Importance of carotid intimal medial thickness measurement in patients with coronary artery disease

Background: Prevalence of CAD in urban India is about double that of rural India and about 4-fold higher than in United States. Mortality related to CAD is high in Indian Population. Early diagnosis can prevent the CAD related morbidity and mortality. Aims and objectives is to study and compare the CIMT among the patients with CAD and asymptomatic control group.Methods: Hundred patients with CAD were studied for the CIMT and compared with age and sex matched asymptomatic control subjects in Department of Medicine of G. R. Medical College, Gwalior for one year from 2012 to 2013. Details on history, risk factors and presenting symptoms were recorded for all. High resolution B mode ultrasonography was performed to assess CIMT of carotid arteries.Results: CAD was more prevalent among males (78%) having mean age of 56.82±8.91 years. Majority of CAD patients had dyslipidemia (42%) followed by hypertension (21%), diabetes (13%) and smoking (17%). Majority of the CAD patients had chest pain (98%) followed by breathlessness (54%) and sweating (12%) as the most common presenting symptom. Mean CIMT was significantly more among the CAD patients (0.76±0.34) as compared to those without it (0.63±0.22) (p<0.001).Conclusions: CIMT was found to be more in CAD as compared to asymptomatic control subjects. CIMT can be an important tool for assessing CAD and atherosclerosis

Acute Coronary Syndrome in Patients of Chronic Obstructive Pulmonary Disease and Its Relationship with Brachial Artery Flow Mediated Dilatation

Background:Both Chronic obstructive pulmonary disease (COPD) and Coronary artery disease (CAD) are closely related etiologically as well as pathophysiologically. Prevalence of both the diseases is rising to a great extent and have become one of the major causes of mortality and morbidity worldwide. Objectives:Present study was carried out in order to study prevalence of CAD among patients of COPD and identify high risk patients via BAFMD (Brachial artery flow mediated dilatation).Materials and Methods:Present cross sectional study was conducted in Medicine Department of a tertiary care hospital over a duration of one year on randomly selected cases of COPD, using pre-designed validated questionnaire. All cases underwent spirometry; cardiac evaluation via electrocardiography and echocardiography; and BAFMD was studied via Doppler USG.Result:The prevalence of CAD in COPD patients was found to be 24%. The prevalence of CAD correlated well with the severity of COPD i.e. 25% in GOLD staging III/IV as compared to 2.5% in GOLD staging I/II. Also, BAFMD was severely impaired in patients who had evidence of CAD. Mean value of BAFMD was significantly low in patients who had CAD as compared to those without CAD (5.37± 2.36% vs 9.20± 2.50%). Conclusion:We recommend the screening of patients of COPD via BAFMD and Echocardiography, for identifying high risk patients and early detection of cardiac involvement giving time for proper preventive and treatment measures for better outcomes

NORMOLIPEMIC TUBEROUS XANTHOMAS

Xanthomas are often a manifestation of underlying lipid abnormalities. A 50-year-old male presented to our hospital with the lesions of multiple tuberous xanthomas all over the body. Routine investigations and systemic examination were normal. Lipid profile was within normal range and serum protein electrophoresis showed normal pattern. Histopathology from a nodular lesion showed collection of foamy macrophages in the dermis. We present a case of normolipemic tuberous xanthomas, which is an uncommon occurrence

Study of sepsis-induced myocardial dysfunction and its correlation with SOFA score and Creatine kinase-MB

Background: Incidence of Sepsis-Induced Myocardial Dysfunction (SIMD) is reported at 18% to 65%, and the mortality rate is 40% to 70%. Few studies have explored the role of Creatine kinase-MB (CK-MB) as a biomarker for SIMD. Previous studies have proved that levels of cardiac biomarkers were higher in non-survivors.Aims and objectives:To study the frequency and spectrum of myocardial dysfunction in patients with sepsis by transthoracic echocardiography and evaluate the association between CK-MB and Sequential Organ Failure Assessment (SOFA) score.Materials and Methods:One hundred patients aged&gt;18 years satisfying the sepsis definition with SOFA score ≥2 were studied at the Department of General Medicine and Cardiology on an in-patient basis. The cohort was grouped into SOFA score &lt;5, between 5 and 7, and &gt; 7.Clinical evaluation, assessment of complete blood counts, liver and renal function tests, serum electrolytes, arterial blood gas analysis, and 12-lead electrocardiography was performed. All patients were also subjected to two-dimensional transthoracic echocardiography.Results:The majority of the patients had a SOFA score &lt;5 (53%), 30 had a SOFA score between 5-7, and 17 had a SOFA score &gt;7. Out of 17 patients who had SOFA score &gt;7, all had elevated CK-MB, similarly out of 30 patients who had SOFA score between 5-7; the majority had elevated CK-MB (86.7%) (P&lt;0.001). Out of 17 patients who had SOFA score &gt;7, all of them had an abnormal myocardial function; out of 30 patients who had SOFA score between 5-7, the majority had abnormal myocardial function (80%) (P&lt;0.001).Conclusion:SOFA score and CK-MB are vital tools for assessing myocardial dysfunction in patients suffering from sepsis. Early detection can reduce the risk of mortality