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ORIGINAL ARTICLES
Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population
Rajni Sharma, Shivkumar Bhairappa, SR Prasad, Cholenahally Nanjappa Manjunath
July-September 2014, 2(3):65-69
DOI:10.4103/2321-449x.140228  
Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5%) and rest were females. Most patients had ST elevation myocardial infarction (STEMI) 995 (63.7%) followed by unstable angina (UA) 390 (25%) and non-STEMI (NSTEMI) 177 (11.3%). Risk factors; smoking was present in 770 (49.3%), hypertension in 628 (40.2%), diabetes in 578 (37%), and obesity in (29.64%) patients. Angiography was done in 1443 (92.38%) patients. left anterior descending was most commonly involved, left main (LM) coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28%) UA, 94 (56.29%) NSTEMI and 468 (51.71%) STEMI patients. Double-vessel disease was present in 67 (18.08%) UA, 25 (14.97%) NSTEMI and 172 (19.01%) STEMI patients. Triple vessel disease was present in 28 (7.55%) UA, 16 (9.58%) NSTEMI, 72 (7.95%) STEMI patients. LM disease was present in 12 (3.23%) UA, 2 (1.19%) NSTEMI and 9 (0.99%) STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%), free wall rupture in 2 (0.1%), cardiogenic shock in 45 (2.9%), severe mitral regurgitation in 3 (0.2%), complete heart block in 11 (0.7%) patients. Total 124 (7.9%) patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent risk factor. Diabetic patients had more of multivessel disease. Complications and in hospital mortality was higher in females and elderly population.
  12 5,994 1,009
Prevalence and spectrum of congenital heart diseases in children
Khurshid Ahmed Wanni, Naveed Shahzad, Mohd Ashraf, Kaisar Ahmed, Muzafer Jan, Shafaqat Rasool
July-September 2014, 2(3):76-79
DOI:10.4103/2321-449x.140230  
Background: Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. Objective: To find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (J&K). Materials and Methods: A retrospective analysis of case-records data of 767,921 patients (0-18 years) over 3 years and 10 months period was conducted to ascertain the prevalence and spectrum of CHDs. Results: A total of 877 patients out of 767,921, were found having CHDs measuring a prevalence of 1.12/1000. About 777 (88.5%) were the acyanotics, and 100 (11.5%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 241 (31.2%), followed by patent ductus arteriosus in 184 (24.3%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 48 (48.0%) patients. Conclusion: Prevalence of 1.12/1000 among the hospital attending patients could be an underestimation of the actual disease burden in our community, and heightened awareness among the treating physicians about the cardiac diseases could actually reduce the mortality and morbidity associated with these ailments.
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Risk Factors for Coronary Artery Diseases: A Study Among Patients With Ischemic Heart Disease in Kerala
Cyril James
April-June 2013, 1(1):7-11
DOI:10.4103/2321-449x.113603  
Objective : The objective of this study was to analyses the major risk factors for coronary artery disease (CAD) for patients with ischemic heart disease in Kerala. Design : A cross-sectional study among patients with established CAD admitted in the Department of Cardiology during the month of June-Dec 2012. Setting : Study was carried out in a tertiary cardiac center in Kerala. Participants: A total of 496 patients who were admitted in the Cardiology department between June 2012 and December 2012 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease. Risk factors studied were the conventional risk factors for coronary artery disease - hypertension, diabetes mellitus, dyslipidemia, body mass index (BMI), smoking, and family history of coronary artery disease. Data are collected from the patients, old medical records, Clinical Examination and Laboratory results of the patients were analyzed for the study. Results: From the study, it was seen that in Keralites-irrespective of gender, diabetes or impaired glucose tolerance (79%) and dyslipidemia (71%) are the major risk factor for Coronary artery disease. Hypertension (39%) and cigarette smoking (24%) were not seen to be a major risk factors for coronary artery disease as only a minority of the study population had hypertension or gives a history of cigarette smoking. 57% of the study population had a family history of coronary artery disease. Among the studied population, 55% of females are with increased BMI, whereas only 16% of males with CAD were with BMI above 30. Conclusion: Among South Indian population irrespective of gender, diabetes mellitus and dyslipidemia are the major Risk factor for Coronary artery disease. So early detection of diabetes mellitus and dyslipidemia and proper treatment of both, before developing the end organ damage, play a vital role for the prevention of coronary artery disease.
  2 27,530 1,491
CASE REPORT
The Vanishing Right Ventricular Masses
Sudarshan Kumar Vijay, Bhuwan Chandra Tiwari, Mukul Misra, Lalit Mohan Joshi
April-June 2013, 1(1):17-19
DOI:10.4103/2321-449x.113598  
The mural endocarditis is a rare cause of intracardiac masses, which is difficult to diagnose and usually requires surgery to prevent embolization and intracardiac complications. We herein present an unusual case of right ventricular mural endocarditis in a patient with rheumatic heart disease, in which presence of multiple mural vegetations was visualized on two-dimensional transthoracic echocardiography and better delineated with three-dimensional echocardiography. There was complete resolution of vegetations with antibiotic therapy.
  1 5,581 288
CASE REPORTS
Scrub typhus causing myocarditis and ARDS: A case report
Sai Lakshmikanth Bharathi, S Jayachandran, N Senthil, S Sujatha
October-December 2013, 1(3):85-86
DOI:10.4103/2321-449x.122785  
Scrub typhus, caused by Orientia tsutsugamushi, is endemic in the so-called "tsutsugamushi triangle". There is a wide spectrum of presentation of the disease ranging from uncomplicated febrile illness to life-threatening sepsis with multiorgan dysfunction. We are presenting a case of scrub typhus causing myocarditis and acute respiratory distress syndrome (ARDS) in an adult female with no previous comorbid illness who recovered fully with prompt treatment in spite of prolonged ventilator support, emphasizng the need for early diagnosis and prompt treatment with antirickettsial antibiotics in a patient presenting with features of scrub typhus.
  1 3,291 357
LETTER TO EDITOR
Complete Occlusion of Subclavian Venous Access: An Unexpected Troubleshoot During Permanent Pacemaker Pulse-Generator Replacement
Arindam Pande, Achyut Sarkar, Imran Ahmed, Naveen GS Chandra
April-June 2015, 3(2):56-57
DOI:10.4103/2321-449X.158883  
  1 1,375 158
ORIGINAL ARTICLES
Ten Years Risk Prediction of a Major Cardiovascular Event in a Rural Block in Tamil Nadu
Logaraj Muthunarayanan, John Kamala Russel, Shailendra Kumar Hegde, Balaji Ramraj
April-June 2015, 3(2):43-48
DOI:10.4103/2321-449X.158878  
Background: India has a high burden of cardiovascular diseases (CVDs). High-risk interventions can be initiated only when individuals at high-risk have been identified. Objectives: The objective was to estimate the prevalence and the sociodemographic pattern of cardiovascular risk factors and to predict the 10 years risk of fatal and nonfatal major cardiovascular events in a rural population in Tamil Nadu. Materials and Methods: A cross-sectional study was conducted among 30 villages of a rural block in Tamil Nadu from March 2012 to February 2013 in the age group of 40-79 years attending our fixed mobile clinics using structured interview schedule and subsequently, the World Health Organization/International Society of Hypertension (WHO/ISH) risk charts were used to predict the 10 years absolute risk of fatal or nonfatal cardiovascular event. Results: A total of 482 individuals were studied of which 68.3% were women and 31.7% were men. Prevalence of overweight, diabetes, and systolic hypertension was found to be 60%, 22.8%, and 34.6%, respectively. A majority (79.9%) of the study population had 10 years cardiovascular risk of <10% while only 2.5% had a risk of more than 40%. As the age advances, the proportion of participants with high-risk also increased and this trend was statistically significant (P = 0.001). Conclusion: Less than 10% of the population had a high-risk of CVD based on WHO/ISH risk score. These charts help identify the high-risk groups in the population in resource-scarce setting and thus an appropriate action can be taken.
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Electrocardiographic Pattern of Apparently Healthy Primary School Children Aged 5-15 Years, in Kano
Ibrahim Aliyu, Mu'uta Ibrahim
January-March 2015, 3(1):12-17
DOI:10.4103/2321-449X.153280  
Background: Electrocardiography (ECG) is a simple, noninvasive, and relatively cheap investigative tool used for cardiac evaluation. However, there are limited electrocardiographic studies of Nigerian children. Adult studies of ECG have shown significant differences between Black and Caucasian populations. These differences may also be seen in children, hence, the need to develop local reference values. Materials and Methods: This was a cross-sectional study and multistage random sampling method was applied to select 650 subjects. The ECG machine was a portable heated stylus direct writing AT-2 Swiss made electrocardiograph (Schiller AG Cardiovit CH6341). Results: There were 350 males (53.3%) and 300 females (46.7 %), with a male:female ratio of 1.2:1. The mean heart rate decreased with increasing age. R-wave amplitudes were higher in the left precordial leads, in keeping with left ventricular dominance. Mean values were higher in boys than girls in the three age-groups in most of the precordial and limb leads. In V 4 R, V 2 , and V 3 highest mean R wave voltages of 0.5 ± 0.1, 1.4 ± 0.3, and 1.4 ± 0.2 mV, respectively, were recorded in the 5-7-year-old. While in V 5 and V 6 , the mean R waves were higher in the 12-15-year-old age group (3.7± 0.5 and 2.5±0.4 mV, respectively). The S-waves showed progressive decrease in its amplitude on the left precordial leads with increasing age. Conclusion: The mean values in heart rate, QRS duration, PR interval, and P-wave amplitude showed higher amplitudes in boys. Similarly higher amplitudes of R-waves in boys were recorded in precordial leads V 2 , V 3 , V 5 , and V 6 in the three age groups.
  1 3,053 292
Variant anatomy of coronary arteries
Jyoti P Kulkarni
July-September 2013, 1(2):46-51
DOI:10.4103/2321-449x.118582  
Introduction: Wide variations exist in the size, position, and shape of various body organs, finger prints, and proteins in different individuals. Some variations are of considerable clinical importance, such as the coronary arteries. Variations of coronary arteries can cause important clinical manifestation, including sudden death of the individual. Materials and Methods: Coronary arteries were dissected in 10% formalin-fixed cadaveric hearts. The normal and variant anatomy of coronary arteries was studied. Result: In 100% of cases, the right coronary artery (RCA) and main left coronary artery (LCA) were found to arise from anterior aortic sinus and left posterior aortic sinus, respectively. In 8% of cases, the conus was found to have independent origin from the anterior aortic sinus. The RCA was found to be dominant in 90% of cases. In 66.7% of cases, the length of RCA ranged from 4.5 cm to 7 cm. The average length of LCA was found to be 7 mm. In 10% of cases, the circumflex coronary artery was found to be dominant, where the length of the artery ranged 9-11 cm. In 10% of cases, LCA trifurcated, where the obtuse marginal branch was replaced by the ramus intermedius branch. Also, 43.3% of LAD showed myocardial bridging predominantly in the middle 1/3 rd segment, and 6.7% of cases of RCA showed myocardial looping. Discussion: Coronary arteries show immense variation in their origin, termination, branching pattern, myocardial bridging, looping, and dominance pattern. This knowledge is clinically and surgically important to manage coronary artery diseases.
  1 4,672 537
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
Jaywant M Nawale, Ajay S Chaurasia, Digvijay Deeliprao Nalawade, Piyush Choudalwar, Nikhil Borikar, Dhirendra Tiwari
October-December 2018, 6(4):133-140
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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Utilization of who-ish 10-year cvd risk prediction chart as a screening tool among supporting staff of a tertiary care hospital, Mysuru, India
BB Savitharani, B Madhu, M Renuka, Sridevi , NC Ashok
January-March 2016, 4(1):13-16
DOI:10.4103/2321-449X.178119  
Background: Noncommunicable diseases are increasing and constitute a serious concern, accounting for 52% of the deaths and 38% of the disease burden in the World Health Organization (WHO) South-East Asia Region. Eighty percent of total deaths due to noncommunicable diseases occur in the low-income countries. Lifestyle changes are resulting in an increased risk of cardiovascular diseases (CVD). Surveillance of CVD risk factors is a key to reduce the burden of CVD. WHO–International Society of Hypertension (ISH) 10-year risk prediction charts have been developed for the screening of CVD risk factors in different regions. The National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) has also recommended the utilization of these charts for routine screening. The present study has used the WHO-ISH CVD risk prediction chart to assess the feasibility of utilization of this chart as a predicting tool of a CVD event. Materials and Methods: A cross-sectional survey was conducted among supporting staff of JSS Hospital, Mysuru, Karnataka, India to assess the CVD risk factors and risk factor profiling, and the prediction of 10-year risk for CVD was done using a WHO-ISH risk prediction chart. Results: A total of 900 supporting staff were screened for CVD risks. Out of them, 30 (3.3%) had hypertension, 20 (2.2%) had diabetes mellitus, 18 (1.99%) consumed tobacco. The proportion of newly detected diabetes cases was 8 (0.9%) and of prediabetics was 32 (3.7%). The proportion of newly detected prehypertensives were 292 (39.08%), and 27 (3.61%) were hypertensives. Out of 175 individuals aged above 40 years, the WHO-ISH risk prediction chart predicted that 1.7% of them had >10% risk of CVD event within 10 years. Conclusion: Hidden, asymptomatic individual of diabetes, and hypertension were identified; the WHO-ISH 10 year risk prediction chart was easier for assessing the CVD risk factors and risk grouping, and could also be used to show them the extent of risk and predicting their 10-year risk of stroke or myocardial infarction (MI).
  1 2,756 299
REVIEW ARTICLE
Functional Angioplasty
Rohit Tewari
April-June 2013, 1(1):3-6
DOI:10.4103/2321-449x.113601  
Coronary angiography underestimates or overestimates lesion severity, but still remains the cornerstone in the decision making for revascularization for an overwhelming majority of interventional cardiologists. Guidelines recommend and endorse non invasive functional evaluation ought to precede revascularization. In real world practice, this is adopted in less than 50% of patients who go on to have some form of revascularization. Fractional flow reserve (FFR) is the ratio of maximal blood flow in a stenotic coronary relative to maximal flow in the same vessel, were it normal. Being independent of changes in heart rate, BP or prior infarction; and take into account the contribution of collateral blood flow. It is a majorly specific index with a reasonably high sensitivity (88%), specificity (100%), positive predictive value (100%), and overall accuracy (93%). Whilst FFR provides objective determination of ischemia and helps select appropriate candidates for revascularization (for both CABG and PCI) in to cath lab itself before intervention, whereas intravascular ultrasound/optical coherence tomography guidance in PCI can secure the procedure by optimizing stent expansion. Functional angioplasty simply is incorporating both intravascular ultrasound and FFR into our daily Intervention practices.
  1 2,443 290
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