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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
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.
  26,785 1,391 2
Primary Varicose Veins on the Whole Body, Including Genital Area: A Case Report
Ram Chandra Sherawat, Anil Sharma, Sunil Dixit, Amit Sharan, Sunil Sample
April-June 2015, 3(2):49-51
Primary varicose veins are a common affliction of the extremities, whereas the whole body including the genitals are very rarely affected, for reasons not clearly understood. The literature has little references in regards to the number of cases and management these type varicose veins. Treatment of the upper and lower extremities is the ligation and stripping of the varicose veins but what we can done for chest, abdomen, back, and genital varicose veins, is a query. Here we present a case of a 20-year-old male with this unusual condition of primary varicose veins of the whole body with genitals. Diagnosis in our case was made by means of physical examination and venography. The patient was treated surgically by ligation and stripping of the varicose vein from the upper and lower extremities with excellent functional and cosmetic outcome, but left the chest, abdomen, back, and genital veins for laser or other methods, and the patient was referred to higher center for that treatment.
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Risk factors for acute myocardial infarction in coastal region of india: A case-control study
Vinay Rao, Prasannalakshmi Rao, Nikita Carvalho
July-September 2014, 2(3):70-75
Background: Various studies have shown that people of Indian origin have an increased risk of ischemic heart disease (IHD) compared with most other ethnic groups. This increased risk has been attributed to multiple risk factors related to lifestyle. Patients and Methods: A total of 100 cases and 100 age and sex-matched controls were taken into this prospective case-control study from Intensive Coronary Care Unit. Prevalence of the following risk factors for myocardial infarction: Age, sex, diet, smoking, alcohol consumption, history of hypertension, history of diabetes mellitus, and lipid profile were studied. Patient data were extracted from the medical records department and by interview. Results: The most important predictor of acute myocardial infarction (AMI) was high low-density lipoprotein (adjusted odds ratio [OR]: 4.124, confidence interval [CI]: 1.44-11.73, P = 0.008) history of hypertension and of overt diabetes mellitus were also independent risk factors (OR: 2, CI: 1.4-3 and OR: 2.29, CI: 1.5-3.5), respectively. Low high-density lipoprotein was found to have no significant association with AMI. Heavy drinkers were found to have a high-risk (OR: 68), while moderate drinkers were found to have protection (OR: 1). Conclusion: Smoking and heavy drinking cessation, treatment of hypertension and reduction in blood glucose, correction of abnormal lipid profile either through use of statins or by dietary modification may be important in preventing IHD in Asian Indians.
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Decoding the 2017 hypertension guidelines: The ten commandments
Akshyaya Pradhan, Pravesh Vishwakarma
October-December 2017, 5(4):139-144
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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
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.
  5,467 921 8
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
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.
  5,617 767 5
The Vanishing Right Ventricular Masses
Sudarshan Kumar Vijay, Bhuwan Chandra Tiwari, Mukul Misra, Lalit Mohan Joshi
April-June 2013, 1(1):17-19
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.
  5,356 259 1
Cystic Medial Degeneration Leading to Aortic Aneurysm and Aortic Regurgitation
Pooja Srivastava, Manju Gupta, Ashish Kumar Mandal
October-December 2014, 2(4):107-109
Aortic aneurysm is a rare, but mostly fatal condition; the incidence is 5.9 new aneurysm/100,000 person-years with median age of 65 years for men and 77 years for women. It becomes still rarer when the cause is idiopathic and is associated with aortic regurgitation. Most of these patients present with aortic regurgitation and on investigation aneurysm is detected. Owing to its rarity and disguised presentation it is important to be aware of this entity. This case is being presented not only because of its rarity, but also because of its atypical presentation.
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Pericardial effusion in severe iron deficiency anemia
Manoj Lakhotia, Jagdish Singh, Hansraj Pahadia, Harish Kumar, Sanjeev Sanghvi
July-September 2014, 2(3):88-90
Two female patients presenting with shortness of breath on routine activity, were found to have severe iron deficiency anemia and moderate transudative pericardial effusion. With the correction of iron deficiency anemia, pericardial effusion disappeared in both patients. Moderate pericardial effusion occurring with severe anemia has not been described in the literature.
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Variant anatomy of coronary arteries
Jyoti P Kulkarni
July-September 2013, 1(2):46-51
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.
  4,181 484 1
Contrast induced nephropathy: Pathophysiology and prevention
Sudarshan Kumar Vijay, Bhuwan Chandra Tiwari, Alok Kumar Singh
July-September 2013, 1(2):39-45
The steadily increasing use of contrast media in radiological and interventional cardiac procedures has led to more research and well designed studies of prophylactic strategies for its leading life threatening side effect of contrast induced nephropathy (CIN). CIN adversely affects the prognosis after interventional procedure and poses substantial extra burden on health care costs. The importance of understanding of CIN lies in the fact that no available treatment can reverse or ameliorate it once it develops, but prevention is possible. Herein, we discuss the detailed pathophysiological aspects, risk factors, proposed risk prediction algorithms and various prophylactic strategies for contrast induced nephropathy.
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Managing heart failure in 2013: Changing paradigms
Akshyaya Kumar Pradhan
October-December 2013, 1(3):67-72
Heart failure (HF) imposes huge morbidity and mortality on society. In recent times, HF with preserved ejection fraction (EF) has emerged as the predominant form of HF syndromes. Natriuretic peptides (B-type natriuretic peptide [BNP] and N-terminal [NT] pro BNP) have now emerged as preferred biomarkers for diagnosis and guiding further therapy in HF. Ivabradine and Eplerenone are now approved for HF patients who are symptomatic despite optimal therapy. Tolvaptan has been shown to improve hyopnatremia as well as dyspnea in patients of HF. Coronary bypass grafting has demonstrated a decrease in cardiovascular death and HF hospitalization in patients with of HF with angina. Cardiac resynchronization therapy has now consistently shown to decrease mortality in Mild HF.
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Risk-factor profile for coronary artery disease among young and elderly patients in Andhra Pradesh
Srinivasa Jayachandra, Gopinath Agnihotram, R Prabhakar Rao, CR Vasudev Murthy
January-March 2014, 2(1):11-14
Background: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. The aim of this study was to determine the conventional risk factors of CAD in young and elderly aged patients in Andhra Pradesh. Materials and Methods: Total of 190 CAD patients admitted in ICCU at Santhiram Medical College General Hospital, Nandyal, Andhra pradesh were selected for the study. In this, 90 patients were aged between 18-45 years, and 100 were more than 45 years of age. These patients were evaluated for risk factor contributing to occurrence of CAD. Results: The hypertension (20%), smoking (22%), diabetes mellitus (11%) and dyslipidemia (8%) were the most common risk factors in young patients. Overall risk factors were more likely in males compared to females (18 to <45 years, 79%; ≥65 years, 69.1%). With reference to elderly patients, the diabetes mellitus (21%), hypertension (14%), smoker (17%), kidney disease (11%) and dyslipidemia (9%) were the most common risk factors. Conclusion: Young patients had a different risk-factor profile when compared with older patients. Hypertension and smoking were the most common risk factors in young patients of CAD, whereas diabetes mellitus, kidney disease, and smoking were found in elderly patients.
  3,320 526 -
Spinal Cord Ischemia after Thoracoabdominal Aortic Procedures
Rupesh George
July-September 2015, 3(3):61-65
Overall prevalence of Thoraco abdominal aneurysm has increased due to widespread use of imaging techniques and aging population. Surgical aneurysm repair and endovascular stent graft repair have refined as successful treatment modalities in preventing aneurysm progression and rupture. Since spinal cord depends on branches of thoracoabdominal aorta for blood supply ,spinal cord ischaemia is a dreadful complication of these procedures. However recent animal experiments and surgical series thrown light in tackling this anatomical obstructions by physiologic means. The adoption of techniques for avoiding hypovolumea, hypotension, CSF pressure has reduced this complication rate from 23% to 2-6%.
  3,587 243 -
Renal sympathetic denervation: A promising therapy for resistant hypertension
Deepak Ameta, Akshyaya Kumar Pradhan, Rishi Sethi
January-March 2014, 2(1):3-10
Despite rapid strides in pharmacotherapy for hypertension over last few decades, resistant hypertension continues to be prevalent. Activation of the sympathetic nervous system is an important etiological factor in the pathogenesis of hypertension and renal sympathetic nervous system is one of its pivotal arm. Thus, renal sympathetic system was the target of therapy for hypertension in the initial period, in the form of sympathectomy. The major adverse events associated with this procedure and the emergence of potent blood pressure (BP) lowering medications led to disrepute of this procedure. Of late, novel techniques targeting the sympathetic nervous system have emerged. Among them and the most promising one is catheter-based radiofrequency ablation of renal nerves-Renal sympathetic denervation (RSD). Clinical trials of renal denervation therapy have shown consistent and durable reduction of systolic as well as diastolic BP persisting up to 3 years. Beyond BP control, renal denervation also exerts favorable effects on glucose metabolism, heart failure, and sleep apnea. As many as five different catheter-based renal denervation systems are now approved for treating resistant hypertension, the maximum clinical experience being with Medtronic's symplicity system. The European Society of Cardiology guidelines for hypertension 2013 now recommend catheter-based renal denervation for management of drug-resistant hypertension. In this review, we briefly discuss the role of sympathetic nervous system in the pathogenesis of hypertension, the present status, and future perspectives of RSD in the treatment of resistant hypertension.
  3,403 331 -
Right bundle branch block pattern in right ventricular endocardial pacing: A needless concern?
Mangalachulli Pottammal Ranjith, Kalathingathodika Sajeer, Peringadan Gopalan Nithin, Vellani Haridasan, Gopalan Nair Rajesh, Cicy Bastian, Chakanalil Govindan Sajeev, Mangalath Narayanan Krishnan
July-September 2013, 1(2):57-58
Right ventricular (RV) endocardial pacing in permanent pacemaker implantation usually yields a left bundle branch block (LBBB) pattern in surface electrocardiogram (ECG). The presence of right bundle branch block (RBBB) pattern raises the suspicion of lead perforation. We report a case of RV endocardial permanent pacemaker implantation showing a RBBB pattern in ECG, suggesting a complication. However, further work-up revealed that the lead was appropriately located at the RV apex.
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Clinical profile, risk factors and short term outcome of acute myocardial infraction in females: A hospital based study
Manish Sahni, Rajesh Kumar, Surinder Thakur, Rajeev Bhardwaj
October-December 2013, 1(3):73-77
Introduction: Coronary heart Disease (CHD) though primarily considered to be man's disease, it is also a leading cause of mortality and morbidity in middle aged women throughout world. Coronary manifestations occurs approximately 20 years later in women as compared to men and may have atypical presentations. The poor prognosis in women due CHD has been attributed to advanced age , concomitant medical illnesses, late presentation because of atypical presentations, ignorance of seriousness of the disease and delayed treatment. Materials and Methods: 80 consecutive female patients admitted in the department of Medicine and cardiology of Indira Gandhi Medical college Shimla from 1 st June 2008 to 31 st May 2009 were included in the study informed consent , demographic profile and risk factors were recorded. After focused clinical examination biochemical investigations such as RBS, Hb A1C, Lipid profile, 12 lead electrocardiogram and echocardiography etc. was done. Results: total 80 patients included in the study had mean age of 62.7 ± 13.6 years. The majority of females between the of age 61-70 years constituted 50% 0f study population. Dyslipidemia was the commonest risk factor followed by obesity, smoking ,hypertension and diabetes. Chest pain was the common presenting feature with atypical pain chest in 25% of females. Conclusion: CHD is a under diagnosed undertreated and under researched disease in women for various reasons and it is more age dependent in women than in men. The primary care physicians, paramedics posted in peripheral institutes' should be appraised about the clinical profile ,risk factors of CHD in females so that effective therapy can be instituted in time to decrease subsequent morbidity and mortality.
  3,090 405 -
Coronary artery disease in young adults: Angiographic study-A single-center experience
G Suresh, K Subramanyam, Srinivasa Kudva, Rama Prakasha Saya
October-December 2016, 4(4):132-135
Background and Objectives: Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. There are fewer data regarding myocardial infarction in young adults, with varying risk factors and patterns of coronary involvement. This study was done to present the coronary angiographic characteristics of CAD in young patients aged <40 years. Materials and Methods: In this cross-sectional record-based study, patients aged <40 years who were evaluated angiographically for chronic stable angina or acute coronary syndrome were included. Single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD) were noted down. Onset of CAD before 40 years of age was considered as PCAD. Results: A total of 4526 cases underwent coronary angiogram between January 2008 and December 2014; 154 (3.40%) were <40 years of age with a mean (standard deviation) age of 36.51 (±3.654) years. In <40 years age group, nearly third-fourth of the cases (112, 72.73%) had critical CAD; among them, 98 (87.5%) were male and 14 (12.5%) were female. About two-third of the cases (74, 66.07%) had SVD, followed by DVD (25, 22.32%) and TVD (13, 11.61%). Conclusions: Incidence of critical CAD in young adults is quite high. Young patients with CAD are mainly males, and SVD is more common. Emphasis should be given on diagnosis and management of risk factors in this vulnerable group.
  2,985 295 -
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
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.
  2,807 309 -
A Case Report of Reversible Dilated Cardiomyopathy
Abhishek Singhai
April-June 2014, 2(2):52-53
Dilated cardiomyopathy (DCM) is mostly an idiopathic disease with a progressive and irreversible course. It carries poor prognosis and outcome. Rarely, a reversible metabolic etiology that is amenable to specific therapy is identified. Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is sensitive to thyroid hormone changes, and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. DCM is a rare presentation of hypothyroidism. Here, we report a case of 40-year-old female diagnosed with DCM due to hypothyroidism
  2,668 272 -
Life-threatening Hyperkalemia: Can Aggressive Medical Therapy Defer Temporary Pacing
Sudhanshu Kumar Dwivedi, Pankaj Kumar, Gaurav Chaudhary, Ram Kirti Saran, Sharad Chandra
April-June 2014, 2(2):59-61
Hyperkalemia is a life-threatening metabolic condition that can induce deadly cardiac arrhythmias. Here, we present a case of severe life-threatening hyperkalemia in a 35-year-old man with preexisting renal impairment who was managed only medically with close electrocardiogram and vital monitoring.
  2,625 226 -
Dilated cardiomyopathy presenting like superior vena cava syndrome
Sumantro Mondal, Tony Ete, Debanjali Sinha, Arijit Nag, Atanu Chakraborty, Jyotirmoy Pal, Alakendu Ghosh
January-March 2014, 2(1):26-28
Dilated cardiomyopathy (DCM) commonly presents with exertional dyspnea, fatigue, dependent edema and ascites. Jugular venous distension with prominent positive waves, S3 gallop, and regurgitant murmur are usual signs of DCM. There is one reported case of DCM presented with superior vena cava (SVC) thrombosis. Our patient presented with classical clinical features of SVC syndrome, later on confirmed as having DCM and there was no evidence of structural SVC obstruction.
  2,593 225 -
Changes in heart rate variability following yogic visual concentration (Trataka)
BR Raghavendra, V Ramamurthy
January-March 2014, 2(1):15-18
Background: The yogic visual concentration technique, trataka is similar to meditation. Research studies have shown a shift toward the vagal tone during meditation. However, autonomic changes in trataka were not studied. Objectives: The present study was planned to assess the changes in heart rate variability (HRV) following trataka. Materials and Methods: HRV and breath rate were assessed in thirty healthy male volunteers with ages ranging from 20 to 33 years (group mean age ± SD, 23.8 ± 3.5) before and after yogic visual concentration (trataka) and control session on 2 separate days. Repeated measures analysis of variance (ANOVA) were performed with two "within subjects" factors, i.e., Factor 1: Sessions; trataka and control and Factor 2: States; "Pre", and "Post". This was followed by post-hoc analyses with Bonferroni adjustment comparing "Post" with "Pre" values. Results: There was a significant decrease in LF (RM ANOVA with Bonferroni adjustment P < 0.01) and increase in high frequency (P < 0.01) after trataka. Breath rate (P < 0.001) and heart rate (P < 0.01) were significantly reduced after trataka compared to before. Control session showed no change. Conclusions: The practice of trataka leads to increased vagal tone and reduced sympathetic arousal. Though trataka is known as cleansing technique, it could induce calm state of mind which is similar to a mental state reached by the practice of meditation.
  2,493 312 -
Obstructive Sleep Apnea in Patients with Myocardial Infarction: Experience from a Tertiary Care Hospital in South India
Uma Devaraj, Priya Ramachandran, George A D'souza
April-June 2013, 1(1):12-16
Aims and Objective: The aim of this study was to describe the occurrence of sleep disordered breathing/obstructive sleep apnea (OSA) in patients admitted with acute myocardial infarction (MI) in a tertiary care hospital. Materials and Methods: All consecutive patients with a recent MI, presenting to the hospital for a period of over 1 year, were administered with a well-designed questionnaire and subjected to polysomnography (PSG) after obtaining a written informed consent. Results: A total of 55 patients were screened with the questionnaire and 44 patients were subjected to PSG. Of the 55 patients 42 (76.4%) were snorers and 14 (25.5%) were insomniacs. OSA was diagnosed in 12 (28.6%) of the 44 patients. There was no significant difference in the presence of hypertension, diabetes mellitus or hypercholesterolemia among the patients diagnosed with OSA and those without OSA. Conclusions: There is a high prevalence of previously undiagnosed OSA in patients admitted to the hospital with acute MI as compared to the general population. OSA is under-recognized in India. Early recognition of undiagnosed OSA in this population of patients with coronary artery disease (CAD), and treatment of the same would help in reducing cardiovascular morbidity and mortality. This study reinforces the need for the routine screening of MI/CAD patients for the presence of OSA.
  2,482 297 -
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
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.
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