D. Bagri, K. Meena, J. Meena, Umesh Gurjar, Balveer Jeengar
Chylothorax is the accumulation of lymphatic fluid in pleural space following traumatic injury to lymphatic vessels, systemic venous obstruction, dysfunction of the right ventricle, thrombosis of the duct, superior vena cava or subclavian vein, or postoperatively. A 2 ½-year-old male child operated for transposition of great arteries (TGA), tricuspid atresia (TA), and hypoplastic right ventricle 15 days ago developed chylothorax and left internal jugular vein thrombus. The child was initially managed conservatively with nutritional management, anticoagulation, and octreotide followed by interventional radiological management with lipoidol injection. Early suspicion and diagnosis are crucial. The management was difficult owing to a lack of proper guidelines. Further research is warranted.
{"title":"Postoperative chylothorax and left internal jugular vein thrombus after complex cyanotic heart disease surgery","authors":"D. Bagri, K. Meena, J. Meena, Umesh Gurjar, Balveer Jeengar","doi":"10.4103/jicc.jicc_26_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_26_22","url":null,"abstract":"Chylothorax is the accumulation of lymphatic fluid in pleural space following traumatic injury to lymphatic vessels, systemic venous obstruction, dysfunction of the right ventricle, thrombosis of the duct, superior vena cava or subclavian vein, or postoperatively. A 2 ½-year-old male child operated for transposition of great arteries (TGA), tricuspid atresia (TA), and hypoplastic right ventricle 15 days ago developed chylothorax and left internal jugular vein thrombus. The child was initially managed conservatively with nutritional management, anticoagulation, and octreotide followed by interventional radiological management with lipoidol injection. Early suspicion and diagnosis are crucial. The management was difficult owing to a lack of proper guidelines. Further research is warranted.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"58 1","pages":"196 - 199"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83367605","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}
Primary cardiac tumors are of rare presentation. We present a case of primary cardiac synovial sarcoma of the right atrium admitted to our hospital. An initial diagnosis of right atrial myxoma or hydatid cyst was made based on echocardiographic and radiological features. Intraoperatively, an irregular mass was excised, and histopathologically, it was reported as monophasic synovial sarcoma. Immunohistochemistry was positive for TLE-1, BCL-2, and MIC-2.
{"title":"A Rare Case of Primary Cardiac Synovial Sarcoma with Thromboctopenia","authors":"Nrushen Peesapati, A. Redrouthu","doi":"10.4103/jicc.jicc_81_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_81_20","url":null,"abstract":"Primary cardiac tumors are of rare presentation. We present a case of primary cardiac synovial sarcoma of the right atrium admitted to our hospital. An initial diagnosis of right atrial myxoma or hydatid cyst was made based on echocardiographic and radiological features. Intraoperatively, an irregular mass was excised, and histopathologically, it was reported as monophasic synovial sarcoma. Immunohistochemistry was positive for TLE-1, BCL-2, and MIC-2.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"1 1","pages":"184 - 188"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72679545","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: Although ventricular tachycardia and the ventricular fibrillation occur more often in adults with coronary artery disease, These ventricular arrhythmias may appear in young people, often early and late after surgery for congential heart disease or in association with a variety of cardiac disease ,autonomic imbalance, drugs, as well as in the absence of detectable cardiac desease, when serious ventricular tachyarrhythmias occur in the young they may be misdiagnosed as aberrantly conducting supraventricular tachycardias because of their presumed infrequency. Information on clinical characteristics and outcome of patients with NIVT in our patient population is limited. Aims and Objectives: This prospective observational study was aimed at patients presenting with NIVT to our tertiary care center and to analyze their clinical features, electrocardiogram (ECG) characteristics, underlying disease, management and clinical outcome at one year of follow up. Methods: It is an observational prospective study of 50 patients who presented with nonischaemic VT (NIVT) to our tertiary care center. History , physical examination ,chest X-RAY, electrocardiogram (ECG) and echocardiography were done. Details of electrophysiological studies and radio frequency ablation were collected. Antiarrhythmic drug history was noted. Patients were followed for a period of one year for their clinical outcome and their response to different modalities of treatment was noted. clinical Events defined as death, hospitalizations, DC shocks and recurrence of disease and time to event was also noted. Results: Among the total 50 patients, 27(54%) were males and 23(46%) were females. The mean age of presentation was 31 to 40 years.Most common presenting symptom was syncope (75%). Most common etiology was found to be idiopathic dilated cardiomyopathy with severe LV dysfunction (26%) followed by inflammatory cardiomyopathy (10%). post valvular replacement surgery for rheumatic heart disease , hypertrophic cardiomyopathy , idiopathic right ventricular outflow tract tachycardia were found in 6 percent of patients in each category. LBBB and RBBB morphology of VT in ECG seen in 37 and 44% of patients respectively. Immediate mortality rate was 12%, mainly seen in patients with electrolyte imbalance secondary to systemic infections and myocarditis related to covid 19 infection. Mean survival time in our study is 39.16 weeks with 95% confidence interval. Events have occurred in 30% of our patients most commonly in patients with idiopathic DCMP. Recurrent episodes of VT are more common in patients with DCMP ejection fraction less than 35 percent and also in ARVD patients after LV involvement. Conclusion: NIVT requires aggressive management to prevent mortality and morbidity.Recurrent episodes of VT can occur after disease progression in DCMP and these patients have poor prognosis. Aggressive management like cervical sympathetic denervation may be required in these patients when present
{"title":"Etiology, clinical profile, and 1-year outcome of patients presenting with nonischemic ventricular tachycardia: An observational study","authors":"S. Mani Krishna, O. Satish","doi":"10.4103/jicc.jicc_7_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_7_22","url":null,"abstract":"Background: Although ventricular tachycardia and the ventricular fibrillation occur more often in adults with coronary artery disease, These ventricular arrhythmias may appear in young people, often early and late after surgery for congential heart disease or in association with a variety of cardiac disease ,autonomic imbalance, drugs, as well as in the absence of detectable cardiac desease, when serious ventricular tachyarrhythmias occur in the young they may be misdiagnosed as aberrantly conducting supraventricular tachycardias because of their presumed infrequency. Information on clinical characteristics and outcome of patients with NIVT in our patient population is limited. Aims and Objectives: This prospective observational study was aimed at patients presenting with NIVT to our tertiary care center and to analyze their clinical features, electrocardiogram (ECG) characteristics, underlying disease, management and clinical outcome at one year of follow up. Methods: It is an observational prospective study of 50 patients who presented with nonischaemic VT (NIVT) to our tertiary care center. History , physical examination ,chest X-RAY, electrocardiogram (ECG) and echocardiography were done. Details of electrophysiological studies and radio frequency ablation were collected. Antiarrhythmic drug history was noted. Patients were followed for a period of one year for their clinical outcome and their response to different modalities of treatment was noted. clinical Events defined as death, hospitalizations, DC shocks and recurrence of disease and time to event was also noted. Results: Among the total 50 patients, 27(54%) were males and 23(46%) were females. The mean age of presentation was 31 to 40 years.Most common presenting symptom was syncope (75%). Most common etiology was found to be idiopathic dilated cardiomyopathy with severe LV dysfunction (26%) followed by inflammatory cardiomyopathy (10%). post valvular replacement surgery for rheumatic heart disease , hypertrophic cardiomyopathy , idiopathic right ventricular outflow tract tachycardia were found in 6 percent of patients in each category. LBBB and RBBB morphology of VT in ECG seen in 37 and 44% of patients respectively. Immediate mortality rate was 12%, mainly seen in patients with electrolyte imbalance secondary to systemic infections and myocarditis related to covid 19 infection. Mean survival time in our study is 39.16 weeks with 95% confidence interval. Events have occurred in 30% of our patients most commonly in patients with idiopathic DCMP. Recurrent episodes of VT are more common in patients with DCMP ejection fraction less than 35 percent and also in ARVD patients after LV involvement. Conclusion: NIVT requires aggressive management to prevent mortality and morbidity.Recurrent episodes of VT can occur after disease progression in DCMP and these patients have poor prognosis. Aggressive management like cervical sympathetic denervation may be required in these patients when present","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"43 1","pages":"168 - 172"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86652419","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}
Temporary pacing lead is placed through the internal jugular, subclavian or femoral vein under fluoroscopic, echocardiographic, or electrocardiographic guidance. However, in most of the developing world, this procedure is done without fluoroscopic guidance. Blind procedures are known to be associated with more complications as compared to guided procedures. Here, we report a case of the right internal jugular vein perforation while placing the temporary pacing lead in an 80-year-old male patient who had permanent pacemaker implantation done 10 years back and had developed right subclavian and brachiocephalic vein stenosis. Clinicians need to be aware of this rare complication and preferably do these procedures under fluoroscopic guidance and avoid an overzealous approach if the pacing lead does not pass through easily. Patients who had undergone any procedure through their central venous system, especially with retained catheters and pacing leads in situ in the past should undergo a venogram before planning any reintervention from the ipsilateral side to avoid such complications.
{"title":"Internal jugular vein perforation due to blind temporary pacing lead insertion: Pitfall of a blind procedure","authors":"N. Sofi, S. Sinha, Mohit Sachan","doi":"10.4103/jicc.jicc_18_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_18_22","url":null,"abstract":"Temporary pacing lead is placed through the internal jugular, subclavian or femoral vein under fluoroscopic, echocardiographic, or electrocardiographic guidance. However, in most of the developing world, this procedure is done without fluoroscopic guidance. Blind procedures are known to be associated with more complications as compared to guided procedures. Here, we report a case of the right internal jugular vein perforation while placing the temporary pacing lead in an 80-year-old male patient who had permanent pacemaker implantation done 10 years back and had developed right subclavian and brachiocephalic vein stenosis. Clinicians need to be aware of this rare complication and preferably do these procedures under fluoroscopic guidance and avoid an overzealous approach if the pacing lead does not pass through easily. Patients who had undergone any procedure through their central venous system, especially with retained catheters and pacing leads in situ in the past should undergo a venogram before planning any reintervention from the ipsilateral side to avoid such complications.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"43 1","pages":"189 - 191"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90930186","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}
P. Goel, P. Rajput, A. Sahu, Roopali Khanna, N. Garg, S. Tewari, Sudeep Kumar, A. Kapoor
Introduction: Cardiovascular implantable electronic device (CIED) infection contributes to a significant clinical and financial burden. We sought to assess CIED postimplant infection rates and the effect of different treatment modalities on reinfection over a long-term follow-up. Methods: We retrospectively analyzed CIED recipients presenting with complications during 2010–2019 at our center. Data related to the different management modalities used as per the discretion of treating physician, were collected and patients were followed up telephonically. Results: A total of 3394 patients underwent CIED implantation of which 122 (3.5%) patients developing complications were included in the study. Mean age of the patients was 66.4 ± 12.5 years. Single-chamber ventricular pacing (VVI), dual-chamber (DDD) pacing, and biventricular pacing were seen in 68 (56.2%), 51 (41%), and 3 (2.8%) patients, respectively. CIED infection was seen in 61 patients (1.8%). Strategies used for CIED infection management included: new device implantation on contralateral side (n = 34; 55.7%), old device repositioning on same side (n = 14; 22.8%), antibiotic therapy alone (n = 5; 8.5%), resterilized device implantation on contralateral side (n = 3; 4.9%), epicardial lead placement (n = 3; 4.9%), and permanent device removal (n = 2; 3.3%). The CIED reinfection rates for the above strategies were 2.9%, 71.4%, 80%, 100%, 0% and 0%, respectively. Conclusion: Multiple strategies are being used in real-world practice for the management of CIED infection. Previously advocated strategy of reimplanting resterilized CIED is associated with high recurrence rates. The best practice still remains to implant a new device on the contralateral side post extraction of infected hardware.
{"title":"Incidence, management patterns, and outcomes of cardiovascular implantable electronic device-related infection – A retrospective registry-based analysis","authors":"P. Goel, P. Rajput, A. Sahu, Roopali Khanna, N. Garg, S. Tewari, Sudeep Kumar, A. Kapoor","doi":"10.4103/jicc.jicc_55_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_55_21","url":null,"abstract":"Introduction: Cardiovascular implantable electronic device (CIED) infection contributes to a significant clinical and financial burden. We sought to assess CIED postimplant infection rates and the effect of different treatment modalities on reinfection over a long-term follow-up. Methods: We retrospectively analyzed CIED recipients presenting with complications during 2010–2019 at our center. Data related to the different management modalities used as per the discretion of treating physician, were collected and patients were followed up telephonically. Results: A total of 3394 patients underwent CIED implantation of which 122 (3.5%) patients developing complications were included in the study. Mean age of the patients was 66.4 ± 12.5 years. Single-chamber ventricular pacing (VVI), dual-chamber (DDD) pacing, and biventricular pacing were seen in 68 (56.2%), 51 (41%), and 3 (2.8%) patients, respectively. CIED infection was seen in 61 patients (1.8%). Strategies used for CIED infection management included: new device implantation on contralateral side (n = 34; 55.7%), old device repositioning on same side (n = 14; 22.8%), antibiotic therapy alone (n = 5; 8.5%), resterilized device implantation on contralateral side (n = 3; 4.9%), epicardial lead placement (n = 3; 4.9%), and permanent device removal (n = 2; 3.3%). The CIED reinfection rates for the above strategies were 2.9%, 71.4%, 80%, 100%, 0% and 0%, respectively. Conclusion: Multiple strategies are being used in real-world practice for the management of CIED infection. Previously advocated strategy of reimplanting resterilized CIED is associated with high recurrence rates. The best practice still remains to implant a new device on the contralateral side post extraction of infected hardware.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"7 1","pages":"156 - 161"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87125195","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}
Calcium deposition in the heart can present in various ways. Mitral annular calcification (MAC) can cause mitral regurgitation but severe mitral stenosis has been reported very rarely. Mitral stenosis in the Indian subcontinent is mostly caused by rheumatic heart disease; however, here, we present a case of severe mitral stenosis due to MAC in a hypertensive and diabetic female that also had severe calcific aortic stenosis and conduction defect. Clinicians need to be aware of other causes of acquired mitral stenosis that include systemic lupus erythematosus, antiphospholipid antibody syndrome, carcinoid syndrome, mucopolysaccharidosis, Whipple disease, radiation, and MAC. Although MAC usually causes mitral regurgitation, severe mitral stenosis has been reported very rarely. However, when MAC is the cause of severe mitral stenosis, those patients are poor candidates for mitral valve replacement. Differentiating the etiology of mitral stenosis is of therapeutic and prognostic significance.
{"title":"Mitral annular calcification leading to severe mitral stenosis in a patient with severe calcific aortic stenosis and complete heart block: Different shades of calcium in heart","authors":"N. Sofi, S. Sinha, Mohit Sachan","doi":"10.4103/jicc.jicc_22_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_22_22","url":null,"abstract":"Calcium deposition in the heart can present in various ways. Mitral annular calcification (MAC) can cause mitral regurgitation but severe mitral stenosis has been reported very rarely. Mitral stenosis in the Indian subcontinent is mostly caused by rheumatic heart disease; however, here, we present a case of severe mitral stenosis due to MAC in a hypertensive and diabetic female that also had severe calcific aortic stenosis and conduction defect. Clinicians need to be aware of other causes of acquired mitral stenosis that include systemic lupus erythematosus, antiphospholipid antibody syndrome, carcinoid syndrome, mucopolysaccharidosis, Whipple disease, radiation, and MAC. Although MAC usually causes mitral regurgitation, severe mitral stenosis has been reported very rarely. However, when MAC is the cause of severe mitral stenosis, those patients are poor candidates for mitral valve replacement. Differentiating the etiology of mitral stenosis is of therapeutic and prognostic significance.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"193 1","pages":"192 - 195"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79705054","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}
An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a rare congenital anomaly, the enlarged right coronary artery supplies the left ventricle through retrograde collaterals before preferentially directing into the lower-pressure pulmonary artery system, resulting in coronary steal. The infant type is characterized by the absence of collateral vessels, and global myocardial ischemia is a major cause of death in infancy. If not treated, up to 90% of them will die during the 1st year of life. Myocardial ischemia or infarction left ventricular (LV) dysfunction with or without mitral regurgitation, life-threatening arrhythmias, or sudden cardiac death may all be manifestations of symptomatic adult-type ALCAPA. In those patients who have survived to adulthood without surgery, pathophysiological mechanisms enabling adequate LV perfusion, such as a large number of well-formed functioning collaterals, and in a few cases, the presence of ostial stenosis of the left coronary artery (LCA), provide selective survival advantage. We review the correlation between clinical presentation, pathophysiological findings, and angiographic features of ostial stenosis of LCA in the setting of adult-type ALCAPA.
{"title":"Ostial stenosis of anomalous origin of the left coronary artery from the pulmonary artery in an adult: Lives from constraints and dies from freedom","authors":"P. Jariwala, K. Jadhav","doi":"10.4103/jicc.jicc_40_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_40_21","url":null,"abstract":"An anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a rare congenital anomaly, the enlarged right coronary artery supplies the left ventricle through retrograde collaterals before preferentially directing into the lower-pressure pulmonary artery system, resulting in coronary steal. The infant type is characterized by the absence of collateral vessels, and global myocardial ischemia is a major cause of death in infancy. If not treated, up to 90% of them will die during the 1st year of life. Myocardial ischemia or infarction left ventricular (LV) dysfunction with or without mitral regurgitation, life-threatening arrhythmias, or sudden cardiac death may all be manifestations of symptomatic adult-type ALCAPA. In those patients who have survived to adulthood without surgery, pathophysiological mechanisms enabling adequate LV perfusion, such as a large number of well-formed functioning collaterals, and in a few cases, the presence of ostial stenosis of the left coronary artery (LCA), provide selective survival advantage. We review the correlation between clinical presentation, pathophysiological findings, and angiographic features of ostial stenosis of LCA in the setting of adult-type ALCAPA.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"38 1","pages":"136 - 138"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84293166","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: Calcified coronary lesions are challenging to the interventional cardiologists to manage. Debulking the calcified lesions with Rotablation is a well known strategy. Shockwave intravascular lithotripsy (IVL) is the newer novel therapeutic procedure found to be very effective in PCI of calcified lesions. Aims and Objectives: To assess the clinical utility of Shockwave IVL in densly calcified coronary lesions. Materials and Methods: Four patients underwent PCI with Shockwave IVL for densly calcified lesions between Febraury and March of 2020 and were followed up clinically in our centre. Results: All patients are doing well clinically without any coronary events. Conclusion: Shockwave IVL is safe and accepted modality of debulking the densly calcified coronary lesions and prepare the bed for optimal stent deployment.
{"title":"Management of densely calcified coronary lesions using OPN–NC balloon and shockwave intravascular lithotripsy procedure: A single-center study","authors":"Manjunath Bagur","doi":"10.4103/jicc.jicc_28_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_28_21","url":null,"abstract":"Background: Calcified coronary lesions are challenging to the interventional cardiologists to manage. Debulking the calcified lesions with Rotablation is a well known strategy. Shockwave intravascular lithotripsy (IVL) is the newer novel therapeutic procedure found to be very effective in PCI of calcified lesions. Aims and Objectives: To assess the clinical utility of Shockwave IVL in densly calcified coronary lesions. Materials and Methods: Four patients underwent PCI with Shockwave IVL for densly calcified lesions between Febraury and March of 2020 and were followed up clinically in our centre. Results: All patients are doing well clinically without any coronary events. Conclusion: Shockwave IVL is safe and accepted modality of debulking the densly calcified coronary lesions and prepare the bed for optimal stent deployment.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"7 1","pages":"123 - 126"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84440232","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}
Nikhilesh Andhi, Prathyusha Desham, C. Madavi, S. Bhavana, D. Naresh
Objectives: To assess the health-related quality of life (QOL) in patients with acute coronary syndrome (ACS) and predict those patients who may have worsened QOL 6 months later and also observe the prescribing patterns of drugs given in their treatment. Materials and Methods: A prospective observational study was conducted at the cardiology department in a tertiary care hospital. The data were collected in both inpatient and outpatient cardiology departments based on our inclusion and exclusion criteria for a period of 6 months. A total of 240 patients were analyzed with a data collection form by interviewing the patients about their sociodemographic details, laboratory parameters, and diagnostic reports. The MacNew Heart Disease Questionnaire, Medical Research Council Breathlessness Scale, and New York Heart Association (NYHA) Functional Scale were used for assessing the QOL in patients with ACS. We calculated Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients for identifying the mortality risk. Results: Urban people were more prone to ACS than rural people, according to our data. According to the NYHA Functional Classification, ability to do physical activity was more considerably affected in NSTEMI patients than STEMI and angina. Most of the patients had Grade 2 shortness of breath. 35% of the patients had a high mortality risk. Based on the MacNew Questionnaire data, 23% of the patients with ACS were doing emotionally poor, 45% of the patients had shown physically impaired symptoms, 28% of the patients were socially dependent, 8% of the patients showed poor gastric condition. 49% of the patients were given reperfusion therapy with either percutaneous coronary intervention (PCI) or coronary artery bypass graft, 25% of the patients were managed with dual-anticoagulant therapy, and 6% of the patients were treated with single-anticoagulant therapy. Commonly prescribed drug classes were statins (90%), antiplatelets (86%), anticoagulants (75%), antianginal (55%), beta-blockers (50%), diuretics (35%), angiotensin-converting enzyme inhibitors (18%), and angiotensin receptor blockers (16%). Conclusion: QOL was significantly affected in ACS patients. Most of the patients had risk factors for ACS. Patients explained impairments in all the four domains used in the questionnaire such as emotional, physical, social, and gastric impairments. QOL was more affected in STEMI patients and they had a high mortality risk. Most of the patients had NSTEMI. Low-risk patients were given single-anticoagulant therapy and medium-risk patients were treated with dual-anticoagulant therapy. PCI was preferred in almost all the patients.
{"title":"Assessment of quality of life and drug prescription pattern in acute coronary syndrome","authors":"Nikhilesh Andhi, Prathyusha Desham, C. Madavi, S. Bhavana, D. Naresh","doi":"10.4103/jicc.jicc_50_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_50_21","url":null,"abstract":"Objectives: To assess the health-related quality of life (QOL) in patients with acute coronary syndrome (ACS) and predict those patients who may have worsened QOL 6 months later and also observe the prescribing patterns of drugs given in their treatment. Materials and Methods: A prospective observational study was conducted at the cardiology department in a tertiary care hospital. The data were collected in both inpatient and outpatient cardiology departments based on our inclusion and exclusion criteria for a period of 6 months. A total of 240 patients were analyzed with a data collection form by interviewing the patients about their sociodemographic details, laboratory parameters, and diagnostic reports. The MacNew Heart Disease Questionnaire, Medical Research Council Breathlessness Scale, and New York Heart Association (NYHA) Functional Scale were used for assessing the QOL in patients with ACS. We calculated Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients for identifying the mortality risk. Results: Urban people were more prone to ACS than rural people, according to our data. According to the NYHA Functional Classification, ability to do physical activity was more considerably affected in NSTEMI patients than STEMI and angina. Most of the patients had Grade 2 shortness of breath. 35% of the patients had a high mortality risk. Based on the MacNew Questionnaire data, 23% of the patients with ACS were doing emotionally poor, 45% of the patients had shown physically impaired symptoms, 28% of the patients were socially dependent, 8% of the patients showed poor gastric condition. 49% of the patients were given reperfusion therapy with either percutaneous coronary intervention (PCI) or coronary artery bypass graft, 25% of the patients were managed with dual-anticoagulant therapy, and 6% of the patients were treated with single-anticoagulant therapy. Commonly prescribed drug classes were statins (90%), antiplatelets (86%), anticoagulants (75%), antianginal (55%), beta-blockers (50%), diuretics (35%), angiotensin-converting enzyme inhibitors (18%), and angiotensin receptor blockers (16%). Conclusion: QOL was significantly affected in ACS patients. Most of the patients had risk factors for ACS. Patients explained impairments in all the four domains used in the questionnaire such as emotional, physical, social, and gastric impairments. QOL was more affected in STEMI patients and they had a high mortality risk. Most of the patients had NSTEMI. Low-risk patients were given single-anticoagulant therapy and medium-risk patients were treated with dual-anticoagulant therapy. PCI was preferred in almost all the patients.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"51 1","pages":"111 - 118"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84860079","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}
Percutaneous transluminal coronary angioplasty is associated with less complications compared to the open surgical technique. Fractured guidewire inside coronary arteries is not common during the procedure. It should be removed with proper technique. Nonremoval of such fractured wire may pose several complications. Different techniques can be used to remove such fractured wires. Here, we have reported a case of such incidence and its removal successfully percutaneous safely.
{"title":"Broken guidewire during percutaneous transluminal coronary angioplasty retrieved properly and nightmare became a good lesson and experience","authors":"S. Mukherjee, K. Paul","doi":"10.4103/jicc.jicc_32_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_32_21","url":null,"abstract":"Percutaneous transluminal coronary angioplasty is associated with less complications compared to the open surgical technique. Fractured guidewire inside coronary arteries is not common during the procedure. It should be removed with proper technique. Nonremoval of such fractured wire may pose several complications. Different techniques can be used to remove such fractured wires. Here, we have reported a case of such incidence and its removal successfully percutaneous safely.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"3 1","pages":"143 - 145"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87809264","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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