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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 7 | Issue 4
Page Nos. 129-174

Online since Wednesday, December 11, 2019

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EDITORIAL  

Preface to the fourth issue of Heart India 2019 p. 129
Alok Kumar Singh
DOI:10.4103/heartindia.heartindia_48_19  
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ORIGINAL ARTICLES Top

The study of prevalence and determinants of white-coat hypertension in medical personnel: A prospective study p. 131
Himanshu Gupta, Sanjay Mehrotra, Ayushi Gupta
DOI:10.4103/heartindia.heartindia_26_19  
Context: White-coat hypertension (WCH) has variable prevalence with prognostic significance, and ambulatory blood pressure monitoring (ABPM) is a reliable method for its identification. Assessment of WCH is necessary to prevent overtreatment. Aims: The objective was to study the prevalence and determinants of WCH in medical personnel. Settings and Design: A cross-sectional observational study was performed on young medical students. Duration was 23 months. Subjects and Methods: A total of 354 medical students were screened for hypertension, and those who were found hypertensive were then subjected to ABPM using CONTEC-06C monitor. Baseline characteristics were compared between white-coat hypertensive and true hypertensive groups. Hamilton Anxiety Rating Scale was used for anxiety assessment. Patients with target organ damage were excluded from the study. Statistical Analysis: Continuous groups were compared by independent Student's t-test, whereas categorical groups were compared using Chi-square test. P < 0.05 was considered as statistically significant. Results: Among 50 hypertensive patients on ABPM, the prevalence WCH was 66% and true hypertension was 34%. Mild anxiety (Hamilton anxiety rating score (HRS) <18) was found to be significantly high (54.5%) among WCH group, while severe anxiety (HRS 25–30) was associated with true hypertensive group (41.2%). A significantly high reverse dipping is found in hypertensive group patients as compared to WCH group (9.1% vs. 23.5%; P = 0.03). Overall, nondippers were found to be in highest percentage in the study. Conclusions: WCH is high in young population, especially among medical professionals. The prevalence of WCH is 66% which is significantly high as compared to the literature available. Reverse dipping on ABPM is strongly associated with true hypertension.
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Radial anomalies in North Indian patients undergoing TRAns-radial catheterization: A prospective observational study (RAIN-TRAC study) p. 137
Dibbendhu Khanra, Pradyot Tiwari, SK Sinha, Puneet Aggrawal, Shishir Soni
DOI:10.4103/heartindia.heartindia_30_19  
Background: Radial artery anomalies are relatively common and one of the major causes of transradial procedure failure. Aim: The study was aimed to assess the incidence of radial axis anomalies in patients undergoing transradial cardiac catheterization and their impacts on procedural failure. Materials and Methods: This was a prospective, single-center study, 1870 consecutive patients underwent transradial coronary catheterization. Radial artery anatomy was determined by injecting diluted contrast agent through radial sheath. Results: About 11.4% patients (213/1870) were noted to have abnormal radial artery anatomy which was associated with significantly higher procedural failure rate (odds ratio [OR] [95% confidence interval [CI] = 240.72 [57.98–999.43]) and radial artery spasm (OR [95%CI] = 7.12 [4.06–12.49]) than patients with normal radial artery anatomy. Among all the radial artery anomalies, high bifurcation was the most common anomaly, found in 128 (60%) patients. The high bifurcation was found most commonly at the mid-humerus level (53.12%). Extremely tortuous radial artery was found in 43 (20%) patients. Radial artery loop was found in 22 (10%) patients and was associated with the highest failure rate (54.5%). Other unclassified anomalies were found in 20 patients (10%). In bivariate analysis, the incidence of each of the radial artery anomalies was found to have significant correlation with older age, short stature, female sex, and hypertension. Conclusion: Radial artery anomalies are not uncommon and are related to significant procedural failure. Retrograde radial arteriography helps to identify patients with unfavorable radial artery anatomy, which can be performed with a minimum amount of contrast and should be considered part of a routine transradial procedure.
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Comparison of del Nido's cardioplegia with St. Thomas's cardioplegia for myocardial protection in adult open-heart surgery p. 145
Ambrish Kumar, Ajaykumar Raghunath Pandey, Sharad Chandra, Bhupendra Kumar
DOI:10.4103/heartindia.heartindia_34_19  
Objective: The del Nido cardioplegia solution provides a long period of arrest with single dose as compare to St. Thomas cardioplegia solution. In our study we compared outcomes of del Nido and St. Thomas cardioplegia in adult open cardiac surgeries. Methods: Sixty patients were studied between January 2017 to December 2017. Out of which 30 patients were operated on St. Thomas cardioplegia and 30 patients were on del Nido cardioplegia solution. Outcome was compared in both group in relation to demographic, cardiac enzymes level, cardiopulmonary bypass data and post operative results. Results: Total cardiopulmonary bypass time (111.27 ± 40.791 vs. 131.77 ± 37.97, P = 0.049), Aortic cross clamp time (71.67 ± 27.68 vs. 87.00 ± 30.95, P = 0.048), Time taken for return of cardiac contraction after de-clamping the aorta (2.40 ±1.453 vs. 3.67 ± 1.971, P = 0.006), dose of cardioplegia required (1361.67 ± 362.388 vs. 2716.67 ± 927.021, P=0.001) repetition of Cardioplegia needed (1.37±0.490 vs. 4.07±1.437, P=0.001), time to wean off from bypass (21.93±4.934 vs. 32.67±10.535 , P=0.001) and intraoperative cardioversion requirement (p=0.001) were significantly lower in del Nido group as compared to St. Thomas group. Postoperative PRO BNP level (2269.8 ±2098.97 pg/mL vs. 10220.0 ± 8343.62 pg/mL, P= 0.001) was significantly lower in the DN group. While troponin T levels (P= 0.314), CPK-MB level (P=0.111) were comparable in between groups. Conclusion: Del Nido cardiplegia is associated with lower bypass and cross clamp time, less dose and repetition of cardioplegia and early return of cardiac activity as compared to ST Thomas solution. There is better myocardial protection with del Nido cardioplegia as assessed with less increase in PRO BNP level.
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The assessment of left/right ventricular strain and deformation in patients with severe rheumatic mitral stenosis before and after balloon mitral valvuloplasty using speckle tracking echocardiography p. 150
Sudarshan Kumar Vijay, Bhuwan Chandra Tiwari, Pawan Mehta, Mukul Misra
DOI:10.4103/heartindia.heartindia_37_19  
Background: Rheumatic mitral stenosis (MS) poses substantial burden in developing countries and is an important cause of cardiovascular morbidity. Speckle tracking echocardiography is a novel technique which assesses the left and right ventricular mechanics and deformation by grey scale imaging. Aims and Objectives: We aimed to assess the left and right ventricular strain and deformation in patients with severe rheumatic mitral stenosis to analyse the subclinical ventricular dysfunction in these patients as compared to healthy controls and to see the effect of balloon mitral valvotomy (BMV) on these parameters. Material and Methods: 50 patients of severe rheumatic mitral stenosis were recruited into study and divided into two groups: cases ( severe MS patients underging BMV, n = 30 ) case controls(severe MS patients on medical management not opting for BMV, n = 20). 10 -healthy normal controls were taken. Baseline LV strain and deformation was assessed in these patients and effect of balloon mitral valvotomy was seen on these parameters in cases at early (24-48 hrs) and short term (1-month) period as compared to changes in case controls and normal controls. Results: Baseline LV global longitudinal (GL) (-13.1 ± 3.67) and circumferential strain (GC) (-19.18 ± 7.58) was significantly reduced in cases as compared to healthy controls (-22.17 ± 2.30) and (-30.21 ± 4.17) respectively (p < 0.001). Right ventricular global longitudinal strain was also significantly reduced in cases (-9.43 ± 5.75). LV and RV rotational parameters were also reduced. BMV significantly improved in left ventricular GL strain from baseline (-13.10 ± 3.67) to post 24-48 hrs (-14.77 ± 3.98) and post one month (-17.20 ± 3.44) and GC strain from baseline (-19.18 ± 7.58, p=<0.05). RV global longitudinal strain also changed significantly (p < 0.01) from baseline (-9.43 ± 5.75) to post 24-48 hrs (-13.87 ± 8.93) and post one month (-17.37 ± 5.72). Conclusions: LV and RV strain and deformation is reduced in severe mitral stenosis patients. 2D speckle tracking echocardiography can detect these early changes in LV and RV function before overt systolic dysfunction. BMV significantly improves LV/RV strain and deformation at early and short term period.
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A retrospective study of surgical outcomes of various congenital heart diseases at tertiary care center, SMS Hospital, Jaipur, Rajasthan, India p. 160
Imran Khan Mansoori, Rajendra Mohan Mathur, Sanjeev Devgarha, Anula Sisodia, Ishant Singla
DOI:10.4103/heartindia.heartindia_23_19  
Paediatric cardiac surgery is still in growing phase in India and the expert and trained personnel for paediatric cardiac surgery is insufficient for congenital heart defects (CHD) cases. Moreover, various types of surgeries have been performed for different CHDs, and the surgical outcomes vary according to the complexity of CHD. There is continuous improvement in outcome of CHD surgery as advancement of surgical technique and post operative care with the time. However, the available data on CHD surgical outcome is limited in India. This paper defines procedure performed for particular CHD, their weightage, age group-wise distribution and the outcome of respective procedures. The paper also analyses result of surgeries performed for CHD at tertiary care centre.
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A retrospective study of surgical outcomes of various congenital heart diseases at tertiary care center, SMS Hospital, Jaipur, Rajasthan, India p. 160
Imran Khan Mansoori, Rajendra Mohan Mathur, Sanjeev Devgarha, Anula Sisodia, Ishant Singla
DOI:10.4103/heartindia.heartindia_23_19  
Paediatric cardiac surgery is still in growing phase in India and the expert and trained personnel for paediatric cardiac surgery is insufficient for congenital heart defects (CHD) cases. Moreover, various types of surgeries have been performed for different CHDs, and the surgical outcomes vary according to the complexity of CHD. There is continuous improvement in outcome of CHD surgery as advancement of surgical technique and post operative care with the time. However, the available data on CHD surgical outcome is limited in India. This paper defines procedure performed for particular CHD, their weightage, age group-wise distribution and the outcome of respective procedures. The paper also analyses result of surgeries performed for CHD at tertiary care centre.
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Study of efficacy of tissue Doppler imaging in diagnosing systolic and diastolic dysfunction and comparison to the conventional methods of left ventricular function assessment in heart failure patients p. 165
Kalyan Kurapati, Krishna Mala Konda Reddy Parvathareddy, Ravi Srinivas, Praveen Nagula
DOI:10.4103/heartindia.heartindia_41_19  
Objective: The study aims to ascertain left ventricular (LV) mitral velocity, systolic Sa, and diastolic Ea measured by tissue Doppler imaging (TDI) and compare with conventional parameters of assessment of LV function in patients with heart failure (HF). Background: HF is a major cause of disability and morbidity all over the globe, and there are increasing trends in epidemic proportions shortly considering the early onset of cardiovascular disease. TDI is a noninvasive method to assess the LV dysfunction both systolic and diastolic. TDI can be helpful as a diagnostic, prognostic tool in patients with HF. Materials and Methods: A total of 100 cases (72 male and 28 female) admitted to Osmania General Hospital with symptoms and signs of HF were studied. All patients underwent echocardiography, and their LV function was assessed by TDI. Peak velocities during systole Sa, early diastole (Ea), and late diastole (Aa) were measured and compared with conventional LV systolic (LV ejection fraction [LVEF]) and LV diastolic Doppler echocardiography (E/A). Results: In patients with HF, TDI parameter Ea in the assessment of diastolic dysfunction (DD) was statistically significant when compared with conventional Doppler echocardiography 79% and 67% respectively in diagnosing diastolic dysfunction (P < 0.01). The TDI parameter “Sa” used for systolic dysfunction less significantly correlated with LVEF (66% vs. 89%). Conclusion: TDI parameter “Ea” was the most powerful predictor of LVDD when compared to “E/A” Doppler echocardiography. LVEF was a more powerful indicator of LV systolic dysfunction when compared to Sa of TDI. TDI “Ea” and “Sa” parameters can be helpful as diagnostic, prognostic markers in HF patients with low ejection and normal EF.
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CASE REPORT Top

Percutaneous transluminal coronary angioplasty in a patient with dextrocardia using left transradial approach p. 172
Naresh Rana, Munish Dev, Ambudhar Sharma
DOI:10.4103/heartindia.heartindia_13_19  
Dextrocardia is a rare condition with mirror-image position of the heart. Given the rarity of this condition, percutaneous coronary intervention in dextrocardia can be technically challenging. A modification in catheter manipulation and image acquisition technique is required for a successful procedure. We report a case of non-ST elevation myocardial infarction in a 55-year-old male patient with dextrocardia, managed successfully with coronary angioplasty of the right coronary artery through the left transradial route.
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