Early diagnosis HFpEF, heart failure with preserved ejection fraction in cardiomyopathy, a chance to treat and reduce morbidity and mortality

Background: Cardiomyopathy as a diagnosis almost signifies a kind of end stage disease of the myocardium. With conditions like hypertension, diabetes and ischemic heart disease on the rise, we are seeing a large number of cases diagnosed as cardiomyopathy, most common presenting feature being Heart failure. Echocardiography (ECG), is non-invasive and easily available and can pick up early signs of failure in the form of diastolic and systolic dysfunction. To study patients with cardiac symptoms, by clinical, ECG, and Echocardiography parameters.Methods: A cross-sectional, observational study of 50 patients aged 18-80 years with cardiac symptoms (dyspnoea, palpitations, pedal odema) was carried out over a period of 3 years in a semi-urban Medical College Hospital in Western Maharashtra. Patients of Acute coronary disease, valvular and congenital heart disease and chronic obstructive pulmonary disease (COPD) were excluded from the study. Data collected, tabulated and subjected to statistical analysis.Results: Our study of 50 patients had 50% Diabetic and 42% Hypertensive patients. 2D echo findings were clinically significant in the form of diastolic dysfunction (36%), systolic dysfunction (12%). Ejection fraction (EF) was significantly reduced, in most patients, but 4% patients had HFpEF, i.e. EF=55% and 24% had EF between 30-55%Conclusions: Our study of 50 patients of Cardiomyopathy had more hypertensives and diabetics, and most of them less than 60 years of age and mostly male. HFpEF was detected in 4% and 76% had EF30-60% and 24% had EF<30%. Diastolic dysfunction was diagnosed in more than half and systolic dysfunction in few on ECG. 

A case of autoimmune hypothyroidism presented as overlap syndrome of mixed connective tissue disorder

Mixed connective tissue disease is a distinct complex overlap disorder characterised by combination of clinical features of systemic lupus erythematosus, systemic sclerosis, polymyositis and rheumatoid arthritis. Higher levels of anti-U1-ribonucleoprotein (anti-U1RNP) antibody has been found in these patients. 39 year old female, known case of hypothyroidism, came with complaints of multiple joint pains with swelling associated with morning stiffness of fingers since last 2 years. She also had dryness of skin, loss of appetite, constipation, difficulty in swallowing and dyspnea on exertion since last 2 months. Considering the joint pains an antinuclear antibody (ANA) was sent. She turned out to be RNP, Sm, Ro 52, Mi-2 positive. Anti-CCP, rheumatoid factors (RA), Raynaud’s phenomenon all were positive. Rheumatologist opinion was taken and she was diagnosed as mixed connective tissue disorder with hypothyroidism. Patient was successfully treated with immunosuppressants and supportive measures and responded well to tablet methotrexate, prednisone, nifedipine and hydroxychloroquine. Our patient had one major and 3 minor criteria: anti RNP antibody positive, Raynaud’s phenomenon, swollen fingers and synovitis. Thus, diagnosed as mixed connective tissue disease

A rare presentation of immune thrombocytopenic purpura

Immune thrombocytopenic purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without any apparent cause. Some patients may be diagnosed during routine blood investigations or may present with bleeding diathesis. Treatment required for moderate to severe thrombocytopenia or those with bleeding manifestations. We present a case of 43 year old male, sputum positive pulmonary tuberculosis on isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E) (HRZE) with persistent thrombocytopenia. He developed hepatitis hence isoniazid (INH) and rifampicin were stopped. He had fever, rash, purpura, hematuria and blood tinged sputum with platelet count of 10,000. 4 random donor platelets (RDPs) given. He suffered from mild COVID-19 infection and recovered in 2 weeks but platelets remained low. Bone marrow examination was suggestive of ITP. Inspite of steroid therapy no improvement was seen. Later was treated with injection romiplostim, and started on systemic lupus erythematosus (SLE) regimen for tuberculosis and discharged with regular follow up. Last platelet count being 1,20000/dl, liver function tests normal and now restarted on HRZE

The anti-synthetase syndrome in a type 1 diabetes

Anti-synthetase syndrome is an autoimmune disease associated with interstitial lung disease (ILD), dermatomyositis and polymyositis. It has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with dermatomyositis. 37-year-old male, known case of type 1 diabetes mellitus, came with complaints of: generalized anasarca, pain in both knees, ankles, wrist and small joints of fingers. He also had dyspnoea on exertion, chronic non-productive cough, and fever off and on, all for 1 month. Initially all involvement was attributed to diabetes. For joint pain an antinuclear antibodies (ANA) was sent. He turned out to be anti-Jo1, antibody positive. Rash on hands was diagnosed by dermatologist as, mechanic’s hand, hence diagnosed as an inflammatory myopathy with dermatomyositis anti-synthetase syndrome. Patient was successfully treated with immunosuppressants and supportive treatment and responded to tablet Prednisolone and Mycophenolate mofetil. The patient had one major and 2 minor criteria-ILD, arthritis and Mechanic’s hand and anti-Jo 1 antibody positive. Thus, diagnosed as anti-synthetase syndrome with type 1 diabetes mellitus