Pub Date : 2023-06-01DOI: 10.1177/26324636231178198
Soumya Patnaik
The major takeaway from 2022 Heart Failure guidelines (AHA/ACC/HFSA) was the 4-pillar concept of use of beta-blockers, RAAS inhibition (preferably ARNI), mineralocorticoid antagonist, and SGLT2 inhibitors (irrespective of diabetes) for HFrEF. The recommendations for HFpEF and HF mildly reduced EF are less robust. Some important heart failure trials are presented every year at ACC, AHA, ESC, and TCT, which can impact our practice even before the release of next guidelines. In this review, some select heart failure trials presented at these scientific meetings after January 2022 are briefly discussed with focus on the message they convey.
{"title":"Management of Heart Failure: Messages from Trials Beyond AHA 2022 Guidelines","authors":"Soumya Patnaik","doi":"10.1177/26324636231178198","DOIUrl":"https://doi.org/10.1177/26324636231178198","url":null,"abstract":"The major takeaway from 2022 Heart Failure guidelines (AHA/ACC/HFSA) was the 4-pillar concept of use of beta-blockers, RAAS inhibition (preferably ARNI), mineralocorticoid antagonist, and SGLT2 inhibitors (irrespective of diabetes) for HFrEF. The recommendations for HFpEF and HF mildly reduced EF are less robust. Some important heart failure trials are presented every year at ACC, AHA, ESC, and TCT, which can impact our practice even before the release of next guidelines. In this review, some select heart failure trials presented at these scientific meetings after January 2022 are briefly discussed with focus on the message they convey.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131459817","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 : 2023-06-01DOI: 10.1177/26324636231174694
{"title":"Obituary: Professor Mohan Nair","authors":"","doi":"10.1177/26324636231174694","DOIUrl":"https://doi.org/10.1177/26324636231174694","url":null,"abstract":"","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128668019","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 : 2023-06-01DOI: 10.1177/26324636231174725
P. Jariwala, G. Kulkarni, K. C. Misra, Ganesh S. Jaishetwar
Angiographic evidence of thrombosis in more than one coronary artery at the same time is uncommon in patients with acute myocardial infarction, and this is hard to identify with routine electrocardiography. Patients may manifest with high-degree atrioventricular block, cardiogenic shock, or sudden cardiac arrest, all of which are potentially fatal outcomes. This case study focuses on a patient who experienced cardiogenic shock, high-degree atrioventricular block secondary to acute anterior-inferior ST-segment elevation myocardial infarction. During the coronary angiogram, thrombotic occlusions of the left anterior descending and right coronary arteries were observed. A patient was salvaged by the use of mechanical circulatory assistance in conjunction with prompt percutaneous coronary intervention of both the culprit arteries. Our case report emphasizes the importance of completing revascularization as soon as possible by opening the culprit arteries and ensuring appropriate mechanical circulatory support to the patient.
{"title":"“Double Myocardial Infarct Syndrome” resulting from Simultaneous Occlusion of Dual Coronary Arteries: A Double Jeopardy","authors":"P. Jariwala, G. Kulkarni, K. C. Misra, Ganesh S. Jaishetwar","doi":"10.1177/26324636231174725","DOIUrl":"https://doi.org/10.1177/26324636231174725","url":null,"abstract":"Angiographic evidence of thrombosis in more than one coronary artery at the same time is uncommon in patients with acute myocardial infarction, and this is hard to identify with routine electrocardiography. Patients may manifest with high-degree atrioventricular block, cardiogenic shock, or sudden cardiac arrest, all of which are potentially fatal outcomes. This case study focuses on a patient who experienced cardiogenic shock, high-degree atrioventricular block secondary to acute anterior-inferior ST-segment elevation myocardial infarction. During the coronary angiogram, thrombotic occlusions of the left anterior descending and right coronary arteries were observed. A patient was salvaged by the use of mechanical circulatory assistance in conjunction with prompt percutaneous coronary intervention of both the culprit arteries. Our case report emphasizes the importance of completing revascularization as soon as possible by opening the culprit arteries and ensuring appropriate mechanical circulatory support to the patient.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116363476","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 : 2023-06-01DOI: 10.1177/26324636231177235
Rajesh Babu Gudipati
The incidence and severity of illness due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more severe illness in adults and the elderly compared to children. But a clinical manifestation characterized by a multisystem inflammatory syndrome is described in children (Multisystem inflammatory syndrome in children (MIS-C)). MIS-C was first described in April 2020. MIS-C is due to a dysregulated immune response. The mechanism by which SARS-CoV-2 triggers the abnormal immune response is unknown. This abnormal immune response has similarities with Kawasaki and macrophage activation syndrome (MAS). Initially, due to a lack of awareness, MIS-C was underdiagnosed. At present, with increased awareness among pediatricians and due to a lack of characteristic clinical features and specific laboratory investigations, MIS-C has been overdiagnosed.
严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)感染的发病率和病情严重程度在成人和老年人中高于儿童。但儿童的临床表现以多系统炎症综合征为特征(multisystem inflammatory syndrome in children (MIS-C))。misc于2020年4月首次被描述。misc是由于免疫反应失调引起的。SARS-CoV-2引发异常免疫反应的机制尚不清楚。这种异常免疫反应与川崎和巨噬细胞激活综合征(MAS)有相似之处。最初，由于缺乏认识，misc未得到充分诊断。目前，随着儿科医生意识的提高，由于缺乏特征性的临床特征和特定的实验室调查，misc已被过度诊断。
{"title":"Multisystem Inflammatory Syndrome: A Diagnostic Dilemma","authors":"Rajesh Babu Gudipati","doi":"10.1177/26324636231177235","DOIUrl":"https://doi.org/10.1177/26324636231177235","url":null,"abstract":"The incidence and severity of illness due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showed more severe illness in adults and the elderly compared to children. But a clinical manifestation characterized by a multisystem inflammatory syndrome is described in children (Multisystem inflammatory syndrome in children (MIS-C)). MIS-C was first described in April 2020. MIS-C is due to a dysregulated immune response. The mechanism by which SARS-CoV-2 triggers the abnormal immune response is unknown. This abnormal immune response has similarities with Kawasaki and macrophage activation syndrome (MAS). Initially, due to a lack of awareness, MIS-C was underdiagnosed. At present, with increased awareness among pediatricians and due to a lack of characteristic clinical features and specific laboratory investigations, MIS-C has been overdiagnosed.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130105124","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 : 2023-06-01DOI: 10.1177/26324636231180988
G. Ravikanth, B. Rao, M. Azam
Aconite is a plant with deceptively beautiful flowers that contain a deadly cardiotoxin. Aconite toxicity presents with often fatal ventricular arrhythmias that are refractory to conventional antiarrhythmic medications. An electrical storm (ES) is an acute cardiac emergency that carries a high mortality. We report one such case of acute aconite toxicity presenting with ES that was managed successfully with hemodynamic support, overdrive pacing, and charcoal hemoperfusion with high-flux ultrafiltration.
{"title":"Aconite Toxicity Presenting as Electrical Storm: A Diagnostic and Therapeutic Challenge","authors":"G. Ravikanth, B. Rao, M. Azam","doi":"10.1177/26324636231180988","DOIUrl":"https://doi.org/10.1177/26324636231180988","url":null,"abstract":"Aconite is a plant with deceptively beautiful flowers that contain a deadly cardiotoxin. Aconite toxicity presents with often fatal ventricular arrhythmias that are refractory to conventional antiarrhythmic medications. An electrical storm (ES) is an acute cardiac emergency that carries a high mortality. We report one such case of acute aconite toxicity presenting with ES that was managed successfully with hemodynamic support, overdrive pacing, and charcoal hemoperfusion with high-flux ultrafiltration.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125921625","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 : 2023-06-01DOI: 10.1177/26324636231178189
Sharath Reddy Annam, Lokanath Seepana, Anil Krishna Gundala, D. R. Gouni, Sampath P. Kumar, Balaji R, Premchand
Stent under expansion is one of the reasons compromising the outcomes of percutaneous coronary interventions. The most common cause of the stent under expansion is calcium deposited in the atherosclerotic plaque. Adequate plaque modification is the paramount before the placement of a stent, as the options to handle under expanded stent are limited and less effective. In this case report, we explore the usage of knuckle wire for the extrastent plaque modification, after being failed with routine methods of handling stent under expansion.
{"title":"Extrastent Plaque Modification With Knuckle Wire for Resistant Stent Underexpansion","authors":"Sharath Reddy Annam, Lokanath Seepana, Anil Krishna Gundala, D. R. Gouni, Sampath P. Kumar, Balaji R, Premchand","doi":"10.1177/26324636231178189","DOIUrl":"https://doi.org/10.1177/26324636231178189","url":null,"abstract":"Stent under expansion is one of the reasons compromising the outcomes of percutaneous coronary interventions. The most common cause of the stent under expansion is calcium deposited in the atherosclerotic plaque. Adequate plaque modification is the paramount before the placement of a stent, as the options to handle under expanded stent are limited and less effective. In this case report, we explore the usage of knuckle wire for the extrastent plaque modification, after being failed with routine methods of handling stent under expansion.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131233526","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 : 2023-06-01DOI: 10.1177/26324636231179001
Angella Patnaik
{"title":"Taking Over a Running Train","authors":"Angella Patnaik","doi":"10.1177/26324636231179001","DOIUrl":"https://doi.org/10.1177/26324636231179001","url":null,"abstract":"","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129146306","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 : 2023-06-01DOI: 10.1177/26324636231178388
Rajesh Babu Gudipati, N. Rao, Y. Vyas, B. Jagannath
The association of total anomalous pulmonary venous connection (TAPVC) with transposition of great arteries (TGA) is a very rare combination of 2 congenital cyanotic heart diseases. TAPVC, in the case of TGA with the intact interventricular septum (IVS), is a cause of early regression of the left ventricle (LV). Very few cases of this rare combination (TAPVC and TGA with or without VSD) have been reported in the world of literature. We found 10 case reports in the literature. The minimum age was 6 days and the maximum age of 16 years. 5 of them, which were operated before 1990, underwent atrial switch with TAPVC repair. Other 4 of them, operated after 1995, underwent arterial switch with TAPVC repair. In this case report we are reporting 2 such rare cases. In both cases, large VSD prevented LV regression.
{"title":"A Rare Combination of Transposition of Great Arteries and Total Anomalous Pulmonary Venous Connection","authors":"Rajesh Babu Gudipati, N. Rao, Y. Vyas, B. Jagannath","doi":"10.1177/26324636231178388","DOIUrl":"https://doi.org/10.1177/26324636231178388","url":null,"abstract":"The association of total anomalous pulmonary venous connection (TAPVC) with transposition of great arteries (TGA) is a very rare combination of 2 congenital cyanotic heart diseases. TAPVC, in the case of TGA with the intact interventricular septum (IVS), is a cause of early regression of the left ventricle (LV). Very few cases of this rare combination (TAPVC and TGA with or without VSD) have been reported in the world of literature. We found 10 case reports in the literature. The minimum age was 6 days and the maximum age of 16 years. 5 of them, which were operated before 1990, underwent atrial switch with TAPVC repair. Other 4 of them, operated after 1995, underwent arterial switch with TAPVC repair. In this case report we are reporting 2 such rare cases. In both cases, large VSD prevented LV regression.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133995888","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 : 2023-05-18DOI: 10.1177/26324636231174797
Vijay Singh, L. Kalimuthu, A. Mishra, M. Ora, S. Gambhir, A. Nazar
Coronary artery disease (CAD) is an important cause of morbidity and mortality worldwide. Perfusion abnormalities precede wall motion abnormalities, ECG changes, and angina in the etiology of CAD. myocardial perfusion imaging (MPI) can detect perfusion alterations due to pathology at sites such as the endothelium, microvasculature, and epicardial coronary arteries. Thus, it measures the universal burden of ischemic heart disease (IHD). Nuclear medicine MPI is an important noninvasive imaging modality to evaluate the perfusion of the myocardium. Positron Emission Tomography (PET) and single-photon emission computed tomography (SPECT) with or without computed tomography (CT) are 2 primary modalities. PET is a highly sensitive modality with an inherent ability to quantify absolute myocardial blood flow (MBF) and variations in MBF due to various stress agents. PET has immense potential to change clinical management, prognosticate, and risk stratify patients presenting with clinical or preclinical CAD. Evidence shows that early PET detection of myocardial perfusion abnormalities, followed by aggressive intervention for cardiovascular risk factors, can reinstate myocardial perfusion. This may reduce morbidity and mortality. We shall be reviewing the clinical impact of PET in CAD and preclinical CAD patients.
{"title":"Role of Positron Emission Tomography Cardiac Perfusion Imaging in Clinical Management, Prognosis, and Risk Stratification of Cardiovascular Disease","authors":"Vijay Singh, L. Kalimuthu, A. Mishra, M. Ora, S. Gambhir, A. Nazar","doi":"10.1177/26324636231174797","DOIUrl":"https://doi.org/10.1177/26324636231174797","url":null,"abstract":"Coronary artery disease (CAD) is an important cause of morbidity and mortality worldwide. Perfusion abnormalities precede wall motion abnormalities, ECG changes, and angina in the etiology of CAD. myocardial perfusion imaging (MPI) can detect perfusion alterations due to pathology at sites such as the endothelium, microvasculature, and epicardial coronary arteries. Thus, it measures the universal burden of ischemic heart disease (IHD). Nuclear medicine MPI is an important noninvasive imaging modality to evaluate the perfusion of the myocardium. Positron Emission Tomography (PET) and single-photon emission computed tomography (SPECT) with or without computed tomography (CT) are 2 primary modalities. PET is a highly sensitive modality with an inherent ability to quantify absolute myocardial blood flow (MBF) and variations in MBF due to various stress agents. PET has immense potential to change clinical management, prognosticate, and risk stratify patients presenting with clinical or preclinical CAD. Evidence shows that early PET detection of myocardial perfusion abnormalities, followed by aggressive intervention for cardiovascular risk factors, can reinstate myocardial perfusion. This may reduce morbidity and mortality. We shall be reviewing the clinical impact of PET in CAD and preclinical CAD patients.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121321387","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 : 2023-05-09DOI: 10.1177/26324636231167334
S. Rajamani, Radha Srinivasan Iyer, N. Karodpati
Cardiovocal syndrome or Ortner’s syndrome can be caused due to a myriad of etiologies in the neck or mediastinum. The syndrome can also be a consequence of many cardiac or mediastinal pathologies or even complications of surgical treatment. The objective of this research was to systematically review to provide an overview of the etiopathogenesis of Cardiovocal syndrome or Ortner’s syndrome. Cochrane Handbook for Systematic Reviews was used for the methodology of the review and the review adhered to the “Preferred Reporting Items for Systematic Review and Meta-analysis Protocols” PRISMA protocol. The database PubMed and ClinicalKey were searched using prompts “hoarseness” OR “recurrent laryngeal nerve paralysis” AND “Ortne’s syndrome” OR “Cardiovocal syndrome” OR “aneurysm” OR “thoracic aorta” OR “unilateral vocal fold paralysis.” After data extraction synthesis was done based on the 24 most relevant and recent publications reporting and outlining this condition. Newer investigative modalities like Videolaryngostroboscopy and Transcutaneous laryngeal ultrasound (TLUSG) are useful for early recognition of this condition before the development of Aortic dissection or Rupture of Aortic Aneurysm. Cardiac physicians and Otolaryngologists must remain vigilant to the sudden onset of left vocal cord palsy as it can be an early warning sign of an ominous mediastinal pathology.
{"title":"Etiopathogenesis of Cardiovocal Syndrome (Ortner’s Syndrome): A Systematic Review of the Literature","authors":"S. Rajamani, Radha Srinivasan Iyer, N. Karodpati","doi":"10.1177/26324636231167334","DOIUrl":"https://doi.org/10.1177/26324636231167334","url":null,"abstract":"Cardiovocal syndrome or Ortner’s syndrome can be caused due to a myriad of etiologies in the neck or mediastinum. The syndrome can also be a consequence of many cardiac or mediastinal pathologies or even complications of surgical treatment. The objective of this research was to systematically review to provide an overview of the etiopathogenesis of Cardiovocal syndrome or Ortner’s syndrome. Cochrane Handbook for Systematic Reviews was used for the methodology of the review and the review adhered to the “Preferred Reporting Items for Systematic Review and Meta-analysis Protocols” PRISMA protocol. The database PubMed and ClinicalKey were searched using prompts “hoarseness” OR “recurrent laryngeal nerve paralysis” AND “Ortne’s syndrome” OR “Cardiovocal syndrome” OR “aneurysm” OR “thoracic aorta” OR “unilateral vocal fold paralysis.” After data extraction synthesis was done based on the 24 most relevant and recent publications reporting and outlining this condition. Newer investigative modalities like Videolaryngostroboscopy and Transcutaneous laryngeal ultrasound (TLUSG) are useful for early recognition of this condition before the development of Aortic dissection or Rupture of Aortic Aneurysm. Cardiac physicians and Otolaryngologists must remain vigilant to the sudden onset of left vocal cord palsy as it can be an early warning sign of an ominous mediastinal pathology.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122816979","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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