Implantable cardioverter defibrillators for primary prevention in cardiomyopathies.

BACKGROUND: Implantable cardioverter defibrillators (ICD) are often used as primary prevention strategy for sudden cardiac death (SCD) in young individuals. This study analyzed appropriate therapies, complications and inappropriate shocks in the real-world Indian population. METHODS: All patients in the cardiomyopathy cohort under follow up who had ICD implanted as a primary prevention strategy were studied. The objective was to assess the incidence of appropriate ICD therapies, inappropriate therapies and complications. ICD was interrogated and stored electrograms analyzed. Underlying arrhythmia or conditions resulting in appropriate or inappropriate ICD therapy were studied. Correlation and regression studies was done to assess for the predictors of appropriate therapy. RESULTS: Fifty patients were followed up for a mean follow-up duration of 4.4 ± 3.1 years with total follow up of 220.2 patient years. Appropriate ICD therapy was delivered in 16 out of 50 (32%) patients, with 65 appropriate therapies (median 2 per patient, range: 0-20). Inappropriate therapy delivered in 7 of the 50 (14%) patients, with 44 inappropriate therapies (median 5 per patient, range: 0-20). Complications occurred in 8 of the 50 (16%) patients. Overall, the rate of appropriate therapy was 29.5 per 100 patient years, that of inappropriate therapy was 19.9 per 100 patient years and the rate of complications was 3.6 per 100 patient years. CONCLUSIONS: When implanted for primary prevention in patients with cardiomyopathies over a mean period of 4.4 ± 3.1 years, appropriate ICD therapy was delivered in 32% patients. However, inappropriate therapy (14% patients) and complications (16% patients) were also common.

Role of bone marrow examination in pyrexia of unknown origin.

A stepwise approach is essential to evaluating pyrexia of unknown origin (PUO). When other investigations are negative, bone marrow examination is a valuable diagnostic tool in PUO. It is particularly helpful in patients with involvement of reticuloendothelial organs (e.g. cytopenia, splenomegaly), immunodeficiency states, or older age.

A study of the cardiac risk factors emerging out of subclinical hypothyroidism.

INTRODUCTION: Subclinical hypothyroidism is defined as a serum TSH level above the upper limit of normal with normal levels of serum free thyroxine. It is a common thyroid disorder affecting 3-15% of the adult population. AIMS AND OBJECTIVES: To study the cardiovascular profile of patients with subclinical hypothyroidism, and to establish cardiac risk factors emerging out of subclinical hypothyroidism. METHODOLOGY: Adult patients attending General Medicine department and diagnosed with subclinical hypothyroidism over a period of 2 months were enrolled. History and general examination was done. Fasting lipid profile, hsCRP, electrocardiography and echocardiography were done. RESULTS: The mean age was 35.1 (SD = 10.26). Most common age group affected is 20-30 years. There are about 12% of the enrolled patients were overweight (OW), and 24% were obese (OB). 16% had stage 1 hypertension, and 4% had stage 2 hypertension. 92% of the patients had dyslipidemia. 64% patients had raised LDL. 44% of the patients had raised hsCRP levels. 44% patients showed abnormal findings and the most common abnormality was found to be grade 1 left ventricular diastolic dysfunction. CONCLUSION: Subclinical hypothyroidism is seen to be associated with a rise in hsCRP independent of other cardiac risk factors. A large number of patients have dyslipidemia which is a significant cardiac risk factor. Early Diagnosis and treatment of subclinical hypothyroidism will have possible cardioprotective advantages.