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| EDITORIAL |
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| Year : 2015 | Volume
: 3
| Issue : 1 | Page : 1-2 |
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Preface to first issue of heart India 2015
Alok Kumar Singh
Department of Cardiology, Heritage Hospital, Varanasi, Uttar Pradesh, India
| Date of Web Publication | 14-Mar-2015 |
Correspondence Address:
Alok Kumar Singh
Department of Cardiology, Heritage Hospital, Varanasi - 221 005, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-449X.153277
How to cite this article:
Singh AK. Preface to first issue of heart India 2015. Heart India 2015;3:1-2 |
"Heart India" is celebrating its continuous publication in its third successive calendar year, for which I would like to thank our esteemed editorial board members, reviewers, and authors who contribute to "Heart India" in a selfless manner. In its 2 years' journey, a total of 156 authors and 29 reviewers registered for "Heart India" and in my opinion this is encouraging for a new superspecialty journal. In this issue of "Heart India" we have published one review article, two original research articles, and four interesting case reports.
The advent of transcatheter aortic valve implantation (TAVI) has allowed many patients with severe aortic valve stenosis who were previously deemed too high-risk or inoperable, to be effectively treated. Dr. Alain Cribier described the first percutaneous aortic valve implantation in a human using an antegrade approach.[1] This technique was feasible, but it was technically demanding and difficult to reproduce. The retrograde technique was subsequently devised by Webb et al. and is now the dominant method of delivering the aortic valve to the native aortic valve leaflets.[2] However, patients who had small femoral arteries or significantly obstructive atherosclerotic disease could not be treated through the femoral route. Dr. Edgar in the first review article has explained TAVI in an exhaustive yet simple manner.
An association between cardiac autonomic neuropathy and QT interval prolongation was demonstrated in many studies, and it may predispose an individual with diabetes mellitus to sudden death; it has been very systematically studied by Pillai and Madhavan in the first, original research article. Fifty patients with type 2 diabetes mellitus of more than 5 years' duration and 30 age-and sex-matched controls without any history of diabetes were selected. A battery of five autonomic function tests was done in all cases. Heart rate, corrected QT (QTc) values, and QTc dispersion were measured and compared among patients with and without autonomic neuropathy and controls. Among the 50 patients in the study population, 21 (42%) had severe autonomic neuropathy and 12 (24%) had early autonomic neuropathy. Mean heart rate was significantly higher in patients with autonomic neuropathy than in those without neuropathy. Diabetics with autonomic neuropathy had significantly higher QTc mean and QTc max values compared to diabetics without autonomic neuropathy and controls. QTc dispersion was significantly higher among patients with autonomic neuropathy than in those without autonomic neuropathy and controls. The authors of this study have concluded that diabetic autonomic neuropathy is associated with increase in resting heart rate and prolongation of QTc intervals. QTc max correlated with severity of autonomic neuropathy. QTc dispersion is significantly high in diabetes mellitus with autonomic neuropathy.
Electrocardiography (ECG) is a simple, noninvasive investigative tool used for cardiac evaluation. 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. This was a cross-sectional study, and a multistage random sampling method was used to select 650 subjects. 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 V4R, V2, and V3, the highest mean R-wave voltages of 0.5 ± 0.1 mV, 1.4 ± 0.3 mV, and 1.4 ± 0.2 mV, respectively, were recorded in the 5-7-year-old age group, while in V5 and V6, the mean R-waves were highest, 3.7 ± 0.5 mV and 2.5 ± 0.4 mV, respectively, in the 12-15-year-old age group. The S-waves showed progressive decrease in amplitude on the left precordial leads with increasing age. This is a very important step in the development of an indigenous database for the native population of Nigeria, by Aliyu et al.
Acute myocardial infarction (AMI) is a rare complication of snakebite with few reported cases in the literature. Chakrabarti reports a case of a 32-year-old male who developed an anterior wall AMI several hours after a Russell's viper bite. The diagnosis of myocardial infarction was confirmed by a characteristic retrosternal chest pain, typical electrocardiographic changes, and elevated troponin I levels. The patient had no risk factors for coronary artery disease, and the coronary arteries were normal on cardiac catheterization. The importance of the case report is that it highlights the fact that physicians, especially from developing countries like India, should be aware of this potentially life-threatening complication of viper snakebite and take immediate steps for its recognition and management. Acute pulmonary embolism with floating right intra-ventricular thrombus is a rare phenomenon associated with poor prognosis. Here, in the second case report of this issue, Singhal et al. present a case of a 35-year-young male with no comorbid illness, diagnosed to have right ventricular thrombus with bilateral pulmonary embolism, which was managed successfully with thrombolytic therapy.
Ventricular septal defect (VSD) is a rare but serious complication of AMI requiring early surgical intervention. Singh et al. report a case of a 75-year-old man who had a silent myocardial infarction followed by an asymptomatic ventricular septal rupture, both of which remained undiagnosed until the patient experienced biventricular failure. Asymptomatic myocardial infarction in the elderly may be a risk factor for acquired VSD. Two-dimensional echocardiography is a sensitive, rapid, reliable, and safe technique for diagnosing VSD post myocardial infarction, so it should be a routine investigation for any patient presenting with sudden onset breathlessness. Intracardiac tumors are rare and may be primary or of secondary metastasis; among primary tumors are atrial myxomas, which are most common in the left atrium, affect females more, and are seen more among teenagers in the pediatric population. It has varied clinical presentation, and asymptomatic cases have been reported. However, the case of a 2-year-old female with right atrial involvement who presented with overt signs of severe malnutrition, quite rare to see in practice, is reported by Aliyu et al. from Nigeria.
| References | |  |
| 1. | Andersen HR, Knudsen LL, Hasenkam JM. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur Heart J 1992;13:704-8.  |
| 2. | Webb JG, Chandavimol M, Thompson CR, Ricci DR, Carere RG, Munt BI, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 2006;113:842-50 |
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