Defining the hemodynamic response of hypertensive and normotensive subjects through serial timed blood pressure readings in the clinic.

Background: Every third patient in the clinic is misdiagnosed due to white-coat phenomenon, necessitating needless and costly treatment. We aimed to study the hemodynamic response of the physician's visit on hypertensive and normotensive patients by investigating the trend of blood pressure (BP) before, during and 15 min after the physician-patient encounter.

Methods: A descriptive, cross-sectional study was conducted over a period of 8 months in the cardiology clinics at the Aga Khan University Hospital, Karachi.

Are BP readings taken after a patient-physician encounter in a real-world clinic scenario the lowest of all the readings in a clinic visit.

Objective: To determine the difference in Blood Pressure (BP) readings taken before, during and after the clinic encounter.

Study Design: Descriptive study.

Place And Duration Of Study: Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013.

QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction.

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.

Study Design: A cross-sectional study.

Place And Duration Of Study: The Aga Khan University, Karachi, from June to September 2007.

Congenital absence of left circumflex artery with a dominant right coronary artery.

Case 1: a 40-year-old man was admitted to our hospital with progressively worsening post myocardial infarction angina. Cardiac catheterisation was performed, which showed total occlusion of the left anterior descending artery (LAD) and the left circumflex artery (LCX) was not visualised. The right coronary artery (RCA) was a large artery supplying the left ventricular inferior and posterolateral walls and filling the LAD artery in retrograde.

Extra [corrected] pulmonary uptake of Tc-99m-MAA perfusion lung scan as a result of right to left intra cardiac shunt.

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin (MAA) is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients. It occurs when the agent bypasses the lungs due to a right to left (R-L) cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size. When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt.