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REVIEW ARTICLES
Oats: A multi-functional grain
Purvi Varma, Hitha Bhankharia, Shikha Bhatia
January-March 2016, 5(1):9-17
DOI:10.4103/2250-3528.183984  
Oats are predominantly a European and North American crop, as they have cool moist climate; Russia, Canada, the United States, Finland, and Poland are leading oat producing countries. Oats have been used as livestock and human foods since ancient times. Oats (Avena sativa) is a class of cereal grain essentially grown for human consumption as well as for livestock fodder. Food industry fundamentally alter agricultural commodities into foods making it edible, palatable as well as appealing; by innumerable physical and chemical operations increasing shelf-life, bioavailability of the nutrients, stabilizing colour, flavour along with increase in the economic value of the grain. Recent observational and human interventional studies indicate that oats can have an impact on various non-communicable diseases like cardiovascular disease, diabetes; obesity and hypertension etc. Therefore it is important to increase awareness of oats and its health benefits among individuals thereby encouraging them to increase the frequency of oats in the diet. In the year 1997, USFDA approved the use of a health claim "3g/day of oat Beta- glucan may help lower blood total and low-density lipoprotein (LDL-C) cholesterol". Over all consumption of oats has increased in the recent years due to its nutritional benefits; presence of Beta-glucan, antioxidants like Avenanthramides, vitamin E (tocotrienols and tocopherols).
  14 14,292 1,213
SPECIAL ARTICLE
Lipid Association of India Expert Consensus Statement on Management of Dyslipidemia in Indians 2016: Part 1 - Executive summary
Shamanna S Iyengar, Raman Puri, SN Narasingan
April-June 2016, 5(2):51-61
DOI:10.4103/2250-3528.186492  
  7 6,985 884
REVIEW ARTICLES
Marathon running for amateurs: Benefits and risks
Nitin Burkule
October-December 2016, 5(4):113-124
DOI:10.4103/2250-3528.192681  
The habitual level of physical activity of the human race has significantly and abruptly declined in the last few generations due to technological developments. The professional societies and government health agencies have published minimum physical activity requirement guidelines to educate the masses about the importance of exercise and to reduce cardiovascular (CV) and all-cause mortality at the population level. There is growing participation in marathon running by amateur, middle-aged cases with a belief that more intense exercise will give incremental health benefits. Experts have cautioned the nonathlete amateurs about the "exercise paradox" and probable deleterious effects of high-intensity prolonged exercise on CV and musculoskeletal system. The epidemiological studies suggest a "reverse J shaped" relationship between running intensity and CV mortality. The highest benefits of reduction in CV and all-cause mortality are achieved at a lower intensity of running while the benefits tend to get blunted at a higher intensity of running. The physicians should have a balanced discussion with the amateur runners training for a marathon, about risks and benefits of high-intensity exercise, and should evaluate them to rule out the occult coronary disease.
  6 8,480 749
VIEW POINT
Prevention or reversal of cardiometabolic diseases
Gundu HR Rao
January-March 2018, 7(1):22-28
DOI:10.4103/JCPC.JCPC_41_17  
Cardiometabolic risk is a condition in which the possibilities of developing vascular diseases including hypertension, metabolic syndrome, obesity, type 2 diabetes, ischemic heart disease, and stroke are significantly enhanced as a consequence of the presence of various risk factors, which are known to promote these conditions. Cardiovascular diseases (CVDs) cause one-third of all deaths worldwide. Noncommunicable Disease Risk Factor Collaboration, in their seminal article in the Lancet (April 2016), concluded that “if the post-2000 trends continue in the incidence and rise of diabetes, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025–2020 level worldwide is lower than one percent.“ According to the Institute for Health Metrics and Evaluation, today, 2.1 billion people, nearly 30% of the global population, are either obese or overweight – a new, first-of-a-kind analysis of trend data from 180 countries. As part of the 2020 impact goals, the American Heart Association (AHA) has set out seven ideal health goals; not smoking, maintaining a normal weight, increased physical activity, a healthy diet, normal blood lipid levels, normal blood pressure, and a normal fasting glucose. An analysis of the National Health and Nutritional Examination Survey showed that individuals who met five of the seven ideal metrics of AHA had a 78% reduction in the hazard ratio for all-cause mortality. The INTERHEART study estimated that modifiable risk factors accounted for 90% of the population attributable risk for heart disease in men and 94% of the risk in women. Consistent with this, Khera et al. (NEJM: 375:2349–582,016) showed that in four studies with over 55,000 participants, a favorable lifestyle intervention was associated with nearly 50% lower risk for coronary artery disease, in spite of the genetic risk. In this overview, we discuss some prevention strategies for the major cardiometabolic conditions such as hypertension, obesity, type 2 diabetes, and ischemic heart disease. We also discuss results of studies in which reversal of these disease conditions has been claimed.
  6 5,032 519
BRIEF REVIEWS
Fragmented QRS: A simple electrocardiographic prognostic marker in cardiovascular disease
Sita Ram Mittal
July-September 2016, 5(3):94-98
DOI:10.4103/2250-3528.191100  
Fragmented QRS is defined as the presence of R' wave or notching of R or S wave in the presence of narrow QRS. It indicates heterogeneous depolarization of the ventricular myocardium that can occur due to ischemia, fibrosis, or scar. It may also be a marker of coronary microvascular dysfunction. In the context of epicardial coronary artery disease, it is associated with multivessel disease and greater incidence of cardiac events. It has been shown to be an indicator of higher incidence of arrhythmias and sudden death in arrhythmic right ventricular dysplasia, Brugada syndrome, and acquired long QT syndrome. Its regression following cardiac resynchronization therapy suggests electrical reverse remodeling. It has also been shown to be a marker of myocardial involvement in congenital heart diseases and is helpful in diagnosing subclinical cardiac involvement in various systemic diseases.
  5 58,376 1,711
EDITORIAL
The Lipid Association of India Expert Consensus Statement 2016: A sea change for management of dyslipidemia in Indians
Enas A Enas, TS Dharmarajan
April-June 2016, 5(2):62-66
DOI:10.4103/2250-3528.186499  
  5 5,728 782
ORIGINAL ARTICLES
Clinical and angiographic profile of young patients with ischemic heart disease: A central India study
Sunita Dinkar Kumbhalkar, Vikas V Bisne
January-March 2019, 8(1):6-12
DOI:10.4103/JCPC.JCPC_22_18  
Objective: The present study was undertaken in young patients of ischemic heart disease (IHD) to assess clinical, biochemical and angiographic profile, conventional and newer risk factors, and correlation of risk factors with significant and nonsignificant coronary artery disease (CAD). Materials and Methods: This was a hospital-based cross-sectional study conducted in 70 cases of young IHD (male ≤35 years and females ≤40 years). Patients were evaluated for clinical, biochemical and angiographic profiles, and conventional risk factors such as dyslipidemia, hypertension (HT), diabetes mellitus (DM), and family history of premature CAD (PCAD). Newer risk factors such as lipoprotein (a) (Lp [a]), homocysteine, and plasma fibrinogen were also assessed in some (n = 44) cases. Results: Mean age of patients was 32.97 ± 3.93 years; 11 (15.7%) were women. Various risk factors such as tobacco/gutka chewing, HT, smoking, DM, and family history of PCAD were observed in 35.7%, 22.8%, 17.1%, 11.5%, and 8.6% of patients, respectively. Nearly 77.6% of patients presented with anterior wall myocardial infarction and 61.4% were having moderate left ventricular dysfunction on echocardiography. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and TC/high-density lipoprotein cholesterol (TC/HDL-C) were increased in 38.6%, 41.4%, 32.9%, and 25.7% patients, respectively. Newer risk factors such as Lp (a), homocysteine, and plasma fibrinogen were elevated in 61.4%, 77.3%, and 18.2% of patients, respectively. On coronary angiography, single-vessel disease was found in more than half of the patients (57.1%) followed by double-vessel disease (11.5%) and triple-vessel disease (7.1%). Coronary angiogram was normal in 24.3% of patients. Positive family history of PCAD, serum TGs, TC/HDL-C, and LDL-C/HDL-C were significantly (P < 0.05) associated with significant CAD as compared to nonsignificant CAD, whereas no such correlation was found in relation to newer risk factors. Conclusion: Indian males in South Asian population appear more prone to develop CAD; therefore, screening for risk factors should start at an earlier age. Smoking and tobacco chewing cessation, promotion of physical activities, and healthy dietary pattern have to be strongly encouraged in this vulnerable group.
  5 3,300 453
Association of depression, anxiety, and stress with myocardial infarction: A case–control study
MT Manoj, KA Joseph, Govindan Vijayaraghavan
July-September 2018, 7(3):86-92
DOI:10.4103/JCPC.JCPC_39_17  
Background: Myocardial infarction (MI), the most common cardiovascular disease, has assumed an epidemic proportion today. Higher prevalence of MI is reported from India (a low-middle income country) with the state of Kerala topping the list. Limited data exist on the impact of psychosocial factors on MI in India. Materials and Methods: A total of 100 cases (with MI) and 100 controls (without MI and matched for age and gender) were selected using consecutive sampling from a tertiary hospital in Trivandrum, Kerala, India. Data on depression, anxiety and stress were collected using the depression, anxiety and stress scales (DASS 21). Chi-square test was used to study the association of the variables under study with MI. Multivariate logistic regression was used to control for confounders. The unadjusted and adjusted odds ratios (OR) and 99% confidence intervals (CI) were estimated. Results: Depression (35% vs. 20%, P = 0.024), anxiety (41% vs. 14%, P < 0.001) and stress (36% vs. 15%, P = 0.002) had a statistically significant association with MI on comparing cases vs. controls. Higher levels of depression, anxiety and stress were associated with an increased risk of MI with OR of 2.790, 6.429, and 3.470, respectively. Conclusion: Depression, anxiety and stress were associated with MI. Prospective studies are required to confirm our findings.
  5 5,362 639
REVIEW ARTICLES
Soluble ST2: A biomarker to monitor heart failure progression and treatment
Marin Nishimura, Justin Sharim, Yu Horiuchi, Olga Barnett, Nicholas Wettersten, Alan S Maisel
October-December 2018, 7(4):148-153
DOI:10.4103/JCPC.JCPC_41_18  
Measurement of cardiac biomarkers has become routine for the care of patients with heart failure (HF). While troponin and natriuretic peptides are well-entrenched in the guidelines, soluble ST2 (sST2) is a novel biomarker that has shown consistent performance and is ready for clinical use. Multiple studies support the use of sST2 in both acute and chronic HF for prognostication. We suggest a novel scheme to guide HF management based on ambulatory sST2 levels.
  4 6,083 630
CASE REPORT
An unusual cause of ST elevation: Coronary vasospasm complicating acute myocarditis - A case report and review of the literature
Matthew K Rowe, Matthew Rutherford, Karam Kostner
October-December 2016, 5(4):146-148
DOI:10.4103/2250-3528.192699  
Coronary vasospasm and myocarditis are both recognized mimics of ST elevation myocardial infarction with normal coronary arteries. The occurrence of both pathologies in the same patient has rarely been described. We report a case of a 27-year-old man initially presenting with history and electrocardiogram (ECG) findings consistent with acute myocarditis who subsequently developed severe chest pain and new ST elevation, mimicking a myocardial infarction. Subsequent coronary angiography was normal, indicative of coronary vasospasm being the cause of ECG changes and symptoms. Previous case reports with a similar presentation are reviewed and potential mechanisms causing this association discussed.
  2 3,823 303
ORIGINAL ARTICLES
A pilot study to assess the effectiveness of cardiac rehabilitative teaching program on quality of life and physiological parameters among patients undergoing coronary artery bypass grafting in tertiary care hospital
KP Jyotishana, Kamlesh Kumari Sharma, Millind P Hote
October-December 2018, 7(4):137-143
DOI:10.4103/JCPC.JCPC_16_18  
Background: Coronary artery bypass grafting (CABG) is the most common of heart surgeries. Cardiac rehabilitation has been identified as an essential and safer part of care for patients undergoing CABG which eventually would improve quality of life (QOL) and physiological parameters. Objective: The aim of this study is to assess effectiveness of cardiac rehabilitative teaching program (CRTP) on QOL and physiological parameters. Subjects and Methods: A randomized controlled study was undertaken in fifty participants undergoing CABG between June 2016 and January 2017 at tertiary care hospitals. The experimental group received CRTP. The control group received routine teaching. Data were collected at the time of admission, 1 week after discharge, and 2 months after surgery using WHOQOL-BREF questionnaire, activity log sheet, and physiological parameter checklist. Results: The QOL scores of experimental group were significantly higher than the control group, at posttest 1 and posttest 2 in all domains except social domain at posttest 2 (P < 0.05). In both the groups, the QOL scores improved significantly within the group in each domain (P < 0.05) except social domain (P > 0.05). Within the groups, there was a significant improvement in all the physiological parameter scores (P < 0.05) in the experimental group whereas only in heart rate in case of the control group. There was a significant improvement in diastolic blood pressure and hip-waist ratio of experimental group as compared to the control group (P < 0.05). Conclusion: Structured CRTP in CABG patients is effective in improving QOL and to some extent in improving physiological parameters.
  2 3,186 282
A Cross-sectional study to look at the determinants of poor adherence to secondary penicillin prophylaxis for rheumatic heart disease at a tertiary care center in South India
Lalita Nemani, Jyotsna Maddury, Ramachandra Barik, Ashok Kumar Arigondam
January-March 2018, 7(1):5-10
DOI:10.4103/JCPC.JCPC_25_17  
Background: Rheumatic heart disease (RHD) continues to create havoc in the developing countries even decades after its discovery. It is entirely preventable through primordial, primary, and secondary level intervention. Secondary prevention is a reasonable treatment option in patients in India, but it suffers due to poor adherence which remains the main impediment to its implementation. The aim is to study the compliance with benzathine penicillin as secondary prophylaxis in RHD patients and to establish the patient-related factors for adherence and reasons for missing of doses. Materials and Methods: This is a cross-sectional study of RHD patients presenting to our institute. The demographic data, clinical history, and details of penicillin prophylaxis were noted. The patient was labeled as compliant or noncompliant depending on frequency and duration of prophylaxis as prescribed. Potential factors between the two groups have been analyzed by univariate and binary logistic regression. Results: The study cohort of 500 patients consisted of 261 compliant and 239 noncompliant patients. Average age of presentation was 29 ± 13 years with females outnumbering the males. Noncompliance with secondary prophylaxis was more prevalent among male (P = 0.003), low socioeconomic class (P = 0.0009), uneducated (P = 0.000018), and the rural population (P = 0.025) while those with previous history of rheumatic fever (RF) were found to be more compliant (P = 0.04). Recurrences of RF were more common in those not on regular prophylaxis (P = 0.011). The most common reason cited for noncompliance was the absence of proper counseling followed by a sense of well-being, injection site pain and financial constraints. Conclusion: Compliance with secondary penicillin prophylaxis is essential to ensure eradication of RHD. Education about the importance and necessity of prophylaxis would improve compliance. A close patient and health personnel relationship is important in improving adherence to secondary prophylaxis.
  2 3,510 393
Clinical profile of young Indian women presenting with acute coronary syndrome
UM Nagamalesh, T Abhinay, K C Karthik Naidu, N Ambujam, Anupama V Hegde, VS Prakash
July-September 2018, 7(3):106-110
DOI:10.4103/JCPC.JCPC_48_17  
Introduction: Coronary artery disease is an important public health issue in India. Over the last few decades, several studies have led to an understanding of the disease with respect to Indian population. However, lacunae still exist in several aspects of this burning health issue. There is a lack of data on acute coronary syndrome (ACS) in the young Indian population. Our study targeted an important subgroup of Indian population which is the young Indian women. In this study, we present a brief overview of the clinical and laboratory characteristics of young Indian women who presented in our Institute with ACS. Methods: A total of 63 female patients aged ≤45 years with a diagnosis of ACS after satisfying inclusion-exclusion criteria were chosen for the study. Baseline demographics, laboratory investigations, electrocardiogram, echocardiographic assessment, and coronary angiogram with subsequent treatment approach and outcomes were recorded. Results: Dyslipidemia was the most common prevalent risk factors among the study patients, while diabetes and hypertension were other common risk factors noted. Among 63 patients admitted with ACS, 77% (n = 21) received primary percutaneous coronary intervention (PCI) and 11.1% (n = 7) received thrombolytic therapy. The average duration of hospital stay was 4 ± 1 day. Conclusion: It was observed that dyslipidemia was major risk factor for ACS among young Indian woman included in our study. Other risk factors included diabetes mellitus and hypertension. Chest pain (95.2%) was the most common complaint. In 76% cases, the coronary angiogram revealed single vessel disease with left anterior descending coronary artery being the culprit vessel in 69.8% cases. Majority of the participants had preserved left ventricular function at the time of discharge. Nearly 85% of our patients received PCI as the revascularization strategy of choice.
  2 2,764 332
Levels of physical inactivity in rural and urban Tamil Nadu, India: A cross-sectional study
Carol Susan Devamani, Anu Mary Oommen, GK Mini, Vinod Joseph Abraham, Kuryan George
January-March 2019, 8(1):13-17
DOI:10.4103/JCPC.JCPC_32_18  
Background and Objectives: Physical inactivity is an important cardiovascular risk factor. This study assessed the prevalence and factors associated with insufficient physical activity (PA) in urban and rural Vellore, Tamil Nadu, India, among adults aged 30–64 years. Methodology: A cross-sectional World Health Organization STEPS survey was carried out in 48 wards of Vellore Municipality and nine rural villages of Tamil Nadu in 2010–2012. Adults (n = 6164, men 43.9%) aged 30–64 years were interviewed using the Global PA Questionnaire (2390 urban and 3774 rural). Insufficient PA was defined as not meeting the recommendation of 150 min of moderate aerobic PA, or 75 min of vigorous aerobic PA, or an equivalent combination, achieving at least 600 metabolic equivalent-minutes per day. Results: The prevalence of insufficient PA was 63.3% (95% confidence interval [CI]: 61.3%–65.3%) in the urban area and 40.6% (95% CI: 39.0%–42.2%) in the rural area. Women had a higher prevalence of insufficient PA compared to men, in both urban (70.8% vs. 53.8%) and rural (44.5% vs. 35.6%) areas. Those with higher education (odds ratio [OR]: 1.36, 95% CI: 1.20–1.53) and who were unemployed (OR: 2.97, 95% CI: 2.59–3.39) reported insufficient PA which was significantly higher than their counterparts. While urban participants had higher leisure time PA, rural participants had higher work- and travel-related PA. Conclusions: The high prevalence of insufficient PA found in this study shows that targeted interventions are needed to reduce insufficient PA, especially for women and urban populations.
  2 4,049 405
Wellysis S-PAtch Cardio versus Conventional Holter Ambulatory Electrocardiographic Monitoring (The PACER Trial): Preliminary Results
Satyanarayana Upadhyayula, Ravi R Kasliwal
October-December 2019, 8(4):173-182
DOI:10.4103/JCPC.JCPC_43_19  
Aims and Objectives: The Wellysis S-PAtch Cardio versus Conventional Holter Ambulatory Electrocardiographic Monitoring (PACER) trial consists of multiple arms. First arm is a prospective, interventional, nonrandomized, single group assignment, diagnostic substudy with intention to treat. This head-to-head trial aims to compare the diagnostic yield, or ability to detect arrhythmias – especially paroxysmal atrial fibrillation (PAF) – of the conventional Ambulatory Holter monitoring device with the Wellysis S-Patch Cardio, a novel, low-profile device consisting of a single positive bipolar lead corresponding to the standard limb lead II (n = 10). Second arm is a validation substudy of the Wellysis S-Patch Cardio device in terms of overall performance (n = 86). Background: It is widely recognized that technology can improve the health of populations in countries around the world. Smartphone technology is at the forefront of innovation in low-, middle-, and high-income countries. The smartphone technology has already improved the doctor–patient interaction, reducing costs and improving care for patients. Methodology: In the comparator arm, patients who satisfied the eligibility criteria as well as referred for ambulatory ECG monitoring were consented and enrolled prospectively to have the Holter monitor and the Wellysis S-Patch Cardio device placed simultaneously (n = 10) for 24–48 h and the incidence of clinically significant arrhythmias were compared. A feedback questionnaire was given to patients/paramedics and clinicians after completion of the study. The overall performance (patient, paramedic and clinician feedback and questionnaire derived subjective composite index of comfort, usability, interference with daily activities, adverse events, adaptability, robustness, repeatability, durability, clinical analysis, clarity of recorded signals, efficiency, accuracy, and cost-effectiveness) of Wellysis S-Patch Cardio device was compared with multi lead Holter Monitor in this head to head trial (n = 10). In the validation arm patients who satisfied the eligibility were consented and enrolled prospectively to have the Wellysis S-Patch Cardio device placed (n = 86) for 24–48 h and the incidence of clinically significant arrhythmias noted. Results: Preliminary results from the comparator arm (n = 10), Mc Nemars analysis, revealed odds ratio 1.000, 95% confidence interval 0.072–13.796, χ2 = 0.250, DF = 1, P < 0.6171; supporting the null hypothesis-Wellysis S-Patch Cardio is comparable to Holter in terms of Overall Performance (comfort, usability, interference with daily activities, adverse events, adaptability, robustness, repeatability, durability, clinical analysis, clarity of recorded signals, efficiency, accuracy, and cost-effectiveness). Conclusion: Multi lead ambulatory Holter monitoring remains the gold standard for arrhythmia detection. However, Wellysis S-Patch Cardio device has a definite complementary role in the detection of PAF in cryptogenic stroke patients.
  2 2,912 257
Correlation between earlobe crease and coronary artery disease in Indian population- A multicentre experience
Vikas Mishra, Dibbendhu Khanra, Kumar Himanshu, Bhavana Jain, Sunil Tripathi, Puneet Aggarwal, Shishir Soni, Navuluri Kranti Kumar Reddy, Rahul Singla, Meenakshi Mishra, Santosh Kumar Sinha
April-June 2020, 9(2):67-72
DOI:10.4103/JCPC.JCPC_10_20  
Background: Earlobe crease (ELC) has been found to be associated with the presence of coronary artery disease (CAD) in many studies; however, studies from India are limited. The aim of this study was to determine the prevalence of CAD in those with ELC and to assess the correlation of ELC with severity of CAD. Materials and Methods: This was a cross-sectional, multicenter study; 1400 patients undergoing coronary angiogram were approached, but 1070 patients were analyzed after excluding patients with ear piercings and other ear diseases. Patients were classified into no ELC, mild ELC, and severe ELC according to Ishi et al. Results: Seven hundred and eighty patients had CAD proven by coronary angiography. Of these, 74% (580/780) had an ELC either mild or severe. The patients with ELC had a significantly higher incidence of hypertension, diabetes mellitus, and hypercholesterolemia. However, the prevalence of smoking and family history of premature cardiovascular death were similar in both the groups. The prevalence of CAD was found to be significantly higher (odds ratio [OR]: 4.22 [95% confidence interval (CI): 3.18–5.61], P < 0.0001) among the patients with ELC (580/698) in comparison to patients without ELC (200/372). The prevalence of multivessel disease (MVD) was found to be significantly higher among the ELC-positive patients than ELC-negative patients (OR: 5.03 [95% CI: 3.61–6.90], P < 0.0001). Moreover, MVD was significantly more prevalent in patients (OR: 6.27 [95% CI: 4.23–9.29], P < 0.0001) in the severe ELC group (150/190) in comparison to the mild ELC group (190/508). Conclusion: ELC is an important clinical sign which should be examined carefully for its presence as well as severity. Both presence and severity of crease were related to occurrence and severity of CAD, respectively, in our study. Long-term cohort studies involving multiple ethnicity populations are necessary to determine the role of ELC in development as well as prognosis of CAD.
  2 1,171 109
Apixaban versus Warfarin in Patients with Left Ventricular Thrombus: A Pilot Prospective Randomized Outcome Blinded Study Investigating Size Reduction or Resolution of Left Ventricular Thrombus
W Yus Haniff W. Isa, Niny Hwong, Ahmad Khairuddin Mohamed Yusof, Zurkurnai Yusof, Ng Seng Loong, Nadiah Wan-Arfah, Nyi Nyi Naing
October-December 2020, 9(4):150-154
DOI:10.4103/JCPC.JCPC_41_20  
Background: Treatment of the left ventricular thrombus (LVT) with Vitamin K antagonists (VKAs) such as warfarin may lead to longer hospitalization. Thus, the potential of non-VKA oral anticoagulants as alternative to warfarin need to be explored. This study aims to investigate the size reduction or resolution of LVT with apixaban compared to conventional warfarin. Materials and Methods: This is a pilot, prospective, single-center, randomized, single-blinded outcome study with patients diagnosed with LVT. Patients diagnosed with LVT by echocardiography were randomized into two treatment groups: apixaban or warfarin, with target international normalized ratio 2–3. Echocardiography was repeated at weeks 6 and 12 to assess the LVT size. The percentage of reduction or total resolution during the first 12 weeks was the primary endpoint. Repeated measure ANCOVA was used to evaluate the differences in left ventricular (LV) thrombus size between treatment groups. Results: Twenty-seven patients were recruited: 14 were treated with apixaban and 13 patients with warfarin. Thirteen patients completed treatment in the apixaban arm with one patient lost to follow-up, and one death observed. In the warfarin arm, nine patients completed the study follow-up, and four died during the follow-up. The mean (standard deviation [SD]) reduction in LV thrombus size in apixaban arm was 65.1% (SD 31.3) versus warfarin arm, 61.5% (SD 44.0) at the 12th week follow-up (P = 0.816). Safety outcomes were similar with both treatment arms. Conclusions: This pilot study suggests that apixaban may have similar effectiveness and safety to warfarin for LVT resolution.
  2 2,835 219
Study of the Prevalence of Microalbuminuria in Patients of Essential Hypertension and its Correlation with Left Ventricular Hypertrophy and Carotid Artery Intima-media Thickness
Rita Rani Maggon, Rupali Malik, Neelima Jain, HS Isser
January-March 2018, 7(1):11-16
DOI:10.4103/JCPC.JCPC_22_17  
Background: Limited evidence is available among Indian patients regarding significance of microalbuminuria (MA) in context of hypertension and future cardiovascular morbidity. Therefore, the current study was undertaken to determine the prevalence of MA in hypertensive patients and to examine its correlation with severity of hypertension, left ventricular hypertrophy (LVH), and common carotid intima-media thickness (CCIMT). Material and Methods: Fifty treatment-naïve hypertensive patients (16–80 years of age) were prospectively enrolled. All patients underwent basic metabolic profile, urine evaluation, echocardiography, and measurement of CCIMT, and the data were evaluated. Results: MA (defined as urinary albumin excretion in the range of 30–300 mg/24 h) was present in 44% of patients with newly detected essential hypertension. A significant number of patients with MA had abnormally high mean left ventricular mass index as compared to those without MA. In addition, a positive correlation was also observed between MA and LVH. Furthermore, mean CCIMT was found to be higher in patients with MA (P < 0.001), with 69.2% of the patients with MA having elevated mean CCIMT. The CCIMT had a positive correlation with both MA and LVH. Conclusions: This study demonstrates the presence of MA in a significant number of newly detected and untreated patients of essential hypertension. Further, MA had a statistically significant relationship with LVH and CCIMT. Thus, screening of all recently diagnosed patients of essential hypertension for MA may be a reasonable strategy to predict the presence of future cardiovascular risk.
  2 4,072 372
Incidence and clinical profile of patients with frozen shoulder after cardiac surgery
M Chokkalingam, S Saradha, A Navitha, Pradeep G Nayar
October-December 2017, 6(4):142-146
DOI:10.4103/JCPC.JCPC_17_17  
Background: Frozen shoulder is a condition characterized by pain and global restriction of movement with loss of external rotation. Cardiac surgery may predispose frozen shoulder as patients tend to immobilize their upper limbs after surgery. Objectives: The aim of this study is to analyze the clinical profile of patients presenting with symptoms of periarthritis shoulder and to determine the incidence of frozen shoulder among patients undergoing cardiac surgery as well as to find the factors associated with its development. Methods: It is a clinical observational study done in the Cardiology Department of Chettinad Hospital and Research Institute, Chennai, between August 2015 and May 2016, on 100 patients who underwent cardiac surgery and attended the follow-up session as an outpatient. Data were collected by face-to-face interview using a standardized questionnaire. Respondents presenting with pain and restricted movement of shoulder joint with positive limitation in lateral rotation, abduction, and medial rotation (LAM) test were considered to have frozen shoulder. Each participant was followed up for 3 months postcardiac surgery. Results: The mean age of the study participants was 53.63 ± 13.03 years, and 65% were males. Of the 100 participants, 20 (20%) developed frozen shoulder. Age (P < 0.01), diabetes mellitus (<0.01), hypertension (P < 0.001), type of surgery (P < 0.02), and regularity of physiotherapy follow-up (P < 0.01) had significant association with positive LAM test on univariate analysis. However, on multivariate logistic regression analysis, only hypertension and physiotherapy regularity were found to have a trend toward a significant independent association with the occurrence of frozen shoulder (P = 0.090 and 0.097, respectively). Conclusion: The present study shows that cardiac surgery increases the risk of developing frozen shoulder during the early postoperative period. Statistically significant correlation existed between positive LAM test and age of the patients, presence of diabetes mellitus and hypertension, type of cardiac surgery, and the regularity of physiotherapy follow-up.
  2 6,107 480
REVIEW ARTICLES
Cardiovascular health in women: The role of diet
Shikha Sharma, Vinita Sharma, Reena Rawat, Swati Arya
January-March 2017, 6(1):18-23
DOI:10.4103/2250-3528.196651  
The prevalence of cardiovascular diseases (CVDs) has been increasing over the years and is one of the leading causes of deaths in the Indian population. While women may have a lower risk of CVD, as compared to men, during the early phases of life, it has been determined that in the later stages of life, more number of women suffer from CVD as compared to men. Moreover, women might also experience disproportionately high mortality due to CVD. Obesity is among one of the most important reasons underlying greater burden of CVD in women. The problem of obesity is continuously growing even in developing countries like India and is more common in females and urban populations. Females are particularly prone to weight gain because of certain bodily changes which they have to go through during their life span. Obesity is associated with several risk factors such as type 2 diabetes, hypertension, dyslipidemia, which increase the risk of CVD. Additionally, obesity also leads to various other health problems such as uterine cancer, gallbladder disease, osteoarthritis, and breast cancer. Accordingly, prevention and management of obesity is an important health goal and diet plays an integral role in this. Diets rich in foods with high glycemic index (GI), high sodium content and low fruit and vegetable intake have been correlated with greater risk of CVD. Therefore, foods with low GI should be incorporated in the diets. In general, diets rich in dietary fiber have been associated with lower plasma cholesterol levels. Adequate intake of dietary fiber, phytochemicals, and antioxidants such as polyphenols, isothiocyanates, carotenoids, flavonoids, ascorbic acid and folates in the form of fresh fruits and vegetables offer cardioprotective benefits.
  2 3,675 374
Isolated infundibular pulmonary stenosis
Sita Ram Mittal
October-December 2018, 7(4):154-160
DOI:10.4103/JCPC.JCPC_18_18  
A case of isolated infundibular pulmonary stenosis is reported and literature is reviewed. Infundibular pulmonary stenosis is usually a part of tetralogy of Fallot or is associated with ventricular septal defect. Isolated infundibular pulmonary stenosis is rare. Patients may be asymptomatic in spite of significant stenosis. Dyspnea, chest pain, and presyncope or syncope on effort are common symptoms in significant obstruction. Ejection systolic murmur is best audible in the left 3rd intercostal space and increases on inspiration. Additional murmur of tricuspid regurgitation may appear if there is right ventricular failure. Absence of pulmonary valvular click and normal intensity and splitting of the second sound differentiate it from pulmonary valve stenosis. Electrocardiogram shows right ventricular overload. Two-dimensional (2D) echocardiography shows right ventricular hypertrophy with narrowing of infundibulum, normal pulmonary valve, main pulmonary artery, and branch pulmonary arteries. Right ventricle and right atrium may dilate if there is right-sided failure with significant tricuspid regurgitation. Doppler evaluation reveals systolic gradient in the region of infundibulum with no additional gradient at the level of pulmonary valve, main pulmonary artery, or branch pulmonary arteries. Tricuspid regurgitation may be present. 2D echocardiography with Doppler evaluation also excludes other lesions. Angiography is usually not required. Surgery is safe and effective in relieving obstruction. Stent implantation is safe and effective in highly selected patients with discretely narrow circumferential stenotic segment and near-normal-sized peristenotic segment between the pulmonary and tricuspid valves.
  2 6,155 386
Management options for coronary microvascular dysfunction: Present status and future perspectives
Sita Ram Mittal
January-March 2016, 5(1):18-24
DOI:10.4103/2250-3528.184011  
Coronary micro vessels are not visible on coronary angiography. These include prearterioles, arterioles, and capillaries. Significant number of patients of angina have coronary microvascular dysfunction alone or in combination with stenosis and/or spasm of epicardial coronary arteries. Its management is challenging. Several different therapeutic options have been tried with variable success. The present review provides overview of the available evidence with various therapeutic modalities for the treatment of microvascular angina.
  2 6,636 619
CASE REPORT
Left ventricular calcification following postpartum toxic shock syndrome
Stella C Pak, Zayd Safadi, John-Philip Markovic, Shawn L Marein
January-March 2018, 7(1):29-31
DOI:10.4103/JCPC.JCPC_29_17  
Toxic shock syndrome (TSS) is a rare but lethal clinical event that can occur during the postpartum period. Early recognition and intervention is critical to improve patient outcomes. This is a case of TSS complicated by cardiac arrest and left ventricular calcification. This is a case report of streptococcal TSS in a 29-year-old female in the postpartum period who presented with fever, abdominal distension, and a purpuric rash. Her hospital course was characterized by multiple organ failure, including respiratory distress syndrome, liver failure, renal failure, and coagulopathy. She was found to have acute compartment syndrome, which resulted in a below-the-knee amputation. She deteriorated further after experiencing cardiac arrest and the development of hypoxic-ischemic encephalopathy with hemorrhagic transformation. A computed tomography scan of the chest revealed evidence of dystrophic myocardial calcification in the left ventricle. She improved clinically but remained ventilator dependent upon discharge to an extended acute care facility. Sepsis-induced cardiomyopathy can result in myocardial calcification. As dystrophic calcification can significantly affect cardiac function, clinicians should rule out cardiac calcification in patients who have had severe septic shock.
  1 2,782 248
ORIGINAL ARTICLES
Effect of ranolazine on improvement of left ventricular dysfunction in patients with chronic stable angina: A randomized controlled clinical trial
C R Madhu Prabhu Doss, Melvin George, Amrita Jena, Varsha Srivatsan, Aruna Sridhar, VE Dhandapani
January-March 2018, 7(1):17-21
DOI:10.4103/JCPC.JCPC_23_17  
Objectives: To study the effect of ranolazine on improvement of left ventricular (LV) dysfunction in comparison to trimetazidine in patients with chronic stable angina (CSA). Ranolazine is an anti-anginal agent that acts on the late inward sodium current and prevents pathologic intracellular calcium accumulation that leads to ischemia, myocardial dysfunction, and electrical instability. Methodology: After screening and obtaining informed consent, 29 patients with CSA who have sustained ST-Elevation Myocardial Infarction more than 12 weeks ago with LV ejection fraction (LVEF) ≤40% in a 2:1 ratio to receive ranolazine 500 mg BD (n = 19) or trimetazidine 35 mg BD (n = 10) were enrolled in the study. The patients were evaluated at the end of 8 weeks for the improvement in LV dysfunction by transthoracic echocardiography. Results: No significant difference was found in the baseline characteristics of the patients between the two groups except the increased body mass index among users of trimetazidine (26.3 ± 5.07 vs. 22.1 ± 3.26, P = 0.03). Study patients receiving ranolazine 500 mg BD for 8 weeks significantly improved the LVEF. No improvement was seen in diastolic function. Ranolazine was well tolerated among the patients. Conclusion: Ranolazine at a dose of 500 mg BD given for 8 weeks helps in improving the LVEF in patients with CSA and is a suitable option than trimetazidine among patients with CSA.
  1 3,347 329
REVIEW ARTICLES
Prevention of cardiovascular disease in India: Barriers and opportunities for nursing
Anice George, Sulochana Badagabettu, Kathy Berra, Linu Sara George, Veena Kamath, Latha Thimmappa
April-June 2018, 7(2):72-77
DOI:10.4103/JCPC.JCPC_31_17  
Currently, the nursing profession lacks specialized training, to be a part of preventive cardiovascular healthcare team. The article aims to describe the obstacles Indian nurses face in becoming active and valued members of the cardiovascular healthcare team and to propose solutions. Cardiovascular disease (CVD) imposes substantial and increasing physical, psychological, societal, and financial burdens. More emphasis needs to be placed on preventive measures, which should be made available and affordable in rural as well as urban areas. Nurses are well positioned to be leaders in these initiatives. However, nurses in India face numerous obstacles in providing optimal care, including a significant shortage of trained personnel. Nursing education at advanced levels needs to be standardized and should reflect core competencies. Appropriate use of nursing resources in CVD prevention can allow physicians to treat the sickest patients, reduce cost of care, and help relieve the human burden of morbidity and mortality due to CVD.
  1 5,682 493
* Source: CrossRef