Background ST elevation myocardial infarction (STEMI) is an acute cardiac manifestation that requ... more Background ST elevation myocardial infarction (STEMI) is an acute cardiac manifestation that requires immediate revascularization preferably through primary percutaneous coronary intervention (PCI). This study aims to describe gender stratified outcomes and epidemiological profile of STEMI patients undergoing treatment at a tertiary care hospital in Karachi, Pakistan. Methods A 5-year, retrospective analysis of hospital records was undertaken on confirmed STEMI patients admitted between 2010 and 2014, undergoing primary PCI. Information was retrieved on demographic variables, risk factors, total ischemia time, door to balloon time, angiographic findings, and treatment strategy and in-hospital outcomes. Results A total of 603 patients were available for analysis. Mean age of the participants was 58 ± 11 years, with 78.6% being males. The most common risk factors were hypertension (48.1%), diabetes (37%), and smoking (22.2%). Gender stratified analysis revealed poorer clinical present...
Supplemental material, sj-pdf-1-aan-10.1177_02184923211027790 for Role of trans-radial band proto... more Supplemental material, sj-pdf-1-aan-10.1177_02184923211027790 for Role of trans-radial band protocols in radial artery occlusion: Randomized trial by Nasir Rahman, Azmina Artani, Farhala Baloch, Moiz Artani, Huma Fatima, Abdus Salam and Sher Ahmed in Asian Cardiovascular & Thoracic Annals
Supplemental material, sj-pdf-1-aan-10.1177_02184923211014001 for Sex-stratified outcomes of prim... more Supplemental material, sj-pdf-1-aan-10.1177_02184923211014001 for Sex-stratified outcomes of primary percutaneous coronary intervention: A tertiary care experience by Azmina Artani, Farhala Baloch, Abid Laghari, Faraz Siddiqui, Moiz Artani and Khawar Kazmi in Asian Cardiovascular and Thoracic Annals
Background Radial artery occlusion is a common complication of coronary angiography via radial ar... more Background Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital’s radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications. Methods This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The ...
ObjectivesThe COVID-19 pandemic has resulted in widespread morbidity and mortality with the conse... more ObjectivesThe COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives.DesignA list of outcomes important to patients and pro...
We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, p... more We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, pedal and periorbital swelling and lethargy for 1 month. Her initial electrocardiogram (ECG) raised the suspicious of a missed myocardial infarction but detailed workup confirm the diagnosis of multiple myeloma with cardiac amyloidosis. The case highlight the importance of considering differentials of various ECG pattern mimicking infarcts and correlating them clinically and with other diagnostic modalities.
ABSTRACT Introduction Transvenous pacemakers are used to temporarily pace heart in emergent situa... more ABSTRACT Introduction Transvenous pacemakers are used to temporarily pace heart in emergent situations. This study was conducted to analyze the current success rate of temporary pacemaker insertion in our institution and discover causes for failure to improve the technique. Methodology A retrospective cohort study was conducted of 263 patients from 2006 to 2016 who underwent TPM insertion at Aga Khan University Hospital, Karachi. Results The success rate for the procedure was 97.7%, with one mortality caused by the pacemaker. No significant risk factor was found for the failure of TPM. Conclusion There was no significant effect of anatomical site or technique on the failure of TPM insertion. However, with better training and higher experience of the residents, the complications and rate of failures can be reduced.
Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifesta... more Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients. Methods: It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at
Journal of the American College of Cardiology, 2018
Background: Radial artery occlusion (RAO) is a common post-procedure complication of Left Heart C... more Background: Radial artery occlusion (RAO) is a common post-procedure complication of Left Heart Catheterization (LHC). It is often ignored by the operator due to dual blood supply to the hand. Although clinically silent usually, RAO necessitate the need of monitoring radial artery for patency after the procedure. The objective of the study was to assess whether the protocol for removal of TR band after LHC at our institute is non-inferior to protocols developed internationally, in decreasing radial artery occlusion (RAO) after transradial catheterization Methods: It is a single center, outcome assessor blinded, non-inferiority, randomized control trial where allocation concealment was ensured using SNOSE technique. After determining eligibility and obtaining informed consent, 100 participants were randomized into two groups. Participants in group 1 received protocol A (3 ml of air deflated with interval of 15 mins beginning after 2 hours of the procedure) which is in current practice at our institution for TR band removal while participants in group 2 received protocol B (5 ml of air deflated with interval of 15 mins beginning after 2 hours of the procedure) which is developed by Cohen and Alfonso and is practiced by across the globe. The primary outcome was occurrence of RAO that was assessed at 24 hours using reverse Barbeau's test and duplex ultrasound. The secondary outcomes included occurrence of other vascular complications such as hematoma and bleeding after TR band removal Results: The mean age of the participants in the trial was 58.3±11.5 years while 63% of the participants were men. At baseline, the two groups had similar clinical and procedural characteristics. The rate of occurrence of RAO was not significantly different between the group receiving Protocol A and Protocol B (10% vs. 14%, p=0.491, respectively) at 24 hours. Also, incidences of hematoma and bleeding after TR band removal showed no difference in both groups, statistically Conclusion: TR band deflation and removal practice that allows 3 ml of air to be deflated with interval of 15 mins after 2 hours of the procedure is non-inferior to Cohen and Alfonso's protocol in the incidence of RAO after diagnostic, Left Heart Catheterization
Background The care of patients presenting with chest pain to multidisciplinary services hospital... more Background The care of patients presenting with chest pain to multidisciplinary services hospital gets compromised due to the busy triage system. A separate and specialized equipped cardiac emergency unit (CAR-ERU) can improve patient’s outcomes. Objectives To enhance early recognition and treatment of acute myocardial infarction (AMI) patients. To sustain key performance quality indicators (KPIs) for AMI. Methods In October 2016, a separate CAR-ERU was established inside the multidisciplinary emergency department (MED). A dedicated specialized heart-lung and vascular teams were hired under the supervision of service line leadership. The KPIs that were identified benchmark with international practice guidelines. Data were collected and stored for analysis. Exemption from the ethical review committee was obtained. Results A total of 2914 patients visited CAR-ERU from October 2016 to September 2017 for a period of one year. Out of which 30% were diagnosed with acute coronary syndrome ...
Suboptimal Cortisol Response (SCR) is an inadequate cortisol response in relation to the severity... more Suboptimal Cortisol Response (SCR) is an inadequate cortisol response in relation to the severity of illness. Also known as critical illness induced corticosteroid insufficiency, it is frequently observed in patients with septic shock. We describe two patients presented to us with sign and symptoms of heart failure. Up titration of diuretics dose was a big challenge to us due to the concomitant severe electrolyte imbalance likely due to altered hypothalamic pituitary axis leading to relative adrenal insufficiency. Random serum cortisol level was checked which was relatively low. Cortisol was replaced which helped us in normalizing serum electrolytes by correcting the SCR. Purpose of writing these two cases is to highlight the importance of SCR in decompensated heart failure, as the early diagnosis and treatment of this condition will help physicians in the better management of patients with heart failure.
Background ST elevation myocardial infarction (STEMI) is an acute cardiac manifestation that requ... more Background ST elevation myocardial infarction (STEMI) is an acute cardiac manifestation that requires immediate revascularization preferably through primary percutaneous coronary intervention (PCI). This study aims to describe gender stratified outcomes and epidemiological profile of STEMI patients undergoing treatment at a tertiary care hospital in Karachi, Pakistan. Methods A 5-year, retrospective analysis of hospital records was undertaken on confirmed STEMI patients admitted between 2010 and 2014, undergoing primary PCI. Information was retrieved on demographic variables, risk factors, total ischemia time, door to balloon time, angiographic findings, and treatment strategy and in-hospital outcomes. Results A total of 603 patients were available for analysis. Mean age of the participants was 58 ± 11 years, with 78.6% being males. The most common risk factors were hypertension (48.1%), diabetes (37%), and smoking (22.2%). Gender stratified analysis revealed poorer clinical present...
Supplemental material, sj-pdf-1-aan-10.1177_02184923211027790 for Role of trans-radial band proto... more Supplemental material, sj-pdf-1-aan-10.1177_02184923211027790 for Role of trans-radial band protocols in radial artery occlusion: Randomized trial by Nasir Rahman, Azmina Artani, Farhala Baloch, Moiz Artani, Huma Fatima, Abdus Salam and Sher Ahmed in Asian Cardiovascular & Thoracic Annals
Supplemental material, sj-pdf-1-aan-10.1177_02184923211014001 for Sex-stratified outcomes of prim... more Supplemental material, sj-pdf-1-aan-10.1177_02184923211014001 for Sex-stratified outcomes of primary percutaneous coronary intervention: A tertiary care experience by Azmina Artani, Farhala Baloch, Abid Laghari, Faraz Siddiqui, Moiz Artani and Khawar Kazmi in Asian Cardiovascular and Thoracic Annals
Background Radial artery occlusion is a common complication of coronary angiography via radial ar... more Background Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital’s radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications. Methods This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The ...
ObjectivesThe COVID-19 pandemic has resulted in widespread morbidity and mortality with the conse... more ObjectivesThe COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives.DesignA list of outcomes important to patients and pro...
We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, p... more We are presenting a case of 65 years old lady who presented in clinic with shortness of breath, pedal and periorbital swelling and lethargy for 1 month. Her initial electrocardiogram (ECG) raised the suspicious of a missed myocardial infarction but detailed workup confirm the diagnosis of multiple myeloma with cardiac amyloidosis. The case highlight the importance of considering differentials of various ECG pattern mimicking infarcts and correlating them clinically and with other diagnostic modalities.
ABSTRACT Introduction Transvenous pacemakers are used to temporarily pace heart in emergent situa... more ABSTRACT Introduction Transvenous pacemakers are used to temporarily pace heart in emergent situations. This study was conducted to analyze the current success rate of temporary pacemaker insertion in our institution and discover causes for failure to improve the technique. Methodology A retrospective cohort study was conducted of 263 patients from 2006 to 2016 who underwent TPM insertion at Aga Khan University Hospital, Karachi. Results The success rate for the procedure was 97.7%, with one mortality caused by the pacemaker. No significant risk factor was found for the failure of TPM. Conclusion There was no significant effect of anatomical site or technique on the failure of TPM insertion. However, with better training and higher experience of the residents, the complications and rate of failures can be reduced.
Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifesta... more Introduction: Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients. Methods: It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at
Journal of the American College of Cardiology, 2018
Background: Radial artery occlusion (RAO) is a common post-procedure complication of Left Heart C... more Background: Radial artery occlusion (RAO) is a common post-procedure complication of Left Heart Catheterization (LHC). It is often ignored by the operator due to dual blood supply to the hand. Although clinically silent usually, RAO necessitate the need of monitoring radial artery for patency after the procedure. The objective of the study was to assess whether the protocol for removal of TR band after LHC at our institute is non-inferior to protocols developed internationally, in decreasing radial artery occlusion (RAO) after transradial catheterization Methods: It is a single center, outcome assessor blinded, non-inferiority, randomized control trial where allocation concealment was ensured using SNOSE technique. After determining eligibility and obtaining informed consent, 100 participants were randomized into two groups. Participants in group 1 received protocol A (3 ml of air deflated with interval of 15 mins beginning after 2 hours of the procedure) which is in current practice at our institution for TR band removal while participants in group 2 received protocol B (5 ml of air deflated with interval of 15 mins beginning after 2 hours of the procedure) which is developed by Cohen and Alfonso and is practiced by across the globe. The primary outcome was occurrence of RAO that was assessed at 24 hours using reverse Barbeau's test and duplex ultrasound. The secondary outcomes included occurrence of other vascular complications such as hematoma and bleeding after TR band removal Results: The mean age of the participants in the trial was 58.3±11.5 years while 63% of the participants were men. At baseline, the two groups had similar clinical and procedural characteristics. The rate of occurrence of RAO was not significantly different between the group receiving Protocol A and Protocol B (10% vs. 14%, p=0.491, respectively) at 24 hours. Also, incidences of hematoma and bleeding after TR band removal showed no difference in both groups, statistically Conclusion: TR band deflation and removal practice that allows 3 ml of air to be deflated with interval of 15 mins after 2 hours of the procedure is non-inferior to Cohen and Alfonso's protocol in the incidence of RAO after diagnostic, Left Heart Catheterization
Background The care of patients presenting with chest pain to multidisciplinary services hospital... more Background The care of patients presenting with chest pain to multidisciplinary services hospital gets compromised due to the busy triage system. A separate and specialized equipped cardiac emergency unit (CAR-ERU) can improve patient’s outcomes. Objectives To enhance early recognition and treatment of acute myocardial infarction (AMI) patients. To sustain key performance quality indicators (KPIs) for AMI. Methods In October 2016, a separate CAR-ERU was established inside the multidisciplinary emergency department (MED). A dedicated specialized heart-lung and vascular teams were hired under the supervision of service line leadership. The KPIs that were identified benchmark with international practice guidelines. Data were collected and stored for analysis. Exemption from the ethical review committee was obtained. Results A total of 2914 patients visited CAR-ERU from October 2016 to September 2017 for a period of one year. Out of which 30% were diagnosed with acute coronary syndrome ...
Suboptimal Cortisol Response (SCR) is an inadequate cortisol response in relation to the severity... more Suboptimal Cortisol Response (SCR) is an inadequate cortisol response in relation to the severity of illness. Also known as critical illness induced corticosteroid insufficiency, it is frequently observed in patients with septic shock. We describe two patients presented to us with sign and symptoms of heart failure. Up titration of diuretics dose was a big challenge to us due to the concomitant severe electrolyte imbalance likely due to altered hypothalamic pituitary axis leading to relative adrenal insufficiency. Random serum cortisol level was checked which was relatively low. Cortisol was replaced which helped us in normalizing serum electrolytes by correcting the SCR. Purpose of writing these two cases is to highlight the importance of SCR in decompensated heart failure, as the early diagnosis and treatment of this condition will help physicians in the better management of patients with heart failure.
Uploads
Papers by Farhala Baloch