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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 19 | Issue 4
Page Nos. 121-163

Online since Monday, April 15, 2019

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ORIGINAL ARTICLES  

Implementation of an ST-segment elevation myocardial infarction bypass protocol in the Northern United Arab Emirates Highly accessed article p. 121
Alan M Batt, Ahmed S Al-Hajeri, Shannon Delport, Sue M Jenkins, Sharon E Norman, Fergal H Cummins
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_81_17  
Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infarction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016–August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48–124), and 81% of patients had a D2B time < 90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of < 90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events.
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Escalation of coronary atherosclerosis in younger people by comparison of two autopsy studies conducted a decade apart p. 128
Kusuma Venkatesh, DC Deepak, VT Venkatesha
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_49_17  
Introduction: Cardiovascular disease is the most common cause of death worldwide which includes coronary heart disease (CHD) as the major contributor. The foremost cause of CHD is atherosclerosis of coronary arteries leading to angina to sudden deaths which is sharply increasing in India; sadly more in the younger people. In this study, results were compared to an autopsy result performed a decade earlier. Aims: Both autopsy studies were conducted to assess the frequency of coronary atherosclerosis, morphological types of lesions and the degree of stenosis in three major coronary arteries. The association of the disease to age, sex, socio-economic status, diet and obesity were studied along with correlating the severity with major risk factors such as hypertension, diabetes mellitus, hyperlipidemia and smoking. Materials and Methods: 60 hearts in the 1st study and 120 in the 2nd study were studied after collecting from Forensic department with details of the deceased. Hearts were dissected by Virchow's method and three major coronary arteries were studied by making serial sectioning. The atherosclerotic lesions were examined histopathologically and typed according to American Heart Association classification along with grading of the luminal stenosis. Results: The second study showed an alarmingly higher incidence of atherosclerosis (90.83%), especially in younger age. Compared to the older study in which 68.33% had coronary atherosclerosis. In both studies coronary atherosclerosis was more in males, severity increased with age and proximal segment of left anterior descending coronary artery was the most commonly affected part with higher grade lesions. Conclusion: The frequency of occurrence of coronary atherosclerosis has definitely increased steeply in the past two decades and alarmingly more in the younger people, with the severity being common in the fourth decade of life itself. There is strong positive correlation with major risk factors reiterating the importance of clinical screening and preventive programs.
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CASE REPORTS Top

Papillary fibroelastoma of the left ventricle in a radiation-treated cancer patient p. 137
Tomas Francisco Cianciulli, María Cristina Saccheri, Alberto Cozzarín, Jorge Alberto Lax, Mario Enrique Simonetti
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_21_18  
We present the case of a 69-year-old female patient with a history of endometrial carcinoma in 1996, who underwent a total hysterectomy and bilateral adnexectomy. The patient also received chemotherapy and mediastinal radiotherapy followed by cancer remission. Ten years later she presented with heart failure and her Doppler-echocardiogram showed severe mitral regurgitation with pulmonary hypertension and a papillary fibroelastoma in the left ventricle. In 2011, she underwent a mitral valve replacement with a biological prosthesis and the pathology exam revealed valve damage consistent with radiotherapy- induced changes and confirmed the presence of a papillary fibroelastoma. This unusual mechanism of papillary fibroelastoma should be disseminated among cardiology physicians and in patients who have survived for long periods after radiotherapy. It is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for detecting them.
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Successful mitraclip transcatheter mitral valve repair in the setting of an interatrial mass p. 141
Sankalp Sehgal, Monica Ahluwalia
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_68_18  
MitraClip procedure is an emerging minimally invasive technique for patients with severe mitral regurgitation (MR) who are at high risk for surgery. Transseptal puncture is a key step in MitraClip procedure that is usually performed superiorly and posteriorly in the interatrial septum for optimal MitraClip placement. The presence of interatrial masses such as patent foramen ovale closure device or thrombus makes transeptal puncture more challenging. Safety and efficacy of MitraClip transcatheter mitral valve repair in the presence of intracardiac masses have not been described in the literature. This case describes a 65-year-old woman deemed high-risk for surgery, with symptomatic, severe primary MR and an unusual interatrial mass who underwent a successful MitraClip procedure with the use of three-dimensional (3-D) transesophageal echocardiography (TEE).
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Late in-hospital rupture of a chronic post-traumatic pseudoaneurysm p. 146
Dimos Karangelis, Dimitrios Tzertzemelis, Alexandros Demis, Matthew Panagiotou
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_62_18  
Chronic posttraumatic pseudoaneurysms of the thoracic aorta are rare clinical entities. Herein, we report a case of an in-hospital cervical rupture of a chronic posttraumatic false aneurysm of the aortic isthmus in a 48-year-old man who had been involved in a traffic accident 20 years earlier.
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Tropheryma Whipplei endocarditis: Case report and literature review p. 150
Mohammad Paymard, Vichitra Sukumaran, Sanjaya Senanayake, Ashley Watson, Chandi Das, Walter P Abhayaratna
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_112_18  
We describe a young man who initially presented with stroke and febrile illness. He was eventually diagnosed with Tropheryma whipplei endocarditis. This is a very rare condition and to the best of our knowledge, this is the first documented case of T. whipplei endocarditis in Australia and New Zealand regions. This report aims to increase awareness of clinicians of this very rare but potentially treatable condition. It is reasonable to exclude T. whipplei endocarditis when dealing with high-risk patients who are suspected for “culture-negative” endocarditis.
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Aorta-right atrial tunnel presenting with heart failure in an adult p. 152
Jyoti Jain, Amar Wani, Aporva Kulkarni, Pallavi Yelne
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_74_18  
Aorta-right atrial tunnel (ARAT) is a rare congenital anomaly characterized by extracardiac tunnel-like vascular connection between aorta and right atrium. Patients are usually asymptomatic, but patient may present with palpitation, dyspnea, and fatigue on exertion. Diagnosis can be made by transthoracic echocardiography during investigations for continuous murmur. Diagnosis can be confirmed by computed tomography, aortography, and coronary angiography. We report a case of a 26-year-old man diagnosed with ARAT arising from right sinotubular junction extending anteriorly and opening into right atrium near the opening of superior vena cava complicated with cardiomegaly and heart failure.
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A PICTURE IS WORTH A THOUSAND WORDS Top

A silent large left ventricular apical pseudoaneurysm presenting as congestive heart failure p. 156
Gopal Chandra Ghosh, Anoop George Alex
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_103_17  
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ART AND MEDICINE Top

Smoking p. 158
Rachel Hajar
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_23_19  
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HISTORY OF MEDICINE Top

Historical perspective on percutaneous mitral valve repair p. 160
Rachel Hajar
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_27_19  
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