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Background: Indian studies on significant atrioventricular (AV) block in entire spectrum of acute coronary syndrome (ACS) and its relation with clinical outcome are limited. Aims: The aim of this study is to determine the incidence, clinical predictor, and outcome of significant AV block complicating entire spectrum of ACS. Methods: All patients presenting with ACS from June 2017 to December 2018 were included in the study. The study population was divided into case and control groups based on the presence of significant AV block, either at admission or during hospitalization. The baseline clinical characteristics, mode of presentation, clinical course in the hospital, treatments in hospital, and complications related to the ACS and its treatment were analyzed between case and control groups. The inhospital and 30 day outcome was also analyzed. Results: A total of 1001 patients with ACS were included. One hundred and twenty-five patients of ACS with significant AV block comprised the study population (cases) and the rest 876 patients with ACS without significant AV block comprised the control population. The overall incidence of significant AV block was 12.48%. Patients with significant AV block had higher incidence of diabetes (40% vs. 20.77%, P-0.001), hypertension (36.8% vs. 20.89%, P-0.002), and history of smoking (57.6% vs. 34.2%, P-0.0001). On clinical presentation, patients with significant AV block had lower mean heart rate and higher killip class. Inferior wall myocardial infarction (44.4% vs. 22.8%, P-0.0001) was higher in cases, whereas anterior wall myocardial infarction (25.6% vs. 43.3% P-0.001) and unstable angina (4% vs. 10.2%, P-0.02) were higher in controls. Percentage of patients undergoing temporary pacemaker implantation or percutaneous coronary intervention during hospitalization was higher in cases. At 30 days, mortality was significantly higher among cases (24% vs. 8.1%, P-0.0001). Conclusion: Our data represent the first reported study on significant AV block in entire spectrum of ACS in North-eastern India and has noted the high incidence of significant AV block in our population and is associated with a worse short-term outcome.

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Background: India has a substantial burden of acute coronary syndromes, yet awareness regarding treatment and outcome of these conditions is limited. Thus, the present study aimed to document the characteristics, treatments, outcomes, and reasons for prehospital delay in patients with ST-segment elevation myocardial infarction (STEMI) admitted to a tertiary care hospital in North East India. Materials and Methods: A prospective, hospital-based, observational study was conducted at a tertiary care hospital in North East India between December 2016 and November 2017. All consecutive patients presenting with electrocardiographic evidence of STEMI were included in the study. Results: A total of 100 patients were assessed. Of these patients, 84 (84.0%) were male and 59 (59.0%) were urban residents. Smoking, hypertension, and dyslipidemia were the most common risk factors observed in 71 (71.0%), 55 (55.0%), and 43 (43.0%) patients, respectively. Anterior wall myocardial infarction was the most frequent type of STEMI observed in 59 (59.0%) patients. Only 54 (54.0%) patients reached the hospital within the window period. The average time to reach the hospital was 355 min. Thirty-three (33.0%) patients underwent thrombolysis, while 14 (14.0%) patients underwent primary percutaneous coronary intervention. Inhospital mortality occurred in 5 (5.0%) patients. Conclusion: Most patients were in the 60–69 years' age group, urban residents, and smokers. They received late medical care and received emergency therapies less often. In most cases, prehospital delay was due to patient inability to recognize symptoms at onset. Strategies to curb tobacco use, decrease prehospital delay, and improve urgent care could reduce morbidity and mortality in this patient subset.

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Background: Early risk stratification is recommended in daily clinical practice to predict adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Complete blood count and blood glucose analysis is routinely performed on admission. Hence, this study was undertaken to find out the predictive value of white blood cell (WBC) indices and glycemia to know adverse outcomes in STEMI. Methods: In an observational study conducted between December 2015 and October 2018 at a tertiary center, 400 patients with acute STEMI were included. Results: We had 400 patients of STEMI. In this study, mean total leukocyte count (TLC), total neutrophil count (TNC), neutrophil-to-lymphocyte ratio (NLR), and plasma glucose were higher in those with complications (13,449.8/mm3, 10,460.5/mm³, 5.20 and 180.8 mg%) than those without complications (11,318.3/mm³, 8581.9/mm³, 4.15, and 151.1 mg%) (P < 0.05). The cutoff point of TLC >13 × 1000 cells/mm³ had a sensitivity of 73.5% and specificity of 63% in predicting postmyocardial infarction mortality (area under the curve = 0.68, P < 0.001). Patients with acute hyperglycemia (≥140 mg%) had higher incidence of hypotension (31.12% vs. 17.64%, P < 0.05), left ventricular failure (32.14% v/s. 21.1%, P < 0.05), ventricular arrhythmias (13.26% vs. 6.86%, P < 0.05), and higher inhospital mortality (P = 0.0001). Multivariate analysis predicting inhospital mortality as dependent variable TLC >13 × 1000 cells/mm3, TNC >10.5 × 1000 cells/mms3, NLR ≥5.20, and plasma glucose >140 mg/dl were the variable found to be statistically significant (P < 0.05). Conclusion: The WBC indices (TLC, TNC, and NLR) and plasma glucose on admission are independent predictors of major cardiovascular events and inhospital mortality in STEMI.

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Context: Cardiovascular manifestations of tertiary syphilis include aortitis, aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. There are few reported cases of coronary aneurysms and coronary dissection. However, in the modern era of antibiotics, classic manifestations are rarely seen. We intend to study the spectrum of coronary artery disease in seropositive syphilis patients undergoing cardiac catheterization. Subjects and Methods: Coronary angiogram of 150 patients seropositive for syphilis from March 2019 to April 2020 was reviewed. Seropositive for both Venereal Disease Research Laboratory and Treponema Pallidum Hemagglutination Assay tests were an essential inclusion criterion. Prevalence of left main stenosis, coronary ostial stenosis, aneurysms, dissections, and other features were studied and compared to standard prevalence in the general population undergoing coronary angiogram. Results: Mean age was 56 years and 109 (73%) were male. Thirty-three percent were smokers, 39% were diabetic, 45% hypertensive, and 5% had prior stroke. We noticed left main stenosis in 8%, isolated ostial left main stenosis in 1.3%, spontaneous coronary artery dissection in 0.7%, and coronary aneurysm and ectasia in 4%; a similar prevalence to the general population as compared with earlier trials. Conclusion: In the present study, there was no significant increase in aorto-ostial stenosis, coronary aneurysm, or coronary dissection in seropositive syphilis patients. The classic manifestations of tertiary syphilis are rare in the modern era. All syphilis patients should be treated with proper antibiotics, as a case of giant aneurysm post left main ostial stenting was noticed in an untreated patient.

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Congenital heart defects are associated with various extracardiac malformations. Among them, association of congenital upper-limb malformations is common and frequently referred as heart–hand syndrome. Thumb malformations are most frequent among upper-limb malformations. The most common among them is Holt–Oram syndrome which consists of atrial septal defect with absent radius or thumb anomalies. Patent ductus arteriosus (PDA) with hand anomalies are quite rare. The authors present a peculiar hand deformity with PDA in a 2-month-old infant. The right hand revealed oligodactyly with syndactyly of the thumb and forefinger, the absence of carpal bones, few metacarpals, and phalangeal components.

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