Incidence of Coronary Artery Disease After Permanent Pacemaker Implantation: A Hospital-based Study from East India.

Bradyarrhythmias, characterized by heart rates of <60 bpm due to conduction issues, carry risks of sudden cardiac death and falls. Pacemaker implantation is a standard treatment, but the interplay between bradyarrhythmias, coronary artery disease (CAD), and patient attributes requires further exploration. This study was a retrospective hospital record-based study that analyzed data from 699 patients who underwent pacemaker implantation for symptomatic bradyarrhythmias between February 2019 and February 2022. Clinical parameters, coronary angiography (CAG) findings, ejection fraction, and indications for pacemaker implantation were documented. The relationship between CAD severity, specific bradyarrhythmias, and ejection fraction was explored. Statistical analysis included chi-squared tests and t tests. The mean age of the study population (n = 699) was 66.75 years (male:female ratio, 70:30), with 77.2% having type 2 diabetes and 61.6% being hypertensive. The majority of patients had minor or non-obstructive CAD (61.8%), followed by normal CAG findings (25.75%) and obstructive CAD (12.45%). Complete heart block (CHB) was the primary indication for pacemaker implantation (55.2%), followed by sick sinus syndrome (22.3%). The results did not show any association between ejection fraction and CAG findings. Patients who presented with CHB had a higher incidence of obstructive CAD, indicating greater severity. This study sheds light on the intricate interplay between severe bradyarrhythmias, CAD, and patient characteristics. Our analysis revealed no statistical significance between obstructive CAD and the need for a permanent pacemaker. This makes us question our practice of maintaining a low threshold for coronary angiography during pacemaker implantation. The observed low yield and anticoagulation protocol reassure us of the choice to delay this diagnostic intervention. These insights can guide tailored management strategies, enhancing clinical care approaches for patients with severe bradyarrhythmias necessitating pacemaker implantation.

Comparative study of acute coronary syndrome in postmenopausal women and age-matched men: A prospective cohort study in Southern India.

Background: Acute coronary syndrome (ACS) differs in women and men with respect to risk factors, clinical presentation, complications and outcome. The major reason for the differences has been the effect of estrogen which protects women from coronary artery disease (CAD) till menopause. Women develop CAD one decade later than men. Hence, we compared the profile of ACS in postmenopausal women with age-matched men to see, does the difference still exist. Materials and Methods: Comparative prospective study of 50 postmenopausal women as study group and fifty age-matched men as a control group diagnosed with ACS, who were admitted in a medical college hospital from December 2013 to September 2015. Chi-square test and Student's t-test have been used to find the significant association of study parameters between women and men. Results: Chest pain was the main complaint in the majority of the women (76%) and men (88%). Radiation of chest pain (60%) and sweating (72%) were significantly present in men compared to women (24% and 26%, respectively), whereas breathlessness was significantly present in women (40%) compared to men (16%). Women had later presentation to the hospital after symptom onset compared to men. Women had a higher respiratory rate (22.02 cycles/min) compared to men (20 cycles/min) and more crepitations compared to men. Men had more ventricular tachycardia (14%) and intracerebral hemorrhage (4%), whereas women had all other complications more than or same as men and higher in-hospital mortality (14%) compared to men (8%). Conclusion: Postmenopausal women with ACS had more atypical presentation of symptoms, later presentation to hospital, more tachypnea, more crepitations, more complications, and higher in-hospital mortality compared to men of the same age group. The difference in the profile of ACS continues to exist even after menopause and age matching.

RésuméContexte: Le syndrome coronarien aigu (SCA) diffère chez les femmes et les hommes en ce qui concerne les facteurs de risque, la présentation clinique, les complications et les résultats. La principale raison des différences a été l'effet de l'œstrogène qui protège les femmes de la maladie coronarienne (CAD) jusqu'à la ménopause. Les femmes développent CAD une décennie plus tard que les hommes. Par conséquent, nous avons comparé le profil du SCA chez les femmes ménopausées avec des hommes du même âge pour voir si la différence existe toujours. Matériels et méthodes: Étude prospective comparative de 50 femmes ménopausées en tant que groupe d'étude et de cinquante hommes du même âge en tant que groupe témoin ayant reçu un diagnostic de SCA, qui ont été admises dans un hôpital universitaire de médecine de décembre 2013 à septembre 2015. Test du chi carré et test de Student. -test ont été utilisés pour trouver l'association significative des paramètres d'étude entre les femmes et les hommes. Résultats: La douleur thoracique était la principale plainte chez la majorité des femmes (76 %) et des hommes (88 %). L'irradiation de la douleur thoracique (60 %) et la transpiration (72 %) étaient significativement présentes chez les hommes par rapport aux femmes (24 % et 26 %, respectivement), tandis que l'essoufflement était significativement présent chez les femmes (40 %) par rapport aux hommes (16 %) . Les femmes se sont présentées plus tard à l'hôpital après l'apparition des symptômes par rapport aux hommes. Les femmes avaient une fréquence respiratoire plus élevée (22,02 cycles/min) par rapport aux hommes (20 cycles/min) et plus de crépitations par rapport aux hommes. Les hommes présentaient plus de tachycardie ventriculaire (14 %) et d'hémorragie intracérébrale (4 %), tandis que les femmes présentaient toutes les autres complications plus ou autant que les hommes et une mortalité hospitalière plus élevée (14 %) que les hommes (8 %). Conclusion: Les femmes ménopausées atteintes de SCA présentaient une présentation plus atypique des symptômes, une présentation plus tardive à l'hôpital, plus de tachypnée, plus de crépitations, plus de complications et une mortalité hospitalière plus élevée que les hommes du même groupe d'âge. La différence dans le profil du SCA continue d'exister même après la ménopause et l'appariement de l'âge. Mots-clés: Syndrome coronarien aigu, infarctus aigu du myocarde, hommes, ménopause, angor instable, femmes.

Radiographic patterns of soft tissue calcinosis in juvenile dermatomyositis and its clinical implications.

Juvenile Dermatomyositis (JDM) is a rare autoimmune inflammatory disease of muscles affecting children and adolescents with soft tissue calcification and varying systemic involvement. Though diagnosis is primarily by clinical, biochemical and histopathological tests, Imaging has unique significance from characterizing the calcinosis, detecting early changes in muscle in active phase of the disease, diagnosing potential complications,rule out other important differentials, guide biopsies ,and assessing the progress on follow up. Four distinct patterns of calcinosis have been described in relation to dermatomyositis which need to be differentiated from other aetiologies of soft tissue calcification and myopathies.