Study of coronary artery disease in young population of Central India

Background: Coronary heart disease is the most common indication among cardiovascular diseases (CVD) and a major cause of mortality and morbidity. According to global burden of disease study estimates, nearly 24.8% of all deaths in India are attributable to CVD. Objectives of the current research study were to establish a correlation between varied risk factors and coronary artery disease (CAD), to determine angiographic characteristics individually in patients with multiple risk factors and to evaluate number of vessels involved in CAD.Methods: Present study was a prospective study conducted on 50 patients with acute coronary syndrome below 40 yrs of age admitted at the department of cardiology, Superspeciality hospital, NSCB medical college, Jabalpur. All patients included in the study were subjected to coronary angiography. The angiographic characteristics such as extent of CAD (characterized by the number of vessels with angiographic lesions) were determined.Results: Current study findings depicted that most of CAD patients were in age group of 36-40 years. Proportion of males was higher than females. One-fifth of patients were diabetics and 34.0% were hypertensive. It was observed that 54.0% CAD patients had history of smoking and 32.0% had history of premature CAD. Most of patients exhibited single vessel disease in CAG and left anterior descending (LAD) was the most commonly involved artery.Conclusions: Smoking was concluded as one of the major risk factor associated with CAD and most of patients exhibited single vessel disease, LAD being the most commonly involved artery. Significant number of patients with family history depicted high risk for CAD. Males were concluded to be more prone to CAD at younger age

Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

BACKGROUND: Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) commonly require hospitalization and admission to intensive care unit (ICU). It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. METHODS: Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. RESULTS: Invasive ventilation was required in 69 patients (84.1%). Fifty-two patients survived to hospital discharge (63.4%). APACHE II score at the time of admission to ICU {odds ratio (95 % CI): 1.32 (1.138–1.532); p < 0.001} and serum albumin (done within 24 hours of admission) {odds ratio (95 % CI): 0.114 (0.03-0.432); p = 0.001}. An equation, constructed using the adjusted odds ratio for the two parameters, had an area under the ROC curve of 91.3%. For the choice of cut-off, sensitivity, specificity, positive and negative predictive value for predicting outcome was 90%, 86.5%, 79.4% and 93.7%. CONCLUSION: APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients

Echocardiographic study of left atrial myxoma

Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma

Fungal endocarditis after cardiac valve replacement

Fungal endocarditis developed in 15 cases out of 205 in whom cardiac valves were replaced during the years 1969-75. Bacterial and fungal infections co-existed in 3 cases. Pure bacterial endo-carditis was seen only in one case during this period. Fungal endo-carditis was not observed following any other type of open or closed heart surgery. Clinicopathologic features of these cases are briefly described. Paucity of clinical signs and symptoms make early diagnosis difficult. The diagnosis of fungal infection was essentially histological. It was corroborated by culture in 3 cases. In 6 cases candida was responsible while in others either Aspergillus or Penicillium was responsible. In 11 out of 15 cases, endocarditis supervened in the early post-operative period stressing the need for vigilance

An unusual instance of mitral valve prolapse in endomyocardial fibrosis

This is a report of an unusual case showing a mitral valve prolapse in the presence of a biventricular endomyocardial fibrosis (EMF). The EMF was strongly suspected on left ventricular angiography and later proved at autopsy. The prolapse of the mitral valve was detected at echocardiography. To the best of our knowledge this is the first report of a case of EMF associated with mitral valve prolapse

Echocardiographic study of left atrial myxoma

Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio­graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my­xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis­appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma

Arterial stiffness in obese children: Role of adiposity and physical activity

Objective: To explore association of adiposity and physical activity with arterial stiffness and to propose optimal waist circumference cutoffs, corresponding to 90 th percentile of NHANES (National Health and Nutrition Examination Survey) for Indian children and adolescents. Materials and Methods: Data on weight, height, waist circumference, physical activity and right Carotid artery Intima-Media-Thickness (CIMT), pulse wave velocity (PWV), elasticity modulus (Ep), stiffness index(β), arterial compliance (AC) were assessed in 250 children (72 normal-weight and 178 overweight/obese) aged 6-17 years from Pune city, India. Body composition was measured using Dual energy X-ray absorptiometry. Results: Total, 37.1% normal-weight and 98.2% overweight/obese children had high adiposity (>95 th body fat percentile). Positive association of PWV and Ep (r = 0.5) also β(r = 0.25) with BMI (Body Mass Index), waist circumference and body fat (P < 0.05) was observed. Physical activity was inversely associated with PWV (r =-0.2), β(r =-0.13), Ep (r =-0.12) and positively with AC (r = 0.12) (P < 0.05). PWV significantly increased with increasing body fat for each tertile of physical activity (P < 0.05). Regression analysis revealed waist circumference, BMI, body fat and physical activity as independent associates for PWV after adjusting for age (P < 0.05). The cutoff of waist circumference yielding sensitivity and specificity for predicting the risk of high PWV was (−0.43, −0.44) for boys and girls with sensitivity in boys (girls) of 78% (87%) and specificity in boys (girls) 51% (70%). The observed cutoffs are less than the NHANES-III cutoff values of waist circumference for 90 th percentiles according to age and sex. Conclusion: High adiposity and low physical activity are adversely related to arterial stiffness in Indian children