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   Table of Contents - Current issue
January-March 2021
Volume 11 | Issue 1
Page Nos. 1-39

Online since Thursday, February 18, 2021

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The relevance of bare-metal stent in the therapy of coronary artery disease in 2020 p. 1
Saumitra Ray
First percutaneous transluminal coronary angioplasty (PTCA) using an expandable balloon was performed by Andreas Gruentzig in 1977. Since then, the process has seen exponential development. Stent deployment was the most important milestone in this journey. An original stent made of metals or metal alloys was called a bare-metal stent (BMS). They ruled the roost for more than a decade when stents coated with antiproliferative drug impregnated polymers, called drug-eluting stent came and became the tool of choice in almost all clinical scenarios of PTCA. However, still today, BMS has got a small but significant place in the cardiac catheter laboratory. The relevance of BMS in the therapy of coronary artery disease in today's world is reviewed in this article.
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Scope of genetic testing for inherited cardiovascular diseases in the clinical practice p. 5
Advithi Rangaraju, Ashwin Dalal
Inherited cardiac disorders are clinically and genetically heterogeneous group of disorders where sudden cardiac death is mostly the first clinical presentation. The available clinical markers are insufficient to make an accurate diagnosis, and therefore, molecular genetic diagnostics is an important tool for clinical decision-making. The advancements in technology have tremendously improved the affordability of genetic testing. In India, though genetic testing is being largely applied in the pediatric settings for chromosomal abnormalities and metabolic disorders, it is still at a nascent stage in the cardiology practice. Since cardiomyopathies and channelopathies have become actionable because of new interventional therapies, this article highlights the importance and need of genetic testing for inherited cardiac disorders by practicing cardiologists, in-view of the American College of Medical Genetics, American College of Cardiology, European Heart Rhythm Association guidelines. Incorporating cardiovascular genetic testing in the routine clinical practice can take it forward by greatly improving the scope of disease management.
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Hypertension and Size of Aortic Root – Cause-and-Effect Relationship p. 13
Vivudh Pratap Singh, Gurpreet S Wander, Bishav Mohan, Naved Aslam, Rohit Tandon, Shibba Takkar Chhabra, B Singh, A Goyal
Background and Objectives: Hypertension and aortic root diameter have been the subject of recent studies. Dilation of the diameter of the aortic root been noted in individuals with Hypertension. A larger aortic root is also recognized as a marker of CVD Incident. A parallel set of cross-sectional studies has repeatedly demonstrated an inverse association between aortic root diameter and Hypertension. Our study try to look at this specific point. Material and Methods: This study was done in patients attending Outdoor Clinic in Dayanand Medical College and Hospital- Unit Hero DMC Heart Institute. 105 patients in Normotensive and 94 patients in the Hypertensive group were enrolled. Study comprised of Normotensive (n=105) and hypertensive (n=94) group. Results: Aorta size was significantly different in both the group. Aorta at annulus was 27.71±3.28 m.m. in Normotensive individual as compared to 31.36±3.39 m.m. in hypertensive individual. Similarly, Aorta at Sinus was 38.68±5.25 and 41.62±6.08 m.m. in both groups. Aorta at Sinotubular junction was 32.31±7.17 m.m. as compared to 36.25±4.88 m.m. Conclusion: Hypertension is associated with a significant but small increase in aortic root size, most notably at the proximal ascending aorta.
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The role of fluoroscopically detected coronary calcium in predicting the presence of significant coronary lesions p. 19
Jostol Pinto, Sunitha K Viswanathan, George A Koshy, Prabha Nini Gupta, VV Radhakrishnan
Context: Coronary artery disease (CAD) accounts for over 16' of deaths worldwide.[1] As part of its diagnosis and stratification of severity in a patient, a noninvasive modality would certainly be useful to triage CAD. Aims: To assess the diagnostic accuracy of fluoroscopically detected coronary artery calcification (CAC) as a tool to grade coronary stenosis. Settings and Design: Comparing severity of fluoroscopic CAC with a severity of CAD by coronary angiograms (CAGs) in a high-volume center. Subjects and Methods: Fluoroscopic presence of CAC was graded using the Yamanaka method and correlated with CAGs in 200 patients. Statistical Analysis Used: Sensitivity, specificity, predictive values, accuracy, Chi-squared tests for significance. Results: The overall prevalence of CAC was 43' varying with age, sex, and CAD severity. The most common location of CAC was the left anterior descending artery followed by right coronary artery. Fluoroscopic CAC had 94' specificity and 96.5' positive predictive value for significant stenosis, albeit lower sensitivity of 55.3'. While 63' of those patients with single-vessel CAC had multivessel CAD, 91' of those with multivessel CAC had multivessel CAD. CAC was detected as follows: 6' in minor CAD, 40' in single-vessel disease (VD), 64' in two- or three-VD, and 100' in those with four-VD (P = 0.001). CAC was seen in 69.6' of patients having chronic total occlusions (CTOs) while in only 32.6' without CTOs (P = 0.001). Conclusions: A strong relation is present between CAC and severity of CAD. CAC is not a good screening tool for CAD due to low sensitivity. Notably, multivessel CAC strongly predicts multivessel CAD.
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Takotsubo cardiomyopathy and new-onset right bundle branch block in uncomplicated right ventricle pacing: Cause or coincidence? p. 24
Manjappa Mahadevappa, Prashanth Kulkarni, KS Poornima, BV Guruprasad
Normally in the right ventricular (RV) paced rhythm, the electrocardiogram pattern will be of left bundle branch block (LBBB) pattern. A small percentage of patients can have right bundle branch block (RBBB) pattern in uncomplicated RV pacing. We are reporting here a rare occurrence of a new-onset RBBB in an RV paced patient which was coinciding with the onset of takotsubo cardiomyopathy following pulse generator re-implantation procedure.
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Myocardial infarction following marijuana consumption in a young male p. 29
Sathyamurthy Immaneni, Narra Lavanya, K Kirubakaran, KN Srinivasan
Recreational use of Marijuna smoking is on the rise among the young and adolescents. This can result in worsening of angina or acute myocardial infarction in those with underlying coronary artery disease (CAD) due to sympathetic nervous system stimulation. Even those without CAD can present with acute coronary syndromes due to coronary spasm which can be confirmed by Coronary angiography by ruling out obstructive lesions in these cases . There is fivefold increase in symptoms during 1st hour after consumption. High chances of recurrence of symptoms when the drug is reused and patients needs to be counselled.
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Working in the mirror: A case series on interventions in children having dextrocardia with congenital heart disease p. 32
Mahua Roy, Debasree Gangopadhyay, Pavan Patel
This case series comprises of five children having dextrocardia with congenital heart disease who underwent percutaneous interventional procedures. Four of them underwent percutaneous device closure and one had percutaneous balloon coarctoplasty. There are a few reports of percutaneous coronary intervention in adults with dextrocardia, however barring a few isolated case reports, literature on intervention in children with dextrocardia is limited?.
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Anomalous right coronary artery from the pulmonary artery in a young infant with ventricular septal defect p. 37
Anil Kumar Singhi, Richard Hawker, Gary Sholler
We report a case of anomalous right coronary artery from pulmonary artery (ARCAPA), which is a very rare congenital coronary defect. It can be an isolated lesion or associated with congenital cardiac defects such as tetralogy of Fallot or shunt lesions in up to 40' of cases. The clinical presentation varies from asymptomatic to signs of myocardial ischemia, cardiac failure, and/or ventricular arrhythmia. The electrocardiogram can be normal in a significant fraction of the cases. The diagnosis of ARCAPA may be confirmed by cardiac catheterization, computed tomographic angiogram, and cardiac magnetic resonance angiogram. Reimplantation of anomalous coronary artery is the treatment of choice. In the current era, systematic preoperative screening by echo is recommended.
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