Background: The role and benefits of lipid-lowering drugs in active management of dyslipidemia are well established. However, a little is known about whether these drugs are prescribed as per the recent guidelines and the desired effect is achieved or not in routine clinical practice. The aim of this study was to evaluate the prescription patterns and adequacy of use of statins at a tertiary care hospital. Patients and Methods: Patients aged ≥18 years eligible to receive statin therapy for primary or secondary prevention according to the American Heart Association 2018 guidelines were included in the study. Clinical records of all the cases were reviewed for indications of statins, and lipid profile was done at baseline and after 3 months of statin therapy. Results: There were 140 men and 103 women with a mean age of 52.24 ± 12.01 years. 109 (44.9%) patients received statins for primary prevention, whereas 134 (55.1%) patients received statins for secondary prevention. A total of 179 (73.7%) and 64 (26.3%) patients each received atorvastatin and rosuvastatin. 81.9% of the study population received statins according to the guidelines. After 3 months of statin therapy, there was a statistically significant change in the lipid profile in both primary and secondary prevention groups. Conclusions: There are some irrational prescribing practices among physicians affecting the performance of statin therapy in primary and secondary prevention of atherosclerotic cardiovascular disease. A need to rationalize the prescription practices by keeping abreast with the latest recommendations as well as effective patient counseling and education seems warranted.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Rheumatic Fever (RF) and Rheumatic heart disease (RHD) are common cardiovascular diseases in developing countries. Long-term Benzathine Penicillin G (BPG) injection is being used for secondary prophylaxis of RF/RHD. Although allergic reactions to BPG are rare, there is a lot of fear and hesitancy in administering it. Objective: The objective of this study is to assess the safety of injection BPG used for secondary prophylaxis of RHD. Methods: Patients who had received secondary prophylaxis to RHD at our institute's outpatient department from January 1, 2015 to December 31, 2020, were analysed retrospectively. Results: Among 25,819 injections of BPG given to 2878 patients, eight patients had adverse events. Five patients had anaphylaxis, two had urticaria, and one had vasovagal syncope. Incidence of adverse events was 0.03% of injections and 0.28% of patients. Majority of adverse events were seen in patients more than 18 years (7 out of 8). All were treated successfully and there was no mortality. Conclusions: Life-threatening allergic reactions are very rare in patients on long-term intramuscular BPG for secondary prevention of RHD.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Acute myocardial infarction with high thrombus burden poses a challenge to the operating surgeon. Thrombus migration can worsen the clinical condition by further occluding flowing vessels. In our case of acute anterior wall myocardial infarction, thrombus migration from left anterior descending (LAD) caused obstruction of the left circumflex artery (LCX), and ramus. Bailout percutaneous transluminal coronary angioplasty (PTCA) was done to LCX, ramus, and left main which helped the patient hemodynamically but soon succumbed to sudden cardiorespiratory arrest. Hence, bailout PTCA remains a challenging procedure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background and Aims: Along with the conventional risk factors and based on the Framingham risk score, a preventive measure can be targeted in those subjects who are in risk category. The use of genotype-based assessment in these subjects can be much benefited in clinical decision-making. Hence, we aimed to match the risk frequency with genotype score for rs10757278 in asymptomatic coronary heart disease (CHD) individuals. Methods: This is a cross-sectional study with 105 participants. These subjects were without any clinical presentation of CHD. Single-nucleotide polymorphism 10757278 was genotyped using tetra-primer amplification refractory mutation system–polymerase chain reaction. Results: The minor allele frequency was 0.84 higher though the subjects were asymptomatic. When the group was categorized using Framingham risk score (low, moderate, and high), it was observed that the risk allele was 0.74 versus 0.77 versus 0.93. The risk allele frequency (male) in low, moderate, and high groups was 0.76 versus 0.79 versus 0.94. This incremental rise was lost in females with risk allele frequency to be 0.81 versus 0.76 versus 0.87. It is observed that the association between gender and risk status was significant (P < 0.001) both while considering risk wise and even after considering the risk allele. Conclusion: A good individual predicted risk can be assessed using global risk stratification along with the knowledge of the interaction of genetics. Further, to determine the accuracy and clinical utility of such reclassification, more prospective studies are needed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Heart failure (HF) causes a high impact on morbidity and mortality; it also affects the quality of life (QOL) and psychometric components. Aim: To develop a simple module to assess QOL including various parameters such as functional status, symptoms, emotional well-being, financial impact, social function, and health-related behavior. Methods: The study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, which has an annual inpatient admissions of over 12,000 cardiac cases. Two hundred patients were included in the study. All 200 patients were given both Minnesota Living with HF (MLHFQ) Questionnaire and Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) Questionnaire after translation into their native language. Results: Out of 200 patients, 75% were male. 71% of them had ischemic heart disease. The mean questions filled were 18.45 in SJICSR-QOL questionnaire and 20.29 in Minnesota questionnaire. The time taken for the researcher to conduct the interview and for the patient to fill up the SJICSRQOL Questionnaire was significantly less than that needed for the Minnesota Questionnaire. Cronbach's alpha tool was utilized to analyze the reliability. When seven subgroups were considered, the questions showed reliability of 0.879, and when six subgroups were considered, the reliability was found to be 0.898. Conclusion: Both SJICR-QOL and MLQOL are valid and reliable tools of measure of QOL in patients with HF. The time taken was lesser, and more questions were answered in SJCISR-QOL questionnaire. It is a potential tool for future use in both research and clinical practice in congestive HF patients, even in primary care setting.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

We present a rare case of Brucella endocarditis in a case of the bicuspid aortic valve in a 51-year-old male presenting with pyrexia of unknown origin for the last 2 months. Infective endocarditis caused by Brucella melitensis is rare to encounter in routine clinical practice. Although we routinely think of Mycoplasma, Legionella, and Coxiella in the cases of blood culture-negative endocarditis, one should think of Brucella melitensis and Scrub typhus as the last arrow to reach the final etiology of infective endocarditis in the subset of diseased aortic or mitral valve. We successfully treated the patient with a combined regimen of rifampicin, gentamicin, and doxycycline therapy; during follow-up, the vegetation of the aortic valve was shrunken and calcified and the patient was asymptomatic.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]