Pub Date : 2021-07-01DOI: 10.4103/heartindia.heartindia_97_21
R. Singh, P. Nayak, Archit Patel, Srikanth Bhumana
Introduction: This study was planned to compare postoperative hemodynamics, blood loss, platelet count, and coagulation parameters in patients undergoing intracardiac repair for tetralogy of Fallot with and without hemofiltration and, in addition, to determine whether hemofiltration during cardiopulmonary bypass (CPB) reduces cytokines in children undergoing intracardiac repair for tetralogy of Fallot. Methods: Thirty children suffering from tetralogy of Fallot were enrolled in the study and randomly divided into two groups: one group had hemofiltration from beginning of rewarming till weaning off CPB, whereas in the other group, hemofiltration was not used during CPB. In the hemofiltration group, samples were taken for the comparison of tumor necrosis factor-α, interleukin-6 (IL-6), and IL-8 levels, before and after hemofiltration. Platelet count, coagulation parameters, postoperative blood loss, extubation time, hemodynamic parameters were recorded for hemofiltration as well as non-hemofiltration group and analysed. Results: The extubation time in the hemofiltration group was 15.6 h (mean), whereas that in the control group was 28.6 h (mean), and the difference, when compared, was significant between the two groups (P = 0.05). The cumulative postoperative blood loss at 24 h was significantly less in the hemofiltration group compared to the control group, 97.4 ml (80–114 ml) versus 159 ml (100–210 ml), respectively, with P = 0.001. No other statistically significant difference could be appreciated in the parameters analyzed. Conclusion: There was a significant reduction in postoperative blood loss and extubation time in the hemofiltration group. There was no significant reduction in cytokines. No significant difference was observed in requirement of inotropic agents, hemodynamic status, and intensive care unit stay between the two groups. Small sample size and shorter ultrafiltration time during rewarming phase were limitations of the study.
{"title":"Effects of hemofiltration during cardiopulmonary bypass in children undergoing intracardiac repair for tetralogy of Fallot","authors":"R. Singh, P. Nayak, Archit Patel, Srikanth Bhumana","doi":"10.4103/heartindia.heartindia_97_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_97_21","url":null,"abstract":"Introduction: This study was planned to compare postoperative hemodynamics, blood loss, platelet count, and coagulation parameters in patients undergoing intracardiac repair for tetralogy of Fallot with and without hemofiltration and, in addition, to determine whether hemofiltration during cardiopulmonary bypass (CPB) reduces cytokines in children undergoing intracardiac repair for tetralogy of Fallot. Methods: Thirty children suffering from tetralogy of Fallot were enrolled in the study and randomly divided into two groups: one group had hemofiltration from beginning of rewarming till weaning off CPB, whereas in the other group, hemofiltration was not used during CPB. In the hemofiltration group, samples were taken for the comparison of tumor necrosis factor-α, interleukin-6 (IL-6), and IL-8 levels, before and after hemofiltration. Platelet count, coagulation parameters, postoperative blood loss, extubation time, hemodynamic parameters were recorded for hemofiltration as well as non-hemofiltration group and analysed. Results: The extubation time in the hemofiltration group was 15.6 h (mean), whereas that in the control group was 28.6 h (mean), and the difference, when compared, was significant between the two groups (P = 0.05). The cumulative postoperative blood loss at 24 h was significantly less in the hemofiltration group compared to the control group, 97.4 ml (80–114 ml) versus 159 ml (100–210 ml), respectively, with P = 0.001. No other statistically significant difference could be appreciated in the parameters analyzed. Conclusion: There was a significant reduction in postoperative blood loss and extubation time in the hemofiltration group. There was no significant reduction in cytokines. No significant difference was observed in requirement of inotropic agents, hemodynamic status, and intensive care unit stay between the two groups. Small sample size and shorter ultrafiltration time during rewarming phase were limitations of the study.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"174 - 178"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47411542","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_99_21
Balveen Singh, D. Agarwal, Archit Dahiya, G. Saxena
Introduction: Higher fasting blood glucose level plus raised glycated hemoglobin (HbA1c) levels is one of the major risk factors for cardiovascular (CV) events in nondiabetic population. HbA1c levels have low intra-individual variability especially in nondiabetic patients. Studies have shown that coronary artery disease (CAD) and HbA1c are predictors of CV mortality. In this study, we have evaluated the association between HbA1c and severity of CAD in nondiabetic patients. Materials and Methods: This is a hospital-based observational study done on 300 patients in Department of Medicine and Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur. Prior approval was taken before the start of study from the Institute Ethics Committee. Gensini score was used to estimate the CAD severity. This score is based on the sum of scores for all 3 coronary arteries to assess the entire extent of CAD. Data were analyzed and appropriate statistical tests were used. P < 0.05 were considered statistically significant. Results: This study showed that the majority of cases (59.33%) were seen in 51–70 years of age group. The maximum number of patients (66.66%) had 5.6–6.5 HbA1c level and 29.36 ± 19.50 Gensini score in our study. Mean Gensini score showed a linear relationship with HbA1c. Conclusion: HbA1c level has a prognostic value for predicting the severity of CAD among nondiabetic patients and can act as a useful marker in risk stratification of nondiabetic patients presenting with acute coronary syndrome and indicated for angiographic evaluation.
{"title":"Evaluation of the association between glycated hemoglobin levels and severity of coronary artery disease in nondiabetic patients","authors":"Balveen Singh, D. Agarwal, Archit Dahiya, G. Saxena","doi":"10.4103/heartindia.heartindia_99_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_99_21","url":null,"abstract":"Introduction: Higher fasting blood glucose level plus raised glycated hemoglobin (HbA1c) levels is one of the major risk factors for cardiovascular (CV) events in nondiabetic population. HbA1c levels have low intra-individual variability especially in nondiabetic patients. Studies have shown that coronary artery disease (CAD) and HbA1c are predictors of CV mortality. In this study, we have evaluated the association between HbA1c and severity of CAD in nondiabetic patients. Materials and Methods: This is a hospital-based observational study done on 300 patients in Department of Medicine and Department of Cardiology, Mahatma Gandhi Medical College and Hospital, Jaipur. Prior approval was taken before the start of study from the Institute Ethics Committee. Gensini score was used to estimate the CAD severity. This score is based on the sum of scores for all 3 coronary arteries to assess the entire extent of CAD. Data were analyzed and appropriate statistical tests were used. P < 0.05 were considered statistically significant. Results: This study showed that the majority of cases (59.33%) were seen in 51–70 years of age group. The maximum number of patients (66.66%) had 5.6–6.5 HbA1c level and 29.36 ± 19.50 Gensini score in our study. Mean Gensini score showed a linear relationship with HbA1c. Conclusion: HbA1c level has a prognostic value for predicting the severity of CAD among nondiabetic patients and can act as a useful marker in risk stratification of nondiabetic patients presenting with acute coronary syndrome and indicated for angiographic evaluation.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"184 - 187"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44847295","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_83_21
M. Hiremath, S. Routray, S. Shetty, J. John, Anil Damle, A. Pradhan, A. Dharmadhikari, B. Desai, M. Abhyankar, S. Revankar
Objective: The objective is to evaluate the pattern for use of triple-drug therapy (dual antiplatelet therapy [DAPT] and statin) in the management of patients with postacute coronary syndrome (ACS) and associated risk factors in Indian settings. Materials and Methods: This was a retrospective multi-centric (n = 63), real-world, cross-sectional study which included patients (aged ≥18 years) diagnosed with an ACS, post-ACS patients from 3 months to 3 years, and receiving DAPT and lipid-lowering agents for ACS. Demographics, baseline characteristics, risk factors, medical history, and therapy details were retrieved from medical charts. Descriptive and comparative analysis for qualitative and quantitative variable was performed. Results: A total of 1548 patients with a mean age of 57.4 years were included. Male preponderance was observed across all the age groups. A total of 973 patients were on triple-drug therapy, and the most common triple fixed-dose combination prescribed was rosuvastatin, clopidogrel, and aspirin, among all the groups (age-wise: 76.1%–88.6%; sex-wise: 78.5% and 79.2%; clinical status-wise: 75.7%–81.4%). The majority of patients with non-ST-segment elevation myocardial infarction (43.0%), ST-segment elevation myocardial infarction (42.7%), and unstable angina (40.8%) received triple-drug therapy for >6 to ≤12 months duration. Adverse effect observed in patients receiving triple-drug therapy were skin rash (n = 5), bleeding (n = 2), facial puffing (n = 2), and hematuria (n = 2). A total of 357 patients were undergone switch in DAPT therapy (prasugrel to clopidogrel or ticagrelor to clopidogrel). Conclusion: DAPT and statin were the standard of care in majority of ACS patients. Triple fixed-dose combination therapy of aspirin, clopidogrel, and rosuvastatin was the most preferred choice of physicians, for optimal management post-ACS patient in Indian setting.
{"title":"Real-world experience of clinical management with antiplatelet and lipid-lowering therapy in post acute coronary syndrome patients in Indian setting","authors":"M. Hiremath, S. Routray, S. Shetty, J. John, Anil Damle, A. Pradhan, A. Dharmadhikari, B. Desai, M. Abhyankar, S. Revankar","doi":"10.4103/heartindia.heartindia_83_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_83_21","url":null,"abstract":"Objective: The objective is to evaluate the pattern for use of triple-drug therapy (dual antiplatelet therapy [DAPT] and statin) in the management of patients with postacute coronary syndrome (ACS) and associated risk factors in Indian settings. Materials and Methods: This was a retrospective multi-centric (n = 63), real-world, cross-sectional study which included patients (aged ≥18 years) diagnosed with an ACS, post-ACS patients from 3 months to 3 years, and receiving DAPT and lipid-lowering agents for ACS. Demographics, baseline characteristics, risk factors, medical history, and therapy details were retrieved from medical charts. Descriptive and comparative analysis for qualitative and quantitative variable was performed. Results: A total of 1548 patients with a mean age of 57.4 years were included. Male preponderance was observed across all the age groups. A total of 973 patients were on triple-drug therapy, and the most common triple fixed-dose combination prescribed was rosuvastatin, clopidogrel, and aspirin, among all the groups (age-wise: 76.1%–88.6%; sex-wise: 78.5% and 79.2%; clinical status-wise: 75.7%–81.4%). The majority of patients with non-ST-segment elevation myocardial infarction (43.0%), ST-segment elevation myocardial infarction (42.7%), and unstable angina (40.8%) received triple-drug therapy for >6 to ≤12 months duration. Adverse effect observed in patients receiving triple-drug therapy were skin rash (n = 5), bleeding (n = 2), facial puffing (n = 2), and hematuria (n = 2). A total of 357 patients were undergone switch in DAPT therapy (prasugrel to clopidogrel or ticagrelor to clopidogrel). Conclusion: DAPT and statin were the standard of care in majority of ACS patients. Triple fixed-dose combination therapy of aspirin, clopidogrel, and rosuvastatin was the most preferred choice of physicians, for optimal management post-ACS patient in Indian setting.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"161 - 168"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41382001","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_95_21
P. Jariwala, Arshad Punjani, H. Boorugu, D. Madhawar, K. Jadhav
Background: The goal of this study is to look at the safety and efficacy of angiotensin receptor-neprilysin inhibitors (ARNI) (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor ARNI, in patients with heart failure with preserved ejection fraction (HFpEF). Materials and Methods: Between June and December 2020, retrospective research was conducted on a study participant of primarily angiographically confirmed computer-aided design patients who underwent complete revascularization. A total of 154 HFpEF patients (87 females and 67 males) were treated with ARNI, which was subsequently titrated up to a maximum tolerable dose and monitored in an outpatient clinic. Fifty-six patients were given ARNI while in the hospital for decompensated heart failure before being discharged. Results: Patients were categorized as the New York Heart Association (NYHA) class III (71.4%) and NYHA class II (28.6%). Diabetes mellitus was identified in 52% of patients, while hypertension was found in 78%. Symptomatic clinical improvement was observed, with a substantial decrease in NYHA class down to NYHA class II (P = 0.018). A considerable decrease in NYHA class resulted in symptomatic clinical improvement as well as the rales and peripheral edema had resolved (P < 0.001). The NT-pro-BNP levels were considerably lowered (P < 0.001). The echocardiographic parameters for diastolic function (E/A, E/E' ratios) improved. In individuals with HFpEF, ARNI resulted in significant clinical benefits. Conclusion: In individuals with HFpEF, sacubitril/valsartan, ARNI resulted in significant clinical benefits. A randomized research is also required to see if it results in beneficial outcomes for a wider sample.
{"title":"Safety and effectiveness of angiotensin receptor-neprilysin inhibitors in Indian patients with heart failure with preserved ejection fraction – “ARNI-PRESERVED” study","authors":"P. Jariwala, Arshad Punjani, H. Boorugu, D. Madhawar, K. Jadhav","doi":"10.4103/heartindia.heartindia_95_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_95_21","url":null,"abstract":"Background: The goal of this study is to look at the safety and efficacy of angiotensin receptor-neprilysin inhibitors (ARNI) (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor ARNI, in patients with heart failure with preserved ejection fraction (HFpEF). Materials and Methods: Between June and December 2020, retrospective research was conducted on a study participant of primarily angiographically confirmed computer-aided design patients who underwent complete revascularization. A total of 154 HFpEF patients (87 females and 67 males) were treated with ARNI, which was subsequently titrated up to a maximum tolerable dose and monitored in an outpatient clinic. Fifty-six patients were given ARNI while in the hospital for decompensated heart failure before being discharged. Results: Patients were categorized as the New York Heart Association (NYHA) class III (71.4%) and NYHA class II (28.6%). Diabetes mellitus was identified in 52% of patients, while hypertension was found in 78%. Symptomatic clinical improvement was observed, with a substantial decrease in NYHA class down to NYHA class II (P = 0.018). A considerable decrease in NYHA class resulted in symptomatic clinical improvement as well as the rales and peripheral edema had resolved (P < 0.001). The NT-pro-BNP levels were considerably lowered (P < 0.001). The echocardiographic parameters for diastolic function (E/A, E/E' ratios) improved. In individuals with HFpEF, ARNI resulted in significant clinical benefits. Conclusion: In individuals with HFpEF, sacubitril/valsartan, ARNI resulted in significant clinical benefits. A randomized research is also required to see if it results in beneficial outcomes for a wider sample.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"179 - 183"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41803591","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_71_21
Debasish Das, D. Acharya, Tutan Das, Jogendra Singh, Sashikant Singh, Subhash R. Pramanik
We present a rare case of left ventricular noncompaction (LVNC) in a 23-year-old female with recurrent syncope with electrocardiography documentation of apical septal ventricular tachycardia (VT). Abnormal embryological myocardial maturation presenting as LVNC with electrogenic heterogenity across the noncompacted spongiform segments result in recurrent VT and mandates automated intracardiac defibrillator implantation (AICD). These subsets of patients in spite of AICD implantation require life-long broad-spectrum antiarrythmic in the form of amiodarone and beta-blocker to prevent a crisis of VT storm or sudden cardiac death.
{"title":"Left ventricular noncompaction cardiomyopathy with apical septal ventricular tachycardia","authors":"Debasish Das, D. Acharya, Tutan Das, Jogendra Singh, Sashikant Singh, Subhash R. Pramanik","doi":"10.4103/heartindia.heartindia_71_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_71_21","url":null,"abstract":"We present a rare case of left ventricular noncompaction (LVNC) in a 23-year-old female with recurrent syncope with electrocardiography documentation of apical septal ventricular tachycardia (VT). Abnormal embryological myocardial maturation presenting as LVNC with electrogenic heterogenity across the noncompacted spongiform segments result in recurrent VT and mandates automated intracardiac defibrillator implantation (AICD). These subsets of patients in spite of AICD implantation require life-long broad-spectrum antiarrythmic in the form of amiodarone and beta-blocker to prevent a crisis of VT storm or sudden cardiac death.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"145 - 147"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43721281","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_81_21
M. John, Jayaprasad Narayanapillai, Suresh Madhavan, V. Jayaprakash, R. George
Context: Approximately half of the patients with heart failure have preserved ejection fraction (HFpEF). Epidemiologic studies and randomized trials provide somewhat conflicting data regarding outcomes of HFpEF. Aims: The objective is to study the clinical and echocardiographic profile of patients admitted with HFpEF and estimate outcomes. Settings and Design: This is a prospective observational study on patients with new-onset HF requiring hospitalization and normal EF and evidence of diastolic dysfunction in echocardiography. Subjects and Methods: Risk factors for HFpEF, clinical features, and echocardiographic parameters were recorded. The primary outcome studied was mortality at 1 year and the secondary outcome was rehospitalization at 1 year. Statistical Analysis Used: Variables were analyzed using Student's t-test and Chi-square test. Univariate and multivariate analysis were done to find out predictors of outcomes. Results: A total of 104 patients admitted with the first episode of HF were found to have left ventricular ejection fraction ≥ 50% and diastolic dysfunction. Associated cardiac conditions were hypertension in 77.8%, diabetes in 38.5%, ischemic heart disease in 30.7%, and atrial fibrillation in 32.7%. In our study, 42 patients (40.1%) had rehospitalization within 1 year. The mortality rate at 1 year was 15.4% (16 patients). The parameters found to be significantly correlated with mortality in the univariate analysis included age, high BP, anemia, hyponatremia, low isovolumetric relaxation time, and higher E/e' ratio. Multivariate analysis showed advanced age, hyponatremia, and high E/e' to be independent predictors of mortality. Conclusions: Among hospitalized patients with new-onset HFpEF annual mortality rate is as high as 15.4%. Advanced age, hyponatremia, and high E/e' were found to be independent predictors of mortality.
{"title":"Clinical, echocardiographic profile, and outcome of heart failure patients with preserved ejection fraction","authors":"M. John, Jayaprasad Narayanapillai, Suresh Madhavan, V. Jayaprakash, R. George","doi":"10.4103/heartindia.heartindia_81_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_81_21","url":null,"abstract":"Context: Approximately half of the patients with heart failure have preserved ejection fraction (HFpEF). Epidemiologic studies and randomized trials provide somewhat conflicting data regarding outcomes of HFpEF. Aims: The objective is to study the clinical and echocardiographic profile of patients admitted with HFpEF and estimate outcomes. Settings and Design: This is a prospective observational study on patients with new-onset HF requiring hospitalization and normal EF and evidence of diastolic dysfunction in echocardiography. Subjects and Methods: Risk factors for HFpEF, clinical features, and echocardiographic parameters were recorded. The primary outcome studied was mortality at 1 year and the secondary outcome was rehospitalization at 1 year. Statistical Analysis Used: Variables were analyzed using Student's t-test and Chi-square test. Univariate and multivariate analysis were done to find out predictors of outcomes. Results: A total of 104 patients admitted with the first episode of HF were found to have left ventricular ejection fraction ≥ 50% and diastolic dysfunction. Associated cardiac conditions were hypertension in 77.8%, diabetes in 38.5%, ischemic heart disease in 30.7%, and atrial fibrillation in 32.7%. In our study, 42 patients (40.1%) had rehospitalization within 1 year. The mortality rate at 1 year was 15.4% (16 patients). The parameters found to be significantly correlated with mortality in the univariate analysis included age, high BP, anemia, hyponatremia, low isovolumetric relaxation time, and higher E/e' ratio. Multivariate analysis showed advanced age, hyponatremia, and high E/e' to be independent predictors of mortality. Conclusions: Among hospitalized patients with new-onset HFpEF annual mortality rate is as high as 15.4%. Advanced age, hyponatremia, and high E/e' were found to be independent predictors of mortality.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"108 - 113"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44446682","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_84_21
B. Kumar, Shishir Soni, P. Gore, Anshuman Darbari
The late rising pacing threshold is an alarming situation in which a possibility of lead dislodgement is usually considered first. This condition is usually picked up on routine follow-up interrogation; however, it can clinically manifest as syncope due to bradyarrhythmia. We report such a case in a 59-year-old male presenting to the emergency with syncope with a double chamber pacemaker in situ. He had a history of pacemaker implantation 16 years back and a pulse generator replacement (PGR) 6 years back with desirable parameters found immediately and up to 4 years after PGR. He was found to have a complete heart block on an electrocardiogram following the evaluation of presyncope and subsequently on his pacemaker interrogation high threshold was found which improved to acceptable levels after 4 weeks of steroid therapy.
{"title":"Use of steroid therapy as a bridge to decision-making in patients with late rising pacing threshold after pacemaker implantation?","authors":"B. Kumar, Shishir Soni, P. Gore, Anshuman Darbari","doi":"10.4103/heartindia.heartindia_84_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_84_21","url":null,"abstract":"The late rising pacing threshold is an alarming situation in which a possibility of lead dislodgement is usually considered first. This condition is usually picked up on routine follow-up interrogation; however, it can clinically manifest as syncope due to bradyarrhythmia. We report such a case in a 59-year-old male presenting to the emergency with syncope with a double chamber pacemaker in situ. He had a history of pacemaker implantation 16 years back and a pulse generator replacement (PGR) 6 years back with desirable parameters found immediately and up to 4 years after PGR. He was found to have a complete heart block on an electrocardiogram following the evaluation of presyncope and subsequently on his pacemaker interrogation high threshold was found which improved to acceptable levels after 4 weeks of steroid therapy.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"135 - 137"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41758316","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_87_21
Akhil Sharma, Diwakar Goel, Gaurav Cahaudhary, A. Tiwari
Background: With the introduction of a huge armamentarium of invasive and noninvasive therapeutic strategies, the mortality related to acute coronary syndrome (ACS) has decreased across the world over the past 20 years, but the mortality remains high among Indian patients due to limited resource settings. Even in India, there is significant difference in health infrastructure in different part of country. This study was performed to evaluate the presentation, management and outcomes of ACS patients admitted in a high volume tertiary center of north India. Enrolment of the study done prior to covid pandemic. Materials and Methods: 3511 ACS patients >18 year of age were included for this prospective observational study. All patients were evaluated with detailed clinical history and examination, ECG, Troponin, and detailed echocardiography. Patients were treated as per current guideline recommendation which included primary percutaneous coronary intervention (PCI), pharmacoinvasive therapy, thrombolysis or medical management only. Data was analysed for age, sex, risk factors, type of ACS, treatment given and complications if any. Those patients who underwent invasive approach also evaluated for coronary anatomy pattern and variables. Results: Study population had younger mean age of 57.2 years, male preponderance (67%) and very high tobacco intake (46%). Out of all ACS patients 39% were STEMI (55% anterior wall myocardial infarction, 43% inferior wall myocardial infarction) and 61% were NSTEMI/USA. In STEMI subgroup, only 18% had primary PCI, while 42% received thrombolytic therapy as primary management. Nearly half of the patients who received thrombolytic therapy underwent pharmacoinvasive treatment (47.5%). A large number of late presenters (32% of all STEMI) did not receive any reperfusion therapy in index admission while few of them (6%) underwent invasive revascularization. Coronary anatomy evaluation showed multivessel disease in 53.1%. Left anterior descending artery was most common vessel involved (69.3%) among all ACS patients underwent coronary angiography. Most of the STEMI patients who underwent invasive route received PCI while very low rate for referral for CABG (2.1%). Major complications noted in study included left ventricular failure/cardiogenic shock (11.7%), advance AV blocks (8.2%), VT/VF (2.8%), Ventricular septal rupture (0.7%) and stent thrombosis (0.5%). In hospital mortality remained high (11.5%) mainly due to late presenters. Conclusion: ACS management specially STEMI care is still needs a boost in north India. With primary PCI rate of only 18% and more than one third being late presenters not receiving any reperfusion therapy, there is urgent need of robust primary and referral health care system. As compared to other part of India, tobacco intake is alarmingly high (46%) and needs widespread health awareness in community of tobacco ill effects.
{"title":"Clinical presentation, management and in-hospital outcomes of Acute coronary syndrome patients in real world scenario in developing countries: Insight from a high volume tertiary care center in North India","authors":"Akhil Sharma, Diwakar Goel, Gaurav Cahaudhary, A. Tiwari","doi":"10.4103/heartindia.heartindia_87_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_87_21","url":null,"abstract":"Background: With the introduction of a huge armamentarium of invasive and noninvasive therapeutic strategies, the mortality related to acute coronary syndrome (ACS) has decreased across the world over the past 20 years, but the mortality remains high among Indian patients due to limited resource settings. Even in India, there is significant difference in health infrastructure in different part of country. This study was performed to evaluate the presentation, management and outcomes of ACS patients admitted in a high volume tertiary center of north India. Enrolment of the study done prior to covid pandemic. Materials and Methods: 3511 ACS patients >18 year of age were included for this prospective observational study. All patients were evaluated with detailed clinical history and examination, ECG, Troponin, and detailed echocardiography. Patients were treated as per current guideline recommendation which included primary percutaneous coronary intervention (PCI), pharmacoinvasive therapy, thrombolysis or medical management only. Data was analysed for age, sex, risk factors, type of ACS, treatment given and complications if any. Those patients who underwent invasive approach also evaluated for coronary anatomy pattern and variables. Results: Study population had younger mean age of 57.2 years, male preponderance (67%) and very high tobacco intake (46%). Out of all ACS patients 39% were STEMI (55% anterior wall myocardial infarction, 43% inferior wall myocardial infarction) and 61% were NSTEMI/USA. In STEMI subgroup, only 18% had primary PCI, while 42% received thrombolytic therapy as primary management. Nearly half of the patients who received thrombolytic therapy underwent pharmacoinvasive treatment (47.5%). A large number of late presenters (32% of all STEMI) did not receive any reperfusion therapy in index admission while few of them (6%) underwent invasive revascularization. Coronary anatomy evaluation showed multivessel disease in 53.1%. Left anterior descending artery was most common vessel involved (69.3%) among all ACS patients underwent coronary angiography. Most of the STEMI patients who underwent invasive route received PCI while very low rate for referral for CABG (2.1%). Major complications noted in study included left ventricular failure/cardiogenic shock (11.7%), advance AV blocks (8.2%), VT/VF (2.8%), Ventricular septal rupture (0.7%) and stent thrombosis (0.5%). In hospital mortality remained high (11.5%) mainly due to late presenters. Conclusion: ACS management specially STEMI care is still needs a boost in north India. With primary PCI rate of only 18% and more than one third being late presenters not receiving any reperfusion therapy, there is urgent need of robust primary and referral health care system. As compared to other part of India, tobacco intake is alarmingly high (46%) and needs widespread health awareness in community of tobacco ill effects.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"102 - 107"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44670277","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_59_21
R. Rai, Rahul Singla, N. Bansal
Libman-Sacks endocarditis is usually associated with systemic lupus erythematosus and malignancies. It usually presents between ages 40 and 70 years. Our case was a seven year old child who was initially suspected and treated on lines of rat bite fever endocarditis based on history of rat bite but on further investigations patient was diagnosed with libman sacks endocarditis. High index of suspicion should be there for Libman-Sacks endocarditis for early diagnosis and treatment in cases with positive family history.
{"title":"Libman-Sacks endocarditis masquerading as suspected rat-bite fever","authors":"R. Rai, Rahul Singla, N. Bansal","doi":"10.4103/heartindia.heartindia_59_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_59_21","url":null,"abstract":"Libman-Sacks endocarditis is usually associated with systemic lupus erythematosus and malignancies. It usually presents between ages 40 and 70 years. Our case was a seven year old child who was initially suspected and treated on lines of rat bite fever endocarditis based on history of rat bite but on further investigations patient was diagnosed with libman sacks endocarditis. High index of suspicion should be there for Libman-Sacks endocarditis for early diagnosis and treatment in cases with positive family history.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"151 - 153"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46112345","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 : 2021-04-01DOI: 10.4103/heartindia.heartindia_82_21
K. Pradeep Yadav, Prakash Tendulkar, R. Kant
The identification of ST-segment elevation on the electrocardiogram is an integral part of decision-making in patients who present with suspected ischemia. Unfortunately, ST-segment elevation is nonspecific and may be caused by noncardiac causes such as electrolyte abnormalities. We present a case of a 52-year-old male who presented with ST-segment elevation secondary to hypercalcemia in a patient with hypertension with osteoporotic vertebral collapse.
{"title":"Severe hypercalcemia mimicking as ST-segment elevation myocardial infarction","authors":"K. Pradeep Yadav, Prakash Tendulkar, R. Kant","doi":"10.4103/heartindia.heartindia_82_21","DOIUrl":"https://doi.org/10.4103/heartindia.heartindia_82_21","url":null,"abstract":"The identification of ST-segment elevation on the electrocardiogram is an integral part of decision-making in patients who present with suspected ischemia. Unfortunately, ST-segment elevation is nonspecific and may be caused by noncardiac causes such as electrolyte abnormalities. We present a case of a 52-year-old male who presented with ST-segment elevation secondary to hypercalcemia in a patient with hypertension with osteoporotic vertebral collapse.","PeriodicalId":32147,"journal":{"name":"Heart India","volume":"9 1","pages":"142 - 144"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48929740","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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