• Users Online: 18
  • Print this page
  • Email this page
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
October-December 2020
Volume 10 | Issue 4
Page Nos. 149-195

Online since Thursday, January 21, 2021

Accessed 1,119 times.

PDF access policy
Journal allows immediate open access to content in HTML + PDF
View as eBookView issue as eBook
Access StatisticsIssue statistics
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list

Guidelines for cardiac life support training programs: A recommendation from national cardiac life support p. 149
C C. Vinil Kumar, Muralidhar Kanchi, Srinath Kumar, Viju Wilben, Shiva Prasad, Ratan Gupta, Balakrishna Pillai Radhakrishnan, BC Srinivas, Alexander Thomas, Vellaiyan Chinnandi Shanmuganandan, Poonam Malhotra Kapoor, Sateesh Kailasam, Saravana Kumar, Bhabatosh Biswas, Cholenahally Nanjappa Manjunath
National cardiac life support training program initiated in October 2016, it is a systematic approach to management of a victim of cardiac arrest. The program aimed to address the training needs of a junior physician such as the one undergoing postgraduate medical education and other health-care professionals. It is a 2-day “hands-on” course that recommends an instructor–candidate ratio of 1:6 and limits the number of candidates to 30 per session to maintain adequate mentee–mentor interaction, monitoring, and evaluation. This program is developed in collaboration with Society for Emergency Medicine in India, Indian College of Anesthesiologists, Indian College of Cardiology, and Association of Healthcare Providers India. In addition, this program has been endorsed by West Bengal University and National Board of Examinations, New Delhi. Currently, The Simulation Society which deals with online teaching simulation has lent its support by endorsing this program.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Current concepts in the management of acute ST-elevation myocardial infarction with ventricular septal rupture – Early versus late approach: Part 1 – Transcatheter device closure of ventricular septal rupture p. 156
Sridhar Kasturi, Narsingarao Pantula
Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR. Acquired ventricular septal defect (VSD) is uncommon, but serious mechanical complication of acute myocardial infarction with poor outcome and high mortality rate in surgically or medically treated patients. Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Coronary artery disease in young diabetics (under 40 years): Are they Different? p. 163
Rahul S Patil, Laxmi H Shetty, CG Chidananda, V A. Sathwik Raj, Anindya Sundar Trivedi, RT Raghu, NC Manjunath
Aims: The aim is to study the clinical, social, biochemical, and angiographic profiles of Indian diabetic youth presenting with premature coronary artery disease (PCAD). Subjects and Methods: Of 3450 patients registered in PCAD registry till date, 375 (10.86%) satisfied the entry criteria. The data were analyzed by statistical software R version 3.5.0. Further, a subgroup analysis based on age was made, and comparisons were drawn. Results: The study had 375 patients. The average age was 35.94 years; there were 228 (60.8%) patients between 36 and 40 years, 104 (27.7%) between 31 and 35 years, and 43 (11.5%) between 26 and 30 years. There were 291 (77.6%) males and 84 (22.4%) females. There were 152 (42.10%) smokers, 102 (27.2%) hypertensives and 68 (18.1%) with family history of CAD in the group. Around 285 (75.9%) had abnormal body mass index (BMI) and 290 (77.3%) had abdominal obesity. The most common index presentation was ST-elevation myocardial infarction (STEMI), 275 (73.34%). Single-vessel disease was the most common presentation in 265 (79.1%). A subgroup analysis by age showed that younger diabetics more often presented with STEMI and triple-vessel disease was less common, whereas the older diabetics presented more often with dyslipidemia and non-STEMI. Conclusions: Patients with diabetes have a high cardiovascular risk. Diabetes negates the cardiovascular protection seen in premenopausal women. High BMI and abdominal obesity are the most common risk factors for diabetes in the young. Diabetics with premature CAD present more often with STEMI and have single-vessel disease, unlike older diabetics. Hence, aggressive lifestyle modifications that begin in childhood are very important to tackle this growing epidemic.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Angiotensin receptor neprilysin inhibitor in heart failure with reduced ejection fraction: Real-world experience from a safety perspective p. 168
Manas Layek, Ankit Kumar Sahu, Mukesh Yadav, Roopali Khanna, Naveen Garg, Satyendra Tewari, Sudeep Kumar, Aditya Kapoor, Pravin K Goel
Background: Angiotensin receptor neprilysin inhibitor (ARNI) reduces morbidity and mortality in patients of heart failure with reduced ejection fraction (HFrEF). However, the use of ARNI in real-world practice is limited by safety issues, especially in acute decompensated heart failure (ADHF) patients. Methods and Results: Forty-seven hospitalized ADHF inpatients and 53 chronic compensated heart failure (CCHF) outpatients were enrolled in the study. ARNI was initiated and aimed to be up-titrated to a target dose of 97 mg of sacubitril with 103 mg of valsartan twice daily. Efficacy endpoints were New York Heart Association functional class, 6-min walk distance (6MWD), change in N-terminal pro B-type natriuretic peptide (NT-pro BNP) levels and left ventricular ejection fraction (LVEF) from baseline with follow-up at 1 month, 6 months, and 2 years. Safety endpoints were the rates of worsening serum creatinine, hyperkalemia, symptomatic hypotension, angioedema, and need for drug discontinuation. Cumulative adverse drug effect was observed in 42.6% and 13.2% patients of ADHF and CCHF groups, respectively. The most common side-effect was symptomatic hypotension that occurred in 10 (21.3%) patients of ADHF group and 3 (5.7%) patients of CCHF group. Drug discontinuation rate was 19.1% in ADHF group and 3.8% in CCHF group. Significant improvement was seen in both the groups with respect to 6 MWD, functional class, change in NT-pro BNP levels and LVEF. At 2-year follow-up, 3 (6.4%) deaths occurred in ADHF group while none was reported from CCHF group. Conclusion: ARNI results in a significant clinical, biochemical, and functional improvement in HFrEF patients but at the cost of worsening renal function and hypotension especially in ADHF setting.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Twelve months outcome of drug-eluting stenting versus off-pump bypass surgery for proximal left anterior descending coronary artery lesion in ischemic cardiomyopathy p. 174
Yasser Gaber Metwally, Ashraf F Mahmoud, Walid S Taha
Background: The precise benefit/risk ratio of either procedure in patients with ischemic cardiomyopathy remains less clear. Objectives: This study is aimed to assess the 12 months outcome of drug-eluting stent (DES) versus off-pump CABG (OPCAB) for proximal left anterior descending lesions in ischemic cardiomyopathy. Patients and Methods: A total of 70 patients diagnosed with ischemic cardiomyopathy with ejection fraction <35% referred for revascularization were assigned to either stenting or surgery. The primary endpoint was (in stent restenosis [ISR]/graft occlusion) rates; the secondary endpoint was MACE at 12 months of follow-up. Results: Out of 70 patients enrolled; 71.4% were assigned to DES, while 28.6% were assigned to OPCAB; the mean the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery score for stent group was 17.5 ± 0.96, while the mean Euro-score II for the surgery group was 3 ± 0.86. The ISR/graft occlusion rates; angina; and target vessel revascularization were significantly higher among the stenting group (30% vs. 5%; P = 0.028); (4% vs. 25%; P = 0.017) and (22% vs. 0%, P = 0.028), respectively, while late transient ischemic attack/stroke and length of hospital stay were significantly higher among the surgery group (2% vs. 20%; P = 0.021) and (2 ± 0.5 days vs. 7.2 ± 0.5, P < 0.001), respectively; similar survival rates among the two groups. The relative risk of ISR/graft occlusion is six times more among the stent group compared to the surgery group (P = 0.028). Conclusion: Similar survival rates at 12 months of follow-up among the two groups; stent carries more risk of ISR; repeat revascularization while surgery carries more risk of late stroke.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Efficacy of percutaneous renal revascularization in resistant hypertension patients p. 181
Bhushan Bari, Deepak Sadashiv Phalgune, Suhas Hardas
Background: Renovascular hypertension is one of the most common potentially curable types of secondary hypertension. Medical therapy alone does not inhibit the progressive loss of renal function. The aim of the present study was to evaluate the efficacy of percutaneous renal revascularization in resistant hypertension patients. Methods: Forty-two patients aged ≥ 45 years with resistant hypertension having renal artery stenosis (>50% luminal narrowing assessed by quantitative renal angiography) undergoing percutaneous transluminal renal angioplasty (PTRA) were included in the study. The primary outcome measures were a response of blood pressure (BP) and the requirement of the number of hypertensive drugs, whereas the secondary outcome measure was to study the correlation of renal vein renin levels (RVRLs) with postrenal angioplasty BP response. Chi-square/Fisher's exact test and unpaired t-test were used to compare qualitative and quantitative variables, respectively. A paired t-test was used for intragroup comparison. Results: The mean systolic BP at 6-month follow-up (159.5 mmHg) was significantly less as compared to baseline (181.3 mmHg) (P = 0.0001). The mean diastolic BP at 6-month follow-up (94.4 mmHg) was significantly less as compared to baseline (106.5 mmHg) (P = 0.0001). The mean number of antihypertensive drugs used at the baseline and 6-month follow-up was 3.4 and 1.8, respectively, which was statistically significant (P = 0.001). There was no significant correlation of RVRL with postrenal angioplasty BP response. Conclusions: In patients with resistant hypertension, PTRA improved BP control and reduced the requirement of antihypertensive drugs.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Localization of focus by 18 F-fludeoxyglucose positron emission tomography computed tomography in the definitive diagnosis of infective endocarditis p. 187
Sathyamurthy Immaneni, V Ramasubramanian, M Indirani, S Shelley
18 F-fludeoxyglucose positron-emission tomography computed tomography scans are helpful in making definitive diagnosis of infective endocarditis (IE) in some selected cases. We are reporting two cases of IE, in one case, the infective focus was in the organized left ventricular mural thrombus and the second case the infective focus was found in the aortic root and annulus and the prosthetic valve was spared. This being a noninvasive test can be repeated to ascertain the adequacy of treatment during follow-up.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Longitudinal compression of ultrathin-strut stent leading to uncrossable iatrogenic mechanical stenosis: Best is enemy of good! p. 190
Pankaj Jariwala, Kartik Jadhav, Ajay Reddy Marri
Changing any element of a stent structure can alter certain aspects of how a stent can function. Although thinner struts and lower metal-to-artery ratio enhance the stent delivery, the disadvantage is lower radial force. Decreasing the number of fixed connectors between cells and changing the geometric and spatial distribution of these connectors improve flexibility and conformability, but at the cost of the longitudinal strength of the stent structure. Never as a standard parameter has the longitudinal strength or compressibility of coronary stents been published nor previously considered important. We discuss a case detailing that, particularly in the contemporary practice of interventional cardiology, stent longitudinal strength is a very significant and important feature of these devices.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Atrial septal defect - Secundum type with eisenmenger's syndrome: A rare occurrence p. 193
Rohit Manoj Jacob, Manjiri Naik
Atrial septal defect is the second most common congenital heart disease in adults.[1] Many experienced physicians make a great effort in diagnosing this heart disease. However, many patients still stand behind the curtain, undiagnosed. Such patients develop complaints such as cough, breathlessness at rest, and easy fatigability during their adolescence or adulthood, which further lead to grave diagnosis such as Eisenmenger's syndrome. One such rare presentation is discussed in the case report ahead.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta