Vol 41 # 3 September 2009 - Kma.org.kw

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September 2009 KUWAIT MEDICAL JOURNAL 221 REFERENCES 1. Zoll PM, Zoll RH, Falk RH, Clinton JE, Eitel DR, Antman EM. External noninvasive temporary cardiac pacing: clinical trials. Circulation 1985; 71: 937-944. 2. Feldman MD, Zoll PM, Aroesty JM, Gervino EV, Pasternak RC, McKay RG. Hemodynamic response to noninvasive external cardiac pacing. Am J Med 1988; 84: 395-400. 3. Cummins RO, Graves JR, Larsen MP, et al. Out of hospital transcutaneous pacing by emergency medical technicians in patients with asystolic cardiac arrest. N Engl J Med 1993; 328:1377-1382. 4. Falk RH, Zoll PM, Zoll RH. Safety and efficacy of noninvasive cardiac pacing. A preliminary report. N Engl J Med 1983; 309:1166-1168. 5. Jaggarao NS, Heber M, Grainger R, Vincent R, Chamerlain DA, Aronson AL. Use of an automated external defibrillator-pacemaker by ambulance staff. Lancet 1982; 2:73-75. 6. Cummins R, Graves J, Larsen MP, Horan S, Ciliberti J. Prehospital transcutaneous pacing of significant bradycardias by paramedics: clinical and system effectiveness. Prehosp Disaster Med 1989; 4: 70. 7. Cummins RO, Haulman J, Quan L, Graves JR, Peterson D, Horan S. Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments. Ann Emerg Med 1990; 19:38-43. 8. Madsen JK, Meibom J, Videbak R, Pedersen F, Grande P. Transcutaneous pacing: experience with Zoll noninvasive temporary pacemaker. Am Heart J 1988; 116:7-10. 9. Rosenthal E, Thomas N, Quinn E, Chamberlain D, Vincent R. Transcutaneous pacing for cardiac emergencies. Pacing Clin Electrophysiol 1988; 11:2160- 2167. 10. Vukov LF, White RD. External transcutaneous pacemakers in prehospital cardiac arrest. Ann Emerg Med 1988; 17:554-555. 11. White JM, Nowak RM, Martin GB, Best R, Carden DL, Tomlanovich MC. Immediate emergency department external cardiac pacing for prehospital bradyasystolic arrest. Ann Emerg Med 1985; 14:298-302. 12. Eitel DR, Guzzardi LJ, Stein SE, Drawbaugh RE, Hess DR, Walton SL. Noninvasive transcutaneous cardiac pacing in prehospital cardiac arrest. Ann Emerg Med 1987; 16:531-534. 13. Cummins RO, Stults KR, Haggar B, Kerber RE, Schaeffer S, Brown DD. A new rhythm library for testing automatic external defibrillators: performance of three devices. J Am Coll Cardiol 1988; 11:597-602. 14. Peterson J, Heller MB, Kaplan RM, Paris PM, Ilkanipour K, Stewart RD. Comparison of performance of five transcutaneous pacing devices. Ann Emerg Med 1987; 16:493. 15. Niemann JT, Haynes KS, Garner D, Rennie CJ 3rd, Jagels G, Stormo O. Post-countershock pulseless rhythms: response to CPR, artificial cardiac pacing, and adrenergic agonists. Ann Emerg Med 1986; 15:112-120. 16. Hedges JR, Syverud SA, Dalsey WC. Developments in transcutaneous and transthoracic pacing during bradyasystolic arrest. Ann Emerg Med 1984; 13:822- 827. 17. Zoll PM, Zoll RH. Noninvasive temporary cardiac stimulation. Crit Care Med 1985; 13:925-926. 18. Syverud S. Cardiac pacing. Emerg Med Clin North Am 1988; 6:197-215. 19. Clinton JE, Zoll PM, Zoll R, Ruiz E. Emergency noninvasive external cardiac pacing. J Emerg Med 1985; 2:155-162. 20. Niemann JT, Rosborough JP, Garner D, Aronson AL, Criley JM. External non-invasive cardiac pacing: a comparative haemodynamic study of two techniques with conventional endocardial pacing. Pacing Clin Electrophysiol 1984; 7:230-236. 21. Murdock DK, Moran JF, Speranza D, Loeb HS, Scanlon PJ. Augmentation of cardiac output by external cardiac pacing: pacemaker-induced CPR. Pacing Clin Electrophysiol 1986; 9:127-129. 22. Holger JS, Minnigan HJ, Lamon RP, Gornick CC. The utility of ultrasound to determine ventricular capture in external cardiac pacing. Am J Emerg Med 2001; 19:134-136. 23. Pride HB, McKinley DF. Third- degree burns from the use of an external cardiac pacing device. Crit Care Med 1990; 18:572-573. 24. Barthell E, Troiano P, Stueven HA, Schwartz J, Thompson B. Successful resuscitation using transcutaneous cardiac pacing. Resuscitation 1987; 15:209-216. 25. Madsen JK, Pedersen F, Grande P, Meibom J. Normal myocardial enzymes and normal echocardiographic findings during noninvasive transcutaneous pacing. Pacing Clin Electrophysiol 1988; 11:1188-1193.
222 KUWAIT MEDICAL JOURNAL September 2009 Original Article Clinical Characteristics and Outcome of Acute Decompensated Heart Failure (ADHF) Patients in Adan Hospital, Kuwait Mustafa Ridha, Ihab Hamdy, Amin AlSayed, Boby Cherian, Sathyan H Cherian Department of Internal Medicine, Cardiac Unit, Adan Hospital, Ministry of Health, Kuwait Kuwait Medical Journal 2009; 41 (3): 222-225 ABSTRACT Objectives: To determine the prevalence of acute decompensated heart failure (ADHF) among the acute medical admissions in Adan Hospital, Kuwait, and describe their clinical characteristics and in-hospital mortality Design: Prospective study Setting: Medical wards and coronary care unit at Adan Hospital, Kuwait Subjects: All adult patients admitted from 18 th of September to 17 th of November 2008 with the diagnosis of ADHF Intervention: Echocardiography Main Outcome Measures: Determination of the prevalence of ADHF among medical admissions, their clinical features, and their in-hospital mortality. Results: The prevalence of ADHF was 14.5%. The mean age of our patients was 60.3 ± 13.2 years. There was a male preponderance (71.8 Vs 28.2%). There was a high percentage of co-morbidities among our patients. The average length of stay was 8.5 days. The in-hospital mortality was 4.9%. Betablocker use was relatively less than other studies. 88.5% patients had echocardiography done and 47.3% of them had preserved left ventricular ejection fraction (LVEF > 45%). Conclusion: The clinical profile of this sample of ADHF reported from Kuwait is different from that observed in other clinical studies. These findings might have implications in the need for a nationwide database for future investigation and comparison. KEY WORDS: acute decompensation, heart failure, prevalence INTRODUCTION Acute heart failure is defined as the rapid onset of signs and symptoms secondary to abnormal cardiac function. It may occur with or without previous cardiac disease. The cardiac dysfunction can be related to systolic or diastolic dysfunction, to abnormalities in cardiac rhythm, or to preload and afterload mismatch [1,2] . The patients with acute heart failure may present with one of several distinct clinical conditions as acute decompensated heart failure (ADHF) (either de-novo or as decompensation of chronic heart failure), hypertensive heart failure, severe pulmonary edema, cardiogenic shock, highoutput heart failure, or right sided heart failure [2] . Heart failure is one of the most important causes of mortality and morbidity in the industrialized world [3] . The prevalence of symptomatic heart failure is estimated to range from 0.4 - 2% in the general European population [4] . Very limited information is available on the characteristics and outcomes of ADHF patients in Kuwait. The aim of the present study was to identify the magnitude of the problem and to clarify the clinical features and the care given to this category of patients and to study their in-hospital outcome at Adan Hospital, Kuwait during two consecutive months. PATIENTS AND METHODS The study population consisted of patients in whom the diagnosis of ADHF was made by the patient’s medical team, and who were admitted through the emergency department at Adan hospital to either the coronary care unit (CCU), or directly to the medical ward in the period from September 18 to November 17 of 2008. The final diagnosis of ADHF was based on the criteria derived from the executive summary of the guidelines on the diagnosis and treatment of acute heart failure - The Task Force on Acute Heart Failure of the European Society of Cardiology [2] . The clinical features, hospital course, and echocardiographic findings were described and compared. Standard echocardiographic techniques were used by an experienced cardiologist and the left ventricular ejection fraction (LVEF) was recorded. Preserved LVEF was defined as those patients with LVEF > 45% by M–Mode echocardiography Address correspondence to: Dr Mustafa Ridha, Department of Internal Medicine, Cardiac Unit, Adan Hospital, Ministry of Health, Kuwait. ridha3@hotmail.com
Page 1 and 2: VOLUME 41 NUMBER 3 KMJ KUWAIT MEDIC
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Page 9 and 10: 186 Swine-origin Influenza A (H1N1)
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Page 29 and 30: 206 Evaluation of Dermatology Resid
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Page 35 and 36: 212 Mode of Detection of Transvenou
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Page 51 and 52: 228 Blunt and Penetrating Thoracic
Page 55 and 56: 232 Small Bowel Tumors: Insidious a
Page 57 and 58: 234 Small Bowel Tumors: Insidious a
Page 61 and 62: 238 Clinical and Radiological Aspec
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Page 67 and 68: 244 Acquired Hemophilia in a Child:
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Page 79 and 80: 256 Urosepsis Simulating Congenital
Page 81 and 82: 258 Rituximab in Severe Refractory
Page 83 and 84: 260 Rituximab in Severe Refractory
Page 85 and 86: 262 Selected Abstracts of Articles
Page 87 and 88: 264 Selected Abstracts of Articles
Page 89 and 90: 266 Forthcoming Conferences and Mee
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272 KUWAIT MEDICAL JOURNAL Septembe
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274 WHO-Facts Sheet September 2009
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