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   Table of Contents - Current issue
April-June 2021
Volume 10 | Issue 2
Page Nos. 47-77

Online since Tuesday, June 22, 2021

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Editor's page April 2021 p. 47
Ravi R Kasliwal
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A study of spectrum of rheumatic heart disease in children at a tertiary care hospital in Western India p. 48
Pooja Vyas, Joshi Hasit, Radhakisan Dake, Iva Patel, Krutika Patel
Context: Rheumatic heart disease (RHD) predominantly affects adults. However, in developing countries like India, it is the most common acquired heart disease in children. The prevalence of RHD also varies from the region to region in the same country due to the differences in educational, economic, and social status as well as health-care facilities of the region. Aim: The aim of the study is to establish and discuss the spectrum of RHD in children from Western India and to explore the relationship between severity of valvular lesion by the age and sex of the children with RHD. Methods: Echocardiographic findings of children (N = 820) ≤18 years with RHD seen at our institute from January 2018 to December 2018 were retrospectively analyzed. RHD was screened by echocardiography. All the echocardiogram were analyzed for the pattern and severity of various valve lesions and associated abnormalities. Results: Eight hundred and twenty children had a diagnosis of RHD. Maximum patients [476 (57.1%)] were from the age group of 13–18 years without any gender difference (418 male and 402 female). Mitral regurgitation (MR) was the most common lesion found in 81.46% children. Aortic regurgitation (AR) was seen in 29.76%, mitral stenosis (MS) was found in 20.48%, tricuspid regurgitation was seen in 66.83%, and aortic stenosis (AS) was found in 0.73% children. AR was found more common in males as compared to females (P = 0.0004). Majority of patients (69.5%) had single mitral valve involvement. Four hundred and eight patients (49.8%) had severe MR, 122 patients (14.9%) had severe MS, 62 patients (7.6%) had severe aortic regurgitation, and 2 (0.2%) patients had severe AS at the time of first presentation. Pulmonary hypertension was found in 69% of children. Children with MS and AS were older than those without MS and AS (P = 0.0001). Conclusion: Majority of children had severe valvular lesion and pulmonary hypertension at the time of first presentation. RHD is the leading cause of heart failure in children with requirement of surgical/catheter intervention and long-term medical management.
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Peripartum cardiomyopathy in Indian population: A pooled analysis p. 54
Rakesh Agarwal, Rashmi Baid, Dhurjati Prasad Sinha
Introduction: Peripartum cardiomyopathy (PPCM) refers to heart failure of unknown etiology in later gestation or early postpartum period. Data regarding its incidence, clinical features, risk factors, and outcomes in the Indian population are scarce. Materials and Methods: We performed a pooled analysis of seven Indian studies on PPCM, including 221 patients to study PPCM. Results: The incidence of PPCM in the Indian population was 1 in 1340 live births. Indian women developed PPCM at a mean age of 27 years and most commonly in the postpartum period (60% cases). Hypertensive disorders and anemia were associated with PPCM in nearly half the number of patients. Maternal mortality was 11.7% and fetal mortality 14.2%. Conclusion: Our study provides data on PPCM in the Indian population. Larger studies with higher number of patients are needed to study PPCM in detail in the Indian subset.
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Clinical profile of ST-elevation myocardial infarction thrombolysed with tenecteplase in Coronavirus Disease 2019 Pandemic: A comparative study p. 58
Kamal Kant Jena, G Manohar, C Elamaran, A Rudrappa
Background: Coronavirus disease-2019 (COVID-19) pandemic has affected millions worldwide. The various complications of COVID-19 have been discussed in the recent studies. We would like to discuss about one such cardiovascular complication, ST elevation myocardial infarction (STEMI) in COVID-19, and its characteristics in this article. Methodology: An observational study was done from April 1, 2020, to July 15, 2020, selecting all STEMI patients admitted to a tertiary care center in Chennai and treated with tenecteplase were grouped in to COVID-19 positive and negative. Their presenting features and complications and outcome were studied. Results: A total of 300 patients were admitted with STEMI during the study period, of which 11.66% were COVID-19 positive. Atherosclerotic cardiovascular risk factors were much lower in COVID-19-positive STEMI patients when compared to non-COVID STEMI patients. Mean oxygen saturation at time of presentation in COVID-19 positive and negative patients was 85.1% and 97.5%, respectively (P < 0.001). COVID-19 group had significantly higher noncardiac complications than non-COVID patients (P < 0.001). The average duration of hospital stay in COVID-19 STEMI was 13.6 days, whereas in non-COVID group was 6.8 days (P < 0.001). Higher mortality was found in the COVID-19 positive group (14.28%) when compared to non-COVID STEMI (7.9%; P < 0.001). Conclusion: COVID-19 itself is a systemic inflammatory disease, which could increase the risk of coronary plaque rupture. Thrombosis has also been described as a mechanism underlying certain cases causing presentation of STEMI, because of endothelial dysfunction and hypercoagulable state.
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Role of N-terminal pro-B-type natriuretic peptide in predicting mortality in heart failure p. 63
Kamal Kant Jena, N Vishwanathan, G Manohar, Prashant Kumar Singh, Nayan Chakraborty
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) improves emergency room diagnosis and is a prognostic marker of acutely decompensated heart failure (HF) after hospitalization. We tried to assess the prognosis in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) using the biomarker. Methods: Patients were categorized into HFpEF (left ventricular ejection fraction [LVEF] ≥50%) (n = 102), HF with midrange EF (LVEF of 40%–49%) (n = 106), and HFrEF (LVEF ≤40%) (n = 112) as per the ESC classification of HF subtypes. Prognosis by absolute and percentage change in NT-proBNP at admission and at the 10th day of treatment was found in 3-month follow-up. Mortality after discharge was also assessed. Results: Among all HF groups, a reduction of NT-proBNP <20% at 10 days predicted mortality, hazard ratio (HR) – 14.9 (95% confidence interval [CI]: 3.8–57.9), P = 0.0001. The risk of mortality in HF patients with NT-proBNP reduction of <20% in 10 days was 14.9 times higher in 3-month follow-up. NT-proBNP more than 12,000 pg/mL at admission had a mortality risk of 23.3% in the HFrEF group, HR – 23.45 (95% CI: 2.9–189.4), P = 0.003. NT-proBNP on the 10th day, more than 9000 pg/mL, had a mortality risk of 21.4% in the HFrEF group, HR – 23.3 (95% CI: 4.9–110.5), P = 0.001. Conclusion: NT-proBNP proved to be a superior modality in finding out prognosis in HF. Patients with the HFrEF group had a higher mortality in our study. Comorbidities play an important role in affecting the prognosis in patients with HFpEF with lower NT-proBNP.
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Exercise tolerance test using duke treadmill: An observational study in a private tertiary care hospital p. 68
Muhammad Maaz Arif, Muhammad Zarrar Arif Butt, Muhammad Affan Arif Butt
Background: Ischemic heart diseases (IHDs) are one of the most prevalent diseases worldwide. Several tests are undertaken for diagnosing IHDs including electrocardiography (ECG), echocardiography, troponin test, and angiography. Exercise tolerance test (ETT) is an ideal noninvasive test for diagnosing IHDs. ETT is quite useful for risk estimation in patients diagnosed with coronary artery diseases or undergoing vascular surgery. The Duke treadmill score has a great prognostic value for ETT. Aims: The study aimed to compare the data between positive, negative, and inconclusive cases undergoing ETT with several variables that are related to cardiac scores, pathologies, and risk factors. Materials and Methods: It was a cross-sectional study that included 61 patients undergoing the test. The study was conducted at the cardiology ward, Fatima Memorial Hospital, Lahore, Pakistan. Results: The demographic characteristics showed majority of the patients to be male with 44 (72.13%) as opposed to female with 17 (27.87%) cases. The average age of all the cases was 43.48 ± 8.65 . Most of the patients undergoing the test had atypical angina with 55 (88.71%), followed by typical angina with 3 (7.14%) and no angina with 3 (7.14%) cases. Cases showed the past history of positive family reports with 20 (32.79%), followed by a history of smoking with 11 (18.03%), diabetes with 9 (14.75%), catheterization with 7 (11.48%), coronary artery bypass grafting with 5 (8.2%), and myocardial infarction with 5 (8.2%) cases. Conclusion: Duke treadmill scores of the three groups revealed that most of the cases (81.97%) fall in the intermediate-risk group (between 4 and − 10 scores) and the standard Bruce protocol showed that majority of the cases only passed Stage II (37.7%) and Stage III (37.7%) of the treadmill. Few studies have been conducted on ETT that shows a detailed analysis of this test with different associated factors. Studies like these will help in conducting greater work of this nature, analyzing important content.
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Eptifibatide-induced acute profound thrombocytopenia in a patient with left main artery plaque rupture complicated by cardiogenic shock and gastrointestinal bleeding p. 74
Savvy Nandal, William Van Gaal, Francis A Ponnuthurai
Eptifibatide inhibits platelet aggregation by reversibly binding to the platelet receptor glycoprotein (GP) IIb/IIIa of human platelets, thus preventing the binding of fibrinogen and adhesion proteins such as fibronectin, vitronectin, and von Willebrand factor to form cross bridges with adjacent platelets. There are two other GP IIb/IIIa inhibitors, namely abciximab and tirofiban, available for clinical use. Profound thrombocytopenia is an uncommon but clinically important complication of GP IIb/IIIa inhibitors. This case discusses a 64-year-old male patient who developed profound thrombocytopenia within 4 h of first administration of eptifibatide. This report adds a case of eptifibatide-induced thrombocytopenia complicated by gastrointestinal bleeding to the medical literature. It highlights the need for complex decision-making regarding cessation of antiplatelet therapy in patients with recent percutaneous coronary intervention and the lack of robust evidence for the benefit of GP IIb/IIIa inhibitors in the ticagrelor era when compared to clopidogrel and aspirin.
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