Clinical profile and immediate outcomes of balloon mitral valvotomy in low gradient rheumatic mitral stenosis.

Objectives: The objective of this study was to assess the clinical, hemodynamic characteristics and immediate outcomes of Percutaneous Balloon Mitral Valvotomy (PBMV) in low gradient severe rheumatic mitral stenosis (LGMS) with normal cardiac index.

Background: The optimal management of LGMS remains incompletely understood.

Methods: We examined 200 consecutive patients with severe rheumatic mitral stenosis (MS) who underwent PBMV between January 2014 and March 2020.

Treatment optimisation for blood pressure with single-pill combinations in India (TOPSPIN) - Protocol design and baseline characteristics.

Background: The burden of over 300 million individuals living with hypertension in India is increasing steadily. Most current guidelines recommend initial combination therapy for effective blood pressure (BP) control. However, there is no randomised evidence to inform which combinations to use in the South Asian population, who account for over one-quarter of the world's population.

Torsemide as a Primary Choice in Edema Associated with Heart Failure.

Heart failure (HF) is the fastest-growing disease with a higher fatality rate. The most differentiating feature of HF is pulmonary or peripheral edema, which is characterized by a gradient between intravascular and extravascular pressure. Loop diuretics were chosen as the primary treatment for edema associated with HF due to their efficacy and early onset of action.

Caffeine - Essentials for anaesthesiologists: A narrative review.

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits.

Idiopathic Chylous Pericardial Effusion Due to Lymphatic Malformation of Mediastinum.

Chylopericardium can be due to a variety of secondary causes like trauma, radiation, tumors, following cardiac surgery, etc., or may be idiopathic due to abnormal lymphatic system and mediastinal lymphangiectasia, which is a rare entity. Here, we present a case of a 34-year-old previously healthy male presenting with idiopathic chylopericardium.

Detailed Morphometric Analysis on Left Coronary Artery in the Population of North-East India.

Introduction The left ventricle, the cardiac chamber responsible for blood supply to the whole of systemic vasculature, receives most of its blood supply from the left coronary arteries (LCAs). Atherosclerosis of these vessels leading to myocardial infarction is a leading cause of death. Several invasive diagnostic or therapeutic coronary interventions are available for such patients.

Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study").

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019.

Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study.

A review on cardiac manifestation of parasitic infection.

Parasites are uncommon causes of heart diseases except in endemic areas, and very few data are available which deals with parasites infecting human heart. However, literatures demonstrated that certain parasites such as protozoan and helminths can lead to significant cardiac complications. Although all organs can be affected, the heart and the lungs are the most frequently affected organs either directly or indirectly.

Anesthesia concerns for a patient with monkeypox requiring emergency surgery: A review.

Monkeypox is a contagious disease that manifests as a smallpox-like skin rash. The disease has shown a sudden surge worldwide across several countries. These patients may present for emergency surgery.

A Cross-Sectional Study to Ascertain the Effect of COVID-19 Pandemic on Regional Anaesthesia Practices Amongst Anaesthesiologists of India.

Background and aims Regional anaesthesia has been advocated as a preferred modality during the coronavirus disease 2019 (COVID‑19) pandemic, but pursuing regional anaesthesia during COVID-19 is challenging. Our cross-sectional survey aimed to analyze the challenges in conducting regional anaesthesia and the alterations in practices imposed by the COVID‑19 pandemic across the nation. Material and methods The questionnaire was validated by seven experts.

A Double-Blind, Randomized Controlled Pilot Trial to Assess the Analgesic Efficacy of Ultrasound-Guided Preemptive Caudal Morphine as an Adjunct to Bupivacaine for Lumbosacral Spine Surgeries in Adults.

Background The analgesic efficacy of preemptive administration of caudal morphine for spine surgeries in adults is not well studied. In a double-blinded, randomized controlled trial, safety and analgesic efficacy of preemptive, single-shot caudal morphine and bupivacaine was compared with caudal bupivacaine alone in lumbosacral spine surgeries. Methods After Institutional Ethics Committee approval, 40 patients aged 18-60 yrs planned for lumbosacral spine surgery were randomized to groups of 20 patients each.

Renal Subcapsular Hematoma Due to Reperfusion Injury Following Renal Angioplasty in Fibromuscular Dysplasia: A Dilemma in Diagnosis and Management.

Fibromuscular dysplasia (FMD) is a potentially treatable cause of renovascular hypertension and it typically affects young females. FMD usually involves distal two-thirds of the renal artery and percutaneous transluminal renal angioplasty (PTRA) is the treatment of choice for FMD with resistant hypertension. PTRA is a safe procedure with minimal complications.

Bilateral continuous serratus anterior plane block: An effective alternative for bilateral multiple rib fracture analgesia.

Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back.

Rationale, Design, and Implications of Bifurcation Coronary Stenting: Insight from the Indian Bifurcation Stenting (IBIS) Registry.

Background Bifurcation coronary stenting (BCS) has unique therapeutic challenges. Several BCS strategies are prescribed for treatment, with conflicting data, and which is the best strategy for optimal short- and long-term outcomes remains a matter of debate. There is no systematic data from an Indian perspective in regard to patterns of BCS and its outcomes.

Coagulation abnormalities & thromboprophylaxis in COVID-19.

The ongoing pandemic of novel coronavirus 2019 is rapidly evolving, and newer organ- and system-specific manifestations are being observed. Thrombotic complications and coagulopathy are frequent manifestations of the disease, especially in sick patients, which appear to be unique and distinct from sepsis-induced coagulopathy, disseminated intravascular coagulation and other viral infection-induced coagulation abnormalities. Elevated D-dimers and fibrinogen in the early stage of the disease with minimally deranged prothrombin time and platelet counts are prominent and distinguishing features.

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

Aim: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.

Methods & Results: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019.

Abnormally Enlarged Singular Thebesian Vein in Right Atrium.

Thebesian veins in the heart are subendocardial venoluminal channels and are usually less than 0.5 mm in diameter. The system of TV either opens a venous (venoluminal) or an arterial (arterioluminal) channel directly into the lumen of the cardiac chambers or via some intervening spaces (venosinusoidal/ arteriosinusoidal) termed as sinusoids.

Giant Coronary Aneurysm Causing Ostial Occlusion of Coronary Artery by Mass Effect: A Case Report.

Coronary atherosclerosis can rarely lead to complications like giant coronary aneurysm (GCA), and acute myocardial infarction (AMI) due to thrombosis in the GCA is even rarer. Multimodality imaging is preferred over relying solely on selective coronary angiogram in such cases due to the limitations of invasive coronary angiogram in visualizing thrombosed aneurysms. We report a rare case of a patient with ST-elevation myocardial infarction caused by ostial occlusion of a right coronary artery (RCA) due to mass effect created by thrombosis in a GCA, thereby highlighting a mechanism of AMI that has not been previously described in GCA.

Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male.

Cannabis usage is increasing throughout the world for both medicinal and recreational purposes. Several countries and states have legalized cannabis, and physicians can expect to encounter more patients who use or abuse cannabis. Adverse cardiovascular effects of cannabis like myocardial infarction, cardiomyopathy, and arrhythmias have been well described but bradyarrhythmia is rare and the mechanisms are not well pronounced.

Adenosine-A drug with myriad utility in the diagnosis and treatment of arrhythmias.

Adenosine has been used in the emergency treatment of arrhythmia for more than nine decades. However, cardiologists are often unfamiliar about its basic mechanism and various diagnostic and therapeutic uses, considering it mainly as a therapeutic drug for supraventricular tachycardia. This article discusses the role of adenosine relevant to emergency physicians, cardiologists, and electrophysiologists.

Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer and cancer related deaths worldwide. Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor thrombus invasion through the major hepatic veins and of vena cava inferior with continuous extension into the right cardiac cavity. Right heart metastasis without invasion of inferior vena cava (IVC), which may be caused by haematogenous spread of cancer cells, is rarely reported.

Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design.

Background: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic.

Ibutilide with magnesium for conversion of atrial fibrillation or flutter in rheumatic heart disease patients: Ibutilide with magnesium for chemical cardioversion of atrial fibrillation or flutter.

Background: Data on adjunctive use of magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm is lacking.

Aim: We aimed to study the efficacy of adjunctive supplementation of intravenous magnesium with ibutilide for conversion of persistent rheumatic atrial fibrillation and flutter to sinus rhythm and to define a definite level of serum magnesium which leads to significant increase in rates of such conversion.

Methods And Results: This was a prospective study including 33 Rheumatic heart disease patients (13 males and 20 females) with mean age of 49.