Clinical characteristics, etiological profile, treatment and long term outcomes in patients with non ischemic systolic heart failure; Himachal Pradesh heart failure registry (HP-HF registry).

BACKGROUND: The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. METHODS: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. RESULTS: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. CONCLUSIONS: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes.

Prevalence of congenital heart disease in rural population of Himachal - A population-based study.

AIM: There is no community-based study about the prevalence of congenital heart disease (CHD) in Himachal; hence, we undertook this study. METHODS AND RESULTS: A population-based survey was done in four villages of different districts of Himachal Pradesh. In total, 1882 persons were examined. 909 were male and 973 were female. There were 12 cases of CHD in the population (6.3/1000): four of these were male (33.3%) and 8 were female (66.6%). Mean age of these patients was 19.5±11.07 years. Atrial septal defect (ASD) was the commonest lesion followed by ventricular septal defect (VSD). CONCLUSION: Prevalence of CHD in general population was 6.3/1000. ASD was the commonest lesion. CHD was more common in female.

Epidemiological study of chronic mountain sickness in natives of Spiti Valley in the Greater Himalayas.

AIMS: This study determined the prevalence of chronic mountain sickness (CMS) and its predisposing factors among natives of Spiti Valley in the northern state of Indian Himalayas. A cross-sectional survey study was conducted in natives of Spiti Valley aged ≥ 20 years residing at altitudes of 3000 to 4200 meters. CMS was diagnosed using Qinghai criteria. Demographics, behavioral characteristics, specified symptoms of CMS were recorded, including BP, anthropometrics, evidence of RHF, PAH, and severe cyanosis. ECG, echocardiography, PFT, and Sao2 were recorded, and Hb level was estimated with the cyanmethhemoglobin method. RESULTS: 694 subjects free of cardiorespiratory diseases were analyzed. Prevalence of CMS was 28.7%, (95% C.I. of 25.9%-32.8%) and was higher in women than in men (36.6% vs. 15.7%, p<0.001). Erythrocythemia and hypoxemia were recorded in 10.5% and 7.5%, respectively. Age, truncal obesity, female gender, altitude of residence, and physical activity index were independent predictors of CMS with z statistics of 4.2, 2.29, -3.7, 2.8, and -2.8, respectively, and were statistically significant p<0.001. 6.2% of the surveyed population had HAPH. CONCLUSION: 28.7% (95% C.I. of 25.9%-32.8%) of the natives of the Spiti Valley in the Indian Himalayas are affected with CMS. Higher prevalence of CMS amongst women needs further studies. Westernized lifestyle appears to have predisposition to CMS.

Prevalence of rheumatic fever and rheumatic heart disease in rural population of Himachal--a population based study.

PURPOSE OF STUDY: Rheumatic heart disease is still the commonest valvular heart disease in India. There is no population based study regarding the prevalence of rheumatic fever/rheumatic heart disease (RF/RHD) from Himachal and hence the purpose of study. METHODS AND RESULTS: A community based survey for prevalence of RF/RHD was done in four villages of different districts of Himachal. The subjects suspected to have RF/RHD on clinical ground were subjected to echocardiography to confirm the diagnosis. Total 1882 subjects were screened. 909 were male and 973 were female. 11 of these were found to have RF/RHD (5.8/1000). Mean age of these patients was 30.35 +/- 14.17 years. 10 of these were female and one was male. Mitral valve was the commonest to be involved. Seven were known to have RF/ RHD and five were on penicillin prophylaxis. CONCLUSION: RF/RHD is still common in rural population of Himachal. Mitral valve is commonest to be involved and prevalence is much more in female than in male.

Prevalence, awareness and control of hypertension in rural communities of Himachal Pradesh.

PURPOSE: There is no community based study of prevalence of hypertension from Himachal Pradesh, so we undertook this study. METHODS AND RESULTS: Population based survey was done in three villages of Himachal Pradesh of different Districts. Total 1092 adults of > or =18 years of age were examined. 507 (46.42%) were males and 573 (52.47%) were females. 392 (35.89%) were found to have hypertension (39.8% in males and 33.15% in females). 267 had their blood pressure in pre-hypertensive range (24.45%). Only 433 (39.6%) had their blood pressure in normal range. 84 (21.98%) of 392 hypertensive persons were aware of their hypertensive status and only 17 of these 84 (20.23%) had their blood pressure under control. CONCLUSION: Prevalence of hypertension was higher than the national average. Only one fifth of hypertensive persons were aware of their disease and only fifth of these had their blood pressure under control.

Coronary artery spasm as a cause of chest pain and re-elevation of ST segment and cardiogenic shock after PTCA.

We describe a case that underwent successful percutaneous transluminal coronary angioplasty in cardiogenic shock but after half an hour, again had severe chest pain with re-elevation of ST segment and was found to have coronary artery spasm as a cause of recurrence of symptoms.

Coronary heart disease in rural population of Himachal--a population based study.

BACKGROUND: Cardiovascular disease has emerged as a major health burden worldwide. There is no study in Himachal about the prevalence of coronary heart disease (CHD), hence the purpose of the study. MATERIAL AND METHODS: Population based study was done in three different villages of different districts of Himachal Pradesh. The people were well notified about the survey in advance. We tried to cover all persons above the age of 30 years. We could cover around 70% of population. Total 812 persons were examined. History regarding presence and nature of chest pain was taken. Detailed physical examination was done. The detailed history about risk factors was taken. ECG of all patients was taken. Patients known to have suffered myocardial infarction, having typical angina on exertion or having undergone coronary angioplasty or coronary artery bypass surgery were labeled to have CHD. RESULTS: Eight hundred twelve patients were examined. Mean age was 47.44 +/- 12.2 yrs. Three hundred ninty-nine were males and 413 were females. Thirty three patients were found to have coronary heart disease, giving the prevalence of 4.06%. Twenty six of 399 males had CHD (6.9%) and 26 of 413 females had CHD (1.69%). Seventeen of these CHD patients were hypertensive, two were diabetic and 10 patients had family history of CHD. CONCLUSION: The prevalence of CHD was low in rural population of Himachal Pradesh, being around 4%, more in males than in females.