A 62-year-old male who is on maintenance hemodialysis for end-stage renal disease presented with sudden onset weakness of bilateral lower limbs, confusion, and disorientation overnight. Investigations revealed methicillin-resistant staphylococcus aureus in the blood culture and echocardiographic features suggestive of infective endocarditis. Imaging of brain revealed bilateral watershed infarcts in various sites.
{"title":"Bilateral watershed infarcts in infective endocarditis","authors":"Soumya Sathyan, N. Abdul Kharim","doi":"10.4103/jicc.jicc_46_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_46_20","url":null,"abstract":"A 62-year-old male who is on maintenance hemodialysis for end-stage renal disease presented with sudden onset weakness of bilateral lower limbs, confusion, and disorientation overnight. Investigations revealed methicillin-resistant staphylococcus aureus in the blood culture and echocardiographic features suggestive of infective endocarditis. Imaging of brain revealed bilateral watershed infarcts in various sites.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"10 1","pages":"137 - 138"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82641610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fazila-tun-nesa Malik, M. Kalimuddin, N. Ahmed, M. Badiuzzaman, A. Khan, Ashok Dutta, T. Huq, D. Banik, M. Ahmed, M. Rahman, Md Tareq Iqbal
Background: The presence of calcified lesions in chronic kidney disease (CKD) patients adversely affects the outcomes of percutaneous coronary interventions (PCIs). Lesion modification using rotational atherectomy (RA) followed by drug-eluting stent (DES) implantation may, therefore, be a suitable strategy to treat heavily calcified coronary lesions in CKD patients. Aim: The aim of the study was to compare the effectiveness and safety of PCI using RA and new-generation DES for treating calcified coronary lesions in patients with mild versus moderate-to-severe CKD. Methods: This was a single-center, retrospective study. Data were collected from the medical records of all CKD patients with calcified coronary artery lesions who underwent RA + DES implantation from November 2014 to October 2019. The primary outcomes were the rates of in-stent restenosis (ISR), repeat revascularization (RR), and major adverse cardiovascular and cerebrovascular events. Secondary outcomes included procedural success, death after intervention, and procedural/in-hospital complications. Results: A total of 77 and 126 patients with mild and moderate-to-severe CKD were treated with RA + DES. Patients with moderate-to-severe CKD were significantly older when compared to patients with mild CKD (mean age: 66.6 ± 8.2 vs. 59.5 ± 7.7 years, respectively, P < 0.0001). Body mass index was significantly lower in moderate-to-severe CKD group compared to the mild CKD group. The number of patients in whom postdilatation was performed after stent implantation was significantly higher in the moderate-to-severe CKD group compared to the mild CKD group (100% vs. 96%, P = 0.025). Overall procedural success was 97.5% with minimal periprocedural complications. The rates of ISR and RR were not significantly different between patients with mild and moderate-to-severe CKD. The two groups did not differ significantly in terms of procedural success, postprocedural complications, and procedural mortality. Conclusion: RA followed by DES implantation is an effective and safe strategy to treat calcified coronary artery lesions in patients with CKD, regardless of the degree of renal dysfunction.
背景:慢性肾脏疾病(CKD)患者存在钙化病变会对经皮冠状动脉介入治疗(pci)的结果产生不利影响。因此，使用旋转动脉粥样硬化切除术(RA)和药物洗脱支架(DES)植入来改变病变可能是治疗CKD患者重度钙化冠状动脉病变的合适策略。目的:本研究的目的是比较PCI使用RA和新一代DES治疗轻度和中重度CKD患者钙化冠状动脉病变的有效性和安全性。方法:本研究为单中心回顾性研究。数据收集自2014年11月至2019年10月所有接受RA + DES植入的CKD合并钙化冠状动脉病变患者的医疗记录。主要结果是支架内再狭窄(ISR)、重复血运重建术(RR)和主要不良心脑血管事件的发生率。次要结局包括手术成功、干预后死亡和手术/院内并发症。结果:共有77例轻重度CKD患者和126例中重度CKD患者接受了RA + DES治疗，中重度CKD患者明显比轻度CKD患者年龄大(平均年龄分别为66.6±8.2岁和59.5±7.7岁，P < 0.0001)。中重度CKD组的体重指数明显低于轻度CKD组。中重度CKD组支架置入术后进行扩张的患者数量明显高于轻度CKD组(100% vs. 96%， P = 0.025)。手术成功率为97.5%，术中并发症最少。轻度和中重度CKD患者的ISR和RR率无显著差异。两组在手术成功率、术后并发症和手术死亡率方面没有显著差异。结论:无论肾功能不全程度如何，RA联合DES植入治疗CKD患者冠状动脉钙化病变是一种安全有效的治疗策略。
{"title":"Percutaneous coronary intervention using rotational atherectomy and new-generation drug-eluting stents in mild versus moderate-to-severe chronic kidney disease patients with coronary artery disease","authors":"Fazila-tun-nesa Malik, M. Kalimuddin, N. Ahmed, M. Badiuzzaman, A. Khan, Ashok Dutta, T. Huq, D. Banik, M. Ahmed, M. Rahman, Md Tareq Iqbal","doi":"10.4103/jicc.jicc_68_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_68_20","url":null,"abstract":"Background: The presence of calcified lesions in chronic kidney disease (CKD) patients adversely affects the outcomes of percutaneous coronary interventions (PCIs). Lesion modification using rotational atherectomy (RA) followed by drug-eluting stent (DES) implantation may, therefore, be a suitable strategy to treat heavily calcified coronary lesions in CKD patients. Aim: The aim of the study was to compare the effectiveness and safety of PCI using RA and new-generation DES for treating calcified coronary lesions in patients with mild versus moderate-to-severe CKD. Methods: This was a single-center, retrospective study. Data were collected from the medical records of all CKD patients with calcified coronary artery lesions who underwent RA + DES implantation from November 2014 to October 2019. The primary outcomes were the rates of in-stent restenosis (ISR), repeat revascularization (RR), and major adverse cardiovascular and cerebrovascular events. Secondary outcomes included procedural success, death after intervention, and procedural/in-hospital complications. Results: A total of 77 and 126 patients with mild and moderate-to-severe CKD were treated with RA + DES. Patients with moderate-to-severe CKD were significantly older when compared to patients with mild CKD (mean age: 66.6 ± 8.2 vs. 59.5 ± 7.7 years, respectively, P < 0.0001). Body mass index was significantly lower in moderate-to-severe CKD group compared to the mild CKD group. The number of patients in whom postdilatation was performed after stent implantation was significantly higher in the moderate-to-severe CKD group compared to the mild CKD group (100% vs. 96%, P = 0.025). Overall procedural success was 97.5% with minimal periprocedural complications. The rates of ISR and RR were not significantly different between patients with mild and moderate-to-severe CKD. The two groups did not differ significantly in terms of procedural success, postprocedural complications, and procedural mortality. Conclusion: RA followed by DES implantation is an effective and safe strategy to treat calcified coronary artery lesions in patients with CKD, regardless of the degree of renal dysfunction.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"65 1","pages":"109 - 115"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89293951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic dilated cardiomyopathy in children is a hopeless disease; most of the time, patients are destine to die or ultimately become transplant candidate. In our case series, on meticulous re-examination, treatable conditions such as obstructive disease (aortic stenosis, coarctation of aorta) or coronary artery abnormality (anomalous origin of the left coronary artery from the pulmonary artery and coronary artery occlusion by thrombus) or rhythm abnormality (supraventricular tachycardia) were diagnosed, and all patients were improved after successful correction of underlying cardiac disease.
{"title":"Do not accept diagnosis of “Idiopathic dilated cardiomyopathy” in pediatric age group: Before comprehensive","authors":"M. Roy, P. Sinha, A. Chattopadhyay","doi":"10.4103/jicc.jicc_19_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_19_20","url":null,"abstract":"Idiopathic dilated cardiomyopathy in children is a hopeless disease; most of the time, patients are destine to die or ultimately become transplant candidate. In our case series, on meticulous re-examination, treatable conditions such as obstructive disease (aortic stenosis, coarctation of aorta) or coronary artery abnormality (anomalous origin of the left coronary artery from the pulmonary artery and coronary artery occlusion by thrombus) or rhythm abnormality (supraventricular tachycardia) were diagnosed, and all patients were improved after successful correction of underlying cardiac disease.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"77 1","pages":"155 - 159"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86749468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Venkata S. Subrahmanya Sarma Palaparthi, D. Srinivas, P. Raghuram, K. Gopalakrishna, G. Somasekhar, K. Purnachandrarao, M. Boochibabu, Y. Sasidhar, M. Prasad
Hydatid disease, is an infection caused by the larval stage (metacestode) of the cestode Echinococcus granulosus. In humans it may result in a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe, even fatal disease. Echinococcal cysts are found in the liver in approximately 70 % of cases, and the lungs in approximately 25 % of cases. Cardiac hydatid disease is seen in 0.5–5% of total hydatid disease patients, the present case highlights the unusual presentation of Hydatid cyst in a different clinical scenario.
{"title":"Cardiac hydatid disease: An unusual pathology in an st-elevation myocardial infarction patient","authors":"Venkata S. Subrahmanya Sarma Palaparthi, D. Srinivas, P. Raghuram, K. Gopalakrishna, G. Somasekhar, K. Purnachandrarao, M. Boochibabu, Y. Sasidhar, M. Prasad","doi":"10.4103/jicc.jicc_33_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_33_20","url":null,"abstract":"Hydatid disease, is an infection caused by the larval stage (metacestode) of the cestode Echinococcus granulosus. In humans it may result in a wide spectrum of clinical manifestations ranging from asymptomatic infection to severe, even fatal disease. Echinococcal cysts are found in the liver in approximately 70 % of cases, and the lungs in approximately 25 % of cases. Cardiac hydatid disease is seen in 0.5–5% of total hydatid disease patients, the present case highlights the unusual presentation of Hydatid cyst in a different clinical scenario.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"140 1","pages":"151 - 154"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86651746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sachin Rao, Harsha Basappa, Hema Raveesh, Srinidhi S. Hegde, C. Manjunath
Kounis syndrome (KS) refers to acute coronary syndrome secondary to a hypersensitivity reaction as a result of exposure to various allergens. Multiple bee stings as a cause of KS is rarely reported in the literature. Its diagnosis in allergic reactions is of utmost importance, as it leads to an entirely different line of management. We report a series of six cases who presented with the diagnosis of KS due to multiple bee stings.
{"title":"Acute Coronary syndrome following honey bee sting: A series of 6 cases of “kounis syndrome” with literature review","authors":"Sachin Rao, Harsha Basappa, Hema Raveesh, Srinidhi S. Hegde, C. Manjunath","doi":"10.4103/jicc.jicc_34_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_34_20","url":null,"abstract":"Kounis syndrome (KS) refers to acute coronary syndrome secondary to a hypersensitivity reaction as a result of exposure to various allergens. Multiple bee stings as a cause of KS is rarely reported in the literature. Its diagnosis in allergic reactions is of utmost importance, as it leads to an entirely different line of management. We report a series of six cases who presented with the diagnosis of KS due to multiple bee stings.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"5 1","pages":"98 - 103"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73573146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Online consultation is the latest challenge in clinical medicine during the COVID pandemic. We utilized our preexisting electronic medical record, video calling, and online payment for online consultation. Methodology: Consultations between April 15, 2020, and July 31, 2020, were compared with a similar period in 2019 to see the change in the pattern of consultation. Results: Between April 15, 2020, and July 31, 2020, there were a total of 1597 appointments compared to 2945 in the previous year a 45% fall in 2020. In the current model, all patients had to compulsorily have an online consultation. Online consultation was first done for 1130 patients, of whom 396 had a physical consultation in the clinic. There were no online consultations in the previous year. The real-world problems with online consultations and how they were overcome are discussed. Analyzing the data month wise, there was a progressive increase in the appointments this year indicating better acceptance for online consultation increasing from 350 appointments in May to 628 in July 2020, which translated into 40% and 70% of 2019 appointments indicating better acceptance over time. Cancellations were 5.2% for online consultation and 2.2% for physical consultation in the clinic. The reasons for cancellations were also analyzed and the most common causes were inability to reach the patient on mobile and blood pressure not recordable nearby. 0.7% had to make an emergency visit before they could complete an online consultation. Conclusions: Simple method of online consultation can be implemented in any clinic. No special app is required. The number of patients undergoing consultation is increasing with every passing month. This should be a motivation for more physicians to start online consultation during the COVID Epoch.
{"title":"Online consultation in the COVID epoch in India: Experience of 1597 appointments – new order cometh","authors":"Prabhakaran Dorairaj","doi":"10.4103/jicc.jicc_64_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_64_20","url":null,"abstract":"Introduction: Online consultation is the latest challenge in clinical medicine during the COVID pandemic. We utilized our preexisting electronic medical record, video calling, and online payment for online consultation. Methodology: Consultations between April 15, 2020, and July 31, 2020, were compared with a similar period in 2019 to see the change in the pattern of consultation. Results: Between April 15, 2020, and July 31, 2020, there were a total of 1597 appointments compared to 2945 in the previous year a 45% fall in 2020. In the current model, all patients had to compulsorily have an online consultation. Online consultation was first done for 1130 patients, of whom 396 had a physical consultation in the clinic. There were no online consultations in the previous year. The real-world problems with online consultations and how they were overcome are discussed. Analyzing the data month wise, there was a progressive increase in the appointments this year indicating better acceptance for online consultation increasing from 350 appointments in May to 628 in July 2020, which translated into 40% and 70% of 2019 appointments indicating better acceptance over time. Cancellations were 5.2% for online consultation and 2.2% for physical consultation in the clinic. The reasons for cancellations were also analyzed and the most common causes were inability to reach the patient on mobile and blood pressure not recordable nearby. 0.7% had to make an emergency visit before they could complete an online consultation. Conclusions: Simple method of online consultation can be implemented in any clinic. No special app is required. The number of patients undergoing consultation is increasing with every passing month. This should be a motivation for more physicians to start online consultation during the COVID Epoch.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"2 1","pages":"133 - 136"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87111075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guidewire fracture (either partial or complete) is an exceedingly rare complication of which is mostly encountered in percutaneous coronary intervention (PCI) of complex lesions. It can be managed mostly with using percutaneous techniques, but at times requires a surgical approach as well. Here, we report a case of a 67-year-old male who underwent PCI of totally occluded proximal left anterior descending artery. Due to excessive manipulation, tip of Sion blue wire (polymer-jacket guidewire) got trapped into the lesion. To unloop the wire, spring tip got partially fractured. The guiding catheter was pushed over the fractured wire near the fracture point and a 2.5 mm × 10 mm Sapphire semi-compliant balloon (Orbus Neisch, Netherland) was inflated near the tip of guiding catheter at 12 atm pressure, and whole assembly was pulled out to successfully retrieve the partially fractured and retained wire.
导丝骨折(部分或完全)是一种极为罕见的并发症，主要见于复杂病变的经皮冠状动脉介入治疗(PCI)。大多数情况下可以通过经皮技术进行治疗，但有时也需要手术治疗。在此，我们报告一位67岁男性接受PCI治疗完全闭塞的左前降支近端。由于操作过度，锡安蓝丝(聚合物护套导丝)尖端卡在病灶内。为了解开铁丝，弹簧头部分断裂。在骨折点附近将导尿管推过骨折丝，在导尿管尖端附近以12atm的压力充气2.5 mm × 10 mm Sapphire半弯曲球囊(Orbus Neisch，荷兰)，并将整个组件拔出，成功取出部分断裂和保留的导丝。
{"title":"Balloon inflation-assisted trapping and successful retrieval of partially fractured and entrapped guidewire","authors":"S. Sinha, M. Razi, Awadesh K. Sharma, U. Pandey","doi":"10.4103/jicc.jicc_58_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_58_20","url":null,"abstract":"Guidewire fracture (either partial or complete) is an exceedingly rare complication of which is mostly encountered in percutaneous coronary intervention (PCI) of complex lesions. It can be managed mostly with using percutaneous techniques, but at times requires a surgical approach as well. Here, we report a case of a 67-year-old male who underwent PCI of totally occluded proximal left anterior descending artery. Due to excessive manipulation, tip of Sion blue wire (polymer-jacket guidewire) got trapped into the lesion. To unloop the wire, spring tip got partially fractured. The guiding catheter was pushed over the fractured wire near the fracture point and a 2.5 mm × 10 mm Sapphire semi-compliant balloon (Orbus Neisch, Netherland) was inflated near the tip of guiding catheter at 12 atm pressure, and whole assembly was pulled out to successfully retrieve the partially fractured and retained wire.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"11 1","pages":"145 - 147"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85096610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Meininghaus, Claudia Waniek, T. Schulz, A. Kushnir
Preprocedural imaging before catheter ablation of atrial fibrillation is often limited. We present a case of a 67-year-old female with unsuspected anatomy relevant to procedure planning. Routine computed tomography revealed an undetected persistent left-sided superior caval vein (LpSVC). All left-sided pulmonary veins drained with the LpSVC by way of a common vessel at the roof of the left atrium (LA). This common vein exhibited low-amplitude signals connected to the LA beyond 25 mm. Both right-sided caval veins and the coronary sinus drained to the right atrium. We struggled to keep the ablation lesions distant from the common vein to avoid an increase of the left-to-right shunt by unintended narrowing of this vessel. The encircling ablation lines around the right-sided pulmonary veins and the common vein were close together so an additional roof line was done. In summary, imaging definitively helped to prepare the ablation procedure and to avoid complications.
{"title":"Pulmonary vein isolation in a case of common drainage of a persistent left superior caval vein and the left-sided pulmonary veins into the left atrium","authors":"D. Meininghaus, Claudia Waniek, T. Schulz, A. Kushnir","doi":"10.4103/jicc.jicc_63_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_63_20","url":null,"abstract":"Preprocedural imaging before catheter ablation of atrial fibrillation is often limited. We present a case of a 67-year-old female with unsuspected anatomy relevant to procedure planning. Routine computed tomography revealed an undetected persistent left-sided superior caval vein (LpSVC). All left-sided pulmonary veins drained with the LpSVC by way of a common vessel at the roof of the left atrium (LA). This common vein exhibited low-amplitude signals connected to the LA beyond 25 mm. Both right-sided caval veins and the coronary sinus drained to the right atrium. We struggled to keep the ablation lesions distant from the common vein to avoid an increase of the left-to-right shunt by unintended narrowing of this vessel. The encircling ablation lines around the right-sided pulmonary veins and the common vein were close together so an additional roof line was done. In summary, imaging definitively helped to prepare the ablation procedure and to avoid complications.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"28 1","pages":"148 - 150"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87991538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report an unusual case of massive hemothorax in a female patient undergoing electrophysiological (EP) procedure for drug-refractory supraventricular tachycardia. She underwent percutaneous intervention with a drug-eluting stent to the right coronary artery 6 months back and was on dual antiplatelet drugs. Timely detection and management of hemothorax prevented a major catastrophe in this patient. This case highlights the importance of keeping a strict vigil for possible occurrence of life-threatening bleeding complications during EP procedure in patients on multiple antiplatelet drug therapy.
{"title":"Massive hemothorax following failed internal jugular vein access during an electrophysiological procedure: “Early detection – catastrophe averted”","authors":"P. Harish, O. Satish","doi":"10.4103/jicc.jicc_50_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_50_20","url":null,"abstract":"We report an unusual case of massive hemothorax in a female patient undergoing electrophysiological (EP) procedure for drug-refractory supraventricular tachycardia. She underwent percutaneous intervention with a drug-eluting stent to the right coronary artery 6 months back and was on dual antiplatelet drugs. Timely detection and management of hemothorax prevented a major catastrophe in this patient. This case highlights the importance of keeping a strict vigil for possible occurrence of life-threatening bleeding complications during EP procedure in patients on multiple antiplatelet drug therapy.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"41 1","pages":"139 - 141"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85212821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Coronary artery disease (CAD) is the leading cause of death in India. There was increased incidence and prevalence of CAD in males than in females. There have been several studies going on across the globe to find a similar equation in males between testosterone and CAD. This study aimed at correlating the serum free testosterone level in CAD patients with the severity of obstruction of the coronary arteries proven by coronary angiogram. This was the first study in South India to correlate the serum free testosterone levels with the severity of obstruction of coronaries. Objective: This study was designed to correlate the serum free testosterone level in male patients above 40 years with proven or newly diagnosed CAD with the severity of obstruction of coronary arteries as evidenced from coronary angiogram. Materials and Methods: This was a hospital-based cross-sectional study conducted from November 2015 to August 2017 in a rural-based teaching tertiary care hospital in Puducherry, India. The sample size was 40, calculated using the formula n = 4 × σ2/d2 from the previous study of serum free testosterone in men with coronary artery atherosclerosis done by Lucyna Siemińska et al. Results: Of 40 patients in the study group, 30% had CAD, 20% had hypertension (HTN), 45% had diabetes mellitus, 45% were smokers, 37.5% were alcoholic, and only 5% had family history of (H/o) CAD. In the study, ejection fraction was < 60 in 80% and ≥ 60 in 20%. In the study, 42.5% had single-vessel disease, 27.5% had double-vessel disease, and 30% had triple-vessel disease. The mean serum testosterone was 4.5 ± 3.1 and the median serum testosterone was 3.3, which showed that most of the patients with CAD had their testosterone levels in the lower range of normal. Conclusion: From the observations made in this study, it was clear that the skewing of serum free testosterone levels toward the lower side of normal can be taken as an indirect evidence that serum free testosterone is inversely related to CAD. There was no significant difference in median testosterone levels with respect to the type of disease. However, a statistically significant positive association between H/o systemic HTN and serum free testosterone level was observed in patients with CAD.
{"title":"Correlation of the severity of obstruction in coronary arteries with serum free testosterone level","authors":"A. Badrinath, M. Venkatram, S. Babu, J. Karthik","doi":"10.4103/jicc.jicc_66_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_66_20","url":null,"abstract":"Background: Coronary artery disease (CAD) is the leading cause of death in India. There was increased incidence and prevalence of CAD in males than in females. There have been several studies going on across the globe to find a similar equation in males between testosterone and CAD. This study aimed at correlating the serum free testosterone level in CAD patients with the severity of obstruction of the coronary arteries proven by coronary angiogram. This was the first study in South India to correlate the serum free testosterone levels with the severity of obstruction of coronaries. Objective: This study was designed to correlate the serum free testosterone level in male patients above 40 years with proven or newly diagnosed CAD with the severity of obstruction of coronary arteries as evidenced from coronary angiogram. Materials and Methods: This was a hospital-based cross-sectional study conducted from November 2015 to August 2017 in a rural-based teaching tertiary care hospital in Puducherry, India. The sample size was 40, calculated using the formula n = 4 × σ2/d2 from the previous study of serum free testosterone in men with coronary artery atherosclerosis done by Lucyna Siemińska et al. Results: Of 40 patients in the study group, 30% had CAD, 20% had hypertension (HTN), 45% had diabetes mellitus, 45% were smokers, 37.5% were alcoholic, and only 5% had family history of (H/o) CAD. In the study, ejection fraction was < 60 in 80% and ≥ 60 in 20%. In the study, 42.5% had single-vessel disease, 27.5% had double-vessel disease, and 30% had triple-vessel disease. The mean serum testosterone was 4.5 ± 3.1 and the median serum testosterone was 3.3, which showed that most of the patients with CAD had their testosterone levels in the lower range of normal. Conclusion: From the observations made in this study, it was clear that the skewing of serum free testosterone levels toward the lower side of normal can be taken as an indirect evidence that serum free testosterone is inversely related to CAD. There was no significant difference in median testosterone levels with respect to the type of disease. However, a statistically significant positive association between H/o systemic HTN and serum free testosterone level was observed in patients with CAD.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"189 1","pages":"116 - 126"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77552843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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