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Background Acute decompensated heart failure (ADHF) poses a significant burden on healthcare systems globally, including in India, due to its high morbidity and mortality rates. This study aimed to evaluate the clinical characteristics of patients presenting with ADHF to the emergency department (ED) of a tertiary care hospital in India. Methodology This observational study was conducted at Dr. D. Y. Patil Medical College, Hospital, and Research Centre in Pune, India. Ninety patients aged 12 years and older who presented with signs and symptoms of heart failure (HF) to the ED between January 2023 and March 2024 were enrolled as participants. Ethical approval was obtained. Written consent was obtained from all participants. Clinical diagnoses were based on patient history, physical examination, chest radiograph, point-of-care ultrasound (POCUS), electrocardiography (ECG), echocardiography, and radiological and laboratory findings. Data were analyzed using IBM SPSS Statistics version 29.0.2.0 (Armonk, NY: IBM Corp.) and represented as mean±SD, frequency (n), and percentage. Results The study involved 90 participants with a mean age of 61.1±16.3 years. The cohort comprised 51 males (56.7%) and females 39 (43.3%). Dyspnea was the most common clinical presentation in all participants, followed by swelling of feet in 58 (64.4%) cases. The mean systolic blood pressure noted was 142.1±42.8 mmHg. Hypertension was the most frequently identified risk factor, present in 52 (57.8%) cases. The most common precipitating factor identified was anemia in 39 (43.3%) cases. Point-of-care ultrasonography (pulmonary) revealed significant B-lines (≥2 of the eight thoracic zones with ≥3 B-lines or B-line count in all eight zones ≥10) in 85 (94.4%) cases. B-type natriuretic peptide (BNP) was elevated in all participants. The mean hemoglobin levels in males and females were 13.2±2.6 g/dL and 10.6±2.8 g/dL, respectively. The mean serum sodium level was 132.4±6.2 mEq/dL. Serum sodium level below 135.0 mEq/L (hyponatremia) was found in 53 (58.9%) cases. The mean serum creatinine level was 1.7±1.4 mg/dL. Diuretics were the most common treatment modality used in the ED. More than half of the patients (72.2%) were transferred to the intensive care unit; the mortality rate in the ED was 2.2%. Conclusion This study provides comprehensive insights into the characteristics, management, and outcomes of ADHF patients presenting to the ED of a tertiary care hospital in India. The findings highlight the challenges and complexities in managing ADHF in this population and underscore the need for tailored therapeutic approaches to improve patient outcomes and reduce healthcare utilization.
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Non-obstructive hypertrophic cardiomyopathy, or apical hypertrophic cardiomyopathy (ApHCM), also referred to as Yamaguchi syndrome, is a type of hypertrophic cardiomyopathy (HCM) characterized by significant thickening of the left ventricular apex without blockage in the left ventricular outflow tract. It is a very rare variant of HCM. Patients with non-obstructive HCM often experience symptoms such as chest pain, palpitations, shortness of breath, and syncope, which may resemble those seen in various cardiovascular and non-cardiac conditions. Yamaguchi syndrome presents as a challenging yet manageable condition in the ED. Early recognition, accurate diagnosis, and appropriate management are crucial for better outcomes. We report a case of a young female who presented to the ED with breathlessness and chest pain. The ECG findings suggested acute coronary syndrome (ACS), but echocardiography and cardiac biomarkers indicated otherwise, leading to the diagnosis of Yamaguchi Syndrome.
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Pulmonary embolism (PE) is a life-threatening condition resulting from the obstruction of pulmonary arteries by blood clots, usually originating from deep veins. Symptoms of PE might vary from nothing to sudden death. Clinically, individuals may present very differently. When a diagnosis of PE is suspected, any possible life-saving intervention must be implemented because survival from cardiac arrest following PE is often quite low. Although there are not many randomized controlled trials that provide guidelines for treating suspected PE in cardiac arrest victims, the few published case reports and other minor studies suggest that thrombolysis and other therapies are associated with good outcomes. We report a patient with PE who presented in cardiac arrest with its clinical, electrographic, and radiologic findings, along with the appropriate therapy chosen based on hemodynamic stability. It is important to intervene early to prevent severe complications and improve the patient's outcomes.