S. Seth, M. Malik, R. Bansal, N. Parakh, A. Roy, VinayKumar Bahl
{"title":"Prognostic value of resting heart rate and heart rate recovery in acute decompensated heart failure: A prospective cohort study","authors":"S. Seth, M. Malik, R. Bansal, N. Parakh, A. Roy, VinayKumar Bahl","doi":"10.4103/jpcs.jpcs_68_22","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_68_22","url":null,"abstract":"","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"30 6 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70816556","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}
A. Zakiei, Habibolah Khazaie, M. Alimoradi, Amirmehdi Kadivarian, N. Rajabi-Gilan, Saeid Komasi
Objective: Given the need for further studies on health-promoting behaviors, the present study aimed to investigate the antecedents of controlling risk factors for cardiovascular diseases (CVDs) according to the affective and emotional composite temperament (AFECT) model and the mediating role of self-regulation. Materials and Methods: The samples of this cross-sectional study included 776 people resident in Kermanshah in Western Iran in 2019. The participants were selected using a cluster sampling method. Data were collected using the controlling the risk factors for cardiovascular disease questionnaire (CRC), the short form self-regulation questionnaire, and the AFECT scale. The structural equation modeling was used to analyze the data. Results: The analysis results indicated that there was a significant correlation between dimensions of AFECT and self-regulation with the control of risk factors for CVDs. The results also indicated that the dimensions of AFECT did not directly affect the control of risk factors for CVDs, but the mediating role of self-regulation was confirmed in this regard. Conclusion: According to the results, the dimensions of AFECT could affect the control of risk factors for CVDs through self-regulation; hence, the role of self-regulation in controlling CVDs should be taken into account.
{"title":"A causal model for the control of risk factors for cardiovascular diseases using a new temperamental personality theory in the general population of Western Iran: The mediating role of self-regulation","authors":"A. Zakiei, Habibolah Khazaie, M. Alimoradi, Amirmehdi Kadivarian, N. Rajabi-Gilan, Saeid Komasi","doi":"10.4103/jpcs.jpcs_62_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_62_21","url":null,"abstract":"Objective: Given the need for further studies on health-promoting behaviors, the present study aimed to investigate the antecedents of controlling risk factors for cardiovascular diseases (CVDs) according to the affective and emotional composite temperament (AFECT) model and the mediating role of self-regulation. Materials and Methods: The samples of this cross-sectional study included 776 people resident in Kermanshah in Western Iran in 2019. The participants were selected using a cluster sampling method. Data were collected using the controlling the risk factors for cardiovascular disease questionnaire (CRC), the short form self-regulation questionnaire, and the AFECT scale. The structural equation modeling was used to analyze the data. Results: The analysis results indicated that there was a significant correlation between dimensions of AFECT and self-regulation with the control of risk factors for CVDs. The results also indicated that the dimensions of AFECT did not directly affect the control of risk factors for CVDs, but the mediating role of self-regulation was confirmed in this regard. Conclusion: According to the results, the dimensions of AFECT could affect the control of risk factors for CVDs through self-regulation; hence, the role of self-regulation in controlling CVDs should be taken into account.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"190 - 197"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44847737","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}
Valve replacement still defines a major proportion of valvular cases in cardiothoracic surgery in a developing country like India. With most patients getting a mechanical prosthetic heart valve and dependent on lifelong anticoagulation, regular international normalized ratio (INR) monitoring is warranted to maintain the optimum range while evaluating for any adverse effects in follow-up. We describe two postoperative patients of mechanical valve replacement on anticoagulant and antiplatelet, presenting with complaints of jaundice, bleeding, and deranged INR diagnosed with hepatobiliary–pancreatic malignancies. Although deranged coagulogram is mostly resulting from dosage modification of anticoagulants and dietary modifications, it should be sought out carefully, particularly in patients with a previously stabilized profile on a similar dosage and not be dismissed on account of anticoagulant therapy, especially if the patient is icteric.
{"title":"Hepatobiliary malignancy presenting as deranged coagulogram in postoperative mechanical valve replacement patients","authors":"Y. Arora, T. Kar, V. Devagourou","doi":"10.4103/jpcs.jpcs_20_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_20_21","url":null,"abstract":"Valve replacement still defines a major proportion of valvular cases in cardiothoracic surgery in a developing country like India. With most patients getting a mechanical prosthetic heart valve and dependent on lifelong anticoagulation, regular international normalized ratio (INR) monitoring is warranted to maintain the optimum range while evaluating for any adverse effects in follow-up. We describe two postoperative patients of mechanical valve replacement on anticoagulant and antiplatelet, presenting with complaints of jaundice, bleeding, and deranged INR diagnosed with hepatobiliary–pancreatic malignancies. Although deranged coagulogram is mostly resulting from dosage modification of anticoagulants and dietary modifications, it should be sought out carefully, particularly in patients with a previously stabilized profile on a similar dosage and not be dismissed on account of anticoagulant therapy, especially if the patient is icteric.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"236 - 238"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46553586","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}
{"title":"A “Cutie” - Diagnosis using cute heuristics","authors":"H. Kiran","doi":"10.4103/jpcs.jpcs_55_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_55_21","url":null,"abstract":"","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"239 - 240"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45344911","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}
T. Muralidharan, B. Kumar, Preetam Krishnamurthy, N. Senguttuvan, J. Balasubramaniyan, S. Sadhanandham, J. Rathinasamy, R. Sankaran, Manokar Panchanatham, J. Murthy, T. Sadagopan
Background: The COVID-19 pandemic has transformed the medical society in many ways. With significant drain on the resources and altered healthcare priorities, there is a greater need for redeployment of the resources from noncommunicable diseases to COVID-19-related healthcare services. To understand the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Tamil Nadu, a survey was administered across cardiologists in Tamil Nadu. Methods: A survey was done using an electronic questionnaire administered regarding the change of patterns of acute coronary syndromes during the COVID through Google Forms with responses collected in excel format. Results: Among 256 cardiologists contacted, 101 responded to the survey. Among cardiologists who responded, all were interventional cardiologists– with most of them performing primary percutaneous coronary intervention (PCI) (95%) regularly during pre-COVID times. Most of them have noticed a significant reduction in the number of patients with ACS seeking health care (94%) and another 61% of respondents felt that there was a reduction in the number of patients with acute coronary syndrome. There was a significant delay in ST-segment elevation myocardial infarction presentation to the hospital (88%) and significant reduction in the number of primary PCI (47%). Only 19% of respondents did primary PCI for COVID-positive patients. Conclusions: COVID pandemic has emerged as a big challenge to the global health care system. Optimal acute coronary care could not be delivered in a timely manner due to multiple social, patient, and physician-related factors. The emerging techniques in rapid diagnosis of COVID-19 and protective measures of COVID infection are expected to improve the situation. Trial Registration: Clinical Trials Registry – India (CTRI), CTRI/2020/09/027517, Registered September 1, 2020 http://CTRI. nic. In/Clinicaltrials/pmaindet2. php? trialid = 47025 and EncHid = and user Name =.
{"title":"COVID-19 and its impact on the management of patients with acute coronary syndrome during the first COVID wave – A questionnaire-based survey among interventional cardiologists from Southern India","authors":"T. Muralidharan, B. Kumar, Preetam Krishnamurthy, N. Senguttuvan, J. Balasubramaniyan, S. Sadhanandham, J. Rathinasamy, R. Sankaran, Manokar Panchanatham, J. Murthy, T. Sadagopan","doi":"10.4103/jpcs.jpcs_43_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_43_21","url":null,"abstract":"Background: The COVID-19 pandemic has transformed the medical society in many ways. With significant drain on the resources and altered healthcare priorities, there is a greater need for redeployment of the resources from noncommunicable diseases to COVID-19-related healthcare services. To understand the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Tamil Nadu, a survey was administered across cardiologists in Tamil Nadu. Methods: A survey was done using an electronic questionnaire administered regarding the change of patterns of acute coronary syndromes during the COVID through Google Forms with responses collected in excel format. Results: Among 256 cardiologists contacted, 101 responded to the survey. Among cardiologists who responded, all were interventional cardiologists– with most of them performing primary percutaneous coronary intervention (PCI) (95%) regularly during pre-COVID times. Most of them have noticed a significant reduction in the number of patients with ACS seeking health care (94%) and another 61% of respondents felt that there was a reduction in the number of patients with acute coronary syndrome. There was a significant delay in ST-segment elevation myocardial infarction presentation to the hospital (88%) and significant reduction in the number of primary PCI (47%). Only 19% of respondents did primary PCI for COVID-positive patients. Conclusions: COVID pandemic has emerged as a big challenge to the global health care system. Optimal acute coronary care could not be delivered in a timely manner due to multiple social, patient, and physician-related factors. The emerging techniques in rapid diagnosis of COVID-19 and protective measures of COVID infection are expected to improve the situation. Trial Registration: Clinical Trials Registry – India (CTRI), CTRI/2020/09/027517, Registered September 1, 2020 http://CTRI. nic. In/Clinicaltrials/pmaindet2. php? trialid = 47025 and EncHid = and user Name =.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"219 - 224"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49165782","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}
Lokesh Khandelwal, V. Trehan, M. Girish, M. Gupta, Safal Safal
Objective: Coronary artery disease (CAD) is the most common etiology of heart failure with reduced ejection fraction (EF). Coronary angiography is usually not done in patients with severe left ventricular systolic dysfunction (LVSD) without a history of acute coronary syndrome or angina, due to fear of increased risk. Hence, the prevalence of CAD in such cases remains unknown. This study aimed at analyzing the clinical and angiographic profile of the patients with severe LVSD (EF ≤35%) without established CAD. Methods: This was a prospective, observational study conducted from January 2018 to July 2019. One hundred consecutive patients (≥18 years) with severe LVSD (EF ≤35%) without established CAD were assessed for underlying CAD by coronary angiography. Patients were divided into those with no CAD and CAD. Patients having CAD were further classified into those with significant CAD and severe CAD based on angiographic lesion severity. The risk factors contributing to significant CAD were analyzed. Results: Sixty-four patients had no CAD and 36 patients had CAD, of which 34 and 26 patients had significant CAD and severe CAD, respectively. 41.7% patients had double-vessel disease followed by 33.3% and 25% patients having triple-vessel disease and single-vessel disease, respectively. The risk factors for significant CAD were male >55 years/female >65 years, male gender, diabetes mellitus, smoking, and dyslipidemia. Multivariate logistic regression analysis showed diabetes and dyslipidemia to be the independent risk predictors for significant CAD. Conclusion: Occult CAD is present in high proportions in patients with severe LVSD without established CAD specially in presence of risk factors such as diabetes, male >55 years/female >65 years and dyslipidemia. Hence, coronary angiography should be considered strongly in such patients having one or more of these risk factors.
{"title":"Clinical and angiographic profile of patients with severe left ventricular systolic dysfunction without established coronary artery disease","authors":"Lokesh Khandelwal, V. Trehan, M. Girish, M. Gupta, Safal Safal","doi":"10.4103/jpcs.jpcs_51_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_51_21","url":null,"abstract":"Objective: Coronary artery disease (CAD) is the most common etiology of heart failure with reduced ejection fraction (EF). Coronary angiography is usually not done in patients with severe left ventricular systolic dysfunction (LVSD) without a history of acute coronary syndrome or angina, due to fear of increased risk. Hence, the prevalence of CAD in such cases remains unknown. This study aimed at analyzing the clinical and angiographic profile of the patients with severe LVSD (EF ≤35%) without established CAD. Methods: This was a prospective, observational study conducted from January 2018 to July 2019. One hundred consecutive patients (≥18 years) with severe LVSD (EF ≤35%) without established CAD were assessed for underlying CAD by coronary angiography. Patients were divided into those with no CAD and CAD. Patients having CAD were further classified into those with significant CAD and severe CAD based on angiographic lesion severity. The risk factors contributing to significant CAD were analyzed. Results: Sixty-four patients had no CAD and 36 patients had CAD, of which 34 and 26 patients had significant CAD and severe CAD, respectively. 41.7% patients had double-vessel disease followed by 33.3% and 25% patients having triple-vessel disease and single-vessel disease, respectively. The risk factors for significant CAD were male >55 years/female >65 years, male gender, diabetes mellitus, smoking, and dyslipidemia. Multivariate logistic regression analysis showed diabetes and dyslipidemia to be the independent risk predictors for significant CAD. Conclusion: Occult CAD is present in high proportions in patients with severe LVSD without established CAD specially in presence of risk factors such as diabetes, male >55 years/female >65 years and dyslipidemia. Hence, coronary angiography should be considered strongly in such patients having one or more of these risk factors.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"202 - 206"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47084731","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: The anatomical characterization of foramen ovale (FO) along with annulus or limbus varies in size and shape from the heart to heart. Patent FO (PFO) has been implicated in the etiology of a number of diseases, PFO is not an uncommon condition; their prevalence rate is 15%–35% in the population. Hence, morphological study of FO serves importance to know the exact location of the fossa ovalis (FOv) and prevalence of PFO in the Indian population by the autopsy method. Materials and Methods: This study was conducted in 106 apparently normal hearts available in the Department of Anatomy and Forensic Medicine and Toxicology. After opening the right atrium, the shape of FOv was observed, and dimensions were measured with the digital Vernier caliper and thickness of anterior and posterior limbus was noted. Probe patency was confirmed. Results: Area of the FOv (160.20 ± 104.9 mm2), thickness anterior limbus (7.24 ± 1.83 mm), and thickness of posterior limbus (6.38 ± 2.46 mm). The shape of FOv was oval (83%) in majority; in 86.7%, the rim of the limbus was raised and 13.3% it was flat; in 20.75%, a recess was found deep to the margin of the limbus and 10.37% showed probe patency. A significant positive correlation was observed between cardiac weight and area of FOv. Conclusion: By autopsy method, we found the prevalence of PFO is 4.71%, which is lower than Western population, our study also provides the accurate measurements related with several morphometric variation such as shape of FOv and limbus FOv.
{"title":"A clinical relevance of fossa ovalis and patent foramen ovale: A morphological study of human heart","authors":"T. Honnegowda, M. Alghamdi","doi":"10.4103/jpcs.jpcs_60_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_60_21","url":null,"abstract":"Background: The anatomical characterization of foramen ovale (FO) along with annulus or limbus varies in size and shape from the heart to heart. Patent FO (PFO) has been implicated in the etiology of a number of diseases, PFO is not an uncommon condition; their prevalence rate is 15%–35% in the population. Hence, morphological study of FO serves importance to know the exact location of the fossa ovalis (FOv) and prevalence of PFO in the Indian population by the autopsy method. Materials and Methods: This study was conducted in 106 apparently normal hearts available in the Department of Anatomy and Forensic Medicine and Toxicology. After opening the right atrium, the shape of FOv was observed, and dimensions were measured with the digital Vernier caliper and thickness of anterior and posterior limbus was noted. Probe patency was confirmed. Results: Area of the FOv (160.20 ± 104.9 mm2), thickness anterior limbus (7.24 ± 1.83 mm), and thickness of posterior limbus (6.38 ± 2.46 mm). The shape of FOv was oval (83%) in majority; in 86.7%, the rim of the limbus was raised and 13.3% it was flat; in 20.75%, a recess was found deep to the margin of the limbus and 10.37% showed probe patency. A significant positive correlation was observed between cardiac weight and area of FOv. Conclusion: By autopsy method, we found the prevalence of PFO is 4.71%, which is lower than Western population, our study also provides the accurate measurements related with several morphometric variation such as shape of FOv and limbus FOv.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"27 21","pages":"198 - 201"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41269969","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}
Although there have been spectacular developments in the diagnosis and treatment of coronary artery disease (CAD), the diagnostic terminology has not evolved accordingly. The present diagnostic terms are symptom, complication, and electrocardiogram based instead of the causative pathology. In the present era of excellent therapies, angina and infarction need not occur. When our efforts are directed at preventing these ill effects of CAD, the present diagnostic terms seem anachronistic. This article presents a simple, logical, and practical approach to CAD terminology.
{"title":"Cleansing the augean stables - Time to reclassify coronary artery disease","authors":"G. Thomas","doi":"10.4103/jpcs.jpcs_61_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_61_21","url":null,"abstract":"Although there have been spectacular developments in the diagnosis and treatment of coronary artery disease (CAD), the diagnostic terminology has not evolved accordingly. The present diagnostic terms are symptom, complication, and electrocardiogram based instead of the causative pathology. In the present era of excellent therapies, angina and infarction need not occur. When our efforts are directed at preventing these ill effects of CAD, the present diagnostic terms seem anachronistic. This article presents a simple, logical, and practical approach to CAD terminology.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"179 - 181"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44508438","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}
Pub Date : 2021-09-01DOI: 10.4103/jpcs.jpcs_106_20
Arun Chopra, S. Patted, Mukesh Parikh, R. Agarwal, K. Jaishankar, N. Modi
In India, ST-elevation myocardial infarction (STEMI) is the predominant form of acute coronary syndrome. It is estimated to affect approximately 30 million people in India. The mainstay treatment approach for STEMI management is primary percutaneous coronary intervention (PCI) within 90 min after the first medical contact. However, due to existent clinical and practical barriers in performing timely PCI, optimal treatment is not offered on a timely basis. The challenges or barriers to timely PCI can be overcome by a pharmaco-invasive approach, in which thrombolysis is performed as soon as the patient is diagnosed with STEMI and transferred for PCI. Pharmaco-invasive approach is effective in shortening time to reperfusion therapy by allowing prompt initiation of thrombolysis followed by PCI as soon as possible. An experts' panel discussion was conducted involving 47 cardiologists all over India to review evidence-based concept of pharmaco-invasive treatment approach and to gain their expert opinion on emergency management of STEMI patients in the Indian setting. The experts highlighted that thrombolysis is the most implemented reperfusion strategy in India, especially when primary PCI is not available for STEMI patients. According to them, pharmaco-invasive approach would be appropriate to gain time to treatment in the event of expected treatment delays. Among thrombolytic agents, the experts recommended using third-generation thrombolytic agents because of their faster patency, more effectiveness, and ease of administration. They also emphasized on various clinical factors and practical considerations to be assessed before employing thrombolytic agents. In their opinion, bolus thrombolytic agents such as tenecteplase and reteplase offer effective, safer, easier, and faster administration for varied clinical profiles in all practical ways.
{"title":"Use of thrombolytic agents for ST-elevation myocardial infarction care in India: An expert consensus","authors":"Arun Chopra, S. Patted, Mukesh Parikh, R. Agarwal, K. Jaishankar, N. Modi","doi":"10.4103/jpcs.jpcs_106_20","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_106_20","url":null,"abstract":"In India, ST-elevation myocardial infarction (STEMI) is the predominant form of acute coronary syndrome. It is estimated to affect approximately 30 million people in India. The mainstay treatment approach for STEMI management is primary percutaneous coronary intervention (PCI) within 90 min after the first medical contact. However, due to existent clinical and practical barriers in performing timely PCI, optimal treatment is not offered on a timely basis. The challenges or barriers to timely PCI can be overcome by a pharmaco-invasive approach, in which thrombolysis is performed as soon as the patient is diagnosed with STEMI and transferred for PCI. Pharmaco-invasive approach is effective in shortening time to reperfusion therapy by allowing prompt initiation of thrombolysis followed by PCI as soon as possible. An experts' panel discussion was conducted involving 47 cardiologists all over India to review evidence-based concept of pharmaco-invasive treatment approach and to gain their expert opinion on emergency management of STEMI patients in the Indian setting. The experts highlighted that thrombolysis is the most implemented reperfusion strategy in India, especially when primary PCI is not available for STEMI patients. According to them, pharmaco-invasive approach would be appropriate to gain time to treatment in the event of expected treatment delays. Among thrombolytic agents, the experts recommended using third-generation thrombolytic agents because of their faster patency, more effectiveness, and ease of administration. They also emphasized on various clinical factors and practical considerations to be assessed before employing thrombolytic agents. In their opinion, bolus thrombolytic agents such as tenecteplase and reteplase offer effective, safer, easier, and faster administration for varied clinical profiles in all practical ways.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"182 - 189"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46381372","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}
Debasish Das, D. Acharya, Jogendra Singh, Subhash R. Pramanik
We report a rare case of inadvertent distal small diagonal branch perforation noted postleft anterior descending coronary artery revascularization, rescued by Gelfoam closure in a 43-year diabetic male presenting with acute anterior wall ST elevated myocardial infarction. Intermittent balloon inflation for 30 min was not able to seal off the perforation; because of impending late (3–6 h) cardiac tamponade, we closed the perforation with Gelfoam embolization through Caravel microcatheter. Although rarely practiced, this armamentarium should be there in the interventional cardiology laboratory to deal with small vessel perforation (<2 mm), for which traditionally covered stents are not available in size.
{"title":"A detailed review of management of coronary perforations by gelfoam closure","authors":"Debasish Das, D. Acharya, Jogendra Singh, Subhash R. Pramanik","doi":"10.4103/jpcs.jpcs_45_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_45_21","url":null,"abstract":"We report a rare case of inadvertent distal small diagonal branch perforation noted postleft anterior descending coronary artery revascularization, rescued by Gelfoam closure in a 43-year diabetic male presenting with acute anterior wall ST elevated myocardial infarction. Intermittent balloon inflation for 30 min was not able to seal off the perforation; because of impending late (3–6 h) cardiac tamponade, we closed the perforation with Gelfoam embolization through Caravel microcatheter. Although rarely practiced, this armamentarium should be there in the interventional cardiology laboratory to deal with small vessel perforation (<2 mm), for which traditionally covered stents are not available in size.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"230 - 235"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48051772","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：