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Aim: To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS). Materials and methods: All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively) Result: n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011). Conclusion: Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.

Introduction: The prevalence of lower extremity artery disease (LEAD) continues to increase worldwide. This is expected to translate into logarithmic rise in lower-limb amputations especially in the developing world. Majority of patients suffering from LEAD remain asymptomatic until late and are vulnerable to limb-threatening complications unless actively screened and treated. Methods: This was a prospective, single-center, observational study to determine the prevalence and predictors of LEAD. Patients with known atherosclerotic vascular disease (but not known LEAD) or those at risk were enrolled. All underwent ankle brachial index (ABI) measurement as per the standard protocol. A threshold of ABI ≤0.90 was taken to diagnose LEAD. Results: A total of 1000 patients were enrolled. The mean age of the group was 61.4 ± 10.0 years and the prevalence of LEAD was 10.2%. Amongst those who had LEAD, the majority of patients (69.6%) had no symptoms. The prevalence of LEAD in diabetic population in our study was 13.2% and it was 30.9% in coronary artery disease patients . Factors independently linked to LEAD on regression analysis included advanced age, presence of diabetes, smoking history, lower serum HDL and a lower ejection fraction. Conclusions: The vast majority of patients suffering from LEAD are asymptomatic. Early diagnoses and institution of appropriate medical and physical therapy can prevent excess morbidity and mortality due to LEAD. Factors independently linked to LEAD are advanced age, presence of diabetes, smoking history, lower serum HDL and a lower ejection fraction. The presence of either of these should signal undertaking of appropriate steps to unmask underlying LEAD.

Limited data exists on patients with cardiac amyloidosis (CA) in India, due to underdiagnosis and late presentation. We present single centre data from 13 patients over a 4 year period with a median age of 65 years. A majority presented with symptomatic heart failure (69%) and eight patients had confirmed AL amyloidosis. At the end of the follow up period, 46% patients died, with 30% of the overall cohort dead within six months. Among the survivors, 71% continue to have NYHA grade III/IV symptoms. A suggested algorithm for earlier diagnosis in resource constrained settings is also presented.

Multisystem inflammatory syndrome in children (MIS-C) can cause significant morbidity and mortality in children. This study was conducted to assess the pattern and outcome of cardiac abnormalities in MIS-C. This retrospective study was conducted in children with MIS-C between 1 month and 18 years. We enrolled 53 children with a mean age of 7.78 ± 4.62 years. Overall, 35.8% of children with MIS-C had cardiac manifestations in the form of coronary artery abnormalities (CAAs) or left ventricular (LV) dysfunction. Younger age (P 0.009) and high C-reactive protein at admission (P = 0.001) were significant predictors of cardiac involvement. CAAs were seen in 11.3% of children. On follow-up, 67% and 83% of children showed regression of CAA at 1 and 6 months, respectively. 24.5% of patients had presented with LV dysfunction. LV ejection fraction improved significantly at 1 month (P = 0.002) and 6 months (P = 0.001). Cardiac outcomes in MIS-C were favorable with timely identification and treatment.

Abstract Background Takotsubo cardiomyopathy (TCM) is a rare disease entity characterized by acute, non-ischemic, reversible myocardial dysfunction that mimics acute myocardial infarction. Activation and excessive outflow of sympathetic nervous system are believed to be central to the figure in the disease pathogenesis. Adrenocortical hormones potentiate the systemic actions of sympathetic nervous system and accordingly are essential for regulation of myocardial function. We present an unusual case of a middle-aged woman with primary adrenal insufficiency who presented paradoxically with TCM. Case presentation A 50-year-old woman with past history of hypothyroidism presented to emergency department with history of acute chest pain and syncope. There was no significant drug history or history of an emotional or physical stimulus prior to admission. Prominent pigmentation over the tongue and skin creases of hands were noted. On presentation, she was in shock and had ventricular tachycardia which required electrical cardioversion. The subsequent electrocardiogram demonstrated diffuse T-wave inversions with prolonged QTC. There was apical hypokinesia on echocardiogram, and cardiac biomarkers were elevated. There was persistent inotropic requirement. She had marked postural symptoms, and a postural blood pressure drop of 50 mm Hg was present. Initial laboratory parameters were significant for hyperkalemia (7.8 mEq/L) and hyponatremia (128 mEq/L). These findings prompted evaluation for adrenal insufficiency which was confirmed with appropriate tests. Autoimmune polyendocrine syndrome II was thus diagnosed based on the above findings. Coronary angiography revealed normal coronaries. The diagnoses of TCM was established in accordance with the International Takotsubo Diagnostic Criteria. She was started on stress dose steroid replacement therapy and improved dramatically. At one month of follow-up, the patient is asymptomatic, and there was normalization of her left ventricular function. Conclusions Intricate relationship and interplay exist between the steroid hormones and catecholamines in the pathogenesis of TCM. Steroid hormones not only potentiate the actions of catecholamines, but they also regulate and channelize catecholaminergic actions preventing their deleterious effects on the cardiac tissue. Hence, both steroid deficiency and exogenous steroid replacement may precipitate TCM. Evidence from more such cases and larger perspective studies in future will further improve our understanding of this complex disease process and its myriad associations.

Objectives: The environmental effect in heart failure (HF) patients is well established. However, the data is limited from low-to middle-income countries like India. This study determined the impact of environment on acute decompensated HF (ADHF) admissions and mortality in India. Methods: Retrospectively, the data of all HF patients admitted between April 2017 and March 2019 was accessed through electronic hospital records. Simultaneously, the environmental-related data was collected from the central pollution control board. Results: The study included 4561 patients of ADHF. The peak of monthly ADHF events (admission and mortality) was observed during the chilly month (January) while the lowest rates were observed in summer months (May–June). The most significant factor correlating inversely with the monthly ADHF admission (r = −0.78, p = 0.003) and mortality (r = −0.65, p = 0.004) was the maximum air temperature, and it was found to be the independent predictor for both ADHF mortality [t = −2.78, β = −0.84; 95%CI(-6.0 to −0.6), p = 0.021] and admission [t = −4.83, β = −0.91; 95%CI(-19.8 to −6.9), p = 0.001]. The above correlation was better seen in the elderly subset and male gender. Humidity and the air pollution attributes did not have a significant correlation with ADHF admission or mortality. Conclusion: In conclusion, even in low-to middle-income country like India, a periodic effect of season was demonstrated for ADHF mortality and admission, with a peak in ADHF events noted during winter months especially in the regions having extremes of seasons. Air pollution could not affect the ADHF outcome for which further studies are needed.

Objective The COVID-19 pandemic necessitated the use of telemedicine to maintain continuity of care for patients with cardiovascular diseases (CVDs). This study aimed to demonstrate the feasibility of implementing a nurse-led teleconsultation strategy for CVD management during the COVID-19 pandemic in India and evaluated the impact of nurse-led teleconsultations on patient treatment satisfaction.Design, setting and participants We developed a two-stage teleconsultation strategy and tested the feasibility of implementing a nurse-led teleconsultation strategy to manage CVD in a northern state (Punjab) in India. A multidisciplinary team of experts developed the treatment protocol used for teleconsultations to manage CVD. Nurses were trained to provide teleconsultation, triaging of patients and referrals to the physicians. Patients with CVD who had an outpatient visit or hospitalisation between September 2019 and March 2020 at the Dayanand Medical College Hospital, Ludhiana, India, were contacted by phone and offered teleconsultations. Telemedicine strategy comprised: stage 1 nurse-led teleconsultations and stage 2 physician-led teleconsultations. Descriptive analysis was performed to report the proportion of patients triaged by the two-stage telemedicine strategy, and patient’s clinical characteristics, and treatment satisfaction between the nurse-led versus physician-led teleconsultations.Results Overall, nurse-led stage 1 teleconsultations were provided to 12 042 patients with CVD. The mean (SD) age of the participants was 58.9 years (12.8), and men were 65.4%. A relatively small proportion of patients (6.3%) were referred for the stage-2 physician-led teleconsultations and of these only 8.4% required hospitalisations. During stage 1 nurse-led teleconsultations, patients were referred to the physicians due to uncontrolled diabetes (24.9%), uncontrolled hypertension (18.7%) and congestive heart failure (16.2%). The patient’s treatment satisfaction was similar between the nurse-led versus physician-led teleconsultations (p=0.07).Conclusion This study showed that a nurse-led telemedicine strategy is feasible to implement in a resource-constraint setting for triaging patients with CVD and reduces physician’s burden.

Background: Pericardial diseases represent a wide spectrum of clinico-pathological entities such as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. The study sought to summarise available data on spectrum of pericardial diseases. The aim of Study is to study the clinical spectrum of pericardial diseases. To study etiopathogenesis, clinical and echocardiographic profile of patients with pericardial disease. Material and Methods: This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana and duration of study was from January 2020 to June 2021. All patients admitted in Medicine/Cardiology department with diagnosis of pericardial diseases were included in the study. Results: A total of 170 patients with pericardial disease were included in this study (100 males and 70 females). The mean age of presentation was 54.7 ± 16.3 years. Pericardial effusion was the most common manifestation i.e. in 71.8% followed by acute pericarditis, effusive-pericarditis and constrictive pericarditis in 19.8%, 7.1 % and 1.8% respectively. Shortness of breath, chest pain and fever were the most common presenting symptoms. The most common etiology of pericardial diseases came out to be tubercular. Cardiac tamponade was found in 20(11.8%) patients. Conclusion: Our study demonstrated tuberculosis as the most frequent etiology of pericardial diseases and also the leading cause of tamponade. High prevalence of tuberculosis in India is attributable to poor socio-economic status and overcrowding. [ABSTRACT FROM AUTHOR]

Risk stratification at the time of hospital admission is of paramount significance in triaging the patients and providing timely care. In the present study, we aim at predicting multiple clinical outcomes using the data recorded during admission to a cardiac care unit via an optimized machine learning method. This study involves a total of 11,498 patients admitted to a cardiac care unit over two years. Patient demographics, admission type (emergency or outpatient), patient history, lab tests, and comorbidities were used to predict various outcomes. We employed a fully connected neural network architecture and optimized the models for various subsets of input features. Using 10-fold cross-validation, our optimized machine learning model predicted mortality with a mean area under the receiver operating characteristic curve (AUC) of 0.967 (95% confidence interval (CI): 0.963–0.972), heart failure AUC of 0.838 (CI: 0.825–0.851), ST-segment elevation myocardial infarction AUC of 0.832 (CI: 0.821–0.842), pulmonary embolism AUC of 0.802 (CI: 0.764–0.84), and estimated the duration of stay (DOS) with a mean absolute error of 2.543 days (CI: 2.499–2.586) of data with a mean and median DOS of 6.35 and 5.0 days, respectively. Further, we objectively quantified the importance of each feature and its correlation with the clinical assessment of the corresponding outcome. The proposed method accurately predicts various cardiac outcomes and can be used as a clinical decision support system to provide timely care and optimize hospital resources. [ABSTRACT FROM AUTHOR]