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.

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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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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.

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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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Context: An association between cardiac autonomic neuropathy and QT interval prolongation was demonstrated in many studies and it may predispose to sudden death in diabetes mellitus. Aims: To find out the prevalence of cardiac autonomic neuropathy and its relation to QTc interval and QTc dispersion in type 2 diabetes. Settings and Design: Observational study. Materials and Methods: 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, QTc values, and QTc dispersion were measured and compared among patients with and without autonomic neuropathy and controls. Statistical analysis used: Students t test/Chi-square test. Results: 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 more in patients with autonomic neuropathy than 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 more among patients with autonomic neuropathy compared to those without autonomic neuropathy and controls. Conclusions: Diabetic autonomic neuropathy is associated with increase in resting heart rate and prolongation of QTc intervals. QTc max was correlating with severity of autonomic neuropathy. QTc dispersion is significantly high in diabetes mellitus with autonomic neuropathy.

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Background and Objective: Hypertension is an important public health problem in both economically developing and developed countries. In India, recent community surveys have reported that the prevalence of hypertension has risen among urban and rural inhabitants. This study was conducted to find out the prevalence of hypertension and to identify the risk factors among adults residing in urban areas of Lucknow. Materials and Methods: The cross-sectional field study involved a survey of 300 respondents, aged 18 years and above using the stratified random sampling and probability proportionate to size technique. A study tool which contained risk factor questionnaire and physical measurements of height, weight, and blood pressure were used to collect the data. Data analysis was performed using the SPSS version 16. The Chi-squared test and logistic regression analysis were used to analyze the data. Results: The prevalence of hypertension was 14.67% among urban adults. Hypertension was significantly higher among individuals aged >40 years and those who consumed tobacco products. A higher proportion of the hypertensives belonged to the illiterate category. There was a significant difference in hypertension prevalence in different education classes. Respondents living in overcrowded houses had higher odds of having hypertension than those not experiencing overcrowding. Conclusion: Age, education, and overcrowding were independent risk factors of hypertension. Prevention measures targeting the modifiable risk factors associated with hypertension should be taken.

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Objective: To discuss the management in a subset of patients with severe mitral valve disease having calcified, nonpliable valves not suitable for percutaneous balloon mitral valvuloplasty during pregnancy, presenting with Stage III–IV of the clinical classification of New York Heart Association. Methods: Patients with nonpliable valves presenting with heart failure in pregnancy at advanced gestation were planned for simultaneous cesarean section followed by mitral valve replacement. Results: All patients underwent successful surgery with good maternal and neonatal outcome. Conclusion: Patients with severe mitral valvular disease in failure in pregnancy, who are at high risk of mortality in pregnancy or during and following delivery, benefit from combined surgery.

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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.

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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.

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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).

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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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Coronary artery disease (CAD) is a huge global burden and is a leading cause of morbidity and mortality across the world. We have done this review to elucidate the pathogenesis of herpesviruses in causing CAD and to study an association between herpesviruses (cytomegalovirus [CMV] and herpes simplex virus [HSV-1 and -2]) and CAD. CMV can cause atherosclerosis directly through the activity of its gene products on endothelial cells, monocytes/macrophages, and smooth muscle cells and indirectly through production of pro-inflammatory cytokines at far off place. HSV infection causes atherosclerosis mainly by causing increased prothrombotic activity on endothelial cells, accumulation of cholesterol esters and triacylglycerols in vascular smooth muscle cells, and upregulating expression of Lectin like oxidized Low density lipoprotein receptor-1 (LOX-1) receptor on macrophages. The association between CMV and CAD is related to its seroprevalence with a positive association in developing countries (higher seroprevalence) and no significant association in developed countries (lower seroprevalence). However, the association between HSV infection and atherosclerosis is not related to its seroprevalence.

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Pulmonary embolism (PE) is the most preventable cause of inhospital death. Although safe and effective, thrombolytic therapy is relatively contraindicated within 10 days of major surgery due to the risk of bleeding. Our patient developed submassive PE, within 48 h of surgery and had catheter-directed thrombolysis with Streptokinase (STK) injection successfully, without any bleeding complications. This case demonstrates that thrombolysis may be safely and effectively done in postoperative patients. In such scenarios, where the therapy is relatively contraindicated, the decision whether to thrombolyse or not, must be multidisciplinary, giving utmost importance to the patient's best interest and to ensure that no single individual is denied potentially life-saving therapy.

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Cardiac mass is always challenging, specially in the right side of the heart that should raise suspicion of a malignancy. A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. Transthoracic echocardiography revealed a large homogeneous mass in the RV apex which disappeared one week after intravenous heparin therapy. A trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility.

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Rasopathy syndromes are a class of phenotypically similar, but genetically distinct multiple anomaly syndromes caused by germ line mutations in genes that encode protein components of the Ras/mitogen activated protein kinase (MAPK) pathway. Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome are part of this group of developmental syndromes and have similar cardiac abnormalities. A 19-year-old male presented with complaints of exertional breathlessness class I for 6 months. Clinical examination revealed characteristic facial features, skeletal abnormalities, growth and neurocognitive problems reported in patients with Noonan syndrome. There was evidence of severe pulmonary hypertension. Trans-thoracic echocardiography revealed right atrial and right ventricular enlargement, severe pulmonary hypertension, no intra cardiac shunt, prolapse of anterior mitral leaflet with mild mitral regurgitation. CT pulmonary angiogram revealed bilateral branch pulmonary artery stenosis. A final diagnosis of Noonan syndrome was made.

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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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Background: Cardiovascular changes and hence electrocardiographic changes do occur as duration of pregnancy proceeds. There is not much data available on particularly QT interval and corrected QT interval (QTc) in different phases of pregnancy. Pregnancy can precipitate cardiac arrhythmias in later phases in apparently healthy women due to changes in the electric activity of the heart and prolonged QTc is one of the causes. Since prolonged QT interval can precipitate arrhythmias, we thought it is essential to find baseline value for QT interval and QTc in different phases of pregnancy to detect pregnant women at risk. Aims: Our aim of the study was to record QTc in pregnant females during different phases to establish fact that QTc can be correlated with duration of pregnancy. Materials and Methods: Cross-sectional study, 202 pregnant individuals were selected from the antenatal clinic with different phases of pregnancy. All were subjected for electrocardiogram (ECG). QTc was calculated using Bazett's formula and QT intervals were correlated with duration of pregnancy. Results: There was significant gradual increase in QTc with duration of pregnancy. There was significant positive correlation between duration of gestation and QTc (r = 0.277) (P < 0.001). Conclusion: QTc prolongation occurs as pregnancy proceeds.

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Introduction: Thalassemia is the most common genetic disorder worldwide. Regular transfusion therapy, while improving patient quality of life, creates a state of iron overload. Once reticuloendothelial stores saturate, iron deposition increases in parenchymal tissues such as endocrine glands, hepatocytes, and myocardium. Cardiac iron deposition produces arrhythmias, systolic and diastolic dysfunction, and congestive heart failure in the second or third life decade. Aims and Objective: The present study was planned to find the prevalence of thalassemia cardiomyopathy and to study the spectrum of cardiac disease in thalassemia patients. Methods: All consecutive patients of thalassemia more than 12-year-old were included in this study. Screening included medical history assessment, focusing on cardiovascular symptomatology, transfusion and chelation history, physical examination, and transthoracic resting echocardiography. Clinical parameters included age, sex, address, height weight, body mass index (BMI), systolic blood pressure (BP), diastolic BP, mean hemoglobin, and mean serum ferritin. Results: A total of 56 patients of thalassemia were included in the study. Fifty-one patients were of thalassemia major and 5 patients were of thalassemia intermedia. Mean age of patients included in our study was 15.9 ± 4.6 years. Mean duration of thalassemia in our patients was 12.9 ± 3.05 years. Mean hemoglobin of the patients included in our study was 8.7 ± 1.1 g%. The level of mean serum ferritin in our patients was 666.69 ± 325.46 ng/ml. In our study, we had 8 (14.2%) patients out of 56 having systolic dysfunction. Furthermore, our patients with left ventricular systolic dysfunction had younger mean age as compared to those patients who had a normal left ventricular function. We also found a higher ferritin value in patients with left ventricular dysfunction as compared to patients with normal left ventricular dysfunction studies. Conclusion: In our study, we found out that patients with left ventricular dysfunction had a younger age of onset of disease, higher ferritin levels, lower blood pressure, and paradoxically higher BMI as compared to patients with normal left ventricular dysfunction.

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Context: Cirrhosis is the leading cause for hepatic transplantation worldwide. Heart is one of the most adversely affected organs in cirrhosis and it increases morbidity and mortality in these patients. Aims: The objective of this study is to identify the echocardiographic abnormalities in patients with cirrhosis and their relation to severity of cirrhosis. Subjects and Methods: An observational study was done on patients with cirrhosis (n = 55) and age- and sex-matched controls (n = 30). Detailed echocardiographic examination including 2D, M-mode, pulsed-wave Doppler, tissue Doppler, and 2D speckle-tracking imaging was performed. Severity of cirrhosis was defined by model for end-stage liver disease (MELD) score. Comparison of various echo parameters among cases and controls and among the two groups with MELD score >12 and <12 was made. Results: The major echocardiographic abnormalities noticed were left ventricular hypertrophy in 47.3%, diastolic dysfunction in 40%, pulmonary artery hypertension in 32.7%, and pericardial effusion in 3.6% of patients. Among the various echocardiographic parameters, mitral annular velocity, deceleration time, isovolumetric relaxation time (IVRT), Sm velocity, e' velocity, E/e' ratio, and average global longitudinal strain (GLS) were significantly different in cirrhosis patients compared to the control population. Mitral annular a velocity and IVRT were significantly more in cirrhotic patients with MELD score >12. Conclusions: Cirrhosis is associated with increased LV mass and cardiac output. Diastolic dysfunction was present in 40% of patients. Although systolic function by ejection fraction was normal in cirrhotic patients, GLS was less compared to controls.

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Introduction: Cardiac disorders complicate approximately 1%–3% of pregnancies and present a real challenge to treating healthcare providers.Maternal mortality may be as high as 7% when New York Heart Association (NYHA) Classes III and IV patients are combined. In contrast, Classes I and II combined yield a mortality of 0.5%. Similarly, fetal mortality maybe as high as 30% in Class III and IV patients, in contrast to 2% for Classes I and II. Managing pregnant patients with complex cardiac disease mandates participation from a multidisciplinary team early in the pregnancy. Audit of misses and near misses helps to determine causes of maternal mortality and morbidity and identify gaps in care. Aims and Objectives: To assess burden of maternal cardiac disease and its influence on maternal and fetal outcome. To assess gaps in multidisciplinary care and to analyze causes associated with increased morbidity and mortality. Methods: A retrospective analysis of all pregnant patients with heart disease admitted to department of obstetrics and gynecology at tertiary care center from January 2017 to January 2018. Results: Of 9563 deliveries, there were 108 cases of pregnancy with heart disease (1.12%). Majority of patients in study cohort belonged to low socioeconomic status and had rural background. 36 patients (33.33%) were primi-gravida; majority presented for antenatal care in the third trimester. 82 (75.92%) in functional Class (NYHA) I – II, predominant cardiac lesion was rheumatic valvular disease diagnosed in 101 patients (93.5%); 60 patients (58.82%) had vaginal delivery, 63 (64%) were delivered before 37 weeks and 6 patients had medical termination of pregnancy. 10 patients (9.2%) developed cardiac failure and 8 (7.4%) had atrial fibrillation. There were 4 maternal death and 8 near misses. Conclusion: The present study highlights need of training of physicians and obstetrician working at peripheral centres for early diagnosis, timely referral and strengthening pre-pregnancy counselling.

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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 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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We report a rare case of benign cardiac tumor - atrial myxoma - who completely recovered after surgery.

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Aortopulmonary window (APW) is an extremely rare cardiac malformation accounting for 0.2-0.6% of all congenital heart defects. In an acyanotic patient with clinical evidence of patent ductus arteriosus with large left to right shunts and systolic rather than continuous murmur one should keep in mind the possibility of APW. If not treated early in childhood or adolescence, they tend to develop pulmonary hypertension, which can be fatal in almost all cases. Few surviving adult patients have symptoms associated with severe pulmonary hypertension, making these cases inoperable. We document an unusual case presenting in the second decade.

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The current study attempts to address an issue which is the need to obtain a preoperative electrocardiography (ECG) in all patients prior to non-cardiac surgery. Significance in patients without symptoms is uncertain. Aims: To study the incidence of ECG abnormalities in preoperative patients posted for elective non-cardiac surgery. 2. To study the co-relation of risk factors with ECG abnormalities. Materials and Methods: All hospitalized clinically stable patients advised ECG for preanesthetic assessment prior to elective non-cardiac surgery were included as subjects. Co-relation of risk factors with ECG abnormalities were studied. Statistical analysis used: Statistical Package for the Social Sciences (SPSS) software (chi-square test) Results: One hundred and twenty-eight males and 65 females were enrolled for study. Preoperative ECG was normal in 116 (60.10%) and abnormal in 77 (39.90%) patients. Abnormal ECG was more common in those with hypertension, diabetes, cardiovascular disease, and smoking. No adverse postoperative event was observed in any of the patient. Conclusions: ECG being a simple non-invasive tool should be considered for all patients undergoing elective procedures and should be mandatory for those with risk factors.

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