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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 6 | Issue 4
Page Nos. 111-161

Online since Monday, December 17, 2018

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EDITORIALS  

Preface to fourth issue of Heart India 2018 p. 111
Alok Kumar Singh
DOI:10.4103/heartindia.heartindia_42_18  
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Treatment of long coronary lesions with single stent: BioMime Morph sirolimus-eluting tapered coronary stent system p. 113
Suresh V Patted
DOI:10.4103/heartindia.heartindia_24_18  
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ORIGINAL ARTICLES Top

Study of coronary angiographic correlation with electrocardiography in patients of acute coronary syndrome-ST-elevation myocardial infarction p. 115
Rohit Prabha Gaude, Deepak Kumar Gautam, Dharmendra Jain, Gyan Prakash Singh, Pritam Das, Ashis Kumar Choudhury, Sankha Shubhra Chakrabarti, Kailash Kumar, Indrajeet Singh Gambhir
DOI:10.4103/heartindia.heartindia_41_18  
Background: Abnormalities in the 12-lead electrocardiography (ECG) are often used to localize the anatomic site of myocardial infarction (MI) and ischemia in patients with coronary artery disease. The same ECG findings are often assumed to correlate with anatomy of coronary arteries as well as the site of occlusion. Unfortunately, there is only limited documentation for correlation between the location of coronary artery occlusion and the finding of Q-waves during MI, thus tending to compromise the predictive value of ECG. Aims and Objectives: The objective of this study is to correlate the accuracy of ECG in localization of culprit coronary vessels involved in acute coronary syndrome-ST-elevation myocardial infarction (ACS-STEMI) and to combine various ECG criteria for localization of culprit vessel and the occlusion site to assess the diagnostic accuracy of ECG as compared to coronary angiographic findings. Materials and Methods: ECGs of patients with MI events, symptomatic or silent, were analyzed for STEMI or non-STEMI. One hundred patients with STEMI satisfying the inclusion and exclusion criteria were included as participants for the study. Coronary angiography was done after an event of acute MI or within 3 months after an event. ECG changes in various leads were used to localize the vessel involved and were correlated with dominant vessel involved in coronary angiography in development of MI. ECG criteria were used to localize the vessel involved. The statistical analysis was done using SPSS for windows version 16.0 software. Results and conclusions: We found that anterior wall myocardial infarction was more common than inferior wall myocardial infarction. Incidence of MI correlated positively with age. Acute MI was more common in males than females. Diabetes was more common risk factor for acute MI. ECG criteria utilized in our study were found to have high sensitivity and specificity, when combined together, in localizing culprit vessel in ACS-STEMI in left anterior descending artery, right coronary artery, and left circumflex coronary artery and this is in accordance with the studies conducted in other populations.
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Mean platelet volume in acute coronary syndrome: Diagnostic implications p. 123
Gaveshna Gargi, Amit Saini, Ashok Sharma, Parmod Jaret
DOI:10.4103/heartindia.heartindia_17_18  
Objective: The aim of the present study was to investigate the association between mean platelet volume (MPV) and platelet count in patients with diagnosis of acute coronary syndrome (ACS). Materials and Methods: It was a case–control study conducted in a tertiary care hospital. We examined 100 cases of ACS and 100 age- and sex-matched healthy controls. All patients were subjected to focused history, focused clinical examination, vital recording, and baseline 12 lead electrocardiogram. MPV and platelet count were measured by a hemogram device, Melet Schloesing (MS-9) based on the Coulter principle. Results: The patients with ACS had a higher MPV 7.70 fl as compared to the normal healthy controls 6.64 fl (P < 0.0001). On the other hand, the platelet count was significantly decreased in the patients of ACS 172.44 × 109/L when compared with the healthy control group 204.98 × 109/L, and this difference was statistically significant with P < 0.0001. Conclusions: We concluded that the patients presenting with features of ACS have a higher MPV and a decreased platelet count as compared to normal population. These simple hematological markers such as MPV and platelet count can help us in reaching the diagnosis of ACS along with traditional tools.
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Baseline hemoglobin and creatinine clearance as independent risk factors for 30-day event rate in patients of acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention p. 127
Richa Agrawal, RK Nath, Neeraj Pandit, Ajay Raj
DOI:10.4103/heartindia.heartindia_28_18  
Background: Primary percutaneous coronary intervention (PCI) is the most effective therapy for managing acute ST-segment elevation myocardial infarction (STEMI). Studies have shown baseline low hemoglobin (Hb) and reduced creatinine clearance (CrCl) as risk factors for adverse outcomes in patients with heart failure, in patients undergoing PCI, and in acute coronary syndrome. However, their similar role in patients of acute STEMI undergoing primary PCI is not known. Objective: The main objective is to study whether baseline Hb and CrCl are the independent risk factors for the 30 days event rate in patients of acute STEMI undergoing primary PCI. Methods: We prospectively studied 500 patients of acute STEMI undergoing primary PCI. Hb and CrCl were measured at baseline and then at 15th and 30th day after the event. Patients were divided into four groups based on whether they have normal or abnormal baseline Hb and CrCl. Patients were followed for 30-day postdischarge for incidence of major adverse events in the form of death, reinfarction, reintervention, and hemodynamically unstable ventricular tachyarrhythmias. We assessed correlation between baseline Hb, CrC, l and 30-day event rate among four groups using Chi-square test. Results: On comparison among groups, compared to Group 1, Group 2, 3, and 4 had significantly higher adverse events ([6.48% vs. 19.44%] [P = 0.021]), ([6.48% vs. 30%] [P = 0.0003]), ([6.48% vs. 51.66%] [P ≤ 0.0001]), respectively, at 30 days after primary PCI. Conclusion: In patients of acute STEMI undergoing primary PCI, both baseline impaired CrCl and low Hb behaved independently as risk factors for increased 30-day event rates.
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Study of clinical profile, incidence, pattern, and atherosclerotic involvement of congenital coronary artery anomalies in adults undergoing coronary angiography: A study from a tertiary care institute in western part of India p. 133
Jaywant M Nawale, Ajay S Chaurasia, Digvijay Deeliprao Nalawade, Piyush Choudalwar, Nikhil Borikar, Dhirendra Tiwari
DOI:10.4103/heartindia.heartindia_33_18  
Objective: Congenital coronary artery anomalies (CCAs) are rare, clinically benign, and majority are diagnosed incidentally during coronary angiography or an autopsy. Identification of CCA is important for management by cardiologists or cardiac surgeons, and also few cases of CCA are potentially serious which may cause sudden cardiac death. We performed a retrospective, single-center study to evaluate the clinical profile, incidence, pattern, and atherosclerotic involvement of CCA in patients undergoing coronary angiography. Methods: Coronary angiographies performed in adult patients during the study period of 2 years were screened for CCA. These patients were retrospectively analyzed in terms of clinical characteristics and angiographic profiles. Results: Of 4481 angiograms screened, 86 patients were found to have CCA with the incidence of 1.91%. Nearly 76.7% were male and 23.3% were female, with a mean age of 53.02 ± 10 years. Anomalies of origin and course were most common (94.18%) followed by anomalies of termination (5.81%), with right coronary artery (RCA) being the most common artery. Anomalous origin of RCA from the left sinus of Valsalva and separate origin of left anterior descending artery and left circumflex artery were both found to be the most common types. The incidence of atherosclerosis in anomalous vessels was 52.32%. Conclusions: CCAs were diagnosed incidentally during coronary angiography and had male predominance with conventional risk factors. The incidence of CCA was slightly higher than that of the previous angiographic studies, but the pattern of anomalies was similar with majority being benign. Anomalous vessels did not predispose to atherosclerotic involvement as compared to normal vessels in the same patients.
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A comparison of outcomes with adjunctive and delayed routine pharmacoinvasive percutaneous coronary intervention strategy after thrombolysis in patients with ST-elevation myocardial infarction: Experience from a tertiary-care center in India p. 141
Akhil Kumar Sharma, Vikas Kumar, Gaurav Kumar Chaudhary, Mahim Saran, Varun Shankar Narain, Sudhanshu Kumar Dwivedi, Sharad Chandra
DOI:10.4103/heartindia.heartindia_31_18  
Objective: Since primary percutaneous coronary intervention (PCI) is not readily available to many patients either due to financial issue or unavailability of invasive cath labs, pharmacoinvasive strategies are now becoming the de facto treatment strategy. The most commonly used strategies are adjunctive PCI (within 3–24 h of thrombolysis) and delayed routine PCI (>24 h to before hospital discharge). However, direct comparison of these two strategies is lacking. Materials and Methods: In this prospective, observational, single-center study, a total of 113 thrombolysed ST-segment elevation myocardial infarction (STEMI) patients in the adjunctive PCI group and 127 thrombolysed STEMI patients in the delayed routine PCI group were analyzed. At 30-day follow-up, patients were evaluated for all-cause mortality, reinfarction, hospitalization due to angina, hospitalization due to heart failure, and improvement in left ventricular (LV) ejection fraction. Results: Patients in the adjunctive PCI group and those in the delayed routine PCI group exhibited comparable baseline characteristics. At 30-day follow up, no significant difference was noted in all-cause mortality, reinfarction, hospitalization due to angina, and hospitalization due to heart failure. There was slight trend toward increased composite end-points in the adjunctive PCI group, probably favoring delayed routine PCI (8.85% vs. 4.72%; P = 0.450). There was no significant difference in improvement in LV ejection fraction between two groups (P = 0.671). Conclusions: Even after 24 h of thrombolytic treatment in STEMI patients, delayed routine PCI can be performed with comparable outcome to that of PCI within 24 h.
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CASE REPORTS Top

A rolling ball like mass in right atrium of a 6 year old child p. 148
Srinivas Kola, Tammiraju Iragavarapu, Sushma Vutukuru
DOI:10.4103/heartindia.heartindia_38_18  
Cardiac myxoma is a common tumor occurring more commonly in the left atrium in adult females. Its occurrence in pediatric age group is rare; the more common tumors are rhabdomyoma and fibroma. Presentation of myxoma on the right side is still rarer in this age group. We report a case of a 6-year-old male child who presented with prolonged fever. On examination, there is an extra diastolic sound with mid-diastolic murmur. Echocardiogram is suggestive of a large ball-like polypoidal mass rolling in the right atrium traversing into the right ventricle. The case was immediately operated, and histopathology confirmed the tumor as myxoma. High index of suspicion is required to diagnose the condition to prevent disastrous complications as the presentation is often enigmatic because of vague constitutional findings in most of the cases.
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Pacemaker lead fracture as a cause of pacing failure p. 153
Vikas Gupta, Akshyaya K Pradhan, Ravninder Singh Kuka, Rishi Sethi
DOI:10.4103/heartindia.heartindia_23_18  
Cardiac pacing is a rapidly advancing technique. There are many potential complications of pacemaker implantation. In view of increasing implantations of pacemakers, we must have some insight of possible complications. We describe here a case of pacing lead fracture which was managed by new lead implantation.
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A case of familial hypercholesterolemia with premature coronary artery disease p. 156
Jaywant M Nawale, Ajay S Chaurasia, Digvijay Deeliprao Nalawade, Dhirendra Tiwari
DOI:10.4103/heartindia.heartindia_27_18  
Familial hypercholesterolemia (FH) is a form of genetic dyslipidemia characterized by high levels of serum low-density lipoprotein cholesterol, tendon xanthomas, and family history of heart disease or elevated cholesterol. We report the case of a 24-year-old young male who presented with acute coronary syndrome, multiple skin and tendon xanthomas, family history of premature cardiac death and diagnosed as FH with coronary artery disease which was treated with percutaneous coronary intervention and lipid-lowering therapy.
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A case of sudden-onset painless unilateral vision loss postintravenous streptokinase in a patient of acute inferior-wall myocardial infarction p. 160
Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi, Prachi Sharma
DOI:10.4103/heartindia.heartindia_20_18  
Coronary thrombolysis with intravenous (IV) streptokinase is widely used as a strategy for coronary reperfusion for acute myocardial infarction (MI). Systemic administration of fibrinolytic agents is associated with hemorrhagic risks such as cerebral hemorrhage, gastrointestinal bleeding, cardiogenic shock, and unusual complications such as splenic rupture, aortic dissection, and cholesterol embolization. Herein, we report a case of intraocular hemorrhage 1 day after the IV administration of streptokinase for acute inferior-wall MI.
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