1.Discrepancy in blood pressure between the left and right arms - importance of clinical diagnosis and role of radiological imaging
Pei Xuan Kuan ; Pui Wen Tan ; Ahmad Tirmizi Jobli ; Norsila Abd Razak
The Medical Journal of Malaysia 2016;71(4):206-208
Introduction: Differences in systolic blood pressure reading
between arms are common but could signal trouble if the
discrepancy is significant. Early detection of aortic
dissection could invariably determine patient’s survivability.
Hence, a high index of suspicion with prompt diagnostic
imaging is vital for accurate diagnosis. Case Presentation: A
previously healthy 35-year-old lady was referred from
district hospital for hypertensive cardiomyopathy
complicated by acute pulmonary oedema. After being
admitted to the Intensive Care Unit, the mean arterial
pressure on the left arm was noted to be significant higher.
On physical examination, both lower limbs were dusky in
appearance because of poor perfusion. Investigations:
Computed Tomography Angiography showed extensive
arch and abdominal aorta dissection extending to the
proximal common carotid artery. There was distal abdominal
aorta thrombosis with partial left renal infarction.
Echocardiogram showed global hypokinesia, presence of
intimal flap, aortic regurgitation and mild pericardial
effusion. Supine chest X-ray showed apparent
cardiomegaly. Treatment: Repair of the ascending aortic
dissection and suspension of the aortic valve by the
cardiothoracic team on Day 2 of admission. The vascular
team did bilateral high above knee amputation on Day 9 of
admission. Outcome: Patient passed away on Day 10 of
admission. Discussion: With the absence of classical
features of aortic dissection, establishing the diagnosis can
be challenging and requires both good clinical judgment
and prompt radiological imaging, such that early treatment
can be initiated. Conclusion: A high index of suspicion and
good clinical judgment is needed in cases of significant
blood pressure discrepancy between arms.
Blood Pressure
2.Lifestyle factors associated with cardiovascular risk among healthcare workers from the tertiary hospitals in Sarawak
Kuan Pei Xuan ; Chan Weng Ken ; Chua Pin Fen ; John Yeo Jui Ping ; Fatin Ellisya Sapri ; Mohamad Adam Hj Bujang ; Asri Said
Malaysian Family Physician 2020;15(1):15-22
Introduction: A cross-sectional study is used to evaluate the lifestyle factors associated with
cardiovascular disease (CVD) risk among healthcare workers in tertiary hospitals in Sarawak, Malaysia.
Methods: A questionnaire-based survey using the Simple Lifestyle Indicator Questionnaire (SLIQ) was
administered to, and anthropometric measurements were collected from, 494 healthcare workers.
Results: Te mean age of the subjects was 32.4±8.4, with a range of 19 to 59 years. Te subjects were
from the allied health (45.5%), management and professional (25.1%) and executive (29.4%) felds.
Overall, 47.4% of the subjects were of normal weight, 30.2% were overweight, 17.2% were obese and
5.2% were underweight. Te mean number of working hours per week for the subjects was 47.6±14.0
with the highest working hours found among the management and professional group, followed by
the executive and allied health groups. Overall, 39.7% of the healthcare workers worked ofce hours,
36.6% worked within the shift system, 20.9% worked ofce hours and were on-call and the remaining
2.8% worked a mixture of ofce hours and shifts. Based on the SLIQ score, 58.1% were classifed as
at intermediate risk for CVD, 38.5% were in the healthy category and 3.4% were in the unhealthy
category. Factors associated with a healthier lifestyle were being female (Odds Ratio [OR]= 12.1; CI=
3.2- 46.4), professional (mean score= 6.70), in the allied health group (mean score=7.33) and in the
normal BMI group (OR= 9.3, CI= 1.8- 47.0).
Conclusion: In our study, healthcare workers had an intermediate risk of developing CVD in the
future. Tus, there is a need to intervene in the lifestyle factors contributing to CVD.