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ORIGINAL ARTICLES
Diagonal earlobe crease: Prevalence and association with medical ailments
Yugantara Ramesh Kadam, Yogesh M Shah, Parth Kore
April-June 2018, 7(2):49-53
DOI:10.4103/JCPC.JCPC_26_17  
Context: It has been hypothesized that diagonal earlobe crease (DELC), “Frank's sign” is indicative of coronary artery disease (CAD) and/or diabetes mellitus (DM). Several studies have confirmed an association between DELC and cardiac morbidity, mortality, and hypertension (HTN). However, some studies have not found any significant association. Aims: This study aims to find out the prevalence of DELC and its association with CAD, DM, and HTN. Settings and Design: Sangli-Miraj-Kupwad Corporation area. This was a cross-sectional analytical study. Subjects and Methods: Study participants: Adults from 18 to 60 years age. Inclusion criteria: willing to participate in the study Exclusion criteria: Wearing heavy ear rings and excessive normal generalized wrinkling of the skin. Sample size: Sample size 6310, determined after a pilot study revealing DELC in 1.5%. Sampling technique: Two-stage cluster sampling. Duration of study: 6 months. Study tools: Predesigned, pilot tested pro forma. Statistical Analysis: Statistical analysis was done by using SPSS 22 software. Prevalence and percentages were calculated, and Chi-square test was applied. Results: Out of 6638 participants, 179 had DELC. The prevalence of bilateral DELC was 2.7%. The prevalence was significantly high among males (4.13%) and in the 51–60 years age group (5.29%). The prevalence of Grade 3 DELC was high and 91% of young adults had Grade 3 DELC. There were 408 (6.15%) participants who gave a history of CAD, 827 (12.46%) of DM, and 670 (10.09%) HTN. Significantly high association observed between DELC and CAD, DM, and HTN. CAD, DM, and HTN were significantly associated with Grade 3. Conclusions: The prevalence of bilateral DELC was 2.7% and is significantly associated with CAD, DM, and HTN.
  12,700 267 -
BRIEF REVIEWS
Fragmented QRS: A simple electrocardiographic prognostic marker in cardiovascular disease
Sita Ram Mittal
July-September 2016, 5(3):94-98
DOI:10.4103/2250-3528.191100  
Fragmented QRS is defined as the presence of R' wave or notching of R or S wave in the presence of narrow QRS. It indicates heterogeneous depolarization of the ventricular myocardium that can occur due to ischemia, fibrosis, or scar. It may also be a marker of coronary microvascular dysfunction. In the context of epicardial coronary artery disease, it is associated with multivessel disease and greater incidence of cardiac events. It has been shown to be an indicator of higher incidence of arrhythmias and sudden death in arrhythmic right ventricular dysplasia, Brugada syndrome, and acquired long QT syndrome. Its regression following cardiac resynchronization therapy suggests electrical reverse remodeling. It has also been shown to be a marker of myocardial involvement in congenital heart diseases and is helpful in diagnosing subclinical cardiac involvement in various systemic diseases.
  9,253 625 1
REVIEW ARTICLE
Exercise for prevention of cardiovascular disease: Evidence-based recommendations
Geevar Zachariah, Anoop George Alex
July-September 2017, 6(3):109-114
DOI:10.4103/JCPC.JCPC_9_17  
Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD). In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD) and the patient-specific factors (the patient's physical activity level and the perceived CVD risk). The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.
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REVIEW ARTICLES
Oats: A multi-functional grain
Purvi Varma, Hitha Bhankharia, Shikha Bhatia
January-March 2016, 5(1):9-17
DOI:10.4103/2250-3528.183984  
Oats are predominantly a European and North American crop, as they have cool moist climate; Russia, Canada, the United States, Finland, and Poland are leading oat producing countries. Oats have been used as livestock and human foods since ancient times. Oats (Avena sativa) is a class of cereal grain essentially grown for human consumption as well as for livestock fodder. Food industry fundamentally alter agricultural commodities into foods making it edible, palatable as well as appealing; by innumerable physical and chemical operations increasing shelf-life, bioavailability of the nutrients, stabilizing colour, flavour along with increase in the economic value of the grain. Recent observational and human interventional studies indicate that oats can have an impact on various non-communicable diseases like cardiovascular disease, diabetes; obesity and hypertension etc. Therefore it is important to increase awareness of oats and its health benefits among individuals thereby encouraging them to increase the frequency of oats in the diet. In the year 1997, USFDA approved the use of a health claim "3g/day of oat Beta- glucan may help lower blood total and low-density lipoprotein (LDL-C) cholesterol". Over all consumption of oats has increased in the recent years due to its nutritional benefits; presence of Beta-glucan, antioxidants like Avenanthramides, vitamin E (tocotrienols and tocopherols).
  5,795 673 7
Saturated fats and cardiovascular disease risk: A review
Ishi Khosla, Gayatri C Khosla1
April-June 2017, 6(2):56-59
DOI:10.4103/JCPC.JCPC_7_17  
Saturated fats have been in the line of fire for more than three decades. The major mistake in understanding fats was to equate all saturated fatty acids as one. The oversimplification of the relationship of saturated fats with cardiovascular disease (CVD) led to unwarranted removal of some valuable fats from our diets. Recently, the relationship of dietary saturated fats and that of individual saturated fatty acids (SFAs) to CVD risk has been reevaluated. All saturated fats are not equal and these fats are not as bad as they are made out to be. Thus, not all SFAs in natural fats are atherogenic (formation of fatty deposits in arteries). Butter, clarified butter (desi ghee), coconut oil, and palm oil as a part of a healthy diet are not contraindicated. The review of literature clearly suggests a relook at saturated fats with respect to atherogenicity and over health.
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Marathon running for amateurs: Benefits and risks
Nitin Burkule
October-December 2016, 5(4):113-124
DOI:10.4103/2250-3528.192681  
The habitual level of physical activity of the human race has significantly and abruptly declined in the last few generations due to technological developments. The professional societies and government health agencies have published minimum physical activity requirement guidelines to educate the masses about the importance of exercise and to reduce cardiovascular (CV) and all-cause mortality at the population level. There is growing participation in marathon running by amateur, middle-aged cases with a belief that more intense exercise will give incremental health benefits. Experts have cautioned the nonathlete amateurs about the "exercise paradox" and probable deleterious effects of high-intensity prolonged exercise on CV and musculoskeletal system. The epidemiological studies suggest a "reverse J shaped" relationship between running intensity and CV mortality. The highest benefits of reduction in CV and all-cause mortality are achieved at a lower intensity of running while the benefits tend to get blunted at a higher intensity of running. The physicians should have a balanced discussion with the amateur runners training for a marathon, about risks and benefits of high-intensity exercise, and should evaluate them to rule out the occult coronary disease.
  4,072 417 1
EDITORS PAGE
From the Editor's desk
Ravi R Kasliwal
October-December 2016, 5(4):107-107
DOI:10.4103/2250-3528.192676  
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REVIEW ARTICLES
Management options for coronary microvascular dysfunction: Present status and future perspectives
Sita Ram Mittal
January-March 2016, 5(1):18-24
DOI:10.4103/2250-3528.184011  
Coronary micro vessels are not visible on coronary angiography. These include prearterioles, arterioles, and capillaries. Significant number of patients of angina have coronary microvascular dysfunction alone or in combination with stenosis and/or spasm of epicardial coronary arteries. Its management is challenging. Several different therapeutic options have been tried with variable success. The present review provides overview of the available evidence with various therapeutic modalities for the treatment of microvascular angina.
  3,503 380 -
REVIEW ARTICLE
Syncope: Approach to diagnosis
Om Murti Anil
July-September 2016, 5(3):84-93
DOI:10.4103/2250-3528.191099  
Syncope is a transient loss of consciousness (LOC) due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Here, the term "transient LOC" encompasses all disorders characterized by self-limited LOC irrespective of the mechanism. Central point in pathophysiology of the development of syncope is fall in systemic blood pressure (BP) with a decrease in global cerebral blood flow. The evaluation and treatment of syncope are very challenging because syncope is not the only cause of transient LOC. Moreover, symptoms of syncope are fleeting, patient is usually asymptomatic at the time of evaluation, and most of the events are often unwitnessed. The guiding principle of assessment is to differentiate syncope from other causes of transient LOC and the more benign causes of syncope from the potentially serious ones. Initial assessment of syncope consists of a detailed history and examination complemented by 12-lead electrocardiography and supine and standing BP. If the cause is suspected, then further investigations may be needed to confirm the particular disorder. A deliberate approach based on initial risk stratification is more likely to give a correct diagnosis. Despite the difficulties, a thorough evaluation of the cause of syncope is warranted in all patients, not just in those deemed to be at high mortality risk. The goal in every case should be to determine the cause with sufficient confidence to provide a reliable assessment of prognosis and treatment options.
  3,469 323 -
BRIEF REVIEW
Mobile communication: Boon or bane? Possible dangers of mobile phone usage
Jitendra Kumar Meena, Mahendra Singh Rathore
April-June 2017, 6(2):70-72
DOI:10.4103/JCPC.JCPC_6_17  
The ever-increasing use of radio devices (mobile phones) has led to widespread concerns among consumers, operators, and governmental authorities regarding environmental and health risks of their use. Various studies have demonstrated the relationship of radiowave exposure with biological effects in the body ranging from molecular to organ scale damage. However, most of them considerably failed to establish a causal association primarily owing to potential biases and errors in their conduct and analysis. Mobile usage also has both social and environmental impacts which have prompted the public health agencies to enforce certain regulations which however remain controversial due to lack of credible research evidence. In such scenario, it is recommended that mobile exposure should be minimized, especially among vulnerable populations. In addition, unbiased high-quality research is needed so as to bring more clarity to the subject and guide governmental policy and regulations.
  3,473 253 -
Hypertension management: Old drug revisited - Cilnidipine
Soumitra Kumar
January-March 2017, 6(1):24-26
DOI:10.4103/2250-3528.196653  
Cilnidipine is a promising fourth-generation calcium channel blocker which along with inhibition of the L-type Ca 2+ channels in vascular smooth muscle cells, also inhibits the N-type Ca 2+ channels in sympathetic neurons. As a result, in addition to hypotensive action secondary to vascular relaxation, it also demonstrates significant sympatholytic action, whereby it attenuates platelet activation (and consequent arterial thrombosis), tachycardia, oxidative stress, and also inhibits activation of renin-angiotensin system in blood vessels. By virtue of the latter effect, they relieve constriction of postglomerular vessels and thereby ameliorate glomerular hypertension and render renoprotective effect. Besides these, cilnidipine also improves insulin resistance, nitric oxide production, and protects against retinal neuronal injury. Thus, it is expected to be a very useful addition in the current armamentarium for the treatment of hypertension.
  3,364 303 -
EDITORIAL
The Lipid Association of India Expert Consensus Statement 2016: A sea change for management of dyslipidemia in Indians
Enas A Enas, TS Dharmarajan
April-June 2016, 5(2):62-66
DOI:10.4103/2250-3528.186499  
  3,087 519 2
Cholesterol controversy
G Vijayaraghavan
January-March 2018, 7(1):2-4
DOI:10.4103/JCPC.JCPC_45_17  
  3,067 337 -
LANDMARK TRIALS
Recent landmark trials in clinical cardiology
Biswajit Paul
April-June 2016, 5(2):73-75
DOI:10.4103/2250-3528.186504  
  2,859 454 -
ORIGINAL ARTICLE
Assessment of high-sensitivity C-reactive protein values in chronic periodontitis patients with and without cardiovascular disease: A cross-sectional study
D Deepa, Chandni Gupta, Abhishek Gupta
October-December 2016, 5(4):108-112
DOI:10.4103/2250-3528.192677  
Background: Periodontal disease is characterized by inflammation and destruction of supporting tissues of the affected teeth. Pro-inflammatory cytokines originating at the site of local pathology activate hepatocytes to produce acute-phase proteins including C-reactive protein (CRP). Numerous cross-sectional studies have suggested that chronic periodontitis is a risk factor for cardiovascular disease (CVD) linked by inflammatory factors including CRP. Materials and Methods: A total of forty patients, twenty with chronic periodontitis only with no CVD (Group A) and twenty with CVD and chronic periodontitis (Group B), were selected for the study. Clinical parameters including gingival index (GI), plaque index, gingival bleeding index, Pocket probing depth (PD), and clinical attachment level (CAL) were recorded. In addition, high-sensitivity CRP (hsCRP) levels were measured from the peripheral blood using turbidimetric immunoassay technique. Results: As compared to the patients in Group A, those in Group B had more severe periodontitis with greater CAL (6.02 ± 0.53 mm vs. 6.63 ± 0.85 mm, P = 0.009), probing pocket depth (PPD) (5.20 ± 0.31 mm vs. 5.73 ± 0.52 mm, P < 0.001), and GI score (2.25 ± 0.51 vs. 2.65 ± 0.76, P = 0.06). Group B patients also had significantly higher hsCRP levels (12.3 ± 8.84 mg/L vs. 2.28 ± 0.38 mg/L; P < 0.001). The hsCRP levels had a significant positive correlation with PPD and GI. Multivariate regression analysis showed that the presence of CVD was independently associated with elevated hsCRP levels in the study population. Conclusion: The present study shows that CVD is associated with more severe periodontitis which is reflected in higher hsCRP levels. In addition, elevated hsCRP showed an independent association with CVD, incremental to various periodontitis measures. These findings suggest that periodontitis may add to the inflammation burden of the individual, which may potentially increase inflammatory activity in atherosclerotic lesions and thus the risk for cardiovascular events.
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Medication adherence and its determinants in myocardial infarction patients: An Indian scenario
Satish Balaji Gonarkar, Priti Pravin Dhande
January-March 2016, 5(1):2-8
DOI:10.4103/2250-3528.183983  
Background: Myocardial infarction (MI) is one of the leading causes of death. Along with lifestyle factors, poor medication adherence is one of the causes. This study was planned to find out the level of adherence in post-MI patients and its related factors. Objectives: Monitoring medication adherence in patients of MI attending cardiac outpatient department and to reveal causes of nonadherence to drug therapy in them. Methods: One hundred and one newly diagnosed MI patients were included in the study. Data collected were patient characteristics, habits, comorbidities, and drugs prescribed. Morisky 8 item scale was used to find out the medication adherence at the end of 1 st and 6 th month of cardiac event. Data were analyzed using McNemar test, Chi-square test, and logistic regression analysis. Results: Most common preventive cardiovascular drugs given were aspirin, clopidogrel, and statins, 98%, 88.1%, and 90%, respectively. Medication adherence at 6 th month post-MI was significantly decreased compared to 1 st month (P < 0.0001). Factors which were related to good adherence were associated comorbidities such as hypertension (P = 0.017), age group of 56-65 years (P = 0.049), higher education (P = 0.045), employees (P = 0.008), and nonsmoker (P = 0.023). Determinants associated with poor adherence were affordability (P = 0.02) and medication complexity (P = 0.03). Conclusion: Medication adherence in post-MI subjects of our study was seen to be reducing over 6 months due to factors such as low monthly income and low educational status of the subjects. Employed, higher educated, and those with comorbidities showed good adherence.
  2,734 392 1
ORIGINAL ARTICLES
Role of electrocardiogram in identification of culprit vessel occlusion in acute ST elevation myocardial infarction in relation to coronary angiography
Kunal K Salunke, Rajesh J Khyalappa
October-December 2017, 6(4):128-132
DOI:10.4103/JCPC.JCPC_11_17  
Objective: The objective of the study is to study the usefulness of electrocardiography in localizing the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and to assess the diagnostic accuracy of the electrocardiogram (ECG) findings by comparing them with coronary angiographic findings. Materials and Methods: This study is prospective observational study, conducted on fifty patients in tertiary care center attached to medical college. Patients with ST-segment elevation in ECG was evaluated to identify culprit vessel and later correlated with their coronary angiography. Results: Among fifty patients in the study, 34 had anterior wall, and 16 had inferior wall myocardial infarction. ST↑ >1 mm in V4R, ST↓V3/ST↑LIII <0.5 were equally sensitive for diagnosing proximal right coronary artery occlusion. For left circumflex occlusion, ST elevation in lead III >lead II was the most sensitive and ratio of ST↓V3/ST↑LIII >1.2 was the most specific criterion. In anterior wall STEMI, 52.9% patients had occlusion proximal to first septal (S1), 17.6% had occlusion proximal to first diagonal (D1), 8.8% had occlusion distal to S1, and 20.5% had occlusion distal to D1. Q wave in aVL had maximum sensitivity for identifying occlusion proximal to D1 and Q wave in leads V4-V6 for occlusion distal to S1. Conclusion: The admission ECG in patients with STEMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.
  2,084 920 -
SPECIAL ARTICLE
Lipid Association of India Expert Consensus Statement on Management of Dyslipidemia in Indians 2016: Part 1 - Executive summary
Shamanna S Iyengar, Raman Puri, SN Narasingan
April-June 2016, 5(2):51-61
DOI:10.4103/2250-3528.186492  
  2,423 389 4
REVIEW ARTICLES
The role of optimal medical therapy in patients with stable coronary artery disease
JPS Sawhney, Dhiman Kahali, Bhupen Desai, Suresh KP Kumar, M Vishvanathan, Vishal Rastogi
April-June 2018, 7(2):60-71
DOI:10.4103/JCPC.JCPC_43_17  
Coronary artery disease (CAD) is a leading cause of mortality and morbidity around the globe. The fact that prevalence and mortality due to CAD are declining in developed countries cannot be held true in developing countries. Almost fourfold increase in CAD prevalence has been reported in India in the past 40 years. This incidence is likely to increase further in the coming years. The heterogeneity of the disease presentation is an important challenge in the management of these patients, and the current therapies are not universally effective in controlling these symptoms. Even with the advancements in medical therapies over the last two decades, it is unclear whether percutaneous coronary intervention (PCI) provides a prognostic advantage over optimal medical therapy (OMT) in the management of stable angina patients. The current review primarily focuses on the use of OMT for stable CAD patients and also discusses the role of coronary revascularization, especially PCI, in the management of these patients. This is based on evidence-based recommendations and guidelines.
  2,294 405 -
REVIEW ARTICLE
Cardiopulmonary resuscitation: What is new in 2017
ST Yavagal
October-December 2017, 6(4):147-153
DOI:10.4103/JCPC.JCPC_24_17  
A timely and effective cardiopulmonary resuscitation (CPR) is crucial for saving lives of the individuals who suffer sudden cardiac arrest. Different relevant authorities have published guidelines for educating the caregivers in delivering effective CPR. The present report summarizes the recent changes in the CPR guidelines.
  2,144 506 -
VIEW-POINT
Contributions of the South Asian Society on Atherosclerosis and Thrombosis and the Indian Society for Atherosclerosis Research, to our understanding of Atherosclerosis and Thrombosis
Gundu H R Rao
April-June 2016, 5(2):67-72
DOI:10.4103/2250-3528.186501  
South Asians (Indians, Bangladeshis, Pakistanis and Sri Lankans) have very high incidence of cardiometabolic diseases, such as hypertension, central abdominal obesity, metabolic syndrome, type-2 diabetes, ischemic heart disease and stroke. To create awareness, develop educational and a prevention program, a professional society was started at the University of Minnesota in 1993. This society (South Asian Society on Atherosclerosis Thrombosis) organized international conferences in India every other year, on the topic of "Atherosclerosis and Thrombosis" and published several monographs on this subject. During the same period, another sister society, Indian Society of Atherosclerosis Research (ISAR) was started in India, which organized conferences on topics related to basic research and clinical aspects of atherosclerosis. Together, these professional societies have contributed significantly to our understanding of chronic cardiometabolic diseases. SASAT is currently located at the Division of Clinical and Preventive Cardiology, Medanta, The MediCity, New Delhi, India and is affiliated with the professional journal; Journal of Clinical and Preventive Cardiology. For information on ISAR, readers are urged to visit their web site: www. isar.co.in.
  2,303 186 -
ORIGINAL ARTICLES
Association of inflammatory cytokines/biomarkers with acute coronary syndrome and its correlation with severity and hospital outcome
Mohd Mahmudullah Razi, Nasar Abdali, S Mohammed Asif, MalikMohammed Azharuddin
April-June 2017, 6(2):44-49
DOI:10.4103/2250-3528.203532  
Objective: Coronary atherosclerosis is one of the major causes of coronary artery disease. Atherosclerosis is an inflammatory process involving vascular wall cells, monocytes, T-lymphocytes, pro-inflammatory cytokines, chemoattractant cytokines (chemokines), and growth factors. The presence of inflammatory cells in the atherosclerotic lesion and elevated levels of the inflammatory markers in peripheral circulation correspond to an active inflammatory process in the body. In view of this background, this study was undertaken to evaluate the association between activation of inflammatory cytokines and acute coronary syndrome (ACS). Furthermore, the correlation of these factors with severity of ACS and in-hospital mortality outcomes was studied. Study Design: It is a prospective case–control study, including forty cases of ACS (as per the inclusion criteria listed below) and twenty controls. The levels of inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and troponin I were estimated in cases and controls. The levels of these markers in the peripheral circulation were also stratified on the basis of the presenting ACS type (unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction). All statistical data were analyzed using SPSS software version 19 Statistical package for windows (Chicago, Inc., IL, USA). Results: The levels of inflammatory markers such as IL-6, TNF-α, and troponin I were higher in the ACS group than the control, and difference was statistically significant. Furthermore, there was a statistically significant difference in the levels of these markers between the various ACS groups. Conclusions: The circulating levels of inflammatory markers such as IL-6 and TNF-α are significantly elevated in patients with ACS, supporting the view that inflammatory cytokines are associated with ACS. There is a direct correlation of the levels of IL-6 and TNF-α with the severity of ACS and in-hospital mortality in these cases.
  2,092 314 -
Influence of hypertension and diabetes mellitus in pattern of coronary artery disease in women
Biji Soman, Muneer A Rahaman, Govindan Vijayaraghavan
January-March 2017, 6(1):7-11
DOI:10.4103/2250-3528.196643  
Introduction: Coronary artery disease (CAD) among women is an ignored entity in India. The aim of this study was to evaluate the role of hypertension (HT) and diabetes mellitus (DM) on the extent of CAD in women, admitted with ischemic chest pain. Materials and Methods: We conducted a retrospective analysis of the data of female patients admitted with chest pain suspected of cardiac origin and then underwent diagnostic coronary angiography. We obtained the ages, blood pressures, blood sugar levels, and angiographic findings of these patients after analyzing the patient records and reviewing the coronary angiograms. Results: We studied 163 female patients with a mean age of 58 ± 10.5 years. Of them, 71 (43.5%) had HT, 46 (28%) had DM, and 46 patients (28%) had neither HT nor DM. DM prevalence was higher (12/25, 48.0%) among women with ST-segment elevation myocardial infarction (STEMI) as compared to those with non-STEMI (6/26, 23.1%) or unstable angina (28/112, 25.0%; P = 0.06). In contrast, a higher proportion of the women with unstable angina had neither HT nor DM. Coronary angiography revealed a significant CAD in 86 (52.8%) women. Of them, 34 had DM (odds ratio: 3.542, 95% confidence interval [CI]: 1.669-7.516, P = 0.001) and forty had HT (odds ratio: 1.290, 95% CI: 0.693-2.404, P = 0.422) while12 had neither of the two risk factors. Triple vessel disease was more common in women >50 years of age, but the relationship between risk factors and CAD remained same in both the age groups. Conclusion: We conclude that increasing age along with DM is major risk factors for CAD among women. However, while older women tend to present with more extensive CAD, presentation with noncritical CAD or normal coronaries and muscle bridge is more common in younger women with suspected acute coronary event.
  2,077 265 -
Incidence and clinical profile of patients with frozen shoulder after cardiac surgery
M Chokkalingam, S Saradha, A Navitha, Pradeep G Nayar
October-December 2017, 6(4):142-146
DOI:10.4103/JCPC.JCPC_17_17  
Background: Frozen shoulder is a condition characterized by pain and global restriction of movement with loss of external rotation. Cardiac surgery may predispose frozen shoulder as patients tend to immobilize their upper limbs after surgery. Objectives: The aim of this study is to analyze the clinical profile of patients presenting with symptoms of periarthritis shoulder and to determine the incidence of frozen shoulder among patients undergoing cardiac surgery as well as to find the factors associated with its development. Methods: It is a clinical observational study done in the Cardiology Department of Chettinad Hospital and Research Institute, Chennai, between August 2015 and May 2016, on 100 patients who underwent cardiac surgery and attended the follow-up session as an outpatient. Data were collected by face-to-face interview using a standardized questionnaire. Respondents presenting with pain and restricted movement of shoulder joint with positive limitation in lateral rotation, abduction, and medial rotation (LAM) test were considered to have frozen shoulder. Each participant was followed up for 3 months postcardiac surgery. Results: The mean age of the study participants was 53.63 ± 13.03 years, and 65% were males. Of the 100 participants, 20 (20%) developed frozen shoulder. Age (P < 0.01), diabetes mellitus (<0.01), hypertension (P < 0.001), type of surgery (P < 0.02), and regularity of physiotherapy follow-up (P < 0.01) had significant association with positive LAM test on univariate analysis. However, on multivariate logistic regression analysis, only hypertension and physiotherapy regularity were found to have a trend toward a significant independent association with the occurrence of frozen shoulder (P = 0.090 and 0.097, respectively). Conclusion: The present study shows that cardiac surgery increases the risk of developing frozen shoulder during the early postoperative period. Statistically significant correlation existed between positive LAM test and age of the patients, presence of diabetes mellitus and hypertension, type of cardiac surgery, and the regularity of physiotherapy follow-up.
  2,093 175 -
ORIGINAL ARTICLE
Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study (Cardiac Rehabilitation Attitudes and Viewpoints on Engagement)
Lucky R Cuenza, Edward Nino Gacrama, Kent Tan, Benjamin Jose Quito, Edgardo Ebba
April-June 2016, 5(2):44-50
DOI:10.4103/2250-3528.186490  
Background: Cardiac rehabilitation (CR), despite numerous evidence of a positive impact on morbidity and mortality, still remains underutilized due to multifactorial reasons. Physician endorsement has been shown to be a very powerful predictor of CR referral. The objective of the study was to describe physicians' attitudes and preferences regarding referral of patients to CR. Methods: A cross-sectional survey of a stratified random sample of 160 physicians specializing in cardiology was conducted at the Philippine Heart Center. One hundred and four physicians responded (65% response rate) to a survey that investigated clinical factors and perceptions affecting referral. Included in the survey was a hypothetical case scenario that elicited open-ended responses affecting physician management preferences. Results: About 78.9% of the physicians stated that they would refer the hypothetical case to CR although there were varied responses in their management practices. The most important factor affecting CR referral was financial limitation, followed by geographic location and issues on program accessibility and benefit. While there is general agreement regarding knowledge of the indications of CR, there is a disparity in the responses with regard to actual referral and management preferences. Conclusions: Financial considerations, accessibility, perceived benefit, and health-care system-related aspects are some of the identified factors that affect physician preferences toward referral to CR. Assessment of physician attitudes and factors affecting CR referral practices provides insight regarding potential targets of improvement to ensure adequate CR referral and provision.
  1,975 281 -