Journal of Cardiovascular Medicine and Surgery

Unexplained collapse can be difficult to decipher. A 67­year­old male presented with recurrent syncope, coronary angiogram illustrated coronary artery disease. Syncope continued post percutaneous coronary intervention. 

Thoracic, abdominal and thoraco­abdominal aortic pathologies have highest mortality and morbidity causing pathologies in cardiovascular surgery. Co­existing diseases and age significantly increase risk of anaesthesia and mortality rate in treatment of these patients. Endovascular techniques are used increasingly due to minimally invasive approach, decreased anaesthesia risk during implementation, reduced length of hospital stay, and low mortality and morbidity rates. The aim of this case report is focused on anaesthetic experiences in endovascular techniques performed at our center.

High risk patients scheduled for off pump coronary artery bypass (OPCAB) surgery imparts tremendous challenges to anesthetists. There is very little literature for the management of high risk patients subjected for off pump coronary artery bypass surgery. High risk patients have increased morbidity and mortality. The review describes the different causes of high risk patients, the problems faced during OPCAB and the management strategy. Risk stratification, optimization of organ functions prior to surgery, stable induction, maintenance and postoperative multidisciplinary team work will provide better outcome. Pre­induction precautionary arrangements of inotropes, defibrillator, intra aortic balloon pump, temporary pacemaker, back up of cardiopulmonary bypass and cell saver are useful for combating the cardiac emergencies. Along with routine monitors, pulmonary artery catheter, Transesophageal echocardiography, pulse contour (Flo Trac), noninvasive cardiac output monitors, bispectral index and near infrared spectroscopy play a major role to diagnose the critical events and hence help in prompt management.

Cardiovascular Diseases (CVD) is considered as one of the leading causes of mortality and morbidity worldwide including India. The aim of this review is to explore and summarize the relationship between air pollution and CVD. Studies have demonstrated that exposures to air pollution have both short and long term effects on mortality. Air pollution comprises of particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), dust, fumes and gases. Therefore, in the recent past there is growing affirmation that long time exposure to air pollution is linked to the development of various CVD like coronary artery disease, heart failure, cardiac arrhythmias and arrest and cerebrovascular diseases. The biological mechanisms such as inflammation and oxidative stress seem to contribute to the occurrence of these diseases due to the exposure to ambient air pollutants. Air pollution can be considered as a modifiable risk factor for the prevention and the treatment of various cardiovascular diseases. Therefore, future research should focus on ways to reduce or eradicate air pollution methods so that these could be implemented in the public domain.

Pulmonary Hypertension is the major cardio vascular complication of chronic obstructive pulmonary disease and long­standing, frequently undetected pulmonary hypertension leads to the development of right ventricular hypertrophy, dilatation and failure with poor prognosis. Echocardiography is the most useful noninvasive method for detecting pulmonary hypertension but there are few data on the utility of echocardiography for measurement of pulmonary artery systolic pressure in chronic obstructive pulmonary disease patients and correlation with pulmonary function tests and arterial blood gas analysis. A study was conducted to estimate pulmonary artery systolic pressure by echocardiography in chronic obstructive pulmonary disease patients, Correlation of the Spirometric and arterial blood gas variables with the pulmonary artery pressure in prediction of pulmonary hypertension. In the present study mild pulmonary hypertension was found in 16 patients (69.56%), moderate pulmonary hypertension in 6 patients (26.08%), and severe pulmonary hypertension in 1 patient (4.34%). Partial Pressure of Oxygen (PO2), Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) were the independent variables significantly correlated with pulmonary artery systolic pressure.

Introduction: Left ventricular diastolic dysfunction (LVDD) is suspected when a patient presents with a clinical diagnosis of heart failure despite a preserved ejection fraction. Left ventricular hypertrophy (LVH) has been associated with poor clinical outcomes in patients of LVDD. In this study, we aimed to compared the clinical characteristics and echocardiographic findings of LVDD patients with and without LVH.

Methodology: LVDD patients at our centre diagnosed with and without LVH were included in the study. LVDD was defined by the abnormal relaxation patterns of Doppler mitral inflow and tissue Doppler. Demographic, clinical, laboratory and echocardiographic parameters were compared between LVH and non­LVH patients with LVDD.

Results: 50 patients of LVH and non­LVH LVDD were included. Age and systolic blood pressure were found to be significantly higher among the LVH group, while mean heart rate and total cholesterol were found to be significantly lower among LVH patients. Mean left ventricular mass index (121.46±19.32 vs 74.93±11.54 gm/m2), p value <0.001), left atrium size (3.82±0.82 vs 3.57±0.34 cm, p value < 0.001), relative wall thickness (0.59±0.11 vs 0.53±0.16, p value < 0.05), filling pressure (16.85±5.21 vs 15.01±4.32 mm of Hg, p value < 0.05) and Tei index (0.59±0.16 vs 0.51±0.11, p value < 0.05) were found to be significantly higher among patients with LVH.

Conclusions: Coexistence of LVH and LVDD can increase the mortality manifold and thus early identification by echocardiography may prompt close monitoring and aggressive management.

Context: The semi continuous monofilament suturing technique has been proposed as a viable alternative to interrupted pledgetted technique for aortic valve replacement. It is a quick, simple technique and may reduce prosthetic material exposure.

Aims: To compare outcome of semi continuous versus interrupted pledgetted suturing techniques for aortic valve replacement.

Settings and Design: Prospective study to compare suturing techniques for aortic valve replacement in our institution.

Methods and Material: 330 patients who underwent isolated aortic valve replacement were included of which 220 patients underwent interrupted (group I) and 110 (group II) semicontinuous technique. Patient characteristics, operative
and early post operative data were compared.

Statistical analysis used: Baseline characteristics were compared using Z test. Student’s t test was used to compare operative data and complication rates. A p value of <0.005 was considered significant.

Results: Analysis showed that the CPB and cross clamp time was significantly shorter and valve size used was atleast one size larger in the semicontinuous group. Valve thrombosis was seen in 3 patients in group I and no patient in group II. They were managed conservatively. Paravalvular leak was seen in 2 patients in group II. Both the patients had native annulus >25mm and regurgitation type with minimal fibrosis of the annulus. Both patients were subsequently reoperated.

Conclusions: Semicontinuous suturing technique for aortic valve replacement is viable with lesser CPB and cross clamp time with larger size valve implantation. It is associated with lesser valve thrombosis. Careful selection of patients can avoid complication of paravalvular leaks.

Background: Transfemoral arterial approach (TFA) is still the most common approach used in many countries for percutaneous coronary intervention(PCI). Transradial arterial access (TRA) is increasingly gaining acceptance globally for PCI. Acccess site for PCI are important considerations especially for high risk and acute coronary syndrome (ACS) patients in whom the negative implications of major bleeding are even greater.

Aims and objective: Our study comparedthetransradial and transfemoral artery approach for PCI in ACS patients in a north Indian population.

Material & Methods: A five year retrospective data (April 2013­ March 2018) of total patients of ACS including ST elevation myocardial infraction (STEMI) and Non ST elevation ACS (NSTEACS), who underwent PCI was retrieved from a registered and computerized database. The patients were divided into two groups depending upon transradial and transfemoral artery approach and compared for the various demographic and clinical features, risk factors profile, vascular access, procedural details and in hospital outcomes.

Results: 1284 patients of ACS underwent percutaneous coronary interventions at our center during this five year period. 79.9% were male and 21.1% were female. 420 patients (32.7%) underwent PCI through the transfemoral route and 864 (67.3%) patients underwent PCI through the transradial route. The mean fluoroscopy time was significantly more prolonged in the TRA group (14.83±9.24 mins) than TFA group (13.2±7.42 mins, p<0.001). Access site related major complications, major bleeding and total duration of hospital stay were significantly (p<0.001) more in the TFA group as compared to TRA group. There was no significant difference in the rate inhospital mortality (0.47% vs 0.46%, p=0.30) between two groups. The rate of TIA/ischemic stroke was similar in TFA and TRA groups (0.23% vs 0.34% respectively, p=0.07).

Conclusions: The transradial approach for PCI in ACS patients is safe and effective approach. The rates of major access site complications are more in transfemoral approach with lesser patient comfort than in transradial approach.

Background: Chronic hypertension (HTN) leads to variouspathophysiological and hemodynamic changes that ultimately culminates into left ventricular hypertrophy (LVH) and heart failure. Two­dimensional speckle tracking echocardiography (2D­STE) is novel technique that allows rapid and accurate analysis of incipient stages of systolic and diastolic left ventricular(LV) dysfunction.

Objective: The objective of this study was to assess the ability of 2D­STE in the assessment regional and global LV strains to characterize features of subclinical LV dysfunction in patients withsystemic hypertension and relatively preserved ejection fraction (EF).

Material and Methods: Two­dimensional echocardiographic (2DE) images of the LV were acquired in apical four­chamber and parasternal short­axis at the basal levels in 60 subjects, including 15 healthy controls and 45 patients with systemic hypertension. Longitudinal strain (LS) and circumferential strain (CS) were quantified in 13­segment model using Philips IE­33 x matrix machine.

Results: In comparison with normal controls, global longitudinal LV systolic strain (LVGLS) and global circumferential LV systolic strain (LVGCS) was significantly attenuated in the patients with chronic systemic hypertension. Regional strain in longitudinal axis was significantly reduced at Apex(Ap) and Apicolateral (Apl) and Mid inferior septum (MIS) segment of LVin hypertensive population compared to normotensive group while the regional strain in circumferential axiswas significantly reduced at all six segments (basal anterior, basal anterior septum, basal inferior septum, basal inferior, basal inferior lateral wall and mid anterolateralwall). Strain rate (SR) values were insignificantly reduced in both hypertensive groups with and without LVH in early diastole (at peak E).

Conclusion: 2D­STE detected substantial impairment of LV strain and regional deformation in chronic hypertensive patients with apparently preserved LVEF, which identifies higher risk subgroups for earlier pharmacolgical intervention in patients with HTN. 

Background and Objectives: Left ventricular hypertrophy is a common condition thatprofoundly affects morbidity and mortality from cardiovascular diseases including myocardial infarction, congestive heart failure, and stroke. The ECG in the assessment of cardiac dimensions has lost its prominence in favor of imaging techniques that provide a multidimensional display of the heart but secondary ST­T changes due to LVH which are uniquely determined from the ECG are known to increase the risk of cardiovascular morbidity and mortality. Two­dimensional echocardiogram still demands considerably more time, cost, technical skill of the operator than routine 12 lead ECG. Considering the magnitude of LVH the study is designed to correlate between three different ECG criteria of left hypertrophy using echocardiography as diagnostic standard and to assess Diastolic dysfunction in patients with ECHO proven LVH with normal systolic function.

Methods: Patients from outpatient and inpatient department of tertiary care centre were included. Diagnostic standard of left ventricular hypertrophy was taken by Echocardiography. Patients with high index of clinical suspicion of left ventricular hypertrophy were subjected to electrocardiography and echocardiography, clinical suspicion was done by thorough physical examination and history. Statistical analysis was done by EPI Info Statistical Software version 3.5.2 and proportions; Chi­square test was used for test of significance.

Results: The sensitivity was 46.5%, 36% and 37% for S – L Index, R.E. system and total QRS voltage criteria respectively. 44% of cases had diastolic dysfunction according to E/A Ratio and among them majority (26%) were in stage 1.

Conclusion: This study shows that all the ECG criteria have low sensitivity than ECHO in diagnosing LVH. And hence these methods have a limited use as screening test. Interestingly ECG criteria were more sensitive in diagnosing Hypertensive LVH than LVH of other causes. Study also concludes that it is important to screen for diastolic dysfunction in patients with LVH.

Introduction: The goal of treatment for spinal tumours of thoracic region is complete removal with minimal postoperative neurological deficit.

Methods: According to the extension of spinal tumour we divided patients into two groups­A­spinal tumours only. B­ Spinal tumours with neuroforaminal and mediastinal extension. We reviewed clinical outcome with intraoperative neuro­monitoring of spinal tumours of thoracic region from 2012 to 2016.

Results: Forty three patients were analyzed (group A and B­ 93% and 6.97% cases respectively). In both groups spinal tumours were common in male (67.5% and 66.6% in group A & B respectively). Intraoperative neuromonitoring used in all cases and help in complete removal of tumour. The posterior midline approach of surgery were used in all cases (100%) in group A while in group B anterior (thoracotomy) and combined approach in 33.3% cases each. We find that the complete neurological recovery in 97.5% in group A and 100% in group B.

Conclusions: Hinojosa et al. find that neuro­monitoring may help to minimize postoperative motor deficit by avoiding or correcting spinal cord tumour manipulation and modifying surgical technique during tumour resection. We concluded that the correlation of changes in transcranial motor evoked potential and electromyography on corresponding muscles help in nerve root identification and complete removal of spinal tumours without any postoperative neurological deficit. Spinal tumours having extension to neurofoamina/mediastinal are very rare and their complete removal needs correct preoperative diagnosis and single or two stage surgical approach.

Background: Left atrial appendage has a significant role in cardiac hemodynamics. In dysfunction this appendage forms as a substrate for thrombus formation leading to potentially destructive embolic problems.

Aim: To assess the effects of left ventricular diastolic dysfunction on left atrial appendage functions, spontaneous echo contrast and development of thrombus in patients having non­valvular atrial fibrillation.

Materials and Methods: We carried our study on 80 subjects suffering from chronic nonvalvular atrial fibrilation at Prathima Institute of Medical Education,  Karimnagar, Telangana, from January 1, 2015 to December 31, 2017. Patients were divided in two groups: Group D (n=40): subjects with diastolic dysfunction, Group N (n=40): subjects without  diastolic dysfunction. Left atrial appendage functions, left atrial spontaneous echo contrast grading and left ventricular diastolic functions were assessed using transoesophageal and transthoracic echocardiograms.

Results: In Group D, pulmonary vein D level was significantly higher than group N (p<0.001) whereas, LAA filling velocity, LAA lateral wall velocity and pulmonary vein S/D levels were significantly lower than Group N (p<0.001).

Conclusion: In patients with left ventricular diastolic dysfunction, left atrial appendage functions was reduced and therefore it may signify a probable risk for formation of thrombus and stroke.

Aims: The objective was to study the clinical, echocardiographic and haemodynamic profile of juvenile rheumatic mitral stenosis (age 20 years), both before and immediately after balloon mitral valvotomy and also to evaluate the safety and efficacy of the procedure in juvenile patients.

Methods: Forty juvenile patients aged 20 years or younger were analysed who underwent balloon mitral valvotomy using Accura balloon in our institution. The procedure was successful in all the patients. The clinical, echocardiographic and haemodynamic parameters were compared pre and post­balloon mitral valvotomy.

Results: New York Heart Association functional class was II and III in 62.5% and 37.5% respectively. Atrial fibrillation was not seen in the juvenile group. Mitral valve deformity asper Wilkins Score was 8.57±0.67. Mitral valve area index by 2D echo was 0.62 ± 0.097 cm2/m2 and was larger (1.38 ± 0.19) after the procedure (p value < 0.0001). Mitral valve gradient (19.85±7.31 mm hg) and mean PASP (70.15±19.2 mm hg) was higher before balloon mitral valvotomy, after balloon mitral valvotomy the values were 7.45 ± 2.57 (P < 0.001) and 40.48±10.30 respectively (p = 0.0001). The mean value for left atrial pressure was 27.48±6.02 and 14.95±5.92 both pre and post­balloon mitral valvotomy (P value 0.0001 and 0.0001 respectively). The procedural success was 95%.

Conclusion: Balloon mitral valvotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results.

Introduction: Ventricular tachycardia (VT) encompasses all the tachycardia’s originating in the ventricular myocardium or the specialized conductive tissue distal to the atrioventricular node. Structural heart disease (SHD) plays a major role in risk stratification, initial management, risk stratification, and treatment of ventricular arrhythmias.

Aim: The aim of the study was to study the clinical profile, various treatment modalities offered to patients and patient’s acceptance for same and the outcome following various treatment modalities in patients of ventricular tachycardia in structural heart disease patients in Indian context.

Materials and methods: 106 patients of ventricular tachycardia with underlying structural heart disease fulfilling the study criteria were enrolled in the study. All patients underwent detailed evaluation including history, clinical examination and laboratory investigations. Patients were managed according to standard guidelines. All patients were followed at 1 month, 3 months,and 6 months.

Results: Mean age was 53.6 years, 77.36% of patients were males. Monomorphic VT was commonest presentation and found in 93.39% of patients. Most common etiology for VT was coronary artery disease in 52.84% of patients. Mean LVEF in our study was 26.46±10.82%.Patients who had LVEF of <30% had maximum mortality of 48.05%. 23 (21.69%) patients in our study had opted for AICD and underwent the procedure accordingly. The main reason behind patients not opting for AICD was the economic issue. There were 2 (8.6%) deaths in AICD group and 12 (14.81%) in non­AICD group on follow­up.

Conclusion: In our study, the most common etiology of VT was coronary artery disease. Monomorphic VT is common in patients with underlying structural heart disease. Patients of VT with associated comorbidities and left ventricular dysfunction has higher mortality. Our study shows that the implantation of a defibrillator in patients with a prior myocardial infarction and left ventricular dysfunction, with symptomatic ventricular tachyarrhythmia have a trend towards survival benefit, compared to similar group of patients on medical follow up. But the main reason in Indian context behind not undergoing AICD implantation is economic issue.

Thyroid disease in cardiac surgery is a challenge in regards to patient management especially post­operative as a result of two systems, endocrine and cardiovascular systems, working in antagonism. In this case review, we narrate a unique case of a 65­year­old African female with severe mitral regurgitation and incidental atrial septal defect who underwent mitral valve replacement and atrial septal defect closure. She later developed poor cardiac function post operatively owing to initially unrecognised subclinical hypothyroidism that was not being treated. This worsened post cardiopulmonary bypass and the setting of acute severe physiological stress secondary to cardiac surgery. On administration of thyroxine 100mcg daily, she improved haemodynamic and was later discharged. A discussion is made in focus to cardiac surgery in the background of hypothyroidism. Various literature reviews provide useful information in this field. However further studies on African based population are recommended to collaborate the existing data or even demonstrate variations in this population. 

Introduction: Chronic obstructive pulmonary disease (COPD) is a major global health issue. COPD affects pulmonary vasculature as well as heart leading to the development of pulmonary artery hypertension (PAH), cor­pulmonale (COR­P), right and left ventricular dysfunction. Echocardiography is a rapid, noninvasive, portable, and accurate method to evaluate cardiac function in these patients. We performed the echocardiographic evaluation of COPD patients to study the prevalence of heart diseases in these patients.

Materials and Methods: Ours was observational study. Total 125 patients of moderate to severe COPD according to GOLD guidelines were included in the study. All patients were evaluated with detailed history, chest X­ray postero­anterior view, electrocardiography (ECG), spirometry and trans­thoracic echocardiography (Echo).

Results: We investigated 89 males and 36 female patients with mean age of 52.54 ± 9.55 years. Fifteen patients had GOLD class I COPD, 45 patients had GOLD class II COPD and 65 patients had GOLD class III and IV COPD. Breathlessness (100%) was most common presenting symptom and tachypnea (73%) was most common presenting sign. ECG was abnormal in 80% patients with right ventricular hypertrophy (53.6%) as most common finding. Eighty percent patients had abnormal echocardiography with PAH (57.6%) and right ventricular dilatation (49.6%) as the most common findings.

Conclusion: There is significant prevalence of cardiac co­morbidities in patients with COPD. Cardiac screening should be done early in the disease which will be helpful in the assessment of the prognosis and to identify the patients who are likely to suffer increase morbidity and mortality.

Background and Objectives: Atherosclerosis is now known to be an active process of cell activation, inflammation and thrombosis [1]. To study, whether there is any correlation between the serum hs­ CRP level, a biomarker of inflammation, and the angiographic severity and extent of coronary artery lesion in patients with acute coronary syndrome, such studies are sparse in India.

Methods: Patients with ACS who were fulfilling the inclusion criteria, were enrolled prospectively in the study during the period February 2017 to February 2018. The patients were further classified three risk groups according to serum hs­CRP levels. < 1 mg/L ­ low risk, 1­3 mg/L ­ average risk and >3 mg/ L­ high risk. The presence and extension of CAD was assessed according to the modified Gensini scoring system. Mean angiographic Gensini scores were compared among the serum hs­CRP risk groups using ANOVA as the test of significance. Direct correlation between angiographic Gensini scores and serum hs­CRP levels were assessed using Pearson’s correlation (2­tailed). A cut­off p value of < 0.05 was set for results to be statistically significant. Independent predictors of Gensini score were assessed with multiple regression analysis.

Results: A total of 100 patients, with diagnosis of ACS, The mean angiographic Gensini scores significantly associated with the plasma hs­CRP, it showed increasing trend from lower to higher serum hs­CRP risk groups, and high serum hs­CRP was independently associated with Gensini score.

Conclusion: Our study found that the severity of coronary atherosclerosis significantly associated with the concentration of the plasma hs­CRP and the mean angiographic Gensini scores, also showed increasing trend from lower to higher serum hs­CRP risk groups. Moreover, high serum hs­CRP was associated with Gensini score independent of age, sex, smoking status, hypertension, diabetes, dyslipidemia and Family history of CAD/CVdeath.

Background: Coronary artery disease (CAD) is a common cause of death or disability in men and women, but CAD manifests differently in women. Besides traditional risk factors, diabetes and hypertriglyceridemia carry greater risk to women than men. CAD is commonly under diagnosed in women.

Objective: To study the frequency, risk factors and presenting symptoms associated with CAD.

Materials and Methods: The study was conducted in Air Force Command Hospital, Bangalore from 01 Oct 2013–31 Mar 2015 after obtaining approval from Institutional Ethical Committee. All females who were diagnosed of CAD in emergency room, medical/ cardiology OPD, intensive coronary care unit and medical wards of Command Hospital were enrolled for the study.

Results: In the present study 91.26% were post menopausal female falling in the age group of 41­80yrs. Among the study subjects, 46.6% had diabetes, 62.13% had hypertension, 4.8% had past history of dyslipidemias and 52.44% were overweight or obese. 17.47% had family history of CAD or CAD risk factors.

Conclusions: Coronary Artery Disease commonly affects postmenopausal women. Overweight, Obesity, Hypertension, Dyslipidemia and Diabetes are the major risk factors in women. They present more often with atypical symptoms. 

There is a global concern about the aesthetic implications of open surgical repair of ASD among patients and the medical community that forcing patients to seek minimally invasive techniques or transcatheter device closure. We reviewed clinical outcome of different approaches of atrial septal defect closure in fifty nine cases from November 2013 to May 2018 and divided patients into three groups­A­Conventional median sternotomy (64.4% cases). B­ Minimally invasive cardiac surgery (8.47% cases). C­ Percutaneous trans catheter device closure (27.11%). All patients were diagnosed (49 cases as ostium secondum, 09 case sinus venosus, 01 case ostium primum, 07 cases with associated cardiac defects) on TTE &TEE using selection criteria. Aortic cross clamp and cardiopulmonary bypass times were in group A (range of 26­42, 43­94 minutes respectively) and group B (range of 78­90, 92­135 minutes respectively).All the cases of percutaneous trans catheter device closure were performed under local anaesthesia with duration of procedure in range of 40­58 minutes. Cocoon occluder device were commonly used in 12 cases. There were no mortality and no conversions to sternotomy in group B while in group C there were one device migration & one deployment failure. ICU stay and hospital stay was shorter in group C. Surgical device retrieval of migrated device from RVOT via sternotomy approach in 6.2% case. Overall success rate in group A, B, C was 97.3%, 100%, 87.5% respectively. There were no significant cost differences in the entire group. Aesthetically group C & B was better than group A. Overall, improved aesthetic implication, reduced operative pain, and a relatively fast rehabilitation are important considerations for less invasive approaches (PTDC & MICS) of ASD closure. Conventional median sternotomy approach is gold standard if associated cardiac defects, contraindication to MICS, unsuccessful or complicated percutaneous closure of ASD.

Introduction: Acute Organ phosphorous compound (OPC) poisoning is an important indication for emergency admission in most hospitals throughout India. Cardiac complications that often accompany poisoning with these compounds may be serious and are often fatal. These complications are preventable, if they are recognized early and treated adequately. Objectives of the study is to assess the cardiac toxicity in Organ phosphorous compound poisoning and to associate electrocardiogram changes and CKMB levels among Organ phosphorous compound poisoning patients.

Materials and methods: A hospital based observational study among 37 adult patients who presented to emergency department of tertiary care centre with Organ phosphorous Compound Poisoning. Informed consent and institutional ethical clearance was obtained before study. Electrocardiography (ECG) was done, plasma Pseudocholiesterase levels and CKMB levels were measured. Outcome measures considered were recovery or death. Post mortem Histopathological findings of cardia were recorded.

Results: In the study 37 adult patients with OP poisoning were included. Mortality rate was 8.1% (3). Significant association was observed between outcome and CKMB levels. All the patients who mortality had significantly higher levels of CKMB compared to others. There was also significant association between outcome and ECG changes. Out of 3 patients who died 2 had abnormal ECG changes. All the patients who died had consumed chlorpyriphos compound. Histopathological findings of heart in all the subjects who had mortality showed myocardial interstitial edema, vascular congestion and Patchy interstitial inflammation and one showed patchy myocarditis with other findings.

Conclusion: Patients with organophorphorus compound poisoning should beevaluated for electrocardiogram along with CKMB which helps in predicting cardiac toxicity and can be considered as a surrogate prognostic marker.

Background: Coronary angiography is often found to be normal in patients with typical cardiac chest pain. There is limited data from India on frequency of normal coronary angiogram in patients undergoing coronary angiography. Aims and

Objectives: To evaluate the frequency of normal coronaries in patients with typical cardiac chest pain.

Material and Methods: This is a registry based retrospective analysis of all the patients undergoing coronary angiography for suspected coronary artery disease in a tertiary care hospital in north India over a period of 3 yrs.

Results: During the study period 3975 patients underwent coronary angiography, out of which 573 patients (14.41%) were found to have no significant obstructive coronary artery disease (coronary artery stenosis <50%). Presenting diagnosis was unstable angina in 73.8%, stable angina in 14.8, Non­ST Elevation MI in 5.6% and ST Elevation MI in 4.4%. Coronary angiogram was completely normal in 82% of patients. Slow flow and other evidences of endothelial dysfunction were seen in 14.8 % of patients. Coronary ectasia or aneurysm was seen in 0.9% and re­canalized artery with no significant residual coronary stenosis was seen in 0.3% of patients. Mortality at 1 yr followup in these patients was 0.2%.

Conclusions: Angiography was found to be normal in 1 out of 7 patients with suspected cardiac origin chest pain. These patients had a very low mortality at 1 yr follow­up on optimal medical management. In spite of normal coronary arteries these patients should be put on optimal medical therapy.