Medico-Legal Update

Ahmed Moyed Hussein ¹, Bahaa Abdullah Ali ², Merah Subhi Mohammed ³

Affiliations
1 M.B.Ch.B, FIBMS (medicine), CABMS (medicine), FIBMS( cardiology), CABMS(cardiology). Interventional cardiologist. Lecturer, department of medicine, Ninevah College of medicine. Mosel, IQ
2 M.B.Ch.B, CABMS (medicine), FIBMS (cardiology). Interventional cardiologist, Salahaddin general hospital.Tikrit, IQ
3 M.B.Ch.B, FIBMS (anesthesia), CABMS (anesthesia). Cardiac anesthetist, Ibn albitar cardiac center. Baghdad, IQ

Abstract

Objectives: to evaluate the prevalence of significant coronary artery disease (CAD) in patients referred for open heart surgery for various valvular and non valvular etiologies. Methods and materials: a total of 160 patients (73 males and 87 females) were included in this study: old age, male gender, hypertension (HT), diabetes mellitus (DM), hyperlipidemia, smoking and left ventricular (LV) systolic dysfunction are recorded as risk factors for CAD. Of the 160 patients: 143 (89.4 %) have valvular disease (VHD) and 17 (10.6%) have non valvular disease. Patients with VHD were classified according to valve lesions into: mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), aortic regurgitation (AR), tricuspid regurgitation (TR) and mixed valvular disease. Correlation between various types of valve diseases and CAD are assessed. Results: CAD were detected in 26.9% (43) of patients. Old age, HT, DM, hyperlipidemia and smoking were significantly correlated with CAD. CAD were more common in patients with VHD than non VHD. 25(50%) patients with AS have significant CAD (P value= 0.0001), in patients with MR: 8(12.7%) have significant CAD, while patients with MS and AR were have CAD in 15.1% and 25% respectively. Among patients with non valvular heart disease (17 patients): 13 patients have atrial septal defect and 4 patients have atrial myxoma. 3 patients (6.1%) have significant CAD (P value=0.2), one of them had HT, DM and smoker man presented with chest pain on exertion. Conclusion: Obstructive CAD were more common in patients with AS and MR and higher in patients with risk factors for CAD.

Keywords

coronary artery disease, valvular heart disease, Aortic stenosis

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Zaidan Jayed Zaidan ¹, Ahmed Moyed Hussein ², Sheet Mutlak Ahmed ³

Affiliations
1 Prof. ass. Internal medicine- Department of Medicine-College of Medicine-Tikrit University-Tikrit, IQ
2 Interventional cardiologist, lecturer-Department of Medicine –Ninevah College of Medicine-Mosul, IQ
3 Interventional cardiologist-Cardiology center-Tikrit Teaching Hospital-Tikrit, IQ

Abstract

Background: Hypertension is prevalent all over the world and represent a major health problem. Dyslipidemia is a major cause of cardiovascular morbidity and mortality. There is a correlation between hyperlipidemia and hypertension. Aim of study: to find out the prevalence of dyslipidemia in Iraqi hypertension patients, and to find out how many of them on statin therapy, and how many reach target according to the last guidelines Patients and methods: a cross-sectional study conducted in outpatient clinic in Salahaddin General Hospital in Tikrit City. About 344 hypertensive patients were included in this study. A questionnaires including general information about patients were filled and venous blood was drawn from every patient and sent for hospital lab to measure necessary investigations. ASCVD risk score was calculated for every patient by ASCVD Risk Estimator Plus. Then data were analyzed by application of Microsoft excel program and Statistical Package for Social Sciences (SPSS) version 23. Results: (49%) of hypertension patients had total cholesterol of >200 mg/dl, (63.4%) had LDL of ≥115 mg/ dl, (57.6%) had HDL of <40 mg/dl, and (54.1%) had triglycerides of ≥150mg/dl. Smoker patients in this study had highest ASCVD risk score (12.65±6.63%) followed by former smokers (7.36±3.56%) and nonsmokers (6.02±4.16%).Only 76 (22.1%) of hypertension patients were on statin therapy for hyperlipidemia and only 18 (23.7%) of them reaching target LDL level according to 2016 ESC/EAS guidelines. While 268 (77.9%) of hypertension patients had no statin therapy and only 65 (24.3%) of them had LDL level within target. Conclusion: Hyperlipidemia is very prevalent in hypertension patients in Tikrit City, despite that only one of five receiving treatment and only one of four from those who received treatment reaching the target of LDL level according to 2016 ESC/EAS guidelines, and three of four of those who are on no treatment are out of the target. This is a major health problem need attention.

Keywords

Hypertension, Dyslipidemia, Cholesterol, HDL, LDL, Triglycerides

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