Background and aims: GIT bleeding is the most common serious complication results from the use of long term antiplatelets. ESC DAPT guidelines 2017 recommend the use of proton pump inhibitors (PPI) with dual antiplatelet (DAPT) as a class 1B recommendation. Our audit aims to ensure that our practice is parallel to the international standard.

Methods: We prospectively audited 18 patients admitted to NHS hospital in England with ACS (STEMI, NSTE-ACS) for six weeks from 05/02/2018-12/03/2018. As a result, we introduce our new ACS patient's safety discharge summary checklist, team education; developed a reminder message appears on the electronic prescription system to consider PPI whenever DAPT are prescribed. One year after implementing the changes, we re-audit our action plan. We used the same methodology; we prospectively audited 26 patients admitted with ACS 04/02/2019-01/03/2019. Results: Total number of patients 18 (N=18), Males 9, females 9, 3 of 18 no PPI prescribed (16.66 %). 83.33% (15/18) patients with DAPT had a PPI prescribed on discharge. On re-auditing, the total number of patients 26 (N=26). Only 1 of 26 no PPI prescribed (3.85%). So the compliance rose to 96.15% (25/26). There were no clear contraindications for PPI prescription for those who did not have their PPI prescribed.

Conclusion: Our steps to minimise the number of patients discharged without having PPI prescribed were successful in improving compliance significantly. Therefore we would recommend to our colleagues over the globe to consider similar steps to ensure patients safety; they are simple, easy to use, and useful.

Background and aims: GIT bleeding is the most common serious complication results from the use of long term antiplatelets. ESC DAPT guidelines 2017 recommend the use of proton pump inhibitors (PPI) with dual antiplatelet (DAPT) as a class 1B recommendation. Our audit aims to ensure that our practice is parallel to the international standard.

Methods: We prospectively audited 18 patients admitted to NHS hospital in England with ACS (STEMI, NSTE-ACS) for six weeks from 05/02/2018-12/03/2018. As a result, we introduce our new ACS patient's safety discharge summary checklist, team education; developed a reminder message appears on the electronic prescription system to consider PPI whenever DAPT are prescribed. One year after implementing the changes, we re-audit our action plan. We used the same methodology; we prospectively audited 26 patients admitted with ACS 04/02/2019-01/03/2019. Results: Total number of patients 18 (N=18), Males 9, females 9, 3 of 18 no PPI prescribed (16.66 %). 83.33% (15/18) patients with DAPT had a PPI prescribed on discharge. On re-auditing, the total number of patients 26 (N=26). Only 1 of 26 no PPI prescribed (3.85%). So the compliance rose to 96.15% (25/26). There were no clear contraindications for PPI prescription for those who did not have their PPI prescribed.

Conclusion: Our steps to minimise the number of patients discharged without having PPI prescribed were successful in improving compliance significantly. Therefore we would recommend to our colleagues over the globe to consider similar steps to ensure patients safety; they are simple, easy to use, and useful.

Heart failure (HF) is a progressive process and gradually remodels heart tissue. In this course, we previously documented “predominant myocardial LV base and diminished regional LV basal cavity volume in LVH using real-time three dimensional imaging and predominant septal wall with blunted systolic regional function in myocardial performance analysis compared to free wall documenting that the importance of regional morphologic as well as functional features in remodeling process of heart failure. We also used exercise in hypertensive individuals as the external stressor using combined tissue analysis and exercise stress test to evaluate their adaptation and determine blood pressure and heart rate increase under stress for rate-pressure product representing hyperfunctional myocardial energetics in the early stage disease.

To test and validate our clinical findings, we have planned microimaging studies. Therefore, we have detected ”focal hypertrophy of LV septal base (basal septal hypertrophy, BSH) is the early imaging biomarker of pressure-overload stress leading to heart failure.”  Very recently, we have validated BSH with HYPERFUNCTION by a small animal study using 3 ^rd generation microscopic ultrasound. ^1,2  As the conclusion, early imaging biomarker, “BSH may support to early diagnosis of remodeling and effective medical therapy in a timely fashion.”

Background: An early diagnosis of myocardial infarction is highly important in the emergency department (ED). It facilitates rapid decision making and treatment and therefore improves the outcome in patients presenting with symptoms of chest pain.

Aims and Objectives: To study diagnostic utility of new point of care high sensitive troponin-I assay in early diagnosis of acute myocardial infarction in patients presenting with acute chest pain.

Material and Methods: Forty six consecutive patients of acute onset chest pain who presented to our cardiac emergency department within three hours of symptom onset were enrolled for study.POC Hs Trop-I test was done on admission (0 hour), and after 3 hours if initial test result was negative. Quantitative troponin I (Q-Trop I) lab assay was done on admission (0 hour), 3 hours and 6 hours after admission. Six hour Q-Trop I assay was taken as gold standard for the initial diagnosis of AMI. The final adjudicated diagnosis of AMI was based on a composite of ECG changes (new ST segment or T wave changes, new onset LBBB), Troponin results, Echocardiography (new wall motion abnormality), angiographic findings (detection of a culprit lesion) and final chart review of observations made.

Results: Comparing the results of POC Hs Trop I results at 0 hour with the gold standard test we found the sensitivity of 97%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 92.3%. Sensitivity of POC Hs Trop I at 3 hours was better than POC Hs Trop I at 0 hour (97 vs. 100%) and equal to gold standard i.e. 100 %.Specificity, PPV and NPV are 100% for POC Hs Trop I at 1 hour.

Conclusion: High sensitive Trop I test is rapid and reliable method to diagnose and exclude acute myocardial infarction in patients presenting with acute onset chest pain to our Emergency Departments.

Ogilvie’s syndrome is a non-mechanical, acute pseudo-obstruction of the colon, causing massive colonic dilation. Medical or surgical conditions can predispose patients to Ogilvie’s syndrome; however, the pathogenesis and clinical findings are still not well understood. Here, we present a case of a 48-year-old male patient who presented to the Emergency Department with intermittent self-resolved left-sided lower chest pain on a background of ischaemic heart disease and positive risk factors for acute coronary syndrome. Troponin testing was negative and an electrocardiogram showed no acute changes. Chest radiography showed a dilated bowel under the left hemidiaphragm and a computed tomography (CT) scan of the abdomen-pelvis confirmed the diagnosis of Ogilvie’s syndrome. The patient was treated conservatively with a short period of nil by mouth and intravenous fluids. From this case there are many learning points as non-cardiac causes of chest pain should be always considered even in patients with previous cardiac history, especially those patients for whom there is no evidence to support recurrent cardiac ischaemia. Acute colonic pseudo-obstruction (Ogilvie’s syndrome) can be presented as chest pain that mimics angina pectoris. Chest radiography is of great value in cases of acute chest pain; a dilated bowel segment can be the only finding of Ogilvie’s syndrome in the initial assessment.

Background: Heart failure places a significant burden on the patients and the health system worldwide. However, information about its burden in Low-income countries is scant. Witnessing a lack of adherence to heart failure guidelines amongst physicians in our environment prompted this study. The main objective is to determine physician adherence to ESC pharmacotherapy guidelines in heart failure in an economically resource-poor tertiary health facility.

Method: Review the prescription pattern of Neurohormonal blocker agent of 102 confirmed heart failure with reducing LVEF was carried out. Data from adherence evaluation were obtained from follow up information form outpatient clinic notes, while data on acute care medication and precipitating factors were from inpatient hospitalization notes.

Result: Heart failure (HFrEF) patients aged 59.03 ± 15.15 years, had NYHA III/IV symptoms (44.1%) and remain hypertension (21.5%), mean LVEF was 30.60± 7.14. hypertension and diabetes were predominant comorbidities, Etiology of heart failure was ICM (50%), Pharmacotherapy average three drug classes and consisted of ACEI/ARB (86.3%), Beta-blocker (50%), and MRA (32.24%) respectively. The use of Beta-blocker and MRA tents to be suboptimal. Combination pharmacotherapy: ACEI/ARB+BB (42.1%), ACEI/ARB+MRA (23.5%), BB+MRA (15.7%), three classes combination (18.7%). Target dose achievement ACEI (1.5%), beta-blockers, and MRA were not. the prescribing dosages were lower than the doses recommended by the guideline Most of the patients were prescribed starting doses in accordance with the guidelines: ACEI- 5mg/d (62.1%), BB-6,25mg/d (72.5%), MRA-25mg/d (97%). However, the maximum dose in this study was low: ACEI (40 mg/d), Beta-blocker (25mg/d), MRA (25mg/d).

Conclusion: As in the other country of the world nonadherence to guideline substantial problem in Laos. Our data confirm the need for a dedicated heart failure treatment program to optimize heart failure outcomes in a low resource environment. Our physicians will benefit from a structured heart failure education and feedback program. Better strategies for heart failure surveillance and management in Laos are need.