All three parameters of SAECG (Total QRS duration, Low Amplitude Signal (LAS) under 40μvolt, Root - mean -square (RMS) voltage of last 40 msec) were recorded, and basing on the results, patients were grouped into normal or abnormal SAECG.</p> <p><strong>Result:</strong> A total of 106 patients of acute MI were studied. Mean age of the patients were 54(SD±10.5) years (range 34 to 90 years). Only 13(12%) patients were female with male to female ratio of 7.15:1. 32% patients were thrombolysed &amp; abnormal SAECG was more in patients who were thrombolysed (p value&lt;0.05) but logistic regression analysis showed no significant association. Smoking had significant association with abnormal SAECG by univariate analysis (p value&lt;0.05) but logistic regression analysis showed no significant association with smoking and sex (p value &gt;0.05). 46% patients had inferior/inferoposterior myocardial infarction. Abnormal SAECG was more among patients with inferior MI (p &lt;0.05). Mean LVEF was 45.81% (SD±9.68). Correlation of LV function was assessed by both Pearson’s correlation and Ç2 test but no significant association was seen. Logistic regression analysis showed the similar result.</p> <p><strong>Conclusion</strong>: In our study, no correlation was found between abnormal signal-averaged ECG and left ventricular ejection fraction following acute myocardial infarction. Further large, multi center study with more selective variables is required to find out any association of SAECG and LV ejection fraction.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 3-9</p> 2020-12-21T10:17:59+00:00 ##submission.copyrightStatement## Relying on ST Segment Depression alone to Predict Ischemic Heart Disease- How Far We can Go ? 2020-12-21T11:11:44+00:00 Md Mashiul Alam Md Mukhlesur Rahman Tanjima Parvin Khurshed Ahmed SM Ahsan Habib Md Fakhrul Islam Khaled Md Azharul Islam Md Ahasanul Kabir Shahin Kamruzzaman Siddiki Md Al Amin <p><strong>Introduction</strong>: Ischemic heart disease (IHD) or coronary artery disease (CAD) has become predominant cause of death across the world and frequently stable angina, which is the most common presentation of this disease, gives hard time to reach a proper diagnosis due to duality of non-invasive testing. While Exercise Treadmill Test (ETT) is an inexpensive non-invasive modality which may have many output depending on method of interpretation, ST segment depression is much utilized but traditionally less perfect than available treadmill scores. We have compared its accuracy to Duke Treadmill Score (DTS), Simple Treadmill Score (STS) and Cleveland Clinic Score (CCS) among Bangladesh people to generate a local insight.</p> <p><strong>Objective</strong>: To estimate and compare accuracy of ST segment response, DTS, Simple Treadmill Score and Cleveland Clinic Score to predict CAD.</p> <p><strong>Method</strong>: In a cross-sectional study total 130 patients who had visited at a medical university with stable chest pain were selected according to predefined inclusion and exclusion criteria over one year. After taking proper history and physical examination their ETT report and Coronary Angiogram (CAG) finding, which were done according to indication defined by their consultants. ETT interpretation as ST segment response and treadmill scores were compared with gold standard test for CAD that is CAG. Accuracy of STdepression and treadmill scores were calculated by the formula “Accuracy = TP+TN / Total Sample”.</p> <p><strong>Result</strong>: Among the total sample (n=130) male and female were 93 &amp; 37, respectively. Nearly half of male sample fell into 5th decade and around same portion of female sample was in 4th decade. About 58%, 28% &amp; 14% patients came with typical, atypical &amp; non-cardiac chest pain. As calculated with above mentioned formula accuracy of ST segment response alone to diagnose IHD came about 68.4% (p value 0.004). Similarly DTS, STS and CCS had 83.3%, 83.9% and 77.2% accuracy, respectively (p value 0.000).</p> <p><strong>Conclusion</strong>: During ETT relying on ST segment depression alone to diagnose CAD is significantly less accurate than treadmill scores namely, Duke Treadmill Score, Simple treadmill Score or Cleveland Clinic Score. Applying any of these treadmill scores during exercise test interpretation can identify ischemic heart disease patients with more accuracy.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 10-15</p> 2020-12-21T10:19:35+00:00 ##submission.copyrightStatement## Outcomes of Early Development of Hyponatremia in Acute ST-Elevated Myocardial Infarction Patients: A Study in a Tertiary Hospital 2020-12-21T11:11:50+00:00 Mohammad Nizamul Hossain Sowdagar Mushtaq Ahmad AKM Musa Khan Zahida Jabbar Md Mukhlesur Rahman Md Ashraf Uddin Sultan <p><strong>Background</strong>: Coronary heart disease is a global health problem and a major cause of death in both developed and developing countries. Clinical importance of hyponatremia in ST-elevated acute myocardial infarction (STEMI) is an important topic of study among present researchers.</p> <p><strong>Objective</strong>: To assess the outcomes and prognostic implications of early development of hyponatremia inhospitalized acute ST-elevated myocardial infarction patients.</p> <p><strong>Methods</strong>: This is a prospective observational study performed in the department of Cardiology, Combined Military Hospital (CMH), Dhaka from July 2018 to June 2019. A purposive sampling technique was used on 82 patients with ST-elevated acute myocardial infarction admitted in CCU and treated with thrombolysis. They were evaluated for serum sodium level at admission and at 48 hours after admission. Here sodium concentration &lt;135 mmol/L is defined as Hyponartemia. Fourty one patients with hyponatremia were included in Group-I and 41 patients with normal sodium level were included in Group-II. Then the in-hospital outcome variables were analyzed.</p> <p><strong>Results</strong>: Among the study population 86.58% were male and 13.42% were female. Age range was 25 years to 74 years. Considering risk factors highest percentage of study population in group- I had hypertension (60.97%) followed by dyslipidemia (51.21%), diabetes mellitus (51.21%), history of smoking (53.60%), and family history of Coronary Artery Disease (CAD) (31.14%). There were five outcome variables such as heart failure, cardiogenic shock, arrhythmia, duration of hospital stay and death. 10 patients died in Group-I and 2 patients died in Group-II. Among the outcome variables death, heart failure and hospital stay was more in Group-I and was statistically significant. hospital outcome of study population according to serum sodium level. Considering in hospital outcome heart failure occurred in 14 patients (p= .001), arrhythmia developed in 17 patients (p=0.108), cardiogenic shock occurred in 9 patients (p=0.354) and death occurred in 10 patients (p=0.002). P-Value of heart failure and death was statistically significant.</p> <p><strong>Conclusion</strong>: Early developed hyponatremia in patients with ST-elevated acute myocardial infarction was an independent predictor of prognosis. It has been found that heart failure, duration of hospital stay and death was more in hyponatremic patients and prognosis worsen with increasing severity of hyponatremia. Plasma sodium level may serve as a simple marker to identify patients at high risk.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 16-21</p> 2020-12-21T10:19:53+00:00 ##submission.copyrightStatement## Echocardiographic Assessment of Myocardial Viability and Prediction of Left Ventricular Functional Recovery after Acute Myocardial Infarction Using Strain and Strain Rate 2020-12-21T11:11:52+00:00 Arif Mohammad Sohan MSI Tipu Chowdhury Khaled Mohammad Iqbal Najnin Akhter ATM Iqbal Hasan Chowdhury Meshkat Ahmed <p><strong>Background</strong>: Extent of viable myocardial tissue has been recognized as a major determinant of recovery of left ventricular (LV) function after myocardial infarction. The present research was aimed at assessment of myocardial viability and prediction of left ventricular functional recovery in patients after acute anterior ST-elevated myocardial infarction using Tissue Doppler strain.</p> <p><strong>Methods</strong>: In this prospective observational research, 47 patients admitted into the hospital with acute anterior ST-elevated myocardial infarction were included. All patients underwent two-dimensional and strain echocardiography within 48-72 hours of admission. Follow up two-dimensional echocardiography had performed at 6 months after baseline examination.</p> <p><strong>Results</strong>: Total 47 patients (mean age, 57±5 years) underwent two-dimensional and strain echocardiography within 48-72 hours of admission. Significant relations were observed between baseline global systolic lengthening strain and wall motion score index (r=0.67), change in left ventricular ejection fraction (LVEF, r= -.844), Global Ses (r=.441) and on admission troponin I (r =0.397). At 6-months follow-up, LV ejection fraction was reassessed. Patients with absolute improvement in LV ejection fraction ≥5% at 6-months follow-up (n=24; 51%) had a higher (more negative) baseline global Ses strain (P&lt;0.001) and lower global systolic lengthening (P&lt;.001). A cutoff value for baseline global systolic lengthening strain of 7.6% yielded a sensitivity of 83% and a specificity of 87% to predict LV functional recovery at 6-months follow-up.</p> <p><strong>Conclusions</strong>: Global Left ventricular strain (Ses and Systolic lengthening) early after acute anterior ST-elevated myocardial infarction reflects myocardial viability and predicts recovery of LV function at 6-monts follow-up.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 22-30</p> 2020-12-21T10:20:02+00:00 ##submission.copyrightStatement## Assessment of left Ventricular Longitudinal Function in Different Hypertensive Left Ventricular Geometry 2020-12-21T11:11:54+00:00 Md Nur Uddin Tareq Chaudhury Meshkat Ahmed Sohel Mahmud KMHS Sirajul Haque <p><strong>Background</strong>: Hypertension remains as the major risk factor for cardiovascular diseases. Hypertensive left ventricular hypertrophy was shown to be associated with increased morbidity and mortality. Left ventricular radial function (Ejection fraction) tends to remain normal in hypertensive patients, particular attention should be given to longitudinal function along with diastolic function. Left ventricular longitudinal function may vary across different hypertensive LV geometry with different prognosis.</p> <p><strong>Results</strong>: Of the total 214 study subjects, 109 (50.9%) were Cases and 105 (49.1%) were Controls. The mean ages of cases and controls were 52.66 (± 10.96) and 50.21 (± 10.91) years respectively. Left ventricular ejection function (LVEF) was almost identical in both groups [mean LVEF in case 68.7 % (± 6.9) Vs control 68.7(± 5.4), (p 0.947)]. Among the cases 43% had concentric hypertrophy (CH), 20% had eccentric hypertrophy (EH), 20% had concentric remodeling (CR), while normal geometry constituted the least 16.5%. Mean systolic mitral annular velocity (Vs) and mean early diastolic velocity (Ve) assesed by pulse wave tissue doppler imaging were observed to be significantly decreased in cases compared to their control counterpart (11.46 ± 1.26 vs. 15.41 ± 1.00 cm/sec, p &lt; 0.001 and 13.80 ± 2.37 vs. 16.76 ± 2.67 cm/sec, p &lt; 0.001. There was significant reduction of Vs in concentric hypertrophy and eccentric hypertrophy (11.31 ± 1.41 and 12.27 ± 2.14). (p &lt;0.001 and &lt;0.005). Among cases 55 (50.5%) and among controls 17 (16%) had diastolic dysfunction. Mean systolic mitral annular velocity (Vs) in patients with diastolic dysfunction (12.42 ± 1.90 cm/sec) was significantly lower than that in patients without diastolic dysfunction (13.86 ± 2.30 cm/sec) (p &lt; 0.001).</p> <p><strong>Conclusion</strong>: Radial function (LVEF) remains normal in patients with systemic hypertension as compared to controls. LVH is common among hypertensive and concentric hypertrophy is the commonest geometry. LV longitudinal systolic function as assessed by systolic mitral annular velocity (Vs) by DTI was significantly reduced in hypertensives and CH is the most severely affected with EH at intermediate risk. Diastolic dysfunction is also common but almost alaways accompanied by impairment of LV longitudinal systolic function.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 31-37</p> 2020-12-21T10:20:12+00:00 ##submission.copyrightStatement## Association of GRACE Risk Score with Angiographic Severity of Coronary Artery Disease in Patients with Non ST-elevation Acute Coronary Syndrome 2020-12-21T11:11:55+00:00 Md Estakur Rahman - Mohammad Safiuddin SM Ahsan Habib Chaudhury Meshkat Ahmed Sajal Krishna Banerjee <p><strong>Background</strong>: Due to the wide spectrum of risk for death and recurrent events among patients with NSTE-ACS, management guidelines emphasise the importance of early risk stratification. In addition to prognostic assessment, predicting the anatomical extension of coronary artery disease is potentially useful for clinical decision. The aim of the study is to determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non ST-elevation ACS</p> <p><strong>Methods</strong>: A total of 50 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low (&lt;108), intermediate (109-140), and high (&gt;140) risk groups. All patients underwent coronary angiography within five days after admission. The severity of the coronary artery disease was assessed by Gensini score. Relation between Grace score and Gensini score was evaluated.</p> <p><strong>Results</strong>: Mean Gensini score were 12.20 ± 13.60, 34.52 ± 13.50 and 48.41 ± 14.56 in low group, intermediate group and high GRACE risk group respectively and the difference of mean Gensini score was statistically significant (p&lt;0.001). A GRACE score of 135 was identified as the optimal cut-off to predict severe CAD (sensitivity = 82.4% and specificity = 75.8%). In our study correlation co-efficient between GRACE risk score and Gensini score was r=0.66 (p&lt;0.001).</p> <p><strong>Conclusion</strong>: The study demonstrates that the GRACE risk score has significant positive correlation with coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 38-41</p> 2020-12-21T11:04:26+00:00 ##submission.copyrightStatement## Echocardiographic Assessment of the Effect of Mitral Stenosis Severity on Left Ventricular Systolic Function Using Isololumic Myocardial Acceleration 2020-12-21T11:11:57+00:00 Md Hasanul Islam Dipal Krishna Adhikary Tanjima Parvin Rabindra Nath Barman Mahbubur Rahman Md Ashraf Uddin Sultan MSI Tipu Chowdhury Md Harisul Hoque <p><strong>Background</strong>: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA.</p> <p><strong>Methods</strong>: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area &lt;2cm2) and 32 healthy control subjects. In addition to standard echocardiographic methods TDI (tissue Doppler imaging) were performed to assess LV function in all participants.</p> <p><strong>Results</strong>: This study showed a clear female preponderence (76%) of mitral stenosis and most of them belonging to age group 21-39 years. All TDI derived LV systolic (IVV, Sm and IVA) velocities were significanty decreased in patients with mitral stenosis, compared to the healthy control (P&lt;.001, for all). However IVA was not different when the degree of MS was evaluated (P=.056). In addition IVA was not correlated with MVA (r=+0.196. P= 0.056).</p> <p><strong>Conclusions</strong>: Isovolumic myocardial acceleration was more accurate and consistent than conventional echocardiography in assessing subclinical left ventricular systolic dysfunction, IVA showed that left ventricular function is impaired with mitral stenosis regardless of severety of the disease. So this new echo parameter can be a good supplement to the existing 2D scoring system to detect systolic dysfunction in rheumatic mitral stenosis.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 42-46</p> 2020-12-21T11:04:36+00:00 ##submission.copyrightStatement## Percuteneous Trans-Mitral Commissurotomy (PTMC); Procedural Success and Immediate Results, an Experience from Tertiary Care Hospital in Northern Division of Bangladesh 2020-12-21T11:11:59+00:00 Mahbubur Rahman Shakil Ghafur Rabindra Nath Barman Haripada Sarkar Abu Zahid Basunia Md Hasanul Islam Abdullah Al Mahmud <p><strong>Background</strong>: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982.</p> <p><strong>Objective</strong>: The aim of this study was to audit the procedural success, in- hospital outcome in patients undergoing PTMC in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted in northern division of Bangladesh with the collaboration of department of cardiology, Rangpur Medical College Hospital, Rangpur &amp; Zia Heart Foundation, Dinazpur from February 2018 to November 2019.</p> <p><strong>Materials and Methods</strong>: Total Thirty patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study. Among them the procedural success &amp; immediate results were assessed.</p> <p><strong>Results</strong>: Among 30 patients , 22(73.33%) were female and 8(26.66%) were male showing a female predominance. The mean age was 28.28±8.4.The procedure was successful in 29(96.66%) patients. In 1(3.3%) patient, we failed due to inability to puncture the septum for unfavourable anatomy. There was no mortality related to the procedure, no systemic embolization but one patient (3.33%) had significant MR(G II ). Pre PTMC mean MVA (cm2) was 0.801± 0.1325 and post PTMC it was 1.545± 0.292 cm2. Mean MVPG pre PTMC was 27.108±5.94 mmHg and post PTMC , 6.61±5.008 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 28.65±8.456 mmHg and post PTMC, 11.27±6.34 and p value was 0.0001. Most of the patients 25(83.3%) before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 21(70%) were in mild pulmonary hypertension.We successfully done 7 special cases like pregnancy, re do cases, H/O CVD etc.</p> <p><strong>Conclusions</strong>: We conclude that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 47-54</p> 2020-12-21T11:04:46+00:00 ##submission.copyrightStatement## Angiographic Studies of Coronary Artery Disease in Rangpur Medical College Hospital 2020-12-21T11:12:01+00:00 Md Hasanul Islam Shakil Ghafur Rabindra Nath Barman Haripada Sarker Abu Zahid Basunia Mahbubur Rahman Abdullah Al Mahmud <p><strong>Background</strong>: Coronary artery disease (CAD), one of the leading causes of death is increasing globally. The number of CAD is also increasing in Bangladesh. Rangpur Medical College &amp; Hospital is also providing cardiovascular services to populations from urban, semiurban and rural population of northern region of the country. It started coronary angiography services from June 2011. This paper aims to analyze pattern of coronary artery occlusion in patients undergoing coronary angiography during January to October 2019.</p> <p><strong>Methods</strong>: This was a retrospective observational study conducted in the cardiology department. There were a total of 308 cases of diagnostic angiography and coronary interventions done in Rangpur Medical College &amp; Hospital from January to October 2019. Among them 308 cases of coronary angiography done for Acute Coronary Syndrome and Stable Angina, were analyzed using SPSS (Statistical Package for Social Science), version 17.</p> <p><strong>Results</strong>: Males were higher in number than females and majority of the patients were at or above 50 years of age. Out of 308 cases 225 had Acute Coronary Syndrome (ACS) and 83 had Stable Angina. 54 out of 308 were found to have normal coronaries. 25 patient with ACS had normal coronary. Out of all the patients with coronary stenosis, 19 had left main disease, 59 had SVD, 62 has DVD, 71 patient had TVD. 9 patients had CTO. 159 patients had severe coronary stenosis. 117 out of 225 ACS patient had more than one coronary artery involved, which is significantly higher than the stable angina group ( p&lt;0.01). Severe stenosis was found to be more common in ACS group (p&lt;0.003) when compared to the stable angina group.</p> <p><strong>Conclusion</strong>: There has been a change with regard to clinical presentation and onset of risk factors for CAD at young age, but the load of atherosclerotic burden and pattern of involvement of coronary arteries have not changed in Elder group. Coronary angiography is a useful diagnostic and therapeutic tool for CAD. Coronary status is significantly different in ACS and stable angina. ACS has more chance of having multivessel stenosis whereas stable angina has single vessel, less severe or normal coronaries. Severity of stenosis is also high in ACS than in stable angina.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 55-59</p> 2020-12-21T11:04:57+00:00 ##submission.copyrightStatement## Heart disease and COVID-19 2020-12-21T11:11:41+00:00 Prabir Kumar Das Fazlur Rahman <p><strong>Background</strong>:Many patients with coronavirus disease 2019(COVID-19) have pre-existing heart disease or develop various cardiac complications during the disease. Understanding the relationship between heart disease and COVID-19 is necessary for optimum management of such condition.</p> <p><strong>Methods</strong>: Literature search done by using Google search engines and PubMed.</p> <p><strong>Results</strong>: Heart involvement occurs in approximately 8-12% of all patients. Acute cardiac injury, as evident by a significant cardiac troponin elevation is the commonest abnormality. Myocarditis, type II myocardial infarction, heart failure, arrhythmia are other cardiac menifestations that are less common. Pre-existing heart disease and/or involvement of the heart by COVID-19 carries worse prognosis.</p> <p><strong>Conclusion</strong>: Most of the reports currently available describes cardiac menifestations briefly. Further study may reveal more clearly the various aspects of cardiac menifestations in COVID-19 patients.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 60-65</p> 2020-12-21T11:05:07+00:00 ##submission.copyrightStatement## Antiplatelet Therapy in Patients with Acute Coronary Syndrome: An Update 2020-12-21T11:11:47+00:00 Adnan Bashar Md Harisul Hoque MSI Tipu Chowdhury ATM Iqbal Hasan Khurshed Ahmed <p>Antiplatelet therapy is the cornerstone in the treatment of acute coronary syndrome. Aspirin is the most widely used antiplatelet agent followed by P2Y12 inhibitors. Glycoprotein (GP) IIb-IIIa antagonists are also gaining popularity as an antiplatelet agents during peri-PCI period. This review article summarizes the indications, duration of dual antiplatelet therapy (DAPT) in ACS setting. Antiplatelet therapy in special situations like atrial fibrillation and thrombocytopenia are discussed here. Issues like switching between P2Y12 inhibitors and genetic testing of antiplatelet agents are also mentioned in this article</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 66-70</p> 2020-12-21T11:05:18+00:00 ##submission.copyrightStatement## Peripartum Cardiomyopathy: A Case Series 2020-12-21T11:11:42+00:00 Md Abu Salim Mohammad Walidur Rahman Dipal Krishna Adhikary Jahanara Arzu Md Harisul Hoque Ariful Islam Joarder Manzoor Mahmood <p>Peripartum cardiomyopathy (PPCM) is a life threatening entity of peripartum period characterized by left ventricular systolic dysfunction and heart failure in absence of any known cardiac disease. Though its incidence is rising but there is still uncertainty regarding its incidence, pathogenesis, and optimum management protocol. Retrospective analysis of twenty cases of PPCM admitted, within July 20016 to June 2018 in the department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka is done here. Mean age of study population was 25 (6.3). Majority of the patients were multi-paras 12 (60%). 80% of the patients were diagnosed after delivery. Breathlessness was the most common symptom. Bibasal lung base crepitations was most frequent sign, which was found in 95% cases. Sinus tachycardia was most frequent electrocardiographic change which was found in 80% cases. Mean left ventricular ejection fraction (LVEF) was 35.2(2.8). All the patients had different extent of global hypokinesia of left ventricle (LV) at rest. The patients were treated with bed rest, water and salt restriction, loop diuretic, digitalis, selective Beta-blocker, vitamin B complex and an anticoagulant in relevant cases in antepartum period, Angiotensin converting enzyme inhibitor (ACEI) or Angiotensin receptor blocker (ARB) was added in postpartum period.70% patients were clinically improved and in 45% the left ventricular functional status returned to normal. 30% developed persistent cardiomyopathy beyond six months of presentation. Maternal mortality was 1 (5%). Among all live births three had intra uterine growth retardation. The pathophysiology, emerging investigations modalities, updated management protocol, and prognosis of PPCM are also discussed in this review.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 71-75</p> 2020-12-21T11:05:28+00:00 ##submission.copyrightStatement## Acute Myocardial Infarction in a Young Lady with Mitral Stenosis – Uncommon Presentation of a Common Problem 2020-12-21T11:11:48+00:00 AKM Mohiuddin Bhuiyan ATM Iqbal Hasan Md Mukhlesur Rahman Partha Pratim Saha <p>Chronic rheumatic heart disease is the major contributor of valvular heart disease in this subcontinent. It can affect all the four valves. Among them mitral valve is affected most of the time. Involvement of the mitral valve could be presented in various nonspecific way like chest pain, palpitation, shortness of breath, difficulty in swallowing, change in voice and so on. There are few causes behind the chest pain. Myocardial infraction is one of the important cause.</p> <p>University Heart Journal Vol. 17, No. 1, Jan 2021; 76-78</p> 2020-12-21T11:05:41+00:00 ##submission.copyrightStatement##