M. Roy, Debasree Gangopadhyay, Siddhartha Saha, Sushil Sukla., P. Sinha
Gerbode defect is very rare cardiac abnormality accounting for <1% of cardiac defects. Historically treated by open heart surgery, many authors have now popularized the concept of percutaneous closure of such defects by various devices. We report three such cases and provide a brief review of the literature.
{"title":"Gerbode defect – Percutaneous closure of three cases and a brief review of literature","authors":"M. Roy, Debasree Gangopadhyay, Siddhartha Saha, Sushil Sukla., P. Sinha","doi":"10.4103/jicc.jicc_9_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_9_21","url":null,"abstract":"Gerbode defect is very rare cardiac abnormality accounting for <1% of cardiac defects. Historically treated by open heart surgery, many authors have now popularized the concept of percutaneous closure of such defects by various devices. We report three such cases and provide a brief review of the literature.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"62 1","pages":"71 - 75"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76968858","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}
R. Subrahmanya Sarma, Gopala Koduru, P. Koduru, Somasekahr Ghanta, Sarada Chowdary Parvathaneni, Raghuram Palaparti, Dasarath Boppana, V. Swarajyam, Y. Srinivas, Y. Sasidhar, M. Prasad
In-stent restenosis (ISR) is a critical drawback of coronary stents, although initially described as benign, guidelines both support the use of intravascular imaging in the diagnosis and treatment of stent failure (Class IIa); however, our case highlights the limitation of optical coherence tomography in the assessment of the ISR (stent failure), it also highlights the association of self-limited severe acute respiratory syndrome coronavirus-2 illness and an acute coronary syndrome ISR presentation.
{"title":"Difficulties with optical coherence tomography in assessment of an in-stent restenosis lesion","authors":"R. Subrahmanya Sarma, Gopala Koduru, P. Koduru, Somasekahr Ghanta, Sarada Chowdary Parvathaneni, Raghuram Palaparti, Dasarath Boppana, V. Swarajyam, Y. Srinivas, Y. Sasidhar, M. Prasad","doi":"10.4103/jicc.jicc_31_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_31_21","url":null,"abstract":"In-stent restenosis (ISR) is a critical drawback of coronary stents, although initially described as benign, guidelines both support the use of intravascular imaging in the diagnosis and treatment of stent failure (Class IIa); however, our case highlights the limitation of optical coherence tomography in the assessment of the ISR (stent failure), it also highlights the association of self-limited severe acute respiratory syndrome coronavirus-2 illness and an acute coronary syndrome ISR presentation.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"20 11 1","pages":"76 - 78"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83887307","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}
R. Sankaran, S. Ramalakshmi, Manish Babbu Uppupetai Ganeshbabbu, M. Jayakumar, M. Ramamurthy, V. Balakrishnan, N. Senguttuvan
Background: Cardiovascular disease is the leading cause of mortality among patients with chronic kidney disease (CKD). Hemodialysis treatment is associated with an increased risk of developing left ventricular (LV) dysfunction. LV global longitudinal strain (GLS) has emerged as a sensitive parameter in evaluating LV function in patients with CKD. We aimed to assess cardiac function using two-dimensional (2D) echocardiogram, 2D speckle-tracking echocardiogram (2DSTE), and traditional ejection fraction (EF) in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted for 3 months in patients with CKD at a tertiary care center in Southern India. Patients were subjected to conventional 2DSTE and evaluated for LV ejection fraction (LVEF), GLS, pulmonary systolic blood pressure, and the degree of tricuspid regurgitation. Results: Among 100 patients with CKD, 54.3% underwent hemodialysis, and 26.7% on drug therapy had impaired LV GLS. The LVEF was normal in 61.4% of patients undergoing hemodialysis and 86.7% of patients on drug therapy. Proportion of patients undergoing hemodialysis were significantly high with moderate-to-severe pulmonary hypertension (21.4%), moderate-to-severe tricuspid regurgitation (21.4%), and mild-to-moderate EF (37.1%) compared to respective patients on drug therapy. Pulmonary hypertension and abnormal EF are significantly associated with lesser GLS in patients undergoing hemodialysis. Conclusions: This study indicated that patients undergoing hemodialysis are at higher risk for impaired LV GLS. The GLS by 2DSTE can act as an early diagnostic tool for this high-risk patient group. Thus, regular cardiac screening is required for early detection, and treatment in patients undergoing hemodialysis with risk of LV dysfunction.
{"title":"Left ventricular global longitudinal strain in patients with chronic kidney disease with and without renal replacement therapy: A cross-sectional study","authors":"R. Sankaran, S. Ramalakshmi, Manish Babbu Uppupetai Ganeshbabbu, M. Jayakumar, M. Ramamurthy, V. Balakrishnan, N. Senguttuvan","doi":"10.4103/jicc.jicc_48_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_48_21","url":null,"abstract":"Background: Cardiovascular disease is the leading cause of mortality among patients with chronic kidney disease (CKD). Hemodialysis treatment is associated with an increased risk of developing left ventricular (LV) dysfunction. LV global longitudinal strain (GLS) has emerged as a sensitive parameter in evaluating LV function in patients with CKD. We aimed to assess cardiac function using two-dimensional (2D) echocardiogram, 2D speckle-tracking echocardiogram (2DSTE), and traditional ejection fraction (EF) in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted for 3 months in patients with CKD at a tertiary care center in Southern India. Patients were subjected to conventional 2DSTE and evaluated for LV ejection fraction (LVEF), GLS, pulmonary systolic blood pressure, and the degree of tricuspid regurgitation. Results: Among 100 patients with CKD, 54.3% underwent hemodialysis, and 26.7% on drug therapy had impaired LV GLS. The LVEF was normal in 61.4% of patients undergoing hemodialysis and 86.7% of patients on drug therapy. Proportion of patients undergoing hemodialysis were significantly high with moderate-to-severe pulmonary hypertension (21.4%), moderate-to-severe tricuspid regurgitation (21.4%), and mild-to-moderate EF (37.1%) compared to respective patients on drug therapy. Pulmonary hypertension and abnormal EF are significantly associated with lesser GLS in patients undergoing hemodialysis. Conclusions: This study indicated that patients undergoing hemodialysis are at higher risk for impaired LV GLS. The GLS by 2DSTE can act as an early diagnostic tool for this high-risk patient group. Thus, regular cardiac screening is required for early detection, and treatment in patients undergoing hemodialysis with risk of LV dysfunction.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"59 1","pages":"60 - 65"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78688217","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: High-probability zones of coronary thrombosis may exist along the coronary tree. We aimed to determine the nature and distribution of significant coronary lesions among our patients. Methods: This study included 529 patients, for whom coronary angiography was done for suspected or proved coronary artery disease (CAD), they were divided into three groups according to the distribution of the coronary lesions: left anterior descending (LAD) group (n = 305) with significant LAD lesion, left circumflex (LCx) group (n = 148) with significant LCx lesion and right coronary artery (RCA) group (n = 181) with significant RCA lesion. Results: One hundred and sixty-nine (31.9%) had nonsignificant lesion, 166 (31.4%) had single-vessel disease, with significantly higher incidence of significant LAD lesion 305 (57.5%) which were proximal 52.4%, LAD lesions were more prone to be the culprit vessel 47.5%, LCx was the least vessel with significant lesion 148 (27.9%), and the least to be prone as a culprit 21.1%. Proximal culprit LAD 63.5% and RCA 55.6% had significantly higher incidence, mid culprit LC× 53.9% had significantly higher incidence. ST-elevation acute coronary syndrome (STE-ACS) was significantly more prevalent in culprit LAD 76.7%. Non-STE-ACS was significantly more prevalent in culprit LC× 56.5% and RCA 55.6%. Conclusion: LAD tends to carry more than one culprit lesion, more to be proximal. Risk factors responsible for instability and sheer stress (uncontrolled diabetes mellitus, uncontrolled hypertension, heavy smoking) were more prevalent between patients with LCx as a culprit followed by RCA in Egyptian; this may throw the light on the need for aggressive control of these risk factors to reduce vulnerability in these patients.
{"title":"Understanding the status of the Egyptian coronary lesions: Lesion location and vulnerability","authors":"I. El-Dosouky, B. Nashy, H. Abomandour","doi":"10.4103/jicc.jicc_17_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_17_21","url":null,"abstract":"Background: High-probability zones of coronary thrombosis may exist along the coronary tree. We aimed to determine the nature and distribution of significant coronary lesions among our patients. Methods: This study included 529 patients, for whom coronary angiography was done for suspected or proved coronary artery disease (CAD), they were divided into three groups according to the distribution of the coronary lesions: left anterior descending (LAD) group (n = 305) with significant LAD lesion, left circumflex (LCx) group (n = 148) with significant LCx lesion and right coronary artery (RCA) group (n = 181) with significant RCA lesion. Results: One hundred and sixty-nine (31.9%) had nonsignificant lesion, 166 (31.4%) had single-vessel disease, with significantly higher incidence of significant LAD lesion 305 (57.5%) which were proximal 52.4%, LAD lesions were more prone to be the culprit vessel 47.5%, LCx was the least vessel with significant lesion 148 (27.9%), and the least to be prone as a culprit 21.1%. Proximal culprit LAD 63.5% and RCA 55.6% had significantly higher incidence, mid culprit LC× 53.9% had significantly higher incidence. ST-elevation acute coronary syndrome (STE-ACS) was significantly more prevalent in culprit LAD 76.7%. Non-STE-ACS was significantly more prevalent in culprit LC× 56.5% and RCA 55.6%. Conclusion: LAD tends to carry more than one culprit lesion, more to be proximal. Risk factors responsible for instability and sheer stress (uncontrolled diabetes mellitus, uncontrolled hypertension, heavy smoking) were more prevalent between patients with LCx as a culprit followed by RCA in Egyptian; this may throw the light on the need for aggressive control of these risk factors to reduce vulnerability in these patients.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"53 1","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77923228","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}
Shaimaa Wageeh, I. El-Dosouky, Arafa M. Elshabrawy, Rasha H Omar, Shimaa Zein
Objectives: The objective of this study investigated the relation between QT-dispersion (QTd) and both number of coronary artery disease and major adverse cardiovascular events (MACEs) among patients with type 2 diabetes after elective percutaneous coronary intervention (PCI). Methods: One hundred ischemic heart disease patients undergoing elective coronary angioplasty were included; 49 patients with diabetes (group I) and 51 patients without diabetes mellitus (group II). Based on the QTd parameter after PCI, both groups were subdivided into tertiles. Angiographic, electrocardiographic parameters, and MACE were compared. Results: Both QTd after PCI and delta QTd were correlated to the number of diseased coronary arteries and MACE in patients with diabetes compared to patients without diabetes. QTd was longer in patients with diabetes developing MACE than those without MACE (r = −0.31, P = 0.04). Conclusion: QTd after PCI and delta QTd are the independent predictors of MACE in patients with type 2 diabetes.
目的:探讨2型糖尿病患者择期经皮冠状动脉介入治疗(PCI)后qt离散度(QTd)与冠状动脉疾病数量和主要不良心血管事件(mace)的关系。方法:择期行冠状动脉成形术的缺血性心脏病患者100例;糖尿病患者49例(I组)，非糖尿病患者51例(II组)。根据PCI术后QTd参数将两组再细分为各组。比较血管造影、心电图参数和MACE。结果:与非糖尿病患者相比，糖尿病患者PCI术后QTd和δ QTd均与冠脉病变数和MACE相关。发生MACE的糖尿病患者的QTd比未发生MACE的糖尿病患者更长(r = - 0.31, P = 0.04)。结论:PCI术后QTd和δ QTd是2型糖尿病患者MACE的独立预测因子。
{"title":"QT-dispersion and major adverse cardiovascular events prediction after percutaneous coronary intervention in patients with Type 2 diabetes mellitus","authors":"Shaimaa Wageeh, I. El-Dosouky, Arafa M. Elshabrawy, Rasha H Omar, Shimaa Zein","doi":"10.4103/jicc.jicc_53_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_53_21","url":null,"abstract":"Objectives: The objective of this study investigated the relation between QT-dispersion (QTd) and both number of coronary artery disease and major adverse cardiovascular events (MACEs) among patients with type 2 diabetes after elective percutaneous coronary intervention (PCI). Methods: One hundred ischemic heart disease patients undergoing elective coronary angioplasty were included; 49 patients with diabetes (group I) and 51 patients without diabetes mellitus (group II). Based on the QTd parameter after PCI, both groups were subdivided into tertiles. Angiographic, electrocardiographic parameters, and MACE were compared. Results: Both QTd after PCI and delta QTd were correlated to the number of diseased coronary arteries and MACE in patients with diabetes compared to patients without diabetes. QTd was longer in patients with diabetes developing MACE than those without MACE (r = −0.31, P = 0.04). Conclusion: QTd after PCI and delta QTd are the independent predictors of MACE in patients with type 2 diabetes.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"17 1","pages":"55 - 59"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80847577","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}
Y. Gokhale, A. Patankar, A. Mahajan, Vikrant Firke
We report an interesting case of a 20-year-old man who was admitted in intensive cardiac care unit with congestive cardiac failure along with thromboembolic manifestations and a raised erythrocyte sedimentation rate. On the basis of two-dimensional echocardiography, he was diagnosed as left ventricular noncompaction syndrome. However, cardiac magnetic resonance imaging (MRI) ruled out noncompaction. After extensive workup, the patient was diagnosed with Takayasu aortoarteritis. Post therapy, the patient has normal cardiac function and cardiac MRI without thromboembolic event in 8 years' follow-up.
{"title":"Takayasu aortoarteritis masquerading left ventricular noncompaction syndrome","authors":"Y. Gokhale, A. Patankar, A. Mahajan, Vikrant Firke","doi":"10.4103/jicc.jicc_7_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_7_21","url":null,"abstract":"We report an interesting case of a 20-year-old man who was admitted in intensive cardiac care unit with congestive cardiac failure along with thromboembolic manifestations and a raised erythrocyte sedimentation rate. On the basis of two-dimensional echocardiography, he was diagnosed as left ventricular noncompaction syndrome. However, cardiac magnetic resonance imaging (MRI) ruled out noncompaction. After extensive workup, the patient was diagnosed with Takayasu aortoarteritis. Post therapy, the patient has normal cardiac function and cardiac MRI without thromboembolic event in 8 years' follow-up.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"10 1","pages":"40 - 42"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87869453","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}
I. Sathyamurthy, Srinivasan Kanthallu, V. PaulPandi
Acute coronary syndromes were thought to be due to plaque rupture with superimposed thrombus. With optical coherence tomography plaque erosion (PE) can be detected in one third of cases. In young patients without major risk factors one can suspect PE. We are reporting one such case in whom stenting was deferred.
{"title":"Optical coherence tomography-guided deferred stenting in acute coronary syndromes","authors":"I. Sathyamurthy, Srinivasan Kanthallu, V. PaulPandi","doi":"10.4103/jicc.jicc_87_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_87_20","url":null,"abstract":"Acute coronary syndromes were thought to be due to plaque rupture with superimposed thrombus. With optical coherence tomography plaque erosion (PE) can be detected in one third of cases. In young patients without major risk factors one can suspect PE. We are reporting one such case in whom stenting was deferred.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"262 1","pages":"37 - 39"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75850527","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}
Sudden cardiac death is estimated to affect approximately three million people worldwide each year. Substrates and triggers often play a complex role in these deaths. Among the heart cells, disturbed potassium homeostasis is one such trigger. Hypokalemia and transient drops in potassium concentration are significant issues. Heart failure (HF) therapy is increasingly complicated by maintaining normal serum potassium (K+) homeostasis. As a result of the use of loop diuretics hypokalemia has become a severe and feared side effect of treatment. Hypokalemia in HF also indicates greater neurohormonal activity and progression of disease. Personalized drug use and monitoring of electrolytes are crucial for successful treatment. The lowest dose of diuretic necessary to maintain euvolemia should be prescribed to HF patients with symptoms (New York Heart Association Class III-IV). Aldosterone receptor antagonists, spironolactone can be used to treat mild hypokalemia. For more severe, K + supplement is recommended. Levels should be routinely monitored and kept between 4.0 and 5.5 mEq/l.
{"title":"Treatment strategies of hypokalemia in heart failure","authors":"Kavya Surendran, B. Joseph, J. Vilapurathu","doi":"10.4103/jicc.jicc_62_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_62_21","url":null,"abstract":"Sudden cardiac death is estimated to affect approximately three million people worldwide each year. Substrates and triggers often play a complex role in these deaths. Among the heart cells, disturbed potassium homeostasis is one such trigger. Hypokalemia and transient drops in potassium concentration are significant issues. Heart failure (HF) therapy is increasingly complicated by maintaining normal serum potassium (K+) homeostasis. As a result of the use of loop diuretics hypokalemia has become a severe and feared side effect of treatment. Hypokalemia in HF also indicates greater neurohormonal activity and progression of disease. Personalized drug use and monitoring of electrolytes are crucial for successful treatment. The lowest dose of diuretic necessary to maintain euvolemia should be prescribed to HF patients with symptoms (New York Heart Association Class III-IV). Aldosterone receptor antagonists, spironolactone can be used to treat mild hypokalemia. For more severe, K + supplement is recommended. Levels should be routinely monitored and kept between 4.0 and 5.5 mEq/l.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"T153 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82636240","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. Thakkar, S. Shankar, Ramnaresh Soudri, T. Babu Reddy, C. Nagesh, B. Srinivas, C. Manjunath
Left ventricular dysfunction is an uncommon complication of Takayasu arteritis (TA) with a prevalence of about 10%–15%. We report a case of a 27-year-old girl who presented with dyspnea, bipedal edema, loss of weight, and easy fatigability for 3 months. Patient also developed right hemiparesis 3 months ago. Computed tomography of the brain was suggestive of the left temporal infarct, on evaluation she was diagnosed as left ventricle (LV) dysfunction and she was treated for CVA and heart failure. Clinical examination revealed the absence of the left upper limb and bilateral lower limb pulses with right upper limb hypertension. Echocardiography revealed severe LV dysfunction (ejection function ~20%). Computed tomography angiogram and other inflammatory markers confirmed the diagnosis of TA and revealed the presence of coaraction of the thoracic and abdominal aorta. Coaractoplasty was done, and immunosuppressant therapy with oral prednisolone and weekly oral methotrexate was started. On follow-up, patient is asymptomatic with improved LV function. Any patient with LV dysfunction or dilated cardiomyopathy, reversible causes have to be ruled out and TA has to be thought of as a differential diagnosis particularly in young females. Checking of all four limbs pulses and blood pressure is strictly recommended. TA is a systemic vasculopathy that can progress to cause vital organ ischemia. Therefore, early diagnosis and management as well as long-term follow-up is recommended.
{"title":"A case of middle aortic syndrome in takayasu arteritis with left ventricle dysfunction and heart failure","authors":"D. Thakkar, S. Shankar, Ramnaresh Soudri, T. Babu Reddy, C. Nagesh, B. Srinivas, C. Manjunath","doi":"10.4103/jicc.jicc_4_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_4_21","url":null,"abstract":"Left ventricular dysfunction is an uncommon complication of Takayasu arteritis (TA) with a prevalence of about 10%–15%. We report a case of a 27-year-old girl who presented with dyspnea, bipedal edema, loss of weight, and easy fatigability for 3 months. Patient also developed right hemiparesis 3 months ago. Computed tomography of the brain was suggestive of the left temporal infarct, on evaluation she was diagnosed as left ventricle (LV) dysfunction and she was treated for CVA and heart failure. Clinical examination revealed the absence of the left upper limb and bilateral lower limb pulses with right upper limb hypertension. Echocardiography revealed severe LV dysfunction (ejection function ~20%). Computed tomography angiogram and other inflammatory markers confirmed the diagnosis of TA and revealed the presence of coaraction of the thoracic and abdominal aorta. Coaractoplasty was done, and immunosuppressant therapy with oral prednisolone and weekly oral methotrexate was started. On follow-up, patient is asymptomatic with improved LV function. Any patient with LV dysfunction or dilated cardiomyopathy, reversible causes have to be ruled out and TA has to be thought of as a differential diagnosis particularly in young females. Checking of all four limbs pulses and blood pressure is strictly recommended. TA is a systemic vasculopathy that can progress to cause vital organ ischemia. Therefore, early diagnosis and management as well as long-term follow-up is recommended.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"22 1","pages":"28 - 30"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75069741","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}
No-reflow is defined as failure to restore normal myocardial perfusion despite removal of mechanical obstruction in the epicardial coronary arteries. This phenomenon is associated with high risk of major adverse cardiac events, recurrent heart failure, arrhythmias, and death. The degree of reperfusion injury depends on the duration of preceding myocardial ischemia, infarct size, procedure variables, and patient characteristics. This complication predominantly occurs during percutaneous coronary intervention for acute coronary syndrome. Cardiac magnetic resonance imaging is the gold standard noninvasive method for assessing this phenomenon. Conditions such as flow-limiting dissection, in situ thrombosis, severe spasm, or high-grade residual stenosis should be excluded prior to making a diagnosis of no-reflow phenomenon. The management of no-reflow should be personalized according to the predominant mechanisms contributing to the microvascular obstruction.
{"title":"Coronary slow flow/no-reflow: Revisited","authors":"Srinivasan Kanthallu, I. Sathyamurthy","doi":"10.4103/JICC.JICC_72_20","DOIUrl":"https://doi.org/10.4103/JICC.JICC_72_20","url":null,"abstract":"No-reflow is defined as failure to restore normal myocardial perfusion despite removal of mechanical obstruction in the epicardial coronary arteries. This phenomenon is associated with high risk of major adverse cardiac events, recurrent heart failure, arrhythmias, and death. The degree of reperfusion injury depends on the duration of preceding myocardial ischemia, infarct size, procedure variables, and patient characteristics. This complication predominantly occurs during percutaneous coronary intervention for acute coronary syndrome. Cardiac magnetic resonance imaging is the gold standard noninvasive method for assessing this phenomenon. Conditions such as flow-limiting dissection, in situ thrombosis, severe spasm, or high-grade residual stenosis should be excluded prior to making a diagnosis of no-reflow phenomenon. The management of no-reflow should be personalized according to the predominant mechanisms contributing to the microvascular obstruction.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"66 1","pages":"8 - 13"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74476413","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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