Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare and serious congenital coronary anomaly typically identified in infancy. This case report details an unusual presentation of ALCAPA in a 49-year-old female who initially appeared as a routine case of anterior wall myocardial infarction (MI) complicated by symptom-free congestive heart failure. Advanced imaging revealed the anomalous origin of the left anterior descending artery from the pulmonary artery, confirming the diagnosis. While surgical correction is strongly recommended by the American Heart Association (AHA) guidelines, the patient opted for conservative management. This case underscores the importance of maintaining a high index of suspicion for congenital coronary anomalies in adult patients presenting with unexplained ischemic events. It also emphasizes the critical role of advanced imaging in ensuring accurate diagnosis and guiding appropriate management strategies.

Objectives: Nomophobia, the fear of being disconnected from mobile communication, is increasingly recognized as a precursor to digital addiction worldwide. As technological advancements introduce novel addictive behaviors akin to traditional substance dependencies, this study investigates the prevalence of nomophobia among healthcare workers (HCWs) at a tertiary care hospital in Karachi, Pakistan, and its association with digital addiction. Methodology: A descriptive cross-sectional study was conducted with 171 HCWs at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, selected via convenience sampling. Participants, diverse in age, gender, and profession, completed two validated tools: the 20-item Nomophobia Questionnaire (NMP-Q) to measure nomophobia severity and the 10-item Smartphone Addiction Scale-Short Version (SAS-SV) to assess digital addiction. Data on demographics (age, gender, profession, hospital affiliation) and daily smartphone usage were also collected to explore influencing factors. Results: The study enrolled 171 HCWs with a mean age of 33.7 ± 4.3 years; 34 (19.9%) were under 30 years, and 108 (63.2%) were male. Professional roles included nurses (70, 40.9%), operation theater technicians (30, 17.5%), cardiac perfusionists (20, 11.7%), and anesthesia technicians (15, 8.8%), among others. Severe nomophobia was prevalent in 136 participants (79.5%), while 75 (43.9%) exhibited severe smartphone addiction. Statistical analysis revealed a significant correlation between nomophobia and digital addiction (p < 0.001). Conclusion: This study reveals a high burden of severe nomophobia and smartphone addiction among HCWs, with a strong association between the two. These findings underscore the urgent need for targeted interventions to mitigate digital dependency in healthcare settings, particularly in the context of an increasingly digitalized workforce.

Objectives: To investigate the association between serum potassium and magnesium imbalances and adverse in-hospital outcomes, including morbidity and mortality, in patients with new-onset atrial fibrillation (AF). Methodology: This cross-sectional study was conducted at the Department of Cardiology, Khyber Teaching Hospital, Peshawar, from October 2021 to September 2022. Serum potassium and magnesium levels were measured at admission in patients diagnosed with new-onset AF. Clinical outcomes, including heart failure, thromboembolism, major bleeding, and in-hospital mortality, were recorded and analyzed. Results: A total of 270 patients were enrolled, with a predominance of females (61.1%). The median age was 60 years (IQR: 20), and most patients (60.0%) were between 51 and 80 years old. Hypokalemia was present in 17% (n=46), while hypomagnesemia occurred in 14.8% (n=40). Hypokalemia showed significant associations with heart failure (p=0.011), transient ischemic attack (p<0.001), non-ST-segment elevation myocardial infarction (NSTEMI) (p<0.001), sustained ventricular tachycardia (p=0.019), and ventricular fibrillation (p=0.001). Mortality was significantly higher in hypokalemic patients (6.5%) compared to those with normokalemia (0.5%) (p=0.008). Magnesium imbalance was significantly linked with ST-segment elevation myocardial infarction (STEMI) (p=0.001) and ventricular fibrillation (p=0.009). The overall in-hospital mortality was 1.5%, with hypokalemia identified as a significant contributing factor. Conclusion: Hypokalemia markedly increases the risk of adverse in-hospital outcomes, including morbidity and mortality, among patients with new-onset AF. Magnesium imbalance also contributes to severe cardiac events. Early detection and correction of these electrolyte disturbances are essential for optimizing clinical management of AF patients.

Objectives: This study aims to identify and describe the patterns of coronary artery occlusion in patients with acute coronary syndrome (ACS) undergoing coronary angiography, with a particular focus on the association of traditional cardiovascular risk factors with disease severity. Methodology: This descriptive, cross-sectional study included 174 ACS patients who underwent coronary angiography between December 30, 2020, and June 30, 2021, at Hayatabad Medical Complex. Patient demographics, clinical presentations, and angiographic findings were systematically analyzed. Statistical analysis, including chi-square tests, was performed to explore associations, with significance set at p<0.05. Results: The mean age of the study population was 57.4 years, with 70.1% male and 29.9% female participants. Single vessel disease (SVD) was the most common coronary artery pattern, present in 43.7% of patients, followed by double vessel disease (DVD) in 33.3% and triple vessel disease (TVD) in 23.0%. The left anterior descending (LAD) artery was most frequently involved, accounting for 58.6% of cases, followed by the right coronary artery (RCA) in 35.1% and the left circumflex artery (LCx) in 25.9%. Significant associations were found between traditional cardiovascular risk factors—hypertension, diabetes, and smoking—and more severe disease, highlighting their role in disease progression. Conclusion: Single vessel disease, particularly involving the LAD artery, emerged as the predominant pattern of coronary occlusion among ACS patients in this study. The strong association of hypertension, diabetes, and smoking with increased disease severity underscores the importance of early and targeted interventions, such as blood pressure control, smoking cessation, and diabetes management, to improve clinical outcomes and reduce the burden of coronary artery disease.

Objectives: This study aimed to identify risk factors and predictors of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) treated at Hayatabad Medical Complex, Peshawar. Methodology: A retrospective cohort analysis was performed on 150 ARVC patients diagnosed between January 2019 and June 2024. Key variables included electrocardiographic findings (e.g., T-wave inversions), NT-proBNP levels, genetic mutations (PKP2, DSP), and echocardiographic parameters. Predictors were assessed using univariate and multivariate Cox proportional hazards models. Results: The mean age of the cohort was 45 years, with 60% male. Significant predictors of VT included older age (HR 1.05, p<0.001), male gender (HR 1.75, p=0.002), T-wave inversions on ECG (HR 2.15, p<0.001), and elevated NT-proBNP levels (HR 1.01 per 100 pg/ml increase, p=0.005). During follow-up, 30% of patients experienced VT, 20% developed sustained ventricular arrhythmias, and 10% mortality was observed. Conclusion: Age, male gender, T-wave inversions, and elevated NT-proBNP levels were identified as significant predictors of VT in ARVC patients. These findings highlight the critical role of biomarker testing and electrocardiographic monitoring in improving risk stratification and management for ARVC, particularly in resource-constrained settings.

Objectives: To assess the utility of the PADIT score in identifying patients at higher risk of developing CIED-related infections within a six-month follow-up period at a tertiary academic medical center. Methodology: This prospective, descriptive, single-center study enrolled 168 consecutive adult patients who underwent pacemaker, implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy defibrillator/pacemaker (CRT-D/CRT-P) placement or generator renewal between June and December 2023 at a tertiary medical center in Pakistan. The primary outcome was hospital admission due to confirmed CIED or pocket infection within six months post-implantation. Results: The study analyzed data from 168 patients (mean age: 64.6 ± 14.43 years; 50.7% male, 49.3% female), revealing a generally low prevalence of pre-existing risk factors. The mean PADIT (Prevention of Arrhythmia Device Infection Trial) score was 1.18 ± 1.65, indicating a predominantly low-risk profile. Three patients (1.7%) developed CIED infections, and only one of these cases was classified as high-risk with a PADIT score >7. The score demonstrated poor predictive performance, with a C-statistic of 0.413 (95% CI). Conclusion: The PADIT score did not effectively identify patients at increased risk of CIED-related infections within a six-month follow-up in this single-center prospective study. Further research may be needed to explore additional risk factors and improve risk stratification models for this patient population.

Objectives: This study aimed to compare the efficacy of intracoronary verapamil versus adenosine in managing the no-reflow phenomenon in normotensive patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methodology: We conducted a prospective observational study at Hayatabad Medical Complex Peshawar from March 2023 to March 2024. A total of 150 normotensive ACS patients scheduled for PCI were enrolled and treated with either intracoronary verapamil (200 µg) or adenosine (48 µg) based on the clinical judgment of the treating cardiologist upon identifying the no-reflow phenomenon. The primary outcomes included improvements in myocardial perfusion, assessed by the achievement of TIMI III flow immediately and at 30 minutes via angiographic analysis. Secondary outcomes assessed were microvascular resistance (IMR), endothelial function (FMD), and the incidence of major adverse cardiac events (MACE) within six months. Results: The verapamil group exhibited a higher percentage of patients achieving TIMI III flow post-treatment compared to the adenosine group (92% vs. 78%, p = 0.03). Both treatment groups demonstrated reductions in IMR (verapamil: 18.5 ± 2.8 units; adenosine: 19.1 ± 3.1 units, p = 0.29) and improvements in FMD (verapamil: 4.1 ± 0.5%; adenosine: 3.9 ± 0.6%, p = 0.15). The incidence of MACE was 18% in the verapamil group and 8% in the adenosine group, indicating comparable safety profiles for both agents. Conclusion: Intracoronary verapamil and adenosine both effectively enhance myocardial perfusion and endothelial function in normotensive ACS patients following PCI. Verapamil showed a slight advantage in achieving TIMI III flow and reducing microvascular resistance, suggesting it may offer superior benefits in specific clinical scenarios. These results support the use of both agents in managing the no-reflow phenomenon, with potential preference for verapamil in particular contexts.