Cardiac Amyloidosis, An Infiltrative Heart Disease Presenting as Arrhythmia-A Case Report.

Cardiac amyloidosis is a manifestation of amyloidosis which is a multisystem disorder. This is difficult to diagnose, rare disease which eventually leads to the mortality. Diagnosis requires a high index of clinical suspicion along with echocardiographic clues like, diastolic dysfunction, bi-atrial enlargement and ventricular thickening. Treatment is mainly supportive with disappointing outcomes. We present a case of systemic amyloidosis with negative congo red staining, presenting with predominantly cardiac features.

Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry.

BACKGROUND: Coronary artery disease (CAD) occurs at younger age in India but only a limited number of studies have evaluated risk factors and management status. This is a multisite observational registry to assess risk factors and treatment patterns in young patients presenting with acute coronary syndrome (ACS) and stable ischemic heart disease (IHD). METHODS: We recruited 997 young patients (men <55, women <65y) presenting with ACS or stable IHD successively at 22 centers across India. Details of baseline risk factors and management status were obtained. Descriptive statistics are reported. RESULTS: Mean age of participants was 49.1±8y, 72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had "possible familial hypercholesterolemia". Metabolic risk factors (high BMI, diabetes and hypertension) were significantly greater in women (p<0.01). Women were older at diagnosis of CAD and presented more often with non-ST elevation ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent percutaneous coronary intervention while coronary bypass surgery was performed in 10.4%. CONCLUSIONS: Conventional risk factors including family history continue to play a pivotal role in premature CAD in Indians. Women have more of metabolic risk factors, present at a later age and have non-ST elevation ACS more often. There is a need to focus on improving use of evidence-based drug therapies and interventions.

Clinical profile and 30-day outcome of women with acute coronary syndrome as a first manifestation of ischemic heart disease: A single-center observational study.

BACKGROUND: Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. AIM: This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days. MATERIALS AND METHODS: 133 successive cases of women presenting with ACS, who met the inclusion criteria between 2012 and 2014, were included. Cases were grouped into ST elevation myocardial infarction (STEMI), non ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). RESULTS AND CONCLUSION: The mean age was 64.4±11 years. The mean BMI was 23.64±3.23kg/m(2). Diabetes was present in 58.3% in NSTEMI, 65.1% in STEMI, and 57.1% in UA group. Hypertension was found in 75% of NSTEMI, 60.2% of STEMI, and 71.4% of UA group. Severe MR was found in 11.1% of NSTEMI and 3.6% of STEMI patients. 8.3% of NSTEMI and 15.7% of STEMI patients presented in Killips class IV. Single vessel disease was most commonly found across the spectrum of ACS. 68.7% patients in STEMI group underwent primary angioplasty. 5.6% of NSTEMI and 7.2% in STEMI group had contrast-induced nephropathy (CIN). All deaths were noted in STEMI group with eight in-hospital deaths and three during 30-day follow-up period. Killips class III and IV and higher grace score (>150) were predictors of in-hospital mortality. Chronic kidney disease, ischemic mitral regurgitation, LV clot, and in-hospital cardiac arrest were associated with higher risk.

Safety of Prasugrel in Indian patients - multicentric registry of 1000 cases.

BACKGROUND: Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACS patients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. METHOD: This is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. RESULTS: Most patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. CONCLUSION: Prasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACS patients when those at a high bleeding risk were excluded.

Isolated type 2 diabetes mellitus causes myocardial dysfunction that becomes worse in the presence of cardiovascular diseases: results of the myocardial doppler in diabetes (MYDID) study 1.

AIMS: Patients with type 2 diabetes mellitus (DM) often suffer disproportionately and have a worse outcome when burdened with cardiovascular complications compared with those without DM. A specific heart muscle disease reportedly caused by DM per se may explain this. We sought to investigate whether an echo Doppler diagnosis of such a myocardial disease is clinically relevant in DM with or without coexistent coronary artery disease (CAD) and/or hypertension (HTN). SUBJECTS AND METHODS: Two hundred subjects (127 males, 73 females, 56 +/- 10 years) including controls (n = 23), patients with HTN (n = 20), CAD (n = 35), uncomplicated DM (n = 59), DM+HTN (n = 27), DM+CAD (n = 16) and DM+CAD+HTN (n = 20) underwent tissue Doppler-enhanced dobutamine stress echocardiography. Myocardial function was assessed by measuring left ventricular myocardial peak systolic velocity (PSV) and early diastolic velocity at rest and during peak stress, besides measurements of standard Doppler variables. RESULTS: Average left ventricular PSV at rest was significantly lower in CAD (4.7 +/- 1.5) compared with controls (5.7 +/- 1.2) and in DM+CAD+HTN (4.6 +/- 1.4) compared with DM (5.6 +/- 1.3; all p < 0.05). During peak stress, lower PSV persisted in CAD (9.5 +/- 3.1) and DM+CAD+HTN (8.1 +/- 2.7), while appearing de novo in DM (11.3 +/- 2.6) and HTN (11.0 +/- 2.3) unlike in the controls (12.5 +/- 2.5; all p < 0.001). When pooled together, DM subjects with CAD and/or HTN or both had significantly lower PSV (9.1 +/- 2.7) than those without (10.0 +/- 2.8; p < 0.001). Early diastolic velocity response was equally lower in both groups compared with the controls. CONCLUSION: The results suggest that dobutamine stress unmasks myocardial functional disturbances caused by uncomplicated DM. The discrete disturbances become quantitatively more pronounced in the presence of coexistent cardiovascular diseases.