Pramesh Gaidhane, J. Prajapati, I. Patel, Bhagyashri Bhutada, C. Yadav, K. Yadav, B. Panakkal
Background: Device closure of atrial septal defect (ASD) is a treatment of choice in selected patients with a suitable defect. We aimed to evaluate short- and intermediate-term outcomes with device closure in special reference to complications in Western Indian population. Materials and Methods: The present prospective observational study enrolled 184 patients with ASD who underwent Device closure. All patients were followed at 15–30 days (short) and 3–12 months (intermediate). Results: Device closure of ASD was done successfully in 180 (97.83%) patients. Systolic (P = 0.02), diastolic (P = 0.007), and mean PA (P = 0.0001) pressure were significantly decreased at postprocedure. Residual defect was resolved in 94.2% of patients by 6 months. Preprocedural Pulmonary artery hypertension was found in 36 (19.56%) patients and was reduced in 15 (8.15%) patients postprocedure and in 10 (5.43%) patients at 1 year. Residual shunt was reported in 34% of patients which was resolved in all by 6 months. At postprocedure and follow–up, patients were developed minor complications included (0.5%) moderate MR, 1 (0.5%) lower respiratory tract infection, and 3 (1.6%) local site hematoma. Eleven (5.98%) major complications involved arrythmia (2.17%), infective endocarditis (0.54%), LAA perforation (0.54%), cardioembolic shock (0.54%), device embolization (0.54%), sudden cardiac arrest (0.54%), intraprocedural acute coronary syndrome (0.54%), and cardiac tamponade (0.54%). Conclusion: Device closure appears to be best available option at the present time. Careful attention to the details of the technique is mandatory to achieve a successful outcome in order to avoid complication related to procedure. Patients of all ages experience reduction in pulmonary artery pressure after percutaneous device closure of ASD.
{"title":"Clinical profile of patients of ASD device closure with special reference to short and intermediate term complications","authors":"Pramesh Gaidhane, J. Prajapati, I. Patel, Bhagyashri Bhutada, C. Yadav, K. Yadav, B. Panakkal","doi":"10.4103/jpcs.jpcs_30_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_30_21","url":null,"abstract":"Background: Device closure of atrial septal defect (ASD) is a treatment of choice in selected patients with a suitable defect. We aimed to evaluate short- and intermediate-term outcomes with device closure in special reference to complications in Western Indian population. Materials and Methods: The present prospective observational study enrolled 184 patients with ASD who underwent Device closure. All patients were followed at 15–30 days (short) and 3–12 months (intermediate). Results: Device closure of ASD was done successfully in 180 (97.83%) patients. Systolic (P = 0.02), diastolic (P = 0.007), and mean PA (P = 0.0001) pressure were significantly decreased at postprocedure. Residual defect was resolved in 94.2% of patients by 6 months. Preprocedural Pulmonary artery hypertension was found in 36 (19.56%) patients and was reduced in 15 (8.15%) patients postprocedure and in 10 (5.43%) patients at 1 year. Residual shunt was reported in 34% of patients which was resolved in all by 6 months. At postprocedure and follow–up, patients were developed minor complications included (0.5%) moderate MR, 1 (0.5%) lower respiratory tract infection, and 3 (1.6%) local site hematoma. Eleven (5.98%) major complications involved arrythmia (2.17%), infective endocarditis (0.54%), LAA perforation (0.54%), cardioembolic shock (0.54%), device embolization (0.54%), sudden cardiac arrest (0.54%), intraprocedural acute coronary syndrome (0.54%), and cardiac tamponade (0.54%). Conclusion: Device closure appears to be best available option at the present time. Careful attention to the details of the technique is mandatory to achieve a successful outcome in order to avoid complication related to procedure. Patients of all ages experience reduction in pulmonary artery pressure after percutaneous device closure of ASD.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"212 - 218"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47772758","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 rapidly changing economic stature and lifestyle choices of young individuals have affected healthcare in India. An increased prevalence of acute coronary syndrome (ACS) in young individuals has been observed. Aims and Objectives: The present cross-sectional, observational study was designed to record the clinical and angiographic profiles of young individuals (<40 years) with ACS. Materials and Methods: This cross-sectional, observational study was also designed to analyze the associations of lifestyle risk factors such as obesity, smoking, and alcohol on the occurrence of ACS and short-term (1 month) prognosis (rehospitalization and mortality). The inclusion criteria were age between 18 and 40 years with angina pectoris or equivalent at presentation and later diagnosed ACS per the consensus paper from the European Society of Cardiology/American College of Cardiology/American Heart Association/World Heart Federation joint task force. Patients with a previous history of ACS/coronary revascularization, atypical chest pain, valvular heart disease, hypertrophic cardiomyopathy, and/or congenital heart disease were excluded. Results: Out of the 403 patients that were screened, 162 young patients (18–40 years, mean ± standard deviation: 31.5 ± 4.64) were enrolled from a single tertiary cardiac care center located at Pune, Maharashtra, from May 2014 to May 2016. Most of the patient population were males (n [%]:151 [93.2]) of which 50% had positive addiction status for alcohol and smoking, family history of coronary artery disease (CAD) and a quarter of the patients had comorbidities of diabetes mellitus, hypertension, and/or abnormal lipid profile. The majority of the young ACS patients had ST-elevated myocardial infarction (STEMI: 87%), wherein anterior wall myocardial infarction was the most common electrocardiogram presentation, and primary angioplasty in myocardial infarction (PAMI) was the preferred modality of treatment in most of the young patients (61.7% vs. 38.3% thrombolysis). Conclusion: The prevalent angiographic profile of this study participants included obstructive CAD, single vessel disease, left ventricular ejection fraction (LVEF) <45, Angina Class IV, New York Heart Association (NYHA) class I, and Killip class I. Low LVEF, NYHA class IV, and Killip class IV showed association with short-term outcomes (mortality). The present study adds to the pool of information related to the western Indian population. However, a larger cohort study with a long-term follow is warranted to analyze the detailed ACS progression status in young individuals.
{"title":"Clinical and angiographic profile of acute coronary syndrome patients (<40 years) and short-term prognosis: A cross-sectional study","authors":"Nivargi Varun, Jadhav Ajitkumar","doi":"10.4103/jpcs.jpcs_58_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_58_21","url":null,"abstract":"Background: The rapidly changing economic stature and lifestyle choices of young individuals have affected healthcare in India. An increased prevalence of acute coronary syndrome (ACS) in young individuals has been observed. Aims and Objectives: The present cross-sectional, observational study was designed to record the clinical and angiographic profiles of young individuals (<40 years) with ACS. Materials and Methods: This cross-sectional, observational study was also designed to analyze the associations of lifestyle risk factors such as obesity, smoking, and alcohol on the occurrence of ACS and short-term (1 month) prognosis (rehospitalization and mortality). The inclusion criteria were age between 18 and 40 years with angina pectoris or equivalent at presentation and later diagnosed ACS per the consensus paper from the European Society of Cardiology/American College of Cardiology/American Heart Association/World Heart Federation joint task force. Patients with a previous history of ACS/coronary revascularization, atypical chest pain, valvular heart disease, hypertrophic cardiomyopathy, and/or congenital heart disease were excluded. Results: Out of the 403 patients that were screened, 162 young patients (18–40 years, mean ± standard deviation: 31.5 ± 4.64) were enrolled from a single tertiary cardiac care center located at Pune, Maharashtra, from May 2014 to May 2016. Most of the patient population were males (n [%]:151 [93.2]) of which 50% had positive addiction status for alcohol and smoking, family history of coronary artery disease (CAD) and a quarter of the patients had comorbidities of diabetes mellitus, hypertension, and/or abnormal lipid profile. The majority of the young ACS patients had ST-elevated myocardial infarction (STEMI: 87%), wherein anterior wall myocardial infarction was the most common electrocardiogram presentation, and primary angioplasty in myocardial infarction (PAMI) was the preferred modality of treatment in most of the young patients (61.7% vs. 38.3% thrombolysis). Conclusion: The prevalent angiographic profile of this study participants included obstructive CAD, single vessel disease, left ventricular ejection fraction (LVEF) <45, Angina Class IV, New York Heart Association (NYHA) class I, and Killip class I. Low LVEF, NYHA class IV, and Killip class IV showed association with short-term outcomes (mortality). The present study adds to the pool of information related to the western Indian population. However, a larger cohort study with a long-term follow is warranted to analyze the detailed ACS progression status in young individuals.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"225 - 229"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48541966","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: Earlier diagnosis of asymptomatic coronary artery disease (CAD) in diabetics may prevent catastrophic cardiac events and hence warrants the need for detection of silent myocardial ischemia (SMI). Therefore, the study aimed to assess the role of treadmill test (TMT) in patients who were asymptomatic, to detect and estimate the occurrence of SMI (positive exercise TMT), and to find the association between presence of SMI and duration of diabetes mellitus (DM). Methodology: A cross-sectional study was undertaken among 162 DM cases (type 2) with a mean age of 55.32 ± 11.89 years, who had undergone a TMT without any CAD evidence clinically. All the subjects had normal 12 lead electrocardiography and underwent TMT. Results: Among 162 subjects, TMT was positive in 63 (38.9%) study subjects. TMT positivity for inducible ischemia in type 2 DM patients was associated with increasing age, higher body mass index (BMI), smoking, higher HbA1C, albuminuria, retinopathy, and atherosclerotic cardiovascular disease (ASCVD) risk score. Smoking, diabetic retinopathy, and urine albumin were associated with TMT significantly (P value < 0.005). A significant linear increasing trend in proportion of TMT positive over HbA1c was observed. Mean height of TMT-positive subjects (159.2 ± 7.47 cm) was more than TMT-negative subjects (P < 0.005). The mean BMI (29.69 ± 3.58 kg/m2) and triglycerides (173.87 ± 112.7 mg/dl) of TMT-positive subjects were more than TMT-negative subjects (P < 0.005). Conclusion: CAD prevalence is greater in asymptomatic cases of type 2 DM in this geographic region. A significant linear increasing trend was observed in TMT positive over HbA1c. Hence, TMT can be incorporated in routine screening for SMI in patients suffering from diabetes.
{"title":"Prevalence of asymptomatic silent myocardial ischemia among type 2 diabetes mellitus patients in Bangalore - A hospital-based cross-sectional study","authors":"Nagappa Handargal, Shristi Shetty","doi":"10.4103/jpcs.jpcs_33_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_33_21","url":null,"abstract":"Background: Earlier diagnosis of asymptomatic coronary artery disease (CAD) in diabetics may prevent catastrophic cardiac events and hence warrants the need for detection of silent myocardial ischemia (SMI). Therefore, the study aimed to assess the role of treadmill test (TMT) in patients who were asymptomatic, to detect and estimate the occurrence of SMI (positive exercise TMT), and to find the association between presence of SMI and duration of diabetes mellitus (DM). Methodology: A cross-sectional study was undertaken among 162 DM cases (type 2) with a mean age of 55.32 ± 11.89 years, who had undergone a TMT without any CAD evidence clinically. All the subjects had normal 12 lead electrocardiography and underwent TMT. Results: Among 162 subjects, TMT was positive in 63 (38.9%) study subjects. TMT positivity for inducible ischemia in type 2 DM patients was associated with increasing age, higher body mass index (BMI), smoking, higher HbA1C, albuminuria, retinopathy, and atherosclerotic cardiovascular disease (ASCVD) risk score. Smoking, diabetic retinopathy, and urine albumin were associated with TMT significantly (P value < 0.005). A significant linear increasing trend in proportion of TMT positive over HbA1c was observed. Mean height of TMT-positive subjects (159.2 ± 7.47 cm) was more than TMT-negative subjects (P < 0.005). The mean BMI (29.69 ± 3.58 kg/m2) and triglycerides (173.87 ± 112.7 mg/dl) of TMT-positive subjects were more than TMT-negative subjects (P < 0.005). Conclusion: CAD prevalence is greater in asymptomatic cases of type 2 DM in this geographic region. A significant linear increasing trend was observed in TMT positive over HbA1c. Hence, TMT can be incorporated in routine screening for SMI in patients suffering from diabetes.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"207 - 211"},"PeriodicalIF":0.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43455367","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}
The Indian Society of Heart and Lung Transplantation started building up a cloud-based registry of heart and lung transplantation from 2018 to 2019. As a first step, the hospitals involved in these procedures were enrolled in a Cloud-based Google Sheet Registry. Data have been updated till April 2021. This brief communication is the first publication from this registry and lists the 72 hospitals which participated in this voluntary registry. Starting in 1994 at AIIMS New Delhi, India as of now has completed 1113 heart transplants, 101 heart lung transplants, 338 lung transplants, and implanted 124 left ventricular assist devices.
{"title":"Annual report of the Indian Heart and Lung Transplant Registry","authors":"","doi":"10.4103/jpcs.jpcs_34_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_34_21","url":null,"abstract":"The Indian Society of Heart and Lung Transplantation started building up a cloud-based registry of heart and lung transplantation from 2018 to 2019. As a first step, the hospitals involved in these procedures were enrolled in a Cloud-based Google Sheet Registry. Data have been updated till April 2021. This brief communication is the first publication from this registry and lists the 72 hospitals which participated in this voluntary registry. Starting in 1994 at AIIMS New Delhi, India as of now has completed 1113 heart transplants, 101 heart lung transplants, 338 lung transplants, and implanted 124 left ventricular assist devices.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"175 - 177"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45639439","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, Tutan Das, S. Singh, J. Gupta, Subhash R. Pramanik
Hypertrophic cardiomyopathy (HCM) commonly presents with nonspecific ST-T changes in an electrocardiogram (EKG), and a paucity of literature description exists about index presentation of HCM totally as ST-elevation myocardial infarction (STEMI) in a very young age. The presence of convex ST elevation in surface EKG in HCM patients indicates disease progression, becomes evident in the fifth or sixth decade of life, and warrants further risk stratification for the need of automated intracardiac defibrillator therapy. We present a rare presentation of nonobstructive HCM totally mimicking acute anterior wall STEMI in a very young male in his third decade of life, which has not been described in the literature so far. Because of the presence of typical convex shaped ST elevation with biphasic terminal T wave inversion across anterior precordial leads with ongoing typical angina, the patient was subjected to right transradial coronary angiogram which revealed the presence of normal nonatherosclerotic coronaries.
{"title":"Hypertrophic cardiomyopathy: Totally a ST-elevation myocardial infarction mimic","authors":"Debasish Das, D. Acharya, Tutan Das, S. Singh, J. Gupta, Subhash R. Pramanik","doi":"10.4103/jpcs.jpcs_26_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_26_21","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) commonly presents with nonspecific ST-T changes in an electrocardiogram (EKG), and a paucity of literature description exists about index presentation of HCM totally as ST-elevation myocardial infarction (STEMI) in a very young age. The presence of convex ST elevation in surface EKG in HCM patients indicates disease progression, becomes evident in the fifth or sixth decade of life, and warrants further risk stratification for the need of automated intracardiac defibrillator therapy. We present a rare presentation of nonobstructive HCM totally mimicking acute anterior wall STEMI in a very young male in his third decade of life, which has not been described in the literature so far. Because of the presence of typical convex shaped ST elevation with biphasic terminal T wave inversion across anterior precordial leads with ongoing typical angina, the patient was subjected to right transradial coronary angiogram which revealed the presence of normal nonatherosclerotic coronaries.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"172 - 174"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45071750","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}
Tammiraju Iragavarapu, Gautham Sunkarapalli, Sushma Vutukuru, A. Kataria
Background: History taking and physical examination have been rendered as the most valuable, cost effective reliable skills taught during medical education which reward the clinicians, the satisfaction of making a diagnosis, while building a natural bond of human touch with the patient. Aims and Objectives: A proper and judicious choice of investigations guided by logical reasoning which was made after integrating the history and physical exam is crucial for timely diagnosis and appropriate management. Materials and Methods: We report a series of 11 cases which were mismanaged in the early stages due to lack of proper history and physical examination. Results: Though these cases appear to be simple, they highlight the proper methodical and systematic way of approach to the patient care which helps in preventing unnecessary investigations and improper management. Conclusions: Excessive worshipping of newer diagnostic modalities will lead to a more “computer oriented” approach rather than a patient centered one.
{"title":"“Art at its Heart” “The Golden Art of History and Clinical Examination”","authors":"Tammiraju Iragavarapu, Gautham Sunkarapalli, Sushma Vutukuru, A. Kataria","doi":"10.4103/jpcs.jpcs_38_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_38_21","url":null,"abstract":"Background: History taking and physical examination have been rendered as the most valuable, cost effective reliable skills taught during medical education which reward the clinicians, the satisfaction of making a diagnosis, while building a natural bond of human touch with the patient. Aims and Objectives: A proper and judicious choice of investigations guided by logical reasoning which was made after integrating the history and physical exam is crucial for timely diagnosis and appropriate management. Materials and Methods: We report a series of 11 cases which were mismanaged in the early stages due to lack of proper history and physical examination. Results: Though these cases appear to be simple, they highlight the proper methodical and systematic way of approach to the patient care which helps in preventing unnecessary investigations and improper management. Conclusions: Excessive worshipping of newer diagnostic modalities will lead to a more “computer oriented” approach rather than a patient centered one.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"113 - 120"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45126027","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}
Objectives: Bifurcation percutaneous coronary interventions (PCIs) remain a challenging subset with tussle between provisional versus dedicated (i.e. two-stent) stenting. Besides technical issues, many other factors such as cost, operator skill, and availability of surgery affect the practice which is followed in a particular region. Because of paucity of data in Indian settings, as also information with later generation stents; this study was planned. Methodology: Patients with bifurcation lesion undergoing elective PCI during 1-year period were prospectively enrolled. Decision of strategy (provisional or dedicated two-stent) and drug-eluting stent type (second or third generation) were operator's choice. Patients were followed telephonically and/or clinically (on routine visits) for 1-year postprocedure for any major adverse cardiac event. Results: One hundred and seven cases (28 in dedicated and 79 in provisional group) with a mean age of 56.2 ± 10.2 years were enrolled. All cases of dedicated arm were true bifurcation compared to 63.2% in provisional group (P < 0.001). In dedicated arm, 75% of patients had stenosis ≥5 mm in side branch (SB), in provisional group, 74.7% had <5 mm stenosis in SB (P < 0.001). T-TAP was most common strategy followed by DK crush and final kissing inflation was done in 96.4% cases of dedicated arm. Nearly 84.1% of patients could be followed up till the end of year. In hospital, events were few in either arm, one patient in the dedicated arm developed acute stent thrombosis and three patients in provisional arm developed in-hospital myocardial infarction. One-year major adverse cardiovascular event (MACE) was not significantly different (9.5% provisional vs. 7.4% dedicated; P = 0.65). Conclusions: One-year MACE did not differ in either 1 or 2-stent strategy in suitable patients with bifurcation lesions.
{"title":"One-year outcome of treating bifurcation coronary artery disease with newer generation drug-eluting stents: A single-center experience","authors":"D. Kumar, Sundeep Mishra","doi":"10.4103/jpcs.jpcs_27_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_27_21","url":null,"abstract":"Objectives: Bifurcation percutaneous coronary interventions (PCIs) remain a challenging subset with tussle between provisional versus dedicated (i.e. two-stent) stenting. Besides technical issues, many other factors such as cost, operator skill, and availability of surgery affect the practice which is followed in a particular region. Because of paucity of data in Indian settings, as also information with later generation stents; this study was planned. Methodology: Patients with bifurcation lesion undergoing elective PCI during 1-year period were prospectively enrolled. Decision of strategy (provisional or dedicated two-stent) and drug-eluting stent type (second or third generation) were operator's choice. Patients were followed telephonically and/or clinically (on routine visits) for 1-year postprocedure for any major adverse cardiac event. Results: One hundred and seven cases (28 in dedicated and 79 in provisional group) with a mean age of 56.2 ± 10.2 years were enrolled. All cases of dedicated arm were true bifurcation compared to 63.2% in provisional group (P < 0.001). In dedicated arm, 75% of patients had stenosis ≥5 mm in side branch (SB), in provisional group, 74.7% had <5 mm stenosis in SB (P < 0.001). T-TAP was most common strategy followed by DK crush and final kissing inflation was done in 96.4% cases of dedicated arm. Nearly 84.1% of patients could be followed up till the end of year. In hospital, events were few in either arm, one patient in the dedicated arm developed acute stent thrombosis and three patients in provisional arm developed in-hospital myocardial infarction. One-year major adverse cardiovascular event (MACE) was not significantly different (9.5% provisional vs. 7.4% dedicated; P = 0.65). Conclusions: One-year MACE did not differ in either 1 or 2-stent strategy in suitable patients with bifurcation lesions.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"128 - 134"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48314658","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}
Pallavi Rai, Santoshi Kumari, Deblina Roy, M. Sahu
Background: COVID-19 pandemic has caused havoc and many deaths around the world. Coronavirus is highly contagious and spreads like wildfire in the community. The nurses and other frontline health-care workers (HCWs) bore the brunt of this pandemic with maximum effect because they all worked with infected patients. Direct exposure has caused stress, anxiety, and physical cum mental discomfort among them. Objective: This study aimed to assess stress among nurses and family members related to COVID-19 outbreak. Methodology: In this study, mixed method of prospective approach was used. The study was conducted virtually using social media platforms by online questionnaire. It included 150 participants and information was collected on demographic data, change in relationship with family, spouse, children, self-concept, and perceived stress among themselves and their family members. Results: All the nurses were involved in the direct care of COVID-infected patients. Many participants (47%) became anxious and worried about themselves. More than half (56.7%) respondents had no change in relationship, while 40.7% experienced change in relationship with their family. Majority of the participants (88%) had long travel hours and accommodation issues. Although the nurses working for COVID patients were stressed, frightened, and anxious, most of them took pride in their work as a contribution toward the nation during this current pandemic. Conclusion: This study demonstrated that frontline HCWs were at increased risk of mental health consequences such as stress, anxiety, and frustration. Their children developed behavioral changes such as agitation and aggressiveness. Many nurses got more family support than before for their contribution during COVID-19 pandemic.
{"title":"Stress among the nurses and their family involved in COVID-19 patient management","authors":"Pallavi Rai, Santoshi Kumari, Deblina Roy, M. Sahu","doi":"10.4103/jpcs.jpcs_19_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_19_21","url":null,"abstract":"Background: COVID-19 pandemic has caused havoc and many deaths around the world. Coronavirus is highly contagious and spreads like wildfire in the community. The nurses and other frontline health-care workers (HCWs) bore the brunt of this pandemic with maximum effect because they all worked with infected patients. Direct exposure has caused stress, anxiety, and physical cum mental discomfort among them. Objective: This study aimed to assess stress among nurses and family members related to COVID-19 outbreak. Methodology: In this study, mixed method of prospective approach was used. The study was conducted virtually using social media platforms by online questionnaire. It included 150 participants and information was collected on demographic data, change in relationship with family, spouse, children, self-concept, and perceived stress among themselves and their family members. Results: All the nurses were involved in the direct care of COVID-infected patients. Many participants (47%) became anxious and worried about themselves. More than half (56.7%) respondents had no change in relationship, while 40.7% experienced change in relationship with their family. Majority of the participants (88%) had long travel hours and accommodation issues. Although the nurses working for COVID patients were stressed, frightened, and anxious, most of them took pride in their work as a contribution toward the nation during this current pandemic. Conclusion: This study demonstrated that frontline HCWs were at increased risk of mental health consequences such as stress, anxiety, and frustration. Their children developed behavioral changes such as agitation and aggressiveness. Many nurses got more family support than before for their contribution during COVID-19 pandemic.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"142 - 148"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47027924","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}
Nandini Pattnaik, A. Ansari, P. Chakraborty, N. Devasenapathy
Background: Safety and efficacy of Vitamin K antagonists (VKAs), the most widely used oral anticoagulant (OAC), is monitored by therapeutic international normalized ratio (INR). The current study was conducted to evaluate the proportion of patients achieving therapeutic range INR and assessment of the knowledge, and awareness among patients regarding OAC therapy, as well as identification of the challenges in the monitoring of INR. Materials and Methods: This hospital-based, single-center cross-sectional study was conducted at a tertiary care hospital in Delhi. Patients on anticoagulation with VKAs were interviewed and their records were reviewed. Information on sociodemographic characteristics, history of cardiac illness, INR range, knowledge, and awareness regarding VKA therapy were analyzed. Data management was done via CSPro and statistical analysis via STATA 13.0. Results: A total of 86 patients were evaluated. The mean age of the study participants was 49 ± 14.9 years. Only 29.1% of the study group achieved therapeutic INR. Overall awareness and knowledge regarding the need for VKA therapy, ideal INR range, complications of poor monitoring, and dietary restrictions were in the range of 31%–48%. Conclusion: Poor INR control is prevalent in Indian patients on VKAs therapy. Although the future practice may move toward newer anticoagulants, a substantial proportion of our population may still need VKAs. Hence, there is a need for improving the knowledge and awareness of patients on VKA therapy to improve therapeutic effectiveness.
{"title":"Use and assessment of knowledge of Vitamin K antagonist therapy in cardiac patients: A Tertiary Care Hospital-based survey","authors":"Nandini Pattnaik, A. Ansari, P. Chakraborty, N. Devasenapathy","doi":"10.4103/jpcs.jpcs_16_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_16_21","url":null,"abstract":"Background: Safety and efficacy of Vitamin K antagonists (VKAs), the most widely used oral anticoagulant (OAC), is monitored by therapeutic international normalized ratio (INR). The current study was conducted to evaluate the proportion of patients achieving therapeutic range INR and assessment of the knowledge, and awareness among patients regarding OAC therapy, as well as identification of the challenges in the monitoring of INR. Materials and Methods: This hospital-based, single-center cross-sectional study was conducted at a tertiary care hospital in Delhi. Patients on anticoagulation with VKAs were interviewed and their records were reviewed. Information on sociodemographic characteristics, history of cardiac illness, INR range, knowledge, and awareness regarding VKA therapy were analyzed. Data management was done via CSPro and statistical analysis via STATA 13.0. Results: A total of 86 patients were evaluated. The mean age of the study participants was 49 ± 14.9 years. Only 29.1% of the study group achieved therapeutic INR. Overall awareness and knowledge regarding the need for VKA therapy, ideal INR range, complications of poor monitoring, and dietary restrictions were in the range of 31%–48%. Conclusion: Poor INR control is prevalent in Indian patients on VKAs therapy. Although the future practice may move toward newer anticoagulants, a substantial proportion of our population may still need VKAs. Hence, there is a need for improving the knowledge and awareness of patients on VKA therapy to improve therapeutic effectiveness.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"158 - 167"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41739215","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}
Shivani G. Varmani, R. Chowhan, Ishani Sharma, R. Narang
Coronavirus disease of 2019 (COVID-19) is a viral pandemic which has taken away more than over 4 million lives all over the world as of July 9, 2021, with the USA, India, and Brazil being the most affected countries. Apart from the respiratory tract, the cardiovascular (CV) system is one of the important organ systems affected by this complex multisystem disease. Various studies have confirmed that COVID-19 predisposes an individual to increased risk of CV complications. In fact, hospitalized patients have been consistently reported to have modulated levels of biomarkers demonstrating coagulation and acute cardiac injury. Understanding of molecular mechanisms underlying CV involvement is strongly believed to be the foundation for developing strategies for early diagnosis and management of COVID-19-affected individuals. We review here various molecular mechanisms underlying CV involvement in COVID-19 and discuss several biochemical prognostic markers, as they have evidently revealed their importance in predicting severe prognosis such as mortality, mechanical ventilation, and ICU admission among severe acute respiratory syndrome coronavirus 2-infected patients with or without previous history of myocardial injury. The therapeutic strategies that could be employed to treat and manage CV manifestations in COVID-19-positive individuals are also discussed.
{"title":"COVID-19 and cardiovascular disease: Clinical implications of biochemical pathways","authors":"Shivani G. Varmani, R. Chowhan, Ishani Sharma, R. Narang","doi":"10.4103/jpcs.jpcs_21_21","DOIUrl":"https://doi.org/10.4103/jpcs.jpcs_21_21","url":null,"abstract":"Coronavirus disease of 2019 (COVID-19) is a viral pandemic which has taken away more than over 4 million lives all over the world as of July 9, 2021, with the USA, India, and Brazil being the most affected countries. Apart from the respiratory tract, the cardiovascular (CV) system is one of the important organ systems affected by this complex multisystem disease. Various studies have confirmed that COVID-19 predisposes an individual to increased risk of CV complications. In fact, hospitalized patients have been consistently reported to have modulated levels of biomarkers demonstrating coagulation and acute cardiac injury. Understanding of molecular mechanisms underlying CV involvement is strongly believed to be the foundation for developing strategies for early diagnosis and management of COVID-19-affected individuals. We review here various molecular mechanisms underlying CV involvement in COVID-19 and discuss several biochemical prognostic markers, as they have evidently revealed their importance in predicting severe prognosis such as mortality, mechanical ventilation, and ICU admission among severe acute respiratory syndrome coronavirus 2-infected patients with or without previous history of myocardial injury. The therapeutic strategies that could be employed to treat and manage CV manifestations in COVID-19-positive individuals are also discussed.","PeriodicalId":17503,"journal":{"name":"Journal of the Practice of Cardiovascular Sciences","volume":"7 1","pages":"97 - 107"},"PeriodicalIF":0.1,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45303377","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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