Journal of Cardiovascular Medicine and Surgery

The patient is a 29-year-old male gynecology resident presented with on and off palpitation since last 10 years who is on irregular diltiazem therapy. He is normotensive, euglycemic and with no reversible cardiovascular risk factors. During the course of routine investigation, EKG revealed low atrial rhythm with negative P waves in leads Il, Ill, aVF, and lateral leads with mild dilation of left ventricle with normal ejection fraction. Beta blocker was initiated and the rhythm shortly reverted to normal sinus rhythm and was asymptomatic. Although a benign phenomenon, early evaluation and management of this ectopic rhythm warrants in a young person.

Non-neoplastic tumors are rarely found in the heart. Calcified amorphous tumor [CAT] of the heart is one such tumor. When present, it is often mistaken for a calcified myxoma, thrombus, vegetation or malignancy. It is found subendocardially with areas of calcification in an amorphous degenerating fibrin background causing obstruction to the outflow tracts. It has to be excised and subjected for histopathological examination to confirm its diagnosis. We found a CAT in an eight-year-old boy who was being evaluated for fever of unknown origin. Heterogenous tumor masses were found in the right ventricle and right ventricular outflow tract. These masses had embolised further into both the left and right pulmonary arteries. Surgery was done on conventional cardiopulmonary bypass and all the tumor masses were excised. Histopathological examination revealed features consistent with CAT. Very few cases of CAT have been reported in the world literature. Resection is curative but if incomplete, recurrences are known to occur.

Statins are frequently prescribed drugs in cardiology practice. One of the most important causes of nonadherence is mainly because of muscle-related symptoms. The main adverse reactions due to statins include myalgia, myopathy, and new onset diabetes mellitus. Lipophylic statins are more prone to produce myopathy compared to hydrophilic ones. Statins increase the incidence of new onset DM in patients already having risk factors for DM. Therefore statins to be continued rather than discontinuing, if patients are diagnosed with new onset diabetes mellitus. The benefits of statin therapy outweigh the risk. Statin intolerance can be effectively managed either by reducing the dosage, switching to other statin or alternate day statin regimen with rosuvastatin. Non-statin therapies like PCSK-9 inhibitors evolocumab and alirocumab are also optional in high-risk patients who are intolerant to statins or in whom statins are contraindicated. Inclisiran is a promising drug, however long-term safety data is needed. Nutraceuticals have cholesterol lowering activity however there is insufficient evidence with respect to long-term safety and effectivenes.

Objective: To study the early outcomes of left atrial reduction plasty in patient undergoing mitral valve surgery with giant left atrium. Methods: We surgically excised the redundant left atrial wall in order to reduce the size of giant LA and replaced the mitral valve. Concomitant tricuspid valve repair was also done in patients having significant tricuspid disease. Results: Twelve patients underwent left atrial reduction plasty with mitral and tricuspid valve surgery. There was 48.15% reduction in left atrial size. Postoperatively, 75% regained sinus rhythm from atrial fibrillation. NYHA function was better. One patient was relieved from bronchial compression. There was no complication and no mortality. Conclusion: Left atrial reduction plasty is an effective modality for treating AF in patients of GLA undergoing mitral valve surgery. The restoration and maintenance of sinus rhythm in short term follow up is satisfactory.

Aim: Our recent studies have shown that to investigate the concentration of hsCRP and Troponin-T in NSTEMI and STEMI patients. Myocardial infarction is the impairment of heart function due to inadequate blood flow to the heart compared to its need, caused by obstructive changes in the coronary circulation to the heart. Cardiac Troponin T is a twin filament protein which takes part in cardiac muscle contraction. Cardiac Troponin T is not normally present in serum unless cardiac cell necrosis has occurred. High sensitivity C-reactive protein, a systemic inflammatory marker is considered to be an independent risk marker of cardiovascular disease. Design/Methods: Acute myocardial infarction was studied in three groups, namely Control, NSTEMI and STEMI patients. Results: In NSTEMI and STEMI groups, mean serum levels of hsCRP and Troponin T is higher than the mean serum control group. Discussion: The serum levels of hsCRP and Troponin T were significantly increased in first, second and third day of NSTEMI and STEMI myocardial infarction patients compared with control normal subjects. Conclusions: The concentration of hsCRP and Troponin T is a useful index, not only in the diagnosis and prognosis, but also in some critical situations of taking some important decisions.

Introduction: Aging may result in numerous changes in the cardiovascular system including the conduction system of the heart. The present study was conducted to describe various subtypes, various comorbidities, clinical and investigational profile and outcome of cardiac arrhythmias among geriatric population. Methodology: The present observational study was conducted with fifty patients diagnosed with cardiac arrhythmia and admitted in the general medicine ward or intensive care unit (ICU) of our hospital. Based on the medical history, examination and various investigations patients were classified as Atrial fibrillation (AF), Complete Heart Block (CHB) or Ventricular tachycardia (VT). Results: History revealed cardiac insufficiency in 38%, renal failure in 30%, acidosis in 24%, hypoxia in 20%, hyperkalemia in 14% and hyperthyroidism in 4% of the patients. Most common comorbidity was hypertension (48%). Breathlessness, palpitations, chest pain, syncope and hemoptysis were the common presenting complaints. 46% were diagnosed with atrial fibrillation (AF), 36% complete heart block (CHB) and rest of the 18% with ventricular tachycardia (VT). We found that patients diagnosed with VT were newly presenting and were significantly associated with cardiac insufficiency, higher admission rates to ICU, and higher mortality. Atrial fibrillation in our study patients was significantly associated with rheumatic heart disease and hypoxia/acidosis. CHB patients were more likely to be associated with diabetes mellitus. Conclusions: Appreciating changes in the cardiac conduction system in the elderly will assist the practitioner in quicker diagnosis and better management.

Aim: In the present study shown that to investigate the comparison between left ventricular dysfunction and type 2 diabetes mellitus. Diabetes mellitus is a metabolic disease characterized by hyperglycemia, resulting from defects in insulin secretion and /or insulin action and/or insulin resistance. The incidence of asymptomatic cardiovascular disease in diabetes mellitus is of considerable importance and it has been suggested that 20% have occult disease like silent myocardial infarction. Echocardiography evaluation of patients have shown systolic and diastolic dysfunction in more than 50% of young insulin-dependent-diabetic patients. Material and Methods: This is a Prospective and Observational Study. The selection of the 50 Type 2 diabetes mellitus patients was done from either in patients admitted for control of diabetes or out patients. 50 controls for the study were chosen from volunteering staff members and patients attenders. Results: Patients with diabetes show an significant increase in the left ventricular mass, E/A ratio diastolic dysfunction as compared to non diabetes. Conclusions: We conclude that earliest detection of preclinical left ventricular abnormalities like dysfunction in both systole and diastole and then to take preventive steps in order to arrest of halt the progress of the disease.