Journal of Cardiovascular Medicine and Surgery

 This article is aimed to inform the readers on the role of exercise therapy in improving quality of life of people with cardiovascular disorders by providing an integrative overview of systematic reviews. There were two systematic reviews on stroke, three on chronic heart failure and two on intermittent claudication found in our search of PubMed database, and most of them reported improvements in physical functioning and bodily pain components of health-related quality of life (HrQoL) in people who were administered supervised aerobic exercise training. This throws light on need for future studies addressing non-operative and pre-/post-operative rehabilitation using exercise and its effect on HrQoL in this population.

 This short communication paper intended to provide a descriptive evidence summary on efficacy studies of exercises in essential hypertension through a PubMed-based search for systematic reviews and/or meta- nalyses. There were high quality evidence for aerobic exercise, device-guided breathing exercise, Tai Chi exercise, with an evidence-based recommendation and American college of sports medicine endorsing a position statement, all of which favored use of exercises as a safe and effective treatment modality.

 Persistent left superior vena cava can be incidental, accidental, descriptive and investigative when the left anterior cardinal veins not obliterated. Dilated coronary sinus in the absence elevated right sided filling presence, coronary sinus opacification after right arm anticubital vein injection are the trinity for left sided superior vena cava. A case of persistent left superior vena cava in a 10 year girl with a normal right superior vena cava and a persistent bridging vein brachiocephalic vein leads to formation of superior vena cava duplication.

 This review article aimed to enlighten evidence-informed researchers and clinicians with a descriptive overview of systematic reviews and metaanalyses on exercises for cardiac rehabilitation from PubMed. Exercise-based cardiac rehabilitation (EBCR) includes either exercise training administered alone or exercise training in addition to psychosocial, risk factor management and/or educational interventions and was considered a Class I indication [i.e., useful and effective] for patients with coronary heart disease.There were six systematic reviews that measured risk factors, clinical and quality of life outcomes following exercise training in cardiac rehabilitation; and five other systematic reviews included one each on high-intensity interval training, resistance training, aerobic training, Chinese Qiqong exercise and physical activity prescription. Overall, there is high-level evidence suggesting exercises as per earlier evidence-based recommendations. 

 Novel risk factors are emerging behind the genesis of atherosclerosis in today’s era of moleculogy. High sensitive CRP is one of the frontiers in this field besides homocysteine, fibrinogen and Lp (a). We report a case of premenopausal lady without conventional risk factors with malignant manifestations of atherosclerosis having only elevated hsCRP to explain the scenario. Being a biomarker behind inflammatory vascular stress, it stands out a promising molecule in today’s atherobiology. Exercise and statins can bring down this inflammatory insult, resulting in a healthy vascular tree.

 Prognosis of patients with Microvascular angina is not as benign as is considered despite normal coronaries. It contributes to increased suffering, health care costs and may have role in long term increased cardiovascular risk. There is increasing consensus about underlying coronary microvasculature abnormality with or without other risk factors. A lot more research and clinical work is required to develope effective and optimum treatment to alleviate the symptoms and improve microvascular function. In this review we have discussed the prevalence, pathophysiology and available investigative and treatment modalities and present limitations and need of further studies and research about coronary microvascular dysfunction.

 Low-density lipoprotein cholesterol (LDL-C) is the most important risk factor for developing coronary artery disease (CAD) as evidenced in landmark INTERHEART study. PCSK9 inhibition offers a novel therapeutic mechanism for lowering low-density lipoprotein cholesterol (LDL-C) levels.PCSK9 is a serine protease that binds the LDL receptor (LDL-R) and acts as a chaperone for endocytosis and shuttling the PCSK9-LDLR complex to lysosomes for degradation. In the absence of PCSK9 the LDLR-LDL-C complex dissociates and LDL-R is recycled back to the cell surface. Humanized monoclonal antibodies against PCSK 9 (evolocumab, alirocumab, bocolicumab) have been developed which increase LDL-R by 2- old and lower LDL-C by up to 75 percent with no significant side effects, with the exception of injection site reactions. These novel agents play a pomising role in filling the therapeutic gap in statin intolerant, difficult dyslipidemics and familial hypercholesterolemic patients. When combined with statins they bring out a better cardiovascular outcome with a stable and target lipid profile. 

 Background: The frequent occurrence of bypass induced systemic inflammation after coronary artery bypass grafting (CABG) is a major concern for scientists. Various attempts in attenuating the inflammation have been tried. Recently few studies showed that pentoxifylline (PTF) treatment reduces inflammation from cardiopulmonary bypass (CPB). The perioperative use of PTF on inflammatory response was estimated by measuring biomarkers of inflammation. Objectives: To evaluate the effect of PTF on biomarker of inflammation in patients undergoing CABG using CPB. Methods: Sixty patients age between 40-65 years scheduled for CABG surgery using CPB were included in the study. The study group was administered PTF (Group I) 400 mg twice daily orally from the day of admission to 6th day after surgery. Whereas the control group was not administered PTF (Group II). Blood samples were collected perioperatively at 4 points of time; before induction of anaesthesia, after 1h of termination of CPB, 24h after surgery and 6thpost-operative day for interleukin-6 (IL6) and C- reactive protein (CRP) as inflammatory markers. The data was analyzed and P<0.05 was considered significant. Results: The IL-6 and CRP values were similarbefore induction of anaesthesia (p= 0.473 and p=0.315) between two groups. The PTF treated group had lesser rise in the level of IL-6 (51.38±30.04 vs 119.74±103.86. p<0.017; 69.70±23.60 vs 135.72±88.19, p<0.002; 12.11±5.65 vs 40.20±30.58; p< 0.000) and CRP (6.04±2.88 vs 8.83±2.9, p< 0.000; 158.79±42.37 vs 223.87±93.00, p<0.004; 92.70±33.07 vs 184.52±117.82, p< 0.000) compared to control group patients after 1h of termination of CPB, 24h after surgery and 6thpost-operative day. Conclusions: Pentoxifylline attenuates rise in level of IL6 and CRP due to cardiac surgery. Hence perioperative treatment of pentoxifylline will reduce inflammatory reaction in patients undergoing CABG with CPB.