Pub Date : 2019-03-01DOI: 10.19080/JOCCT.2019.13.555857
G. Gullace
The practice of Medicine since its origins has evolved going to meet many changes; to go back to history and to follow this evolution you have the feeling of being “tourists in search of a certain mysterious charm of the past that helps us to achieve the future” [1]. But also fascinated in looking for all those elements that help us to understand the changes and to guide us in correcting the errors of the present. “Describing the past, understanding the present, predicting the future: this is the task of medicine”[2]. There are still many Hippocratic principles that remain cornerstones of Modern Medicine, written in the Hippocratic Oath, either in its ancient [3] or in its modern version [4], on which the new graduates in Medicine and Surgery swear at the time of graduation. Today, Medicine is at a very high level of evolution (knowledge of diseases, technological development, knowledge of new therapeutic interventions, etc.) with an awesome improvement in diagnostic and therapeutical procedures as well as in the field of training, planning, management and implementation; nevertheless, it remains quite complex and for this, with difficult interpretations, inappropriateness’s, possible human errors that sometimes are unpredictable.
{"title":"Hippocrates’ Dream. What has Hippocratic Revolution Left in Modern Medicine","authors":"G. Gullace","doi":"10.19080/JOCCT.2019.13.555857","DOIUrl":"https://doi.org/10.19080/JOCCT.2019.13.555857","url":null,"abstract":"The practice of Medicine since its origins has evolved going to meet many changes; to go back to history and to follow this evolution you have the feeling of being “tourists in search of a certain mysterious charm of the past that helps us to achieve the future” [1]. But also fascinated in looking for all those elements that help us to understand the changes and to guide us in correcting the errors of the present. “Describing the past, understanding the present, predicting the future: this is the task of medicine”[2]. There are still many Hippocratic principles that remain cornerstones of Modern Medicine, written in the Hippocratic Oath, either in its ancient [3] or in its modern version [4], on which the new graduates in Medicine and Surgery swear at the time of graduation. Today, Medicine is at a very high level of evolution (knowledge of diseases, technological development, knowledge of new therapeutic interventions, etc.) with an awesome improvement in diagnostic and therapeutical procedures as well as in the field of training, planning, management and implementation; nevertheless, it remains quite complex and for this, with difficult interpretations, inappropriateness’s, possible human errors that sometimes are unpredictable.","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44355086","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 : 2019-02-26DOI: 10.19080/jocct.2019.13.555856
Ratnagiri Ravi Kumar
Just before Heart Transplant, all patients received 10-20 mg of Induction with Injection Basiliximab (dose as per body weight and general condition) single dose. Second dose of Basiliximab was Given selectively in 15 patients. Post op immunosuppression regimen was Tacrolimus in 54, Tacrolimus (low dose with a target of 2-3 ng/ml) PLUS Everolimus 0.25 mg bid in 5 patients, Mycophenolate in all patients. Steriod Wysolone was given for 6 months in 45 patients and in the rest upto 1 year. Post operatively in 38 patient’s creatinine levels Normalized by day 5, allowing initiation of Tacrolimus. While in other 12 patients Tacrolimus could be started only at day 10 with NO Ill effects or rejection episodes. In all patient’s CD 25 level was checked on day 3 and second dose of basiliximab given only if CD 25 more than 3%. Post op no patient had sustained neutropenia. Only 2 patient needed therapy for Azotemia with post-operative dialysis. 3 patients died of Severe RF and sepsis [2]. 15 patients (27%) has new onset Diarrhoea in the First year after Transplant of whom 4(7%) were found to have CMV antigen Positive these resolved with IV Gancyclovir in 3. One had clostridium difficile positive diarrhoea-treated with IV Vancomycin Plus Metronidazole. In 7 patients diarrhoea resolved with termination of Mycophenolate and other 4 had E-coli or Salmonella diarrhea resolved with Oral antibiotics. One Patients had extensive Herpes Zoster which resolved with anti-Viral drug Acyclovir. One Patient had Hepatic Mucormycosis Tretaed with Amphoterecin [3].
{"title":"Side effect profile of 55 Heart Transplant patients - an Indian study","authors":"Ratnagiri Ravi Kumar","doi":"10.19080/jocct.2019.13.555856","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555856","url":null,"abstract":"Just before Heart Transplant, all patients received 10-20 mg of Induction with Injection Basiliximab (dose as per body weight and general condition) single dose. Second dose of Basiliximab was Given selectively in 15 patients. Post op immunosuppression regimen was Tacrolimus in 54, Tacrolimus (low dose with a target of 2-3 ng/ml) PLUS Everolimus 0.25 mg bid in 5 patients, Mycophenolate in all patients. Steriod Wysolone was given for 6 months in 45 patients and in the rest upto 1 year. Post operatively in 38 patient’s creatinine levels Normalized by day 5, allowing initiation of Tacrolimus. While in other 12 patients Tacrolimus could be started only at day 10 with NO Ill effects or rejection episodes. In all patient’s CD 25 level was checked on day 3 and second dose of basiliximab given only if CD 25 more than 3%. Post op no patient had sustained neutropenia. Only 2 patient needed therapy for Azotemia with post-operative dialysis. 3 patients died of Severe RF and sepsis [2]. 15 patients (27%) has new onset Diarrhoea in the First year after Transplant of whom 4(7%) were found to have CMV antigen Positive these resolved with IV Gancyclovir in 3. One had clostridium difficile positive diarrhoea-treated with IV Vancomycin Plus Metronidazole. In 7 patients diarrhoea resolved with termination of Mycophenolate and other 4 had E-coli or Salmonella diarrhea resolved with Oral antibiotics. One Patients had extensive Herpes Zoster which resolved with anti-Viral drug Acyclovir. One Patient had Hepatic Mucormycosis Tretaed with Amphoterecin [3].","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49327827","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 : 2019-02-26DOI: 10.19080/jocct.2019.13.555855
Ratnagiri Ravi Kumar
We studied 12 Patients who underwent Successful heart Transplant with High Pre-operative Pulmonary pressures – defined as PA systolic pressure more than 50 mm Hg but with Transpulmonary Gradient less than 16 mm hg after Vasodilator testing, for analysis of Pulmonary heamodynamic parameters like Pulmonary Vascular Resistance, (PVR) and Pulmonary Compliance(Pca) early (one month) and one Year after Heart Transplantation along with Survival at 6 months and one year. These 12 patients were statistically compared with 25 patients who had preoperative PA systolic pressures less than 50mm hg 11 of above patients were on both Sildenefil and Ambrisentan for PAH [1].
我们研究了12名成功接受心脏移植且术前肺高压（定义为PA收缩压大于50 mm Hg，但经肺梯度小于16 mm Hg）的患者，用于分析肺血流动力学参数，如肺血管阻力，（PVR）和肺顺应性（Pca），以及6个月和1年的存活率。将这12名患者与25名术前PA收缩压小于50mmhg的患者进行统计学比较，其中11名患者同时服用西地那非和安必生坦治疗PAH[1]。
{"title":"Pulmonary Vascular Resistance (PVR) Late after Heart Transplant in Patients with Higher Preoperative Pulmonary Hypertension and Influence on Survival-A Study from India","authors":"Ratnagiri Ravi Kumar","doi":"10.19080/jocct.2019.13.555855","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555855","url":null,"abstract":"We studied 12 Patients who underwent Successful heart Transplant with High Pre-operative Pulmonary pressures – defined as PA systolic pressure more than 50 mm Hg but with Transpulmonary Gradient less than 16 mm hg after Vasodilator testing, for analysis of Pulmonary heamodynamic parameters like Pulmonary Vascular Resistance, (PVR) and Pulmonary Compliance(Pca) early (one month) and one Year after Heart Transplantation along with Survival at 6 months and one year. These 12 patients were statistically compared with 25 patients who had preoperative PA systolic pressures less than 50mm hg 11 of above patients were on both Sildenefil and Ambrisentan for PAH [1].","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41993226","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 : 2019-02-25DOI: 10.19080/jocct.2019.13.555854
H. Taha
Background: Contrast induced acute kidney injury (CI-AKI) is a common and serious complication of contrast agents used in imaging studies. Clinical markers useful for early detection of CI-AKI and prediction of outcome are needed in order to speed diagnosis and implementation of renal protective measures. In septic shock, postoperative setting of cardiac surgery and TAVI subjects, an increased Doppler Renal Resistive Index (RRI) is a predictor of AKI. This study aims to test the hypothesis that Doppler-based renal resistive index would similarly predicts contrast induced acute kidney injury in patients undergoing cardiac catheterization. Methods: We enrolled 100 patients undergoing cardiac catheterization and at risk of CI-AKI. All presented with at least two CI- AKI risk factors and were free of other identifiable causes of acute kidney injury or arrhythmia. Doppler RRI was measured before and at first day after catheterization. CI-AKI was assessed, defined by serum creatinine increase 25% above the pre-procedural baseline or rise in serum creatinine of >0.5 mg/dl from baseline value or a >25% decrease in eGFR within 5 days after cardiac catheterization. Results: Nineteen subjects developed CI- AKI in the first five days post-procedure, with two requiring dialysis. Post procedural RRI value was higher in CI-AKI subjects [RRI: 0.77±0.02 with CI- AKI vs 0.67±0.03 without CI-AKI, (P <0.001)]. In addition, the RRI increased significantly in the first day after the procedure [from RRI 0.7±0.38 preprocedural to 0.77±0.02 in patients developing CI-AKI (p<0.001)]. Post procedural RRI >0.744 predicted CI- AKI with a sensitivity of 94% and specificity of 92%. Conclusion: Measurement of the Doppler-based RRI early post-catheterization in high risk patients enabled early prediction of contrast induced acute kidney injury.
{"title":"Renal Resistive Index as an early Predictor of Contrast Induced Nephropathy in Patients Undergoing Coronary Angiography","authors":"H. Taha","doi":"10.19080/jocct.2019.13.555854","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555854","url":null,"abstract":"Background: Contrast induced acute kidney injury (CI-AKI) is a common and serious complication of contrast agents used in imaging studies. Clinical markers useful for early detection of CI-AKI and prediction of outcome are needed in order to speed diagnosis and implementation of renal protective measures. In septic shock, postoperative setting of cardiac surgery and TAVI subjects, an increased Doppler Renal Resistive Index (RRI) is a predictor of AKI. This study aims to test the hypothesis that Doppler-based renal resistive index would similarly predicts contrast induced acute kidney injury in patients undergoing cardiac catheterization. Methods: We enrolled 100 patients undergoing cardiac catheterization and at risk of CI-AKI. All presented with at least two CI- AKI risk factors and were free of other identifiable causes of acute kidney injury or arrhythmia. Doppler RRI was measured before and at first day after catheterization. CI-AKI was assessed, defined by serum creatinine increase 25% above the pre-procedural baseline or rise in serum creatinine of >0.5 mg/dl from baseline value or a >25% decrease in eGFR within 5 days after cardiac catheterization. Results: Nineteen subjects developed CI- AKI in the first five days post-procedure, with two requiring dialysis. Post procedural RRI value was higher in CI-AKI subjects [RRI: 0.77±0.02 with CI- AKI vs 0.67±0.03 without CI-AKI, (P <0.001)]. In addition, the RRI increased significantly in the first day after the procedure [from RRI 0.7±0.38 preprocedural to 0.77±0.02 in patients developing CI-AKI (p<0.001)]. Post procedural RRI >0.744 predicted CI- AKI with a sensitivity of 94% and specificity of 92%. Conclusion: Measurement of the Doppler-based RRI early post-catheterization in high risk patients enabled early prediction of contrast induced acute kidney injury.","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45986347","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 : 2019-02-21DOI: 10.19080/jocct.2019.13.555853
N. Espinola-Zavaleta
{"title":"Spontaneous Coronary Artery Dissection and Left Ventricular Diverticulum. A Rare Associationy","authors":"N. Espinola-Zavaleta","doi":"10.19080/jocct.2019.13.555853","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555853","url":null,"abstract":"","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44465023","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 : 2019-02-20DOI: 10.19080/jocct.2019.13.555852
K. Vora
A 14-year-old female patient presented for evaluation of dyspnea (NYHA Class III). CTA revealed bifurcation arising from the single coronary artery 1 cm distal to the Left Coronary Cusp (LCC). Right Coronary Artery (RCA) courses normally at right AV groove. Left Anterior Descending coronary artery (LAD) courses anterior to the main pulmonary artery and supplies the anterior interventricular septum (Figure A). Left Main Coronary Artery (LMCA). Segment is absent. Diagonal branch (D1) is a large vessel arising from LAD and supplies the anterior wall. Left Circumflex Coronary Artery (LCX) arises from the RCA at the Anterior Interventricular groove (AV) (Figure B) and has a retroaortic course and supplies the inferolateral wall. Obtuse Marginal Branch (OM) is a moderate size vessel; Arises from the LCX at the left AV groove and supplies the inferolateral wall. RCA arises from the single coronary artery 1 cm distal to the left coronary cusp and courses posteriorly and to the right and supplies the inferior wall. Posterior Descending Artery (PDA) arises from RCA and supplies the posterior interventricular septum. Posterolateral Ventricular Branch (PLVB) arises from RCA and supplies the posterolateral wall of the LV (Figure C). As per the classification system, this coronary system is a benign single coronary artery of ShiraniRoberts Subtype IB4 [1].
{"title":"Shirani-Roberts IB4 – Rare Type of Benign Single Coronary Artery Diagnosed by Cardiac Computed Tomography","authors":"K. Vora","doi":"10.19080/jocct.2019.13.555852","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555852","url":null,"abstract":"A 14-year-old female patient presented for evaluation of dyspnea (NYHA Class III). CTA revealed bifurcation arising from the single coronary artery 1 cm distal to the Left Coronary Cusp (LCC). Right Coronary Artery (RCA) courses normally at right AV groove. Left Anterior Descending coronary artery (LAD) courses anterior to the main pulmonary artery and supplies the anterior interventricular septum (Figure A). Left Main Coronary Artery (LMCA). Segment is absent. Diagonal branch (D1) is a large vessel arising from LAD and supplies the anterior wall. Left Circumflex Coronary Artery (LCX) arises from the RCA at the Anterior Interventricular groove (AV) (Figure B) and has a retroaortic course and supplies the inferolateral wall. Obtuse Marginal Branch (OM) is a moderate size vessel; Arises from the LCX at the left AV groove and supplies the inferolateral wall. RCA arises from the single coronary artery 1 cm distal to the left coronary cusp and courses posteriorly and to the right and supplies the inferior wall. Posterior Descending Artery (PDA) arises from RCA and supplies the posterior interventricular septum. Posterolateral Ventricular Branch (PLVB) arises from RCA and supplies the posterolateral wall of the LV (Figure C). As per the classification system, this coronary system is a benign single coronary artery of ShiraniRoberts Subtype IB4 [1].","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941095","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 : 2019-02-08DOI: 10.19080/jocct.2019.13.555851
R. Rodriguez
{"title":"Transient STEMI with Spontaneous Resolution as an Infrequent Intraoperative Complication of Radiofrequency Ablation of Symptomatic Premature Ventricular Contractions","authors":"R. Rodriguez","doi":"10.19080/jocct.2019.13.555851","DOIUrl":"https://doi.org/10.19080/jocct.2019.13.555851","url":null,"abstract":"","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46139514","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 : 2019-01-24DOI: 10.19080/jocct.2019.12.555850
M. Oliveira
Takotsubo (stress) cardiomyopathy is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wallmotion abnormalities. it predominantly affects elderly women and is often preceded by emotional and/or physical triggers but has also been reported without evident trigger(s). The clinical presentation, electrocardiographic findings and cardiac biomarker profiles are often similar to those of Acute Coronary Syndromes (ACS). We report herein an interesting case of the most rare (focal) type of the Takotsubo (stress) cardiomyopathy.
{"title":"Focal type of the Takotsubo (stress) Cardiomyopathy","authors":"M. Oliveira","doi":"10.19080/jocct.2019.12.555850","DOIUrl":"https://doi.org/10.19080/jocct.2019.12.555850","url":null,"abstract":"Takotsubo (stress) cardiomyopathy is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wallmotion abnormalities. it predominantly affects elderly women and is often preceded by emotional and/or physical triggers but has also been reported without evident trigger(s). The clinical presentation, electrocardiographic findings and cardiac biomarker profiles are often similar to those of Acute Coronary Syndromes (ACS). We report herein an interesting case of the most rare (focal) type of the Takotsubo (stress) cardiomyopathy.","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44631463","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 : 2019-01-23DOI: 10.19080/jocct.2019.12.555849
S. Pagano
There are clearly visible sinus P-waves in the first two beats and in the last one (marked with * in Figure 1). From the third beat an irregular wide QRS complex rhythm with left bundle branch block (LBBB) morphology begins, without visible P-waves. Although the LBBB may suggest a supraventricular rhythm, the second beat is a fusion complex, revealing a ventricular origin of the wide QRS complex rhythm. On an accurate analysis indeed, the second beat has shorter PR interval and a different QRS morphology compared to the previous one (in DI lead for example it is entirely positive and slightly wider comparing to the previous one which is isodifasic and narrow).
{"title":"An Irregular wide QRS Complex Rhythm","authors":"S. Pagano","doi":"10.19080/jocct.2019.12.555849","DOIUrl":"https://doi.org/10.19080/jocct.2019.12.555849","url":null,"abstract":"There are clearly visible sinus P-waves in the first two beats and in the last one (marked with * in Figure 1). From the third beat an irregular wide QRS complex rhythm with left bundle branch block (LBBB) morphology begins, without visible P-waves. Although the LBBB may suggest a supraventricular rhythm, the second beat is a fusion complex, revealing a ventricular origin of the wide QRS complex rhythm. On an accurate analysis indeed, the second beat has shorter PR interval and a different QRS morphology compared to the previous one (in DI lead for example it is entirely positive and slightly wider comparing to the previous one which is isodifasic and narrow).","PeriodicalId":73635,"journal":{"name":"Journal of cardiology & cardiovascular therapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49300052","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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