THESIS
THESIS
TITLE : FACTORS INFLUENCING DEVELOPMENT OF HEART FAILURE AND OTHER OUTCOMES IN SUSPECTED CORONARY ARTERY DISEASE PATIENTS IN RURAL MEDICAL COLLEGE
INTRODUCTION :
Coronary artery disease is the major cause of mortality and morbidity all over the world
Coronary artery disease is an inflammatory disease which occurs due to the formation of atherosclerotic plaque, and the deposition of lipids leads to blockage of coronary artery which causes ischaemia and decreases the oxygen to the myocardium
Coronary disease is the most common cause of heart failure(HF) and an important therapeutic target for improving HF associated morbidity and mortality.
Heart failure is a complex clinical syndrome and represents the final path of numerous heart diseases.
The risk factors include diabetes mellitus , hypertension , smoking , hyperlipidemia, obesity( visceral fat and sarcopaenia) homocystinuria , and psychological stress.
The prevalence of these risk factors among healthy individual elucidates the probable occurence of CAD in near future.
Coronary artery disease leads to an abnormal sequence such as angina, myocardial infarction, arrhythmias, heart failure and sudden cardiac arrest is common in CAD (1)
PROBLEM STATEMENT :
CAD is the most common cause of HF in developed countries. The incidence of HF after MI is significant and is associated with poor outcomes
The world health organization reported that ischaemic heart disease was responsible for approximately 22.9 million deaths.
Nearly two- thirds of HF cases are attributed to underlying CAD.
Detection and early optimal treatment strategies are needed to reduce the clinical and economic burden of the disease.
Developing and developed countries shows opposite trends in mortality due to CAD.
The status of CAD in developing countries is worse with increasing trends of mortality(2) where as increased implementation of primary and secondary prevention methods of cardiovascular diseases is responsible for the decline in mortality in developed countries(3).
AIM
To evaluate various factors influencing development of heart failure and other outcomes in suspected spectrum of CAD patients
OBJECTIVES :
1) To summarise the known modifiable and unmodifiable risk factors and evaluate hitherto unknown factors in a spectrum of suspected coronary artery disease patients presenting to general medicine department
2) To classify patients with suspected CAD into 3 groups
These patients will represent the entire spectrum of CAD that we see here
Group 1) Mild and early with metabolic and atherosclerotic risk factors such as visceral obesity and hypertension
Group 2) Advanced CAD who present with heart failure and multimorbidity with multiple risk factors for progressive atherosclerosis and micro and macrovascular dysfunction
Group 3) Atherosclerotic plaque rupture presenting with acute coronary syndrome
Group 4) Miscellaneous suspected microvascular CAD
3) To evaluate the factors influencing outcomes in the spectrum of suspected coronary artery disease patients presenting to general medicine department
PATIENTS AND METHODS
TYPE OF STIDY: Qualititve research design, non interventional prospective study evaluating factors influencing patient outcomes in different suspected coronary artery disease spectrum on current standard of care
METHODOLOGY
After taking a written consent from the patients/relatives, a detailed history is taken and a thorough physical and systemic examinations are performed
according to standard open ended case report formats recorded in standard case report forms
The case report forms, document the patient’s name, age, sex, comorbidities, risk factors associated with coronary artery disease, and family history etc.
The findings of the clinical exam are also recorded in this case report form along with baseline ECG, Chest xray, 2D echo at admission and in-hospital evaluation of various factors.
INCLUSION CRITERIA
Patients of suspected coronary artery disease presenting to general medicine department with following features among others:
a) Chest pain
b) syncope
c) shortness of breath
d) palpitations
e) Signs of heart failure
f) ECG, chest X-ray, echocardiography showing evidence of acute or chronic coronary artery disease with or without heart failure
EXCLUSION CRITERIA
Symptoms and mimicking coronary artery disease at first but later proved to be not coronary artery disease on subsequent investigations
1) PATIENTS LESS THAN 13 YEARS AGE
2) PATIENTS NOT WILLING TO GIVE CONSENT FOR THE STUDY
PROFORMA
SERIAL NO:
NAME:
AGE:
IP NO.:
EDUCATION:
OCCUPATION:
SOCIOECONOMIC STATUS:
PHONE NUMBER:
ADDRESS:
COMPLAINS
CHEST PAIN
SHORTNESS OF BREATH
EXCESSIVE SWEATING
PEDAL EDEMA
PALPITATIONS
GIDDINESS /SYNCOPE
OLIGURIA/ ANURIA
ALTERED SENOSORIUM
FEVER
COUGH
PAST HISTORY
Diabetes
Hypertension
Sepsis
CKD
Thyroid disorders
COPD
Epilepsy
Tubercilosis
GENERAL EXAMINATION
PALLOR
ICTERUS
CLUBBING
CYANOSIS
PERIPHERAL EDEMA LYMPHADENOPATHY
CAPILLARY REFILL TIME
WARM PERIPHERIES
BLOOD PRESSURE MONITORING/ MEAN ARTERIAL PRESSURE
PULSE RATE
PULSE PRESSURE
RESPIRATORY RATE
TEMPERATURE MONITORING
SATURATION
RESPIRATORY EXAMINATION
CENTRAL NERVOUS EXAMINATION
GASTROINTESTINAL SYSTEM:
CARDIOVASCULAR SYSTEM
INVESTIGATIONS
HEMOGRAM
COMPLETE URINE EXAMINATION
ECG
CHEST XRAY PA/AL VIEW
2D ECHO
TROP I
FASTING LIPID PROFILE
ERYTHROCYTE SEDIMENTATION RATE
C REACTIVE PROTEIN
RFT
LFT
ABG
OUTCOMES :
MORBIDITY AND MORTALITY
DURATION OF HOSPITAL STAY
REFERENCES
1. Erdmann J, Kessler T, munoz venegas L, schunkert H. A decade of genome wide association studies for coronary artery diseases: the challenges ahead. Cardiovasc Res. 2018 jul 14,114(9): 1241-1257. https: //doi.org/ 10.1093/ cvr/cvy084. PMID : 29617720
2.Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019 Jun;12(6):e005375. [PMC free article] [PubMed]
3. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P., American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018 Mar 20;137(12):e67-e492. [PubMed]
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