Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

Patients with Wellen’s syndrome often present with chest pain and found to have specific precordial T-wave changes on the electrocardiogram (ECG). They subsequently develop a large anterior wall myocardial infarction. These specific electrocardiographic abnormalities are associated with critical stenosis of the proximal left anterior descending coronary artery (LAD). This syndrome is often under-recognised and has fatal consequences; it is, therefore, also known as the widow maker. We highlight a case of a 39-year old gentleman who had a history of coronary artery disease and typical ECG characteristics of Wellen’s syndrome.
Electrocardiography ; chest pain

Introduction: Nicotine cravings and withdrawal symptoms are associated with higher rates ofrelapse. It has been shown that combining behavioral therapy and pharmacotherapy leads to ahigher long-term abstinence rate in those who quit smoking. Al-Quran recitation has been provento reduce anxiety among athletes before tournaments and pulse and heart rates among patientsawaiting cardiac operations. As most of the patients who wish to stop smoking experience highanxietystates, we postulate that Al-Quran recitation will also able to reduce craving among smokersattempting to quit smoking.Methods: Fifty smokers from an outpatient clinic were randomly assigned to control andintervention groups. They were taught different ways of coping with smoking urges, i.e., counselingusing the 12’M’ method (control group) versus Al-Quran recitation (intervention group). Theymet for four consecutive weeks of counselling and to fill out a withdrawal scale. Carbon monoxide(CO) levels were tested at baseline and at week 4. At week 12, the number of cigarettes smoked wasmeasured again. The decrease in the number of cigarettes considered to be clinically significant forthe calculation of sample size was based on expert opinionResults: The reduction in the number of cigarettes smoked was 7 cigarettes in the counsellinggroup and 9 cigarettes in Al-Quran recitation group over 12 weeks duration. There was astatistically significant difference in the number of cigarettes smoked between the groups. Therewas also a statistically significant difference in the change in cravings between the groups at week 4(p-value= 0.005). However, the difference in the changes in CO levels between the two groups wasnot statistically significant.Conclusion: Al-Quran recitation produced a statistically significant reduction in the numberof cigarettes smoked at week 12 and a significant change in cravings at week 4 among smokersattempting to quit. Difference in smoking abstinence rates was not measured in this study.