Journal of Cardiovascular Medicine and Surgery

 Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiomyopathy. The identification of patients with HCM is sometimes still a challenge. Moreover, the pathophysiology of the disease is complex because of left ventricular hyper-contractile state, diastolic dysfunction, ischemia and obstruction which can be coexistent in the same patient. We report a case of 35 year old male presenting with effort dyspnea NYHA class II with ECG showing deep arrowhead T wave inversion in anterolateral leads and TTE revealed it to be HCM with thickened LV posterior wall (26mm) as compared to septum (12 mm) which belongs to Marons Type IV type, rarest across HCM phenotypes. 

Keywords: Cardiomyopathy; Classification; Septum.

 Systemic sclerosis is rare autoimmune connective tissue disorder often localized to the skin. Some occasion; it spread to heart, gastrointestinal system, lung and kidney. The cardiac structures like valve, coronary artery and conduction systems are mostly affected. Systemic sclerosis patients have associated pulmonary hypertension, restrictive pulmonary function, thick skin with ulcers and dysrhythmias. We discuss the management of a 39 year female diagnosed case of systemic sclerosis presented for double valve replacement. She had previous mitral valve commisurotomy 25 yrs back, past episode of stroke, restricted mouth opening resulting in difficult tracheal intubation and restrictive lung disease. The case report described the meticulous medical and surgical management for double valve replacement andsuccessful intubation with fibreoptic bronchoscope. 

Keywords: Systemic Sclerosis; Restrictive Mouth Opening; Cardiac Surgery; Double Valve Replacement.

 There is a resurgence of interest by healthcare designers and healthcare providers to provide ambience of healing into the architecture, artwork and philosophy for the patients undergoing treatment in intensive care units. This is considered to be one of the healing strategies for ICU Patients. Reviewing various researches and reports and patient’s experience, it is evident that not only the physical environment like natural light, peaceful colors, soothing sounds are the factors affecting patient healing but also the holistic approach by yoga, meditation, and acupressure may help in preventing ICU psychosis. Psychoneuroimmunology research demonstrates the need for mind body interventions like Yoga Meditation for well being and early healing of the patients admitted in ICU. 

Keywords: Intensive Care Unit; Holistic Care; Raj Yoga Meditation.

 Pulmonary Arterial Hypertension (PAH) is a disease with high mortality and morbidity. Current pharmacotherapy includes prostacyclin analogues, endothelin antagonists and phospho-diesterase inhibitors. The limitation of these molecules coupled with the modest efficacy has fueled research for better drug candidates in the treatment of PAH. Selexipag is a novel non–prostanoid IP receptor agonist. The drug inhibits the proliferation of vascular smooth muscle cells and induces vasodilation in the pulmonary circulation. The drug is hydrolyzed to its active metabolite ACT – 333679 which has high affinity for prostanoid receptor. In the GRIPHON study, a multi-centric phase III clinical trial, selexipag was found to reduce mortality as compared to placebo, when given for over a year. Common adverse events with selexipag use includes headache, jaw pain, nasopharyngitis, nausea and pain in the extremity. The drug is given at a dose of 200 to 1600 mcg twice daily via oral route. Although selexipag is yet to be evaluated for its long term effects in PAH, its entry into the market is likely to usher hope and reduce the bleak prognosis associated with this devastating illness. 

Keywords: Selexipag; Pulmonary Arterial Hypertension (PAH); Non– Prostanoid IP Receptor Agonist; New Drug; Mortality.

 Inappropriate sinus tachycardia (IST), a form of dysautonomia that is estimated to impact around 1.2% of the population. IST is characterized by unexpectedly fast heart rates at rest, with minimal physical activity, or both. Patients with IST range in presentation from asymptomatic to complaining of extremely debilitating symptoms such as palpitations, weakness, chest pain, shortness of breath fatigue, dizziness, or near syncope. IST is a diagnosis of exclusion. If IST is suspected, a thorough medical history review and physical examination should be performed, in order to rule out secondary causes for the tachycardia . The echocardiogram should reveal a structurally normal heart, and a treadmill exercise test (if used) should document an exaggerated tachycardic response to exercise. 

Keywords: Sinus Tachycardia; Inappropriate; Rate.

 Last few decades have seen tremendous increase in patients with ischemic heart disease and despite advances in medical treatment patients with severe LV dysfunction are on rise due to improved survival rates. The myocardial revascularization has been attempted to aim at improving myocardial function and thereby symptomatic as well as survival benefit. LV dysfunction may be due to myocardial stunning and hibernation which are reversible causes of LV dysfunction and viability testing helps in differentiating them from necrosed myocardium as revascularization in patients with nonviable myocardium has no benefit but may be harmful.

Keywords: Viability; Revascularization; Pet; Spect; Cmr; Dobutamine.