Search

Objectives: The objective of the study is to evaluate plasma homocysteine level and its relation with serum estrogen in pre and postmenopausal women as a risk factor in coronary artery disease (CAD). Materials and Methods: A cross-sectional study was conducted among premenopausal (n = 50) and postmenopausal women (n = 50) with an estimation of plasma homocysteine (Hcy) and serum estradiol (E2). Postmenopausal women based on their angiographic status were sub-grouped into A (with normal coronaries) and B (with CAD). Results: The levels of Hcy, 21.98 (20.89-24.05) μmol/L, increased significantly (P < 0.0001) and that of E2, 3.05 (2.32-3.6) pg/mL, decreased significantly (P = 0.0001) in the postmenopausal group when compared to Hcy, 6.11 (4.94-8.27) μmol/L and E2, 26.37 (25.3-29) pg/mL in premenopausal group. The levels of Hcy were elevated (24.7 ± 3.92 μmol/L) in postmenopausal Group B in comparison with postmenopausal Group A (21.37 ± 3.31 μmol/L), P = 0.002. Logistic regression analysis showed Hcy and body mass index to be independent predictors of CAD. Plasma Hcy showed an area under curve (AUC) of 1.00 with sensitivity and specificity of 100% at cutoff >12.6 μmol/L between pre and postmenopausal groups and AUC of 0.722 with 60% sensitivity and 84% specificity at cutoff >23.7 μmol/L between postmenopausal Groups A and B. Conclusion: We observed low E2 and high Hcy levels in postmenopausal women in comparison with premenopausal women. Among postmenopausal women, those with CAD had higher Hcy levels. Assessing Hcy levels routinely in postmenopausal women will help in better risk prediction of CAD and may also help in conjunction with other risk factors to decide the initiation of hormone replacement therapy. [ABSTRACT FROM AUTHOR]

Background: Although ventricular tachycardia and the ventricular fibrillation occur more often in adults with coronary artery disease, These ventricular arrhythmias may appear in young people, often early and late after surgery for congential heart disease or in association with a variety of cardiac disease, autonomic imbalance, drugs, as well as in the absence of detectable cardiac desease, when serious ventricular tachyarrhythmias occur in the young they may be misdiagnosed as aberrantly conducting supraventricular tachycardias because of their presumed infrequency. Information on clinical characteristics and outcome of patients with NIVT in our patient population is limited. Aims and Objectives: This prospective observational study was aimed at patients presenting with NIVT to our tertiary care center and to analyze their clinical features, electrocardiogram (ECG) characteristics, underlying disease, management and clinical outcome at one year of follow up. Methods: It is an observational prospective study of 50 patients who presented with nonischaemic VT (NIVT) to our tertiary care center. History, physical examination, chest X-RAY, electrocardiogram (ECG) and echocardiography were done. Details of electrophysiological studies and radio frequency ablation were collected. Antiarrhythmic drug history was noted. Patients were followed for a period of one year for their clinical outcome and their response to different modalities of treatment was noted. clinical Events defined as death, hospitalizations, DC shocks and recurrence of disease and time to event was also noted. Results: Among the total 50 patients, 27(54%) were males and 23(46%) were females. The mean age of presentation was 31 to 40 years. Most common presenting symptom was syncope (75%). Most common etiology was found to be idiopathic dilated cardiomyopathy with severe LV dysfunction (26%) followed by inflammatory cardiomyopathy (10%). post valvular replacement surgery for rheumatic heart disease, hypertrophic cardiomyopathy, idiopathic right ventricular outflow tract tachycardia were found in 6 percent of patients in each category. LBBB and RBBB morphology of VT in ECG seen in 37 and 44% of patients respectively. Immediate mortality rate was 12%, mainly seen in patients with electrolyte imbalance secondary to systemic infections and myocarditis related to covid 19 infection. Mean survival time in our study is 39.16 weeks with 95% confidence interval. Events have occurred in 30% of our patients most commonly in patients with idiopathic DCMP. Recurrent episodes of VT are more common in patients with DCMP ejection fraction less than 35 percent and also in ARVD patients after LV involvement. Conclusion: NIVT requires aggressive management to prevent mortality and morbidity. Recurrent episodes of VT can occur after disease progression in DCMP and these patients have poor prognosis. Aggressive management like cervical sympathetic denervation may be required in these patients when presented with VT storm. A comprehensive evaluation of patients with NIVT will allow recognition of underlying etiology and selection of appropriate treatment strategies like cervical sympathetic denervation, radiofrequency ablation and AICD implantation apart from drug therapy for effective control of VT. [ABSTRACT FROM AUTHOR]

We report an unusual case of massive hemothorax in a female patient undergoing electrophysiological (EP) procedure for drug-refractory supraventricular tachycardia. She underwent percutaneous intervention with a drug-eluting stent to the right coronary artery 6 months back and was on dual antiplatelet drugs. Timely detection and management of hemothorax prevented a major catastrophe in this patient. This case highlights the importance of keeping a strict vigil for possible occurrence of life-threatening bleeding complications during EP procedure in patients on multiple antiplatelet drug therapy. [ABSTRACT FROM AUTHOR]

A 46-year-old male patient who had long-term right ventricular (RV) pacing for symptomatic complete heart block, initially by an epicardial, later with an endocardial pacing lead at the RV apex, developed congestive heart failure (CHF) and chronic atrial fibrillation 7 years following the pacemaker implantation and was medically treated. During follow-up, his pacemaker was upgraded to a cardiac resynchronisation therapy (CRT) device, because of uncontrolled CHF symptoms, New York Heart Association (NYHA) functional class IV, while on drugs. The patient's symptomatic status improved to NYHA functional class II with CRT. After 17 months of CRT, the battery became depleted, because of the high capture threshold of the left ventricular lead. The patient was then given dual site RV pacing (RV outflow tract + RV apex) in place of CRT, which showed similar efficacy at 12 weeks follow-up. [ABSTRACT FROM PUBLISHER]

Ventricular tachycardia originating from the right ventricular septum is very uncommon. In a 54-year-old male patient with right ventricular tachycardia, the focus of the ventricular tachycardia was localized to the subtricuspid septum of the right ventricle, which could be successfully eliminated with radiofrequency catheter ablation. The patient's echocardiogram and coronary angiogram were normal. The available literature on idiopathic right ventricular tachycardia is reviewed. [ABSTRACT FROM PUBLISHER]

Till recently, ST segment elevation in the absence of conduction abnormalities or chest pain occurring particularly in young bradycardia individuals has been considered a normal variant called early repolarisation (ER). However, recent studies suggest a more worrisome picture as patients with history of idiopathic ventricular fibrillation showed increased prevalence of ER in ECG. ER is an ECG pattern characterised by elevation of the QRS-ST junction (J point) ≥ 2 mv from baseline in the inferior (II, III, aVF) or lateral (I, aVL, V4-V6) leads manifested as QRS slurring or notching. The ER pattern describes the patient with appropriate ECG findings in the absence of symptomatic arrhythmias. The Early Repolarisation Syndrome (ERPS) applies to the patient with both appropriate ECG findings and symptomatic arrhythmias. The current experimental data support the concept that J-point elevation is a marker of increased transmural heterogeneity of ventricular .repolarisation, which increases the vulnerability to ventricular tachyarrhythmias. Male gender, history of syncope or sudden cardiac death (SCD) in family, ER in inferior leads or global ER pattern, terminal notching of QRS complex, J wave amplitude of more than 0.2 mv, horizontal or downward direction of ST segment elevation signify higher risk features for SCD in ER patients. Patients with ER pattern on ECG should have complete cardiac evaluation. The management options for ERPS include anti arrhythmic drugs, implantable cardioverter-defibrillator (ICD) and radiofrequency ablation. There is a need for the physicians to be aware of this entity, hitherto considered as variant of normal ECG pattern especially in young adults and understand its implications, identify high risk subsets and manage with appropriate strategy., (© Journal of the Association of Physicians of India 2011.)

We report here on three patients who underwent biventricular pacing (BVP) for severe heart failure and the problems encountered with pseudo-bipolar left ventricular (LV) lead configuration. With this configuration, right ventricular anode capture with simultaneous biventricular stimulation was noted at higher output during the isolated LV pacing mode in these patients, which forced us to program the LV pacing to unipolar configuration in one patient. The implication of this phenomenon in sequential BVP therapy is discussed.

A 46-year-old male patient who had long-term right ventricular (RV) pacing for symptomatic complete heart block, initially by an epicardial, later with an endocardial pacing lead at the RV apex, developed congestive heart failure (CHF) and chronic atrial fibrillation 7 years following the pacemaker implantation and was medically treated. During follow-up, his pacemaker was upgraded to a cardiac resynchronisation therapy (CRT) device, because of uncontrolled CHF symptoms, New York Heart Association (NYHA) functional class IV, while on drugs. The patient's symptomatic status improved to NYHA functional class II with CRT. After 17 months of CRT, the battery became depleted, because of the high capture threshold of the left ventricular lead. The patient was then given dual site RV pacing (RV outflow tract+RV apex) in place of CRT, which showed similar efficacy at 12 weeks follow-up.

Ventricular tachycardia originating from the right ventricular septum is very uncommon. In a 54-year-old male patient with right ventricular tachycardia, the focus of the ventricular tachycardia was localized to the subtricuspid septum of the right ventricle, which could be successfully eliminated with radiofrequency catheter ablation. The patient's echocardiogram and coronary angiogram were normal. The available literature on idiopathic right ventricular tachycardia is reviewed.

A diagnostic triad characterizes Brugada syndrome. It consists of a right bundle branch block, ST-segment elevation in leads V1-V3 and sudden cardiac death (SCD). Approximately 50% of patients with Brugada syndrome noted to have familial occurrence, this suggests a genetic component of the disease. Mutations in gene SCN5A, an encoder for human cardiac sodium channel on chromosome 3p21, causes Brugada syndrome. Before considering the diagnosis of Brugada syndrome, exclude precordial ST-segment elevation secondary to acute coronary syndrome, electrolyte imbalance, myocarditis, drug over dosage (cocaine, tricyclic antidepressants), and arrhythmogenic right ventricular cardiomyopathy/dysplasia. Intravenous administration of ajmaline, flecainide, and procainamide may exaggerate the ST-segment elevation, or unmask it when it is initially absent in patients with suspected Brugada syndrome. Programmed electrical stimulation (PES) may help in risk stratification, and in some cases, establish the diagnosis. However, the accuracy of PES in predicting outcome is debatable, especially in patients showing an asymptomatic Brugada ECG, and reporting no family history of SCD. Treatment with an implantable cardioverter-defibrillator (ICD) is the only established effective therapy for the disease. With ICD therapy, the mortality rate at a 10 year follow-up was 0%. Supporting data for long-term pharmacological therapy with quinidine, or isoproterenol for prevention of SCD, in these patients, is uncomplete. Future advances in understanding the molecular mechanisms of Brugada syndrome may provide answers to many of the controversial issues in the management of this disease.