The effect of mobile application-based technology use on medication compliance and modification of risk factors in post PTCA cohort of patients.

Mobile application-based technology was used to study medication compliance and influence on cardiovascular lifestyle in ischemic heart disease (IHD) patients who undergo percutaneous transluminal coronary angioplasty (PTCA). The Mobile-app was made available at Google play store; the app was downloaded and instructions to use were thought to patients by the research team during hospitalization in the study group. A total of two hundred patients with ischemic heart disease who underwent PTCA were enrolled into the study. The control group had telephonic follow up at periodic interval. Both groups had clinical follow ups at appropriate time intervals. Higher medication compliance, smaller number of adverse events and regular follow ups were significantly more in mobile-app group than in control group.

In vivo delamination of coronary guidewire polytetrafluoroethylene layer - A dreaded complication.

Coronary guidewires are coated with polytetrafluoroethylene (PTFE) layer to decrease resistance and enhance trackability. Delamination and embolization of PTFE material can be detrimental during percutaneous coronary interventions. We report an occurrence of such delamination and discuss the implications and possible mechanism of this dreaded complication.

Takotsubo cardiomyopathy precipitated by negative pressure pulmonary oedema following total thyroidectomy.

'Takotsubo cardiomyopathy (TCM)' or 'stress cardiomyopathy' is a reversible cardiomyopathy that is precipitated by intense emotional or physical stress. This syndrome is characterised by symptoms mimicking acute coronary syndrome with transient systolic dysfunction associated with regional wall motion abnormalities, which extend beyond a single coronary vascular bed in the absence of obstructive coronary vascular disease. The presentation of TCM and myocardial infarction is similar with sudden onset of chest pain, breathlessness as well as abnormalities in both the electrocardiogram and cardiac enzymes. It is difficult to differentiate between the two until cardiac catheterisation establishes the diagnosis. We report a case of TCM in a post-menopausal female, precipitated by negative pressure pulmonary oedema following total thyroidectomy in whom timely cardiac catheterisation established the diagnosis and influenced the management. Heightened awareness of this unique cardiomyopathy is essential to have a high index of suspicion in at-risk population for the prompt diagnosis of stress-related cardiomyopathy syndromes occurring in the perioperative period.

Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India.

BACKGROUND: In acute decompensated heart failure (ADHF), diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia (serum sodium concentration, <135 mEq/L) is a predictor of death among patients with heart failure. OBJECTIVE: We prospectively observed the short term efficacy and safety of low dose (15 mg) tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. METHODOLOGY: A total of 40 patients with ADHF along with hyponatremia (<125 mEq/L) on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. RESULTS: Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline (P < 0.02). There was a significant improvement in symptoms and New York Heart Association (NYHA) class after starting tolvaptan (P ≤ 0.05). Total diuretic dose and mean body weight was reduced non-significantly at 7(th) day from the baseline. Side-effects associated with tolvaptan included increased thirst, dry mouth and increased urination. Few patients had worsening renal function. However, several patients developed hypernatremia. CONCLUSION: In this small observational study, tolvaptan initiation in patients with ADHF with hyponatremia in addition to standard therapy may hold promise in improvement in NYHA class and serum sodium. At the same time, we observed that serious adverse events such as renal function deterioration and hypernatremia developed after tolvaptan treatment, which needs to be addressed in future by randomized study with larger sample size.

Successful retrieval of a fractured and embolised Judkin's catheter during a coronary angiogram.

We report the successful retrieval of a large broken segment of right Judkin's catheter using a snare catheter by a retrograde approach. A 69-year-old woman presented with an anterior wall myocardial infarction. A coronary angiogram revealed severe stenosis of distal left main coronary artery, ostio-proximal portion of the left anterior descending artery and the ostial left circumflex artery. During right shoot, the Judkin's right catheter was broken at almost 15 cm from the distal end. The distal end of the broken catheter was lying in the ascending aorta, whereas proximal end was in the left subclavian artery. First, we snared the distal end and pulled out the catheter in right common iliac artery but owing to the curvature of the fragment, this attempt was unsuccessful. Finally, we were successful in removing the fractured segment retrogradely through the arterial sheath placed in left femoral artery.