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   Table of Contents - Current issue
October-December 2021
Volume 11 | Issue 4
Page Nos. 161-212

Online since Monday, October 25, 2021

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Rheumatic heart disease: Is it reversible? p. 161
Kumar Narayanan
Rheumatic heart disease (RHD) continues to be responsible for the loss of millions of young productive lives worldwide, with a disproportionate burden being borne by the underdeveloped and economically disadvantaged strata of society. There is an urgent need to develop approaches to identify RHD in its early stages and reverse it before it can cause significant valvular damage. This is especially relevant for the developing world where advanced cardiac surgery is inaccessible to many. Research over the last decade has made it possible to diagnose subclinical or latent RHD through systematic echocardiographic screening using standardized criteria, which can pick up early disease better compared to clinical screening alone. Furthermore, initial studies show promise that timely institution of penicillin prophylaxis can lead to regression of such latent disease. This brief review summarizes the current state of the field in this regard and outlines some of the challenges in translating this concept from benchside to public health policy.
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Transcatheter aortic valve replacement for bicuspid aortic valve p. 166
Immaneni Sathyamurthy, Sai Satish
Transcatheter aortic valve replacement (TAVR) is being routinely done in various centres for aortic stenosis due to tricuspid aortic valves. The number of TAVR procedures are increasing, but the data on bicuspid aortic valves (BAV) is scanty. BAV is commonest abnormality in general population and can progress to severe aortic stenosis. BAVs are a heterogeneous group due to anatomical variations and these valves are large, elliptical with asymmetric calcification. Echocardiography, multidetector CT scans help in diagnosing various phenotypes and in pre TAVR work up in sizing the device. The major issues regarding TAVR in BAVs are improper deployment of the valve , increased risk of strokes, paravalvular leaks, need for second device and requirement for pacemakers. With new generation devices the complication rates are coming down indicating their safe usage in BAVs. Data from TAVR registries and published studies have shown the applicability of TAVR in BAVs with acceptable outcomes.
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Newer oral anticoagulants in venous thromboembolism p. 172
Sunil Modi, Ranjan Modi
Venous thromboembolism (VTE) is an important medical condition for morbidity and mortality. Adequate anticoagulant treatment is necessary to reduce short- and long-term VTE related conditions. In the past low molecular weight heparin (LMWH) and Vitamin K antagonists (VKAs) have been the mainstay of anticoagulation therapy for VTE patients. The patients require frequent monitoring with INR to keep balance between effectiveness and safety in clinical practice. NOACs have been the main stay of treatment in conditions requiring effective anticoagulation. They may prove to do the same in VTE. This article analyses, the present literature on use of NOACs in VTE.
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Nonvalvular atrial fibrillation and acute coronary syndrome: Present Indian perspective and assessment p. 179
Ranjan Modi, Aparna Jaswal, Sunil Modi
Background: The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy, due to presence of Atrial Fibrillation (AF), has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the trade-off is an increased risk for bleeding while on DAPT. The addition of an anticoagulation further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on anticoagulation (VKA/ NOAC) must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Aims and Objectives: The aim of the study was to determine the diversity in the antiplatelet and anticoagulation treatment of patients with nonvalvular AF or flutter who develop acute coronary syndrome (ACS) or undergo PCI in India.Materials and Methods: All patients who had AF and underwent PCI were included in the study. Results: In the study 100 patients of AF with PCI were evaluated, among who 95 % were started on triple therapy (TT) and 5 % on DAPT. The patients were followed up at 1 month, 3 months, 6 months, and 1 year for adjustment of antiplatelet, anticoagulation medicines, and their dosage. Conclusion: The study reviewed the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.
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Impact of low early high-density lipoprotein cholesterol on inhospital outcome and short-term prognosis in patients with acute coronary syndrome p. 186
Tarek E Elkholy, Ekram S Saeed, Mahmoud A Abo Omar, Yasser H El-barbary
Background: Acute coronary syndrome (ACS) is a cardiac emergency and constitutes a major burden globally. Association between serum lipid and ACS is established many years ago. Our study tried to have more information about the impact of high-density lipoprotein cholesterol (HDL-C) on inhospital outcome and short-term prognosis of patients with ACS. Materials and Methods: The study was a prospective comparative study. Clinical and chemical and interventional evaluation was done in hospital settings. A total number of 50 patients were included in the study and divided into two groups. Patients with low HDL-C level were in Group I and patients with normal HDL-C were in Group II. Results: Group I populations had more inhospital complications than Group II represented in acute heart failure (48% vs. 13%), cardiogenic shock (40% vs. 6%), complex coronary lesions (57% vs. 20%), and prolonged hospital stay (54% vs. 20%). A statistical significance was found regarding these variables (P < 0.05). Regarding the outcome after 1 month, it is observed that patients of Group I significantly experienced heart failure (59.38% vs. 21.43%) and worsening angina (62.5% vs. 28.57%) with a statistically significant difference. In contrast, there is no statistically significant difference regarding myocardial infarction, new cerebrovascular events, shock, and mortality. Conclusion: The study showed a strong association of HDL-C level with inhospital adverse events of ACS patients in addition to short-term adverse events. Complications of ACS were more in patients with low HDL-C level.
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Cyanotic congenital heart disease_effects of iron supplementation on hematological indices in iron-sufficient and iron-deficient children p. 193
Rambabu Sharma, Devendra Meena, Dhan Raj Bagri
Background: Cyanotic congenital heart disease (CCHD) children often have malnutrition and iron-deficiency anemia along with poor weight gain. Low arterial oxygen saturation due to CCHD affects hematological indices. Objective: The objective of the study is to find iron status and hematological indices in children having CCHD and to study the impact of iron therapy in the sample population under study. Materials and Methods: This hospital-based, prospective, cross-sectional, observational type of study evaluated 50 CCHD children aged more than 1 year with informed written consent from the parents. Sample size is calculated at 95% confidence level and alpha error 4.005 assuming 52.2% iron deficiency in patient with CCHD with hematocrit value <60%. Results: Tetralogy of Fallot was the most common CCHD followed by transposition of great arteries and tricuspid atresia. Most common age of presentation is <50 months with cyanosis (50%) and congestive cardiac failure (16%) with male preponderance (M:F = 3:1). 60% CCHD patients were iron deficient. Iron-deficient group shows significant improvement in all hematological parameters after iron supplementation compared with iron-sufficient group. Results and Discussions: Serum iron levels, serum ferritin levels, mean hemoglobin levels, total red blood cell count, hematocrit, and red cell distribution width along with red cell indices (mean corpuscular volume, mean corpuscular hemoglobin, and MCHC) should be used as diagnostic tool for the evaluation of iron status in patients as well as for monitoring improvement. This emphasizes that iron therapy iron must be supplemented with special focus on iron status of children.
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Giant right ventricular clot: Smoking is injurious to veins! p. 198
Pankaj Jariwala, Kartik Pandurang Jadhav, Harikishan Boorugu, Arshad Punjani, Krushna Chandra Mishra
Giant right ventricular thrombus is a rare characteristic of pulmonary thrombosis-embolism that is typically associated with chronic obstructive pulmonary disease (COPD) exacerbation. We found such a giant right ventricular thrombus in a patient who was a heavy smoker who had extreme type of COPD with cor pulmonale. He also had hypotension, hypoxia, low tolerance for exercise, congestive heart failure, and poor quality of life, which are the prognostic qualities in the patient's clinical scenario we mentioned.
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Simultaneous presence of atrial arrhythmia and hypocalcemia in dilated cardiomyopathy: A series of two cases p. 201
Anil Kumar Singhi, Sanjeev S Mukherjee, KH Shine Kumar, Raman Krishna Kumar
Dilated cardiomyopathy in young children has varied etiological factors. Some cases have correctable causes such as incessant arrhythmia, correctable metabolic abnormality, and left ventricular obstructive lesions. Two 4-month-old infants presented with severe left ventricular dysfunction and ectopic atrial tachycardia. Biochemical profile of the infants showed low ionic and total calcium, elevated serum phosphate, elevated alkaline phosphatase, and elevated serum lactate. The parathyroid hormone was elevated and 25-hydroxyvitamin D3 was reduced. The patients were treated with beta-blocker, calcium, and Vitamin D supplementation, along with antifailure therapy. The tachycardia resolved over a 12-h period and calcium normalized in the next few days. The left ventricular function returned to normal over a 5–16-month period. In 6–8 years of follow-up, patients were in sinus rhythm doing very well with normal cardiac function with normal calcium-related biochemical parameters. The presence of incessant atrial arrhythmia in a case of hypocalcemic cardiomyopathy is rare and can have link with hypocalcemia-induced electrical changes in the cardiomyocyte in selected cases. Thorough and protocol-based treatment approach helps in correct diagnosis and treatment. Further study and molecular research can shed more light on the complex interaction of hypocalcemia and arrhythmia.
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Perforation of Coronary Artery Side Branch: A Lesson for Novice Interventionist during Angiography p. 205
Rakesh Kumar Ola, Manish Ruhela
In the modern era of cardiology, coronary angiography is a relatively safe procedure. Complication rate occurs in < 1% of cases. We report a case of coronary artery side branch perforation during coronary angiography using 5 French tiger radial catheter. Contrast injection into a side branch following accidental superselective intubation leads to the perforation at the tip and contrast extravasation. We were able to manage the patient conservatively because there is no hemodynamic compromise or pericardial effusion. Check angiography was done after 7 days and there was no leak. During angiography, pressure tracing should always be monitored and dye injection should be stopped if there is superselective intubation of the branch.
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Post Myocardial Infarction sudden cardiac death within 90 days after coronary revascularization – therapeutically, a no-man's land p. 208
Hemanshu Bhatia, Pankaj Jariwala
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Woes of follow-up patients: A stumbling block, every cardiologist needs to intervene p. 210
B Sadananda Naik, Sangram Biradar
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Retrograde his activation and resetting of the sinus node in parahisian pathway p. 211
Debasis Acharya, Debasish Das, Tuton Das, Subhas Pramanik
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Retraction: The sensitivity and specificity of electrocardiogram in localizing the culprit artery with angiographic correlation in indian patients with acute st-segment elevation myocardial infarction p. 212

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