Coronary Vasospasm after Giving Adenosine for Supraventricular Tachycardia

Palpitations due to supra-ventricular tachycardia are a common mode of presentation to the emergency department. A 12 lead electrocardiography usually leads to immediate diagnosis and prompt management of this condition. Adenosine injection is the treatment of choice for rapid termination of supra-ventricular tachycardia which is widely used. It is generally considered safe and serious side effects are rare. We presented a rare case of a post-menopausal female admitted with supra-ventricular tachycardia and after injection of Adenosine, chest pain with a transient elevation of ST segment occurred. The ST segment changes reverted back to normal after a few minutes spontaneously without any therapy. This phenomenon could be explained due to coronary vasospasm produced by Adenosine. A review of literature revealed anecdotal cases of adenosine induced possible coronary vasospasm

A Prospective Study of Prevalence of Carotid Artery Disease in Patients with Coronary Artery Disease and its Correlation with Traditional Atherosclerotic Risk Factors in Central India

Introduction: Early atherosclerosis mainly involves carotid artery, which leads to increased carotid artery intima media thickness (CIMT).The potential value of CIMT improving the predictive capacity of traditional risk factors of CAD is an understudied and underutilized issue. Because of increasing availability of highly sensitive ultrasonography probes and for a noninvasive procedures, we can predict coronary artery disease (CAD) more precisely in patients having multiple traditional risk factors so it may reduce morbidity and mortality due to CAD and elevated CIMT can be used as surrogate marker of underlying CAD.Methods: This study enrolled 250 admitted patients as a case of CAD. The patients were assessed by detailed history taking, thorough clinical examination, measurement of CIMT, blood sugar and lipid level.Results: Carotid artery disease was present in 88 (35%) of 250 CAD patients. All modifiable cardiovascular risk factors were statistically significantly high in patients of CAD with carotid artery disease. In obese, diabetic, hypertensive, dyslipidemia and smoker patients, carotid artery disease was present in 55% (P = 0.00), 41% (P = 0.00), 43% (P = 0.007), 47% (P = 0.002) and 43% (P = 0.003) respectively. CAD patients who had 1 risk factor, 29% were associated with carotid artery disease. Comparison of single risk factor with patients who had no risk factor, there was non-significant correlation for carotid artery disease. CAD patients who had 2, 3, 4 and 5 risk factors, carotid artery disease was present 24 (32%) (p = 0.02), 15 (55%) (P = 0.0003), 17 (61%) (P = 0.00006) and 6 (67%) (P = 0.0008).Conclusion: elevated CIMT can be used as one of the important risk factor for early diagnosis of CAD and to reduce morbidity and mortality due to CAD

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Utility of physical examination and comparison to echocardiography for cardiac diagnosis

Objective: To find out the accuracy of cardiac auscultation using non-digital stethoscope in physical diagnosis of cardiac diseases. Methods: We enrolled 104 consecutive patients with abnormal cardiac auscultatory findings attending cardiology clinic and not previously evaluated by echocardiography. One time detailed cardiac physical examination followed by echocardiography within 1 month was undertaken. Agreement between two methods was calculated using mean pair percentage agreement, kappa statistics (κ) and calculation of 95% confidence interval (CI) for kappa statistics. Results: Using kappa statistics, there was almost perfect agreement between cardiac auscultation and echocardiography for the detection of mitral stenosis (κ = 0.865; CI 0.76–0.97) and ventricular septal defect (κ = 0.872; CI = 0.73–1.01). Substantial agreement was noted for aortic stenosis (κ = 0.752; CI = 0.56–0.94), pulmonary stenosis (κ = 0.647; CI = 0.33–0.97) and atrial septal defect (κ = 0.646; CI = 0.32–0.97), while moderate agreement was found for mitral regurgitation (κ = 0.470; CI = 0.30–0.64), aortic regurgitation (κ = 0.456; CI = 0.25–0.66) and tricuspid regurgitation (κ = 0.575; CI = 0.38–0.77). For combined mitral stenosis and mitral regurgitation lesions, almost perfect agreement was found for mitral stenosis (κ = 0.842; CI = 0.691–0.993) while fair agreement noted for mitral regurgitation (κ = 0.255; CI = −0.008 to 0.518). Conclusion: Careful clinical auscultation using a stethoscope remains a valuable tool for cardiac diagnosis. Decision on initial diagnosis and management of valvular and congenital heart diseases should be based on clinical examination and integrating such information with echocardiography as required

Prevalence of hypertension and prehypertension in schoolchildren from Central India

Background: Epidemiological transition with increasing burden of cardiovascular risk factors is evident not only in adults but also in children. The data on the prevalence of prehypertension and hypertension in children show large regional differences in India and such data are not available from Central India. We, therefore, conducted a large cross-sectional study in Indore to determine the distribution of blood pressure (BP) and the prevalence of hypertension and prehypertension among schoolchildren. Methods: A total of 11,312 children (5305 girls, 6007 boys) aged 5–15 years, drawn from 80 government and private schools in equal proportion, were evaluated. Anthropometric measurements were obtained and BPs were measured using The Fourth Report on The Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents as reference standard. BP ≥90th to <95th percentile for given percentile of height was considered as prehypertension, whereas any BP ≥95th percentile was defined as hypertension. Multiple linear regression analysis was used to find out the determinants of hypertension in these children. Results: Prehypertension was detected in 6.9% and 6.5% and hypertension was found in 6.8% and 7.0% of boys and girls, respectively. Height and weight were found to be a significant predictor of systolic and diastolic BP among both boys and girls. Conclusions: Our results show a high prevalence of prehypertension and hypertension in Indore schoolchildren with age and height being significant determinants. This highlights the need for routine BP measurements in children by pediatricians when they treat them for intercurrent illnesses or vaccinate them. It should also be mandatory as a part of school health checkup programs to detect childhood hypertension for further counseling and therapy

Biomedical applications of polysaccharide nanoparticles for chronic inflammatory disorders: Focus on rheumatoid arthritis, diabetes and organ fibrosis

Polysaccharides are biopolymers distinguished by their complex secondary structures executing various roles in microorganisms, plants, and animals. They are made up of long monomers of similar type or as a combination of other monomeric chains. Polysaccharides are considered superior as compared to other polymers due to their diversity in charge and size, biodegradability, abundance, bio-compatibility, and less toxicity. These natural polymers are widely used in designing of nanoparticles (NPs) which possess wide applications in therapeutics, diagnostics, delivery and protection of bioactive compounds or drugs. The side chain reactive groups of polysaccharides are advantageous for functionalization with nanoparticle-based conjugates or therapeutic agents such as small molecules, proteins, peptides and nucleic acids. Polysaccharide NPs show excellent pharmacokinetic and drug delivery properties, facilitate improved oral absorption, control the release of drugs, increases in vivo retention capability, targeted delivery, and exert synergistic effects. This review updates the usage of polysaccharides based NPs particularly cellulose, chitosan, hyaluronic acid, alginate, dextran, starch, cyclodextrins, pullulan, and their combinations with promising applications in diabetes, organ fibrosis and arthritis