Pub Date : 2022-01-01DOI: 10.4103/heartindia.heartindia_5_22
Archit Dahiya, Piyush Joshi, Ramanand D. Sinha, H. Wardhan
Introduction: Left ventricular (LV) thrombus is a known complication of myocardial infarction (MI) and it usually occurs in areas of poorly contracting LV muscle as a result of endocardial injury with associated inflammation. There is a high risk of embolization within 3 months among patients with MI complicated by mural thrombus and this risk is maximum during the first 1–2 weeks. We report a case series of five patients who presented with acute coronary syndrome with LV apical thrombus and treated with triple anti-thrombotic therapy of rivaroxaban, aspirin, and clopidogrel. Case Series: Our series involves 5 cases who developed LV apical thrombus after acute coronary syndrome. Four patients had anterior wall ST-elevation MI (STEMI) whereas 1 patient had inferior wall STEMI. One of the patients with anterior STEMI also had COVID pneumonitis. All of these patients received triple anti-thrombotic therapy consisting of tab Aspirin 75 mg OD, tab clopidogrel 75 mg OD, and tab rivaroxaban 20 mg OD for 3 months duration. Repeat ECHO after 3 months showed complete resolution of LV thrombus in all of our cases. Discussion: LV thrombus reported in STEMI patients is from 1.6% up to 39% in various studies. The incidence of LV thrombus is on decreasing trend as a result of modern revascularization strategies. The role of novel oral anticoagulants (NOACs) in treating LV thrombus is scant as compared to oral Vitamin K antagonists (VKAs) like warfarin. The current recommendation for anticoagulation in the presence of a LV thrombus after acute coronary syndrome is with VKAs for up to 6 months. Conclusion: Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases.
{"title":"Novel oral anticoagulant in treatment of left ventricular thrombus in acute coronary syndrome – A case series","authors":"Archit Dahiya, Piyush Joshi, Ramanand D. Sinha, H. Wardhan","doi":"10.4103/heartindia.heartindia_5_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_5_22","url":null,"abstract":"Introduction: Left ventricular (LV) thrombus is a known complication of myocardial infarction (MI) and it usually occurs in areas of poorly contracting LV muscle as a result of endocardial injury with associated inflammation. There is a high risk of embolization within 3 months among patients with MI complicated by mural thrombus and this risk is maximum during the first 1–2 weeks. We report a case series of five patients who presented with acute coronary syndrome with LV apical thrombus and treated with triple anti-thrombotic therapy of rivaroxaban, aspirin, and clopidogrel. Case Series: Our series involves 5 cases who developed LV apical thrombus after acute coronary syndrome. Four patients had anterior wall ST-elevation MI (STEMI) whereas 1 patient had inferior wall STEMI. One of the patients with anterior STEMI also had COVID pneumonitis. All of these patients received triple anti-thrombotic therapy consisting of tab Aspirin 75 mg OD, tab clopidogrel 75 mg OD, and tab rivaroxaban 20 mg OD for 3 months duration. Repeat ECHO after 3 months showed complete resolution of LV thrombus in all of our cases. Discussion: LV thrombus reported in STEMI patients is from 1.6% up to 39% in various studies. The incidence of LV thrombus is on decreasing trend as a result of modern revascularization strategies. The role of novel oral anticoagulants (NOACs) in treating LV thrombus is scant as compared to oral Vitamin K antagonists (VKAs) like warfarin. The current recommendation for anticoagulation in the presence of a LV thrombus after acute coronary syndrome is with VKAs for up to 6 months. Conclusion: Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"26 - 29"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46602317","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 : 2022-01-01DOI: 10.4103/heartindia.heartindia_103_21
R. Roy, Baisakhi Maji, Y. Ray, Arijit Sinha
Background: Covid 19 pneumonia presents with various cardiovascular manifestations. The proposed mechanisms of cardiovascular involvement in COVID-19 are direct invasion of myocardial cell by the virus, hyper- inflammatory state secondary to cytokine storm, increased angiotensin II, low ACE2 levels, antiphospholipid antibodies and increased platelet reactivity which contribute significantly to thrombus formation in systemic and pulmonary vasculature. Objectives: To find out various cardiovascular manifestation of patients admitted with covid 19 pneumonia. Methodology: A retrospective observational study had been conducted in a tertiary care infectious disease hospital from July 2020 to December 2020 that included a total of 108 patients. Results: Most common risk factor were combination of hypertension and diabetes( 40.7%) followed by hypertension alone (28.7% )and diabetes in 18.5% patients. Most common presentation was asymptomatic myocarditis found in 37 patients followed by sinus tachycardia in 34, sinus bradycardia in 18, Orthostatic hypotensionin in 16, Atrial fibrillation in 14, cerebrovascular accident in 9, Acute limb ischemia in 7 , and acute coronary syndrome in 4 patients. Asymptomatic diastolic dysfunction (Grade 2 or more ) found in 17 patients without any overt features of heart failure (all have raised NTproBNP and HSTrop I along with clinical features ). A positive correlation was found between D- dimer level and severity of pneumonia by CT severity score. Conclusion: A high index of suspicion and necessary investigation may be needed for early detection of myocarditis and to prevent any complication particularly fatal arrhythmia and sudden cardiac death.
{"title":"Cardiovascular involvement in patients with COVID-19 pneumonia: Observation from a tertiary care infectious disease Hospital","authors":"R. Roy, Baisakhi Maji, Y. Ray, Arijit Sinha","doi":"10.4103/heartindia.heartindia_103_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_103_21","url":null,"abstract":"Background: Covid 19 pneumonia presents with various cardiovascular manifestations. The proposed mechanisms of cardiovascular involvement in COVID-19 are direct invasion of myocardial cell by the virus, hyper- inflammatory state secondary to cytokine storm, increased angiotensin II, low ACE2 levels, antiphospholipid antibodies and increased platelet reactivity which contribute significantly to thrombus formation in systemic and pulmonary vasculature. Objectives: To find out various cardiovascular manifestation of patients admitted with covid 19 pneumonia. Methodology: A retrospective observational study had been conducted in a tertiary care infectious disease hospital from July 2020 to December 2020 that included a total of 108 patients. Results: Most common risk factor were combination of hypertension and diabetes( 40.7%) followed by hypertension alone (28.7% )and diabetes in 18.5% patients. Most common presentation was asymptomatic myocarditis found in 37 patients followed by sinus tachycardia in 34, sinus bradycardia in 18, Orthostatic hypotensionin in 16, Atrial fibrillation in 14, cerebrovascular accident in 9, Acute limb ischemia in 7 , and acute coronary syndrome in 4 patients. Asymptomatic diastolic dysfunction (Grade 2 or more ) found in 17 patients without any overt features of heart failure (all have raised NTproBNP and HSTrop I along with clinical features ). A positive correlation was found between D- dimer level and severity of pneumonia by CT severity score. Conclusion: A high index of suspicion and necessary investigation may be needed for early detection of myocarditis and to prevent any complication particularly fatal arrhythmia and sudden cardiac death.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"38 - 44"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48583403","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 : 2022-01-01DOI: 10.4103/heartindia.heartindia_1_22
S. Halder, S. Roy, A. Mukherjee, D. Khanra, Malyaban Das, B. Samanta, S. Saha, M. Mandal
Introduction: Echocardiography has been an integral part of neonatal care since the 1990s and the application of this technology is increasing ever since. It is already known that differences in weight, age, and race significantly affect the normal heart dimensions. Therefore, establishing the normative values for cardiac dimensions among Indian healthy newborn infants is of paramount importance. In this study, we report the normal reference values of echocardiographic chamber dimensions of newborn infants from Eastern India. Methodology: One hundred healthy newborn infants were included in this cross-sectional, observational, single hospital-based pilot study. A single experienced cardiologist performed the transthoracic echocardiographic studies on the participants in supine position in their respective bassinets. No sedation was used. The parameters were distributed according to body weight and in percentiles. Results: Participants were categorized according to their body weight into three groups: 2–2.4 kg, 2.5–2.9 kg, and 3–3.5 kg. Each group comprises 7, 50, and 43 newborns, respectively. The left ventricular end-diastolic dimension and left ventricular end-systolic dimension showed incremental trends across body weight. Conclusion: This study shows the difference of cardiac dimensions in Indian newborn infants from Western data. This is the first study presenting the normative reference ranges and percentiles of echocardiographic parameters in Indian newborn infants which needs confirmation with larger multicenter studies.
{"title":"A study on normal reference values of echocardiographic chamber dimensions in newborn infants from Eastern India – A pilot study","authors":"S. Halder, S. Roy, A. Mukherjee, D. Khanra, Malyaban Das, B. Samanta, S. Saha, M. Mandal","doi":"10.4103/heartindia.heartindia_1_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_1_22","url":null,"abstract":"Introduction: Echocardiography has been an integral part of neonatal care since the 1990s and the application of this technology is increasing ever since. It is already known that differences in weight, age, and race significantly affect the normal heart dimensions. Therefore, establishing the normative values for cardiac dimensions among Indian healthy newborn infants is of paramount importance. In this study, we report the normal reference values of echocardiographic chamber dimensions of newborn infants from Eastern India. Methodology: One hundred healthy newborn infants were included in this cross-sectional, observational, single hospital-based pilot study. A single experienced cardiologist performed the transthoracic echocardiographic studies on the participants in supine position in their respective bassinets. No sedation was used. The parameters were distributed according to body weight and in percentiles. Results: Participants were categorized according to their body weight into three groups: 2–2.4 kg, 2.5–2.9 kg, and 3–3.5 kg. Each group comprises 7, 50, and 43 newborns, respectively. The left ventricular end-diastolic dimension and left ventricular end-systolic dimension showed incremental trends across body weight. Conclusion: This study shows the difference of cardiac dimensions in Indian newborn infants from Western data. This is the first study presenting the normative reference ranges and percentiles of echocardiographic parameters in Indian newborn infants which needs confirmation with larger multicenter studies.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"45 - 50"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44948035","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 : 2022-01-01DOI: 10.4103/heartindia.heartindia_9_22
S. Kakroo, N. Kumari, M. Lateef, Remala Archana
Background: Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population. Materials and Methods: A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN. Results: The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (<0.001), heart failure (<0.001), anemia (0.001), and median eGFR (P < 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P = 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P < 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P < 0.001) in the very high-risk groups (MRS >16) when compared to the low-risk group (MRS < 5). Dialysis was required only in 2 (3.1%) patients (P < 0.022). Conclusions: The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS >16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).
{"title":"Risk factor profile, incidence, and relevance of Mehran risk score to predict contrast-induced nephropathy in patients undergoing percutaneous coronary intervention","authors":"S. Kakroo, N. Kumari, M. Lateef, Remala Archana","doi":"10.4103/heartindia.heartindia_9_22","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_9_22","url":null,"abstract":"Background: Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population. Materials and Methods: A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN. Results: The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (<0.001), heart failure (<0.001), anemia (0.001), and median eGFR (P < 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P = 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P < 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P < 0.001) in the very high-risk groups (MRS >16) when compared to the low-risk group (MRS < 5). Dialysis was required only in 2 (3.1%) patients (P < 0.022). Conclusions: The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS >16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"9 - 13"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42728503","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 revascularization of a femoropopliteal (CTO) always remains challenging through a retrograde or contralateral crossover approach, we report a case of successful revascularization of a long-segment femoropopliteal CTO through antegrade femoral puncture which stands as the crux of the procedure. In routine peripheral intervention, long-segment femoropopliteal occlusion is usually approached from a contralateral femoral artery or ipsilateral brachial artery, antegrade revascularization of femoropopliteal CTO is not adapted by many in routine practice. Here, we describe the technique and the tips and tricks of antegrade puncture of common femoral artery. We will also discuss the literature review of antegrade technique versus retrograde and crossover technique for revascularization of femoropopliteal CTO which may be useful for budding young interventionists. Our case carries another important learning point about management of popliteal disease where revascularization with a stent is of concern due to high knee joint mobility.
{"title":"Antegrade revascularization of long-segment femoropopliteal chronic total occlusion: A case report and literature review","authors":"Debasish Das, Abhinav Kumar, Dibyasundar Mahanta, Sashikant Singh, Subhash R. Pramanik","doi":"10.4103/heartindia.heartindia_101_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_101_21","url":null,"abstract":"Although revascularization of a femoropopliteal (CTO) always remains challenging through a retrograde or contralateral crossover approach, we report a case of successful revascularization of a long-segment femoropopliteal CTO through antegrade femoral puncture which stands as the crux of the procedure. In routine peripheral intervention, long-segment femoropopliteal occlusion is usually approached from a contralateral femoral artery or ipsilateral brachial artery, antegrade revascularization of femoropopliteal CTO is not adapted by many in routine practice. Here, we describe the technique and the tips and tricks of antegrade puncture of common femoral artery. We will also discuss the literature review of antegrade technique versus retrograde and crossover technique for revascularization of femoropopliteal CTO which may be useful for budding young interventionists. Our case carries another important learning point about management of popliteal disease where revascularization with a stent is of concern due to high knee joint mobility.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"3 - 8"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41374868","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 : 2022-01-01DOI: 10.4103/heartindia.heartindia_100_21
Pradeep K. Jain, V. Athwani, Amit B. Kinare, Shravan Kanaparthi, V. Mishra, Suhel Siddiqui
Context: There are very few data about the unrepaired congenital heart disease (CHD) in adults. There are high chances of errors in diagnosis of CHD in adult population due to various reasons. If proper diagnosis is made, many of these CHDs are amenable to surgery leading to improved quality of life. Aims: Primary objective of the study was to know the detection rate of unrepaired CHD in adults. We have also reported common errors done while making the diagnosis of CHD in adults. Subjects and Methods: This was a retrospective observational study conducted from March 2020 to September 2021. Patients more than 18 years old who came for transthoracic echocardiogram (TTE) for any reason were included, and the detection rate of unrepaired CHD was calculated. Simultaneously, we have also checked for any errors in reports done outside our center and classified them based on their effect on management. Results: During the study period, 6675 TTEs were done in the study population, out of which 89 (1.33%) were detected with unrepaired CHD. Acyanotic CHD was detected in 81 (91%), whereas the rest 8 (9%) had cyanotic CHD. Forty-one patients had echocardiography report done outside, out of which 25 (61%) had discrepancies. Discrepancies were more in complex CHD. Conclusions: Cardiologists or echocardiographers should follow systematic approach and place special emphasis on identifying congenital heart diseases. Many potential lesions are amenable to surgery and near-complete correction leading to improved duration and quality of life.
{"title":"Unrepaired congenital heart diseases in adults – Detection rate and diagnostic errors","authors":"Pradeep K. Jain, V. Athwani, Amit B. Kinare, Shravan Kanaparthi, V. Mishra, Suhel Siddiqui","doi":"10.4103/heartindia.heartindia_100_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_100_21","url":null,"abstract":"Context: There are very few data about the unrepaired congenital heart disease (CHD) in adults. There are high chances of errors in diagnosis of CHD in adult population due to various reasons. If proper diagnosis is made, many of these CHDs are amenable to surgery leading to improved quality of life. Aims: Primary objective of the study was to know the detection rate of unrepaired CHD in adults. We have also reported common errors done while making the diagnosis of CHD in adults. Subjects and Methods: This was a retrospective observational study conducted from March 2020 to September 2021. Patients more than 18 years old who came for transthoracic echocardiogram (TTE) for any reason were included, and the detection rate of unrepaired CHD was calculated. Simultaneously, we have also checked for any errors in reports done outside our center and classified them based on their effect on management. Results: During the study period, 6675 TTEs were done in the study population, out of which 89 (1.33%) were detected with unrepaired CHD. Acyanotic CHD was detected in 81 (91%), whereas the rest 8 (9%) had cyanotic CHD. Forty-one patients had echocardiography report done outside, out of which 25 (61%) had discrepancies. Discrepancies were more in complex CHD. Conclusions: Cardiologists or echocardiographers should follow systematic approach and place special emphasis on identifying congenital heart diseases. Many potential lesions are amenable to surgery and near-complete correction leading to improved duration and quality of life.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"51 - 55"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47036292","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 : 2022-01-01DOI: 10.4103/heartindia.heartindia_102_21
K. Parvathareddy, S. Maale, Praveen Nagula, Srinivas Ravi
Ventricular thrombus is a major risk factor for systemic thromboembolism. It complicates both acute and chronic phases of ischemic heart disease (IHD) and, less frequently, non-ischemic cardiomyopathies. However, ventricular thrombus does not always manifest with thromboembolism. Advances in technology, especially the echocardiography, have improved the detection rates of intracardiac thrombi. Regarding the management, there are several uncertainties to date. We present six varied cases with incidental detection of ventricular thrombus on echocardiography with no clinically evident embolism at admission. Of the six cases, three patients had embolic complications after initiation of systemic anticoagulation.
{"title":"Incidentally detected large ventricular thrombus on echocardiography: A case series","authors":"K. Parvathareddy, S. Maale, Praveen Nagula, Srinivas Ravi","doi":"10.4103/heartindia.heartindia_102_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_102_21","url":null,"abstract":"Ventricular thrombus is a major risk factor for systemic thromboembolism. It complicates both acute and chronic phases of ischemic heart disease (IHD) and, less frequently, non-ischemic cardiomyopathies. However, ventricular thrombus does not always manifest with thromboembolism. Advances in technology, especially the echocardiography, have improved the detection rates of intracardiac thrombi. Regarding the management, there are several uncertainties to date. We present six varied cases with incidental detection of ventricular thrombus on echocardiography with no clinically evident embolism at admission. Of the six cases, three patients had embolic complications after initiation of systemic anticoagulation.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"10 1","pages":"56 - 59"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41630202","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 : 2021-07-01DOI: 10.4103/heartindia.heartindia_85_21
B. Kumar, Shishir Soni, Ashutosh Kumar Singh
We report a case of primary angioplasty of right coronary artery (RCA) through right radial artery access in a patient with aberrant right subclavian artery (arteria lusoria) and anomalous origin of RCA. Major challenges in such cases are difficulty in hooking coronary ostia and getting enough support from the guide catheters. However, another challenge confronted in this patient was the anomalous origin of RCA from the left sinus. Herein, we discuss key aspects of management in this scenario. Arteria lusoria with anomalous RCA can be confronted during the transradial intervention. Use of an appropriate guide catheter to facilitate the procedure in this scenario can help interventionists to manage such a situation, and this can be a useful alternative in those patients with unfavorable transfemoral access along with this rare anomaly.
{"title":"Right coronary artery intervention through right radial access in a patient with aberrant right subclavian artery and anomalous origin of right coronary artery","authors":"B. Kumar, Shishir Soni, Ashutosh Kumar Singh","doi":"10.4103/heartindia.heartindia_85_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_85_21","url":null,"abstract":"We report a case of primary angioplasty of right coronary artery (RCA) through right radial artery access in a patient with aberrant right subclavian artery (arteria lusoria) and anomalous origin of RCA. Major challenges in such cases are difficulty in hooking coronary ostia and getting enough support from the guide catheters. However, another challenge confronted in this patient was the anomalous origin of RCA from the left sinus. Herein, we discuss key aspects of management in this scenario. Arteria lusoria with anomalous RCA can be confronted during the transradial intervention. Use of an appropriate guide catheter to facilitate the procedure in this scenario can help interventionists to manage such a situation, and this can be a useful alternative in those patients with unfavorable transfemoral access along with this rare anomaly.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"188 - 190"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46008090","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 : 2021-07-01DOI: 10.4103/heartindia.heartindia_96_21
Suyash Tated, Dinesh Joshi, Anand N. Shukla, Pratik Raval, Karthik Natrajan, K. Kanabar, Surender Kumar, J. Patel
Context: Catheter-directed thrombolysis (CDT) is a novel mode of thrombolysis where thrombolytic agents are directed through catheter to a specific area of interest; hence, low-dose thrombolytic agent will be required to produce satisfactory thrombolysis results. This will subsequently decrease the bleeding complications. With this postulation, a study was conducted to compare the outcome of CDT versus systemic thrombolysis (ST) in patients with massive and submassive pulmonary embolism (PE). Methods: The present study prospectively included the cases of massive and submassive (high-risk) PE and randomly distributed 25 patients into two groups each: Group A underwent CDT, whereas Group B underwent ST. The outcomes of both the groups were studied including mortality and bleeding complications, and patients were followed up for 6 months. At the end of the study, data were analyzed, and outcomes of both the groups were compared. Results: Baseline characteristics were similar in both the groups. The success rate was 90.4% in Group A (CDT) and 75% in Group B (ST) among patients with massive PE (P = 0.95). The mortality rate was numerically higher in the ST group (12%) than in the CDT group (8%). Bleeding complications were higher in the ST group (20%) than in the CDT group (8%). Conclusion: CDT was found to be noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered viable alternative to ST in patients with high bleeding risk.
{"title":"A simple randomized prospective study comparing catheter-directed thrombolysis versus systemic thrombolysis in patients with massive and submassive pulmonary embolism","authors":"Suyash Tated, Dinesh Joshi, Anand N. Shukla, Pratik Raval, Karthik Natrajan, K. Kanabar, Surender Kumar, J. Patel","doi":"10.4103/heartindia.heartindia_96_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_96_21","url":null,"abstract":"Context: Catheter-directed thrombolysis (CDT) is a novel mode of thrombolysis where thrombolytic agents are directed through catheter to a specific area of interest; hence, low-dose thrombolytic agent will be required to produce satisfactory thrombolysis results. This will subsequently decrease the bleeding complications. With this postulation, a study was conducted to compare the outcome of CDT versus systemic thrombolysis (ST) in patients with massive and submassive pulmonary embolism (PE). Methods: The present study prospectively included the cases of massive and submassive (high-risk) PE and randomly distributed 25 patients into two groups each: Group A underwent CDT, whereas Group B underwent ST. The outcomes of both the groups were studied including mortality and bleeding complications, and patients were followed up for 6 months. At the end of the study, data were analyzed, and outcomes of both the groups were compared. Results: Baseline characteristics were similar in both the groups. The success rate was 90.4% in Group A (CDT) and 75% in Group B (ST) among patients with massive PE (P = 0.95). The mortality rate was numerically higher in the ST group (12%) than in the CDT group (8%). Bleeding complications were higher in the ST group (20%) than in the CDT group (8%). Conclusion: CDT was found to be noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered viable alternative to ST in patients with high bleeding risk.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"169 - 173"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44852162","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 : 2021-07-01DOI: 10.4103/heartindia.heartindia_94_21
Debasish Das, D. Acharya, A. Banerjee, Tutan Das, Subhash R. Pramanik
Right coronary artery after origin from right coronary sinus traverses horizontally to run in right atrioventricular groove till the crux of the heart where it divides into posterior descending artery and posterior left ventricular branch. When the right coronary artery after its origin takes an acute high take off from the ostium and then abruptly descends down making a hairpin loop to run in the right atrioventricular groove, it is known as Shepherd's crook right coronary artery which is extremely rare to encounter in routine clinical practice. This interesting coronary artery deformity has great significance per se so far as the coronary physiology and intervention is concerned. We present a case of Shepherd's crook right coronary artery in the most elderly patient of 84 years of age in world literature and detailed review of this peculiar anatomy. Review literature about Shepherds Crook deformity is yet not there in the literature except some case reports and this review article will be providing the interventional cardiologists a detailed insight into the right coronary ischemia secondary to this interesting anomaly.
{"title":"Shepherd' Crook right coronary artery in an octagenerian: A case report and literature review","authors":"Debasish Das, D. Acharya, A. Banerjee, Tutan Das, Subhash R. Pramanik","doi":"10.4103/heartindia.heartindia_94_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_94_21","url":null,"abstract":"Right coronary artery after origin from right coronary sinus traverses horizontally to run in right atrioventricular groove till the crux of the heart where it divides into posterior descending artery and posterior left ventricular branch. When the right coronary artery after its origin takes an acute high take off from the ostium and then abruptly descends down making a hairpin loop to run in the right atrioventricular groove, it is known as Shepherd's crook right coronary artery which is extremely rare to encounter in routine clinical practice. This interesting coronary artery deformity has great significance per se so far as the coronary physiology and intervention is concerned. We present a case of Shepherd's crook right coronary artery in the most elderly patient of 84 years of age in world literature and detailed review of this peculiar anatomy. Review literature about Shepherds Crook deformity is yet not there in the literature except some case reports and this review article will be providing the interventional cardiologists a detailed insight into the right coronary ischemia secondary to this interesting anomaly.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"157 - 160"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43610003","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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