Consensus Statement on Holistic Management of Angina.

Worldwide, coronary heart disease (CHD), have assumed epidemic proportions. Increasing use of interventional therapy and a higher adherence to medical therapy have led to a 33% reduction in cardiac deaths at 5 years after hospital discharge. Angina pectoris is a common symptom of ischemic heart disease. The goals of anti-ischemia therapy in patients with stable coronary artery disease (CAD) include relieving angina symptoms, improving duration of exercise and quality of life, improving prognosis and preventing cardiovascular (CV) events. The consensus statement was devised with the help of multiple meetings held across India. Ten regional advisory board e-meetings were held in Mumbai, Delhi, Chennai, Kolkata, Ahmedabad, Cochin, Trivandrum, Lucknow, Bhopal and Varanasi. These meetings were attended by ten eminent experts from the field of cardiology from each region. Extensive literature review, intense discussions, and feedback from the cardiologists led to the development of the following consensus statements on definition, diagnosis, and management of angina, which have been reported in this article.

Real-World Clinical Experience of Rosuvastatin as a Lipid-Lowering Therapy for Primary and Secondary Prevention of Cardiovascular Events (REAL ROSE).

Background Rosuvastatin effectively reduces endogenous cholesterol synthesis and low-density lipoprotein (LDL) cholesterol and increases high-density lipoprotein (HDL) cholesterol. This study aimed to evaluate the clinical characteristics of patients and treatment patterns of rosuvastatin as a lipid-lowering therapy for primary and secondary prevention of cardiovascular events in Indian settings. Methods This real-world, retrospective multi-centric observational study included patients aged >18 years who received treatment with a rosuvastatin/rosuvastatin-based combination. Demographic and data about concomitant diseases and medications were recorded. Results Out of 1,816 patients, the majority were men (66.2%); the mean age was 54.1 years. The patients prescribed rosuvastatin for primary and secondary prevention of cardiovascular events were 71.9% and 28.1%, respectively. Rosuvastatin 10 mg (56.8%) was the most commonly prescribed dose. For primary prevention, 10 mg (65.0%) was the most preferred dose, and for secondary prevention, 20 mg (54.3%) was the most preferred dose. Rosuvastatin treatment significantly (pre- vs. post-treatment) reduced the levels of total cholesterol (227.2 vs. 178.4 mg/dL), triglycerides (212.6 vs. 154.4 mg/dL), and LDL cholesterol (167.0 vs. 125.6 mg/dL), and increased HDL cholesterol levels (40.7 vs. 44.3 mg/dL) (p<0.0001). A total of 1,196 patients received combination therapy with rosuvastatin (aspirin, 34.0%, and fenofibrate, 21.9%). Adverse events were reported in 0.4% of the study population (leg pain, nausea, muscle cramps/pain, bleeding, and myalgia). Conclusion This study demonstrated the clinical effectiveness and safety of moderate- to high-intensity rosuvastatin (5-40 mg) for primary and secondary prevention of cardiovascular events in the Indian population. A primary prevention strategy with statins can reduce cardiovascular events and associated morbidity and mortality.

Prehypertension--a hidden risk of Indian subcontinent.

Prehypertension as an entity has been given Importance after JNC VII report. The magnitude of this problem in India and the importance of recognising prehypertension is slowly growing and getting established. Under these circumstances it was decided to study the prevalence of prehypertension in the city of Belgaum in Karnataka and the literature was reviewed. The objective of this study was to find out the prevalence of prehypertension in the urban population of Belgaum above thirty years of age. The urban population of Belgaum city was screened for prehypertension and hypertension by measuring blood pressure of all individuals aged 30 years and above. Blood pressure of 52196 persons was checked and the data was analysed. JNC VII criteria was used for defining hypertension, prehypertension and normal blood pressure. Among 52196 persons prehypertension was present in 41.1%, 67.1% were in the age group of 30-50 years. The prevalence was similar in both male and female population. Thirty-three percent of diabetic population had prehypertension. About 22.8% of prehypertensives were obese. Prehypertension is highly prevalent in urban population of India, more often seen in persons below 50 years of age. This study recognises the importance of detection of prehypertension and emphasises the need for mass education on life style modification to prevent the development of hypertension and its complications.

A case of symptomatic double coronary artery-pulmonary artery fistulae.

A 57-year-old lady presenting with angina was found to have multiple coronary arterio venous fistulae (CAVF) arising from both left and the right coronary arteries and draining into the pulmonary artery. She underwent successful surgical closure of these CAVF.

Transcatheter occlusion of multiple pulmonary arterio venous malformations.

Pulmonary arterio venous malformations are one of the rare vascular anomalies. Usually single large pulmonary arteriovenous fistula (PAVF) can be closed through transcatheter route but multiple PAVF require surgical lobectomy. We describe a case of an 8-year-old boy with multiple PAVF, who underwent successful transcatheter closure with multiple coils.

Candida krusei infection presenting as a right ventricular mass in a two month old Infant.

The prevalence of fungal infections in newborns and small infants is on the rise consequent to the improved care and survival of preterm babies. Most of these premature infants are immunocompromised and subjected to invasive monitoring and therapy in neonatal intensive care units making them susceptible to nosocomial infections. We report a rare case of right ventricular mass secondary to candida krusei infection which was excised surgically. This article reemphasizes the importance of stringent aseptic practices in neonatal intensive care units to prevent nosocomial infections and the early use of echocardiography in neonates presenting with atypical unexplained symptoms to hasten diagnosis and facilitate timely intervention.