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   Table of Contents - Current issue
April-June 2019
Volume 20 | Issue 2
Page Nos. 37-75

Online since Wednesday, July 31, 2019

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Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable and acute coronary heart disease in the United Arab Emirates Highly accessed article p. 37
Wael Al Mahmeed, Sherif Bakir, Salem A Beshyah, Bassem Morcos, Sameh Wajih, Martin Horack, Dominik Lautsch, Baishali Ambegaonkar, Philippe Brudi, Carl A Baxter, Ami Vyas, Anselm K Gitt
Background: Careful management of lipid abnormalities in patients with coronary heart disease (CHD) or an acute coronary syndrome (ACS) can reduce the risk of recurrent cardiovascular events. The extent of hyperlipidemia in these very high-risk patients in the United Arab Emirates (UAE), along with the treatment strategies employed, is not clear. Methods: The Dyslipidemia International Study II was a multinational observational analysis carried out from 2012 to 2014. Patients were enrolled if they had either stable CHD or an ACS. Patient characteristics, lipid levels, and use of lipid-lowering therapy (LLT) were recorded at enrollment. For the ACS patients, the LLT used during the 4 months' follow-up period was documented, as were any cardiovascular events. Results: A total of 416 patients were recruited from two centers in the UAE, 216 with stable CHD and 200 hospitalized with an ACS. Comorbidities and cardiovascular risk factors were extremely common. A low-density lipoprotein cholesterol level of <70 mg/dl, recommended for patients at very high cardiovascular risk, was attained by 39.3% of the LLT-treated CHD patients and 33.3% of the LLT-treated ACS patients at enrollment. The mean atorvastatin-equivalent daily statin dose was 29 ± 15 mg for the CHD patients, with 13.7% additionally using ezetimibe. For the ACS patients, the daily dosage was 23 ± 13 mg at admission, rising to 39 ± 12 mg by the end of the 4-month follow-up. The use of nonstatin agents was extremely low in this group. Conclusions: Despite LLT being widely used, hyperlipidemia was found to be prevalent in ACS and CHD patients in the UAE. Treatment strategies need to be significantly improved to reduce the rate of cardiovascular events in these very high-risk patients.
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Incidence, risk factors, and outcome of cardiac arrhythmia postcardiac surgery in children p. 47
Akanksha Jain, Shahzad Alam, S Kiran Viralam, Tanzila Sharique, Saurabh Kapoor
Objective: To study the incidence of postoperative cardiac arrhythmias in children undergoing cardiac surgery and to evaluate the risk factors and outcome of these patients. Materials and Methods: This retrospective observational study was conducted in the cardiac pediatric intensive care unit and included children <18 years of age. Children were monitored in the early postoperative period (72 h) for any sustained rhythm abnormality and were classified using standard definition. Details of treatment and their response were assessed. Risk factors for arrhythmias were evaluated using multivariate logistic regression analysis. Results: Five hundred and thirty-six children were included and the prevalence of arrhythmia was 14.4% (n = 77). The most common arrhythmia was complete heart block (CHB) (n = 28; 5.2%), followed by junctional ectopic tachycardia (JET) (n = 25; 4.7%), junctional escape rhythm (n = 13; 2.4%), supraventricular tachycardia (SVT) (n = 8; 1.5%), and ventricular tachycardia (VT) (n = 3; 0.6%). Cardiac pacing was required in all CHB; 8 (28.6%) required a permanent pacemaker. Six (24%) patients with JET responded to conventional measures; 19 (76.0%) patients required amiodarone and 5 (20%) required cooling to 34°C or cardiac pacing. Temporary cardiac pacing was required in 9 (69.2%) cases of junctional escape rhythm. Seven (87.5%) events of SVT responded to adenosine and 1 (12.5%) required cardioversion. Two (66.7%) of VT responded to cardioversion while 1 (33.3%) was refractory. Five (6.5%) patients with arrhythmia died. In the multivariate logistic regression analysis, age <1 year, risk adjustment for congenital heart surgery category ≥3, and cross-clamp time >67 min were independent risk factors. Conclusion: Early postoperative period following cardiac surgery is extremely vulnerable to cardiac arrhythmias. Although majority are self-limiting, some can be life-threatening.
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A rare case of “acute take off” of left circumflex artery successfully intervened using dual-lumen microcatheter p. 53
Ajay S Chaurasia, Jaywant M Nawale, Digvijay Deeliprao Nalawade
“Acute take off” of the left circumflex artery (LCX) is a rare coronary artery variant. Development of coronary artery disease in such a vessel increases technical difficulty and failure rate for percutaneous coronary intervention. We report a rare case of “acute take off” of the LCX with proximal critical stenosis successfully intervened using dual-lumen microcatheter.
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Pericardial effusion in systemic sarcoidosis: a rare manifestation of cardiac sarcowid p. 56
Jorge Isaac Peña-Garcia, Sana Javeed Shaikh, Diana Sofia Villacis-Nunez, Murali Krishna Gurram
We present a 65-year-old African American woman who was found to have pericardial effusion secondary to cardiac sarcoid. Pericardial effusion is a rare manifestation of cardiac sarcoid. All cases of sustemic sarcoid should be evaluated for cardiac involvement which can be difficult to detect.
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Radial artery pseudoaneurysms treated by ultrasound-guided differential compression: An effective and simple method p. 60
Raghuram Palaparti, Gopala Krishna Koduru, Sudarshan Palaparthi, Purnachandra Rao Kondru, Somasekhar Ghanta, PS Srinivas Chowdhary, Srinivas Dandamudi, Boochi Babu Mannuva
Transradial approach has become preferable to conventional femoral artery access for both diagnostic coronary angiography and percutaneous coronary intervention. A rare but recognizable complication of radial access is radial artery pseudoaneurysm (RAp), which represents a potentially catastrophic complication. Treatment options comprise ultrasound (USG)-guided manual compression or thrombin injection or surgical correction. In this case series, we report four cases of RAps that we encountered at a single tertiary care center from July 2015 to January 2018. We compressed the radial artery using a sphygmomanometer cuff differentially rather than a TR band proximal to the pseudoaneurysm to treat three of them. One of the patients underwent surgical repair of the pseudoaneurysm as the location of the aneurysm was not suitable for compression or thrombin injection. In our series of cases, we conclude that RAp, a rare complication of radial catheterization, was seen more commonly in elderly female patients and can be easily treated by the USG-guided differential compression, a simple and readily available method. Prevention and early diagnosis is the key to avoid serious consequences.
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“The unpredictable ABSORB” – very late stent thrombosis of bioresorbable vascular scaffold p. 65
Akshyaya Pradhan, Pravesh Vishwakarma, Sameer Vankar, Rishi Sethi
Bioresorbable vascular scaffolds represent the next revolution in stent technology. They serve the dual purpose of antiproliferative drug delivery to vascular lumen like a drug-eluting stents (DES) as well as phased strut resorption over time leading to virtual elimination of stent thrombosis. The ABSORB GT-1 stent was the prototype bioresrbable vascular scaffold with maximum clinical experience and initial promising results. However, reports of stent thrombosis emerged with ABSORB too. Although the use of intracoronary imaging and proper implantation technique has the potential to reduce stent thrombosis rates, the device has been withdrawn from the market for now. We report a case of late stent thrombosis with ABSORB which was managed with DES-supported intracoronary imaging.
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Single coronary artery with superdominant left circumflex artery: A rare coronary anomaly p. 70
Rahul Choudhary, Surender Deora
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Art imitates life (what art can teach medical students) p. 72
Rachel Hajar
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PCSK 9 inhibitors: A short history and a new era of lipid-lowering therapy p. 74
Rachel Hajar
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