Thyroid hormones influence several cardiovascular functions, including myocardial contractility, vascular tone, and lipid metabolism. Abnormal thyroid activity – ranging from overt hypo- or hyperthyroidism to transient low T3 syndrome – has been linked to the onset, severity, and prognosis of acute coronary syndrome (ACS). Hospital-based studies report thyroid function abnormalities in approximately 15%–30% of patients presenting with ACS, most commonly low T3 syndrome and subclinical hypothyroidism. This narrative review summarizes current evidence on how thyroid dysfunction affects cardiovascular physiology and clinical outcomes in ACS. Proposed mechanistic links include effects on myocardial contractility, vascular tone, endothelial function, inflammation, and arrhythmogenesis. Hypothyroidism promotes atherogenesis through dyslipidemia and endothelial dysfunction, while hyperthyroidism increases myocardial oxygen demand and arrhythmic risk. Low T3 syndrome, frequently observed during ACS hospitalization, correlates with larger infarct size, left ventricular dysfunction, and increased mortality. Although these hormonal alterations may partly reflect adaptive responses to acute illness, they carry important prognostic implications. Evidence from Indian and global studies indicates that thyroid abnormalities are common among ACS patients, yet routine screening remains limited. Understanding these interactions may help clinicians identify high-risk individuals, refine risk stratification, and optimize post-ACS management, particularly in settings where cardiovascular and endocrine disorders frequently coexist.
Sudden cardiac death (SCD) is a major global public health issue, especially among young Indians. Genetic conditions such as arrhythmogenic disease and inherited cardiomyopathies cause many SCD cases under 40 years, with 30% remaining unexplained after death. Despite advances, at-risk individuals are often undetected due to inadequate screening tools and healthcare resources. This article advocates for a holistic approach combining current diagnostics and best practices. It highlights artificial intelligence, particularly electrocardiogram (ECG)-based deep learning models, for risk stratification in low-resource settings. The use of the American Heart Association’s 14-item screening questionnaire is recommended for early detection of congenital and genetic heart issues. Genetic testing is also emphasized as vital for selectively identifying high-risk individuals. The article reviews primary care screening methods such as integrating SCD tools into routine noncommunicable disease checks, telemedicine ECG models, and risk questionnaires, followed by urgent referral. Pilot studies are essential to evaluate tool effectiveness, and community engagement is needed for implementation. Ultimately, SCD prevention requires a collaborative effort that integrates innovative approaches into existing healthcare systems.
Purpose:Older patients undergoing abdominal aortic aneurysm (AAA) repair are at risk of functional decline. Endovascular aneurysm repair (EVAR) has better perioperative outcomes than open abdominal surgery (OAS), but its impact on postoperative muscle preservation is unclear. We compared rectus femoris muscle changes after EVAR versus OAS.Methods:We retrospectively analyzed 50 patients undergoing elective AAA repair (EVAR n = 30; OAS n = 20) at a single center (2012-2014). The primary endpoint was the pre- to postoperative change in the bilateral rectus femoris short-axis diameter product on computed tomography (mm2) at the level of the pubic symphysis 3-6 months after surgery. Baseline and follow-up rectus femoris values were 1120 +/- 410 versus 1132 +/- 441 mm2 (EVAR) and 791 +/- 336 versus 805 +/- 431 mm2 (OAS); baseline values were lower in the OAS group. Propensity score matching (1:1 nearest-neighbor, caliper 0.05, with replacement) produced 30 matched pairs. Treatment effects were estimated using a two-time-point difference-in-differences (DiD) model; effect sizes were summarized as standardized mean differences (Cohen's d).Results:After matching, EVAR was associated with better preservation of the rectus femoris muscle than OAS (DiD 17.25 mm & sup2;; 95% confidence interval 2.54-31.97; P = 0.02).Conclusion:EVAR may confer advantages over OAS in preserving rectus femoris muscle mass after AAA repair, particularly in older patients at risk of postoperative functional decline.
Background:Acute coronary syndrome is the leading cardiovascular cause of mortality and necessitates prompt diagnosis and treatment. Hence, determination of intracoronary thrombus burden and related angiographic milieu is important to manage the complications during the procedure and to prevent adverse outcomes. Objective:To evaluate the correlation between the C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio with thrombus burden in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methodology:This study was conducted as a hospital-based prospective observational study in the department of cardiology of our tertiary care hospital for a period of 1 year, between 2024 and 2025, on patients who were presented with STEMI and underwent primary PCI. Results:A total of 101 patients were included in our study over 1 year time period. Median CAR value is 1.074617 +/- 0.645692, and patients are divided into two categories according to high and low thrombus grade. Pearson correlation coefficient between thrombus grade and CAR is 0.4853, along with P < 0.0001, which show significant correlation between both entities. Conclusion:The CAR was found to be a potentially useful prognostic tool for predicting a poor prognosis in STEMI patients. However, this finding needs to be validated in the future prospective studies.
Background:While large multinational trials such as STEP-heart failure with preserved ejection fraction (HFpEF) have demonstrated benefits with subcutaneous semaglutide across diverse populations, real-world evidence on the oral formulation, particularly in Indian practice settings, remains limited.Objective:We aimed to assess the feasibility, short-term biomarker and functional responses, and tolerability of oral semaglutide in routine care of obesity-related HFpEF in India.Methods:We retrospectively analyzed 145 adults with obesity-related HFpEF who received oral semaglutide or no semaglutide. The primary endpoint was the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels from baseline to follow-up. Reassessments were performed at a mean of 4 +/- 1 weeks (median 4 weeks) after baseline. The secondary endpoints included change in body mass index, New York Heart Association (NYHA) functional class, 6-min walk distance (6-MWD), and exploratory time-to-event outcomes. Oral semaglutide was initiated at 3 mg daily and titrated to 7-14 mg, as tolerated.Results:The semaglutide group showed a larger NT-proBNP reduction than controls (-350 vs. -180 pg/mL; P = 0.032), corresponding to a baseline-adjusted between-group difference of - 160 pg/mL (95% confidence interval [CI]: -233 to - 87). Associations were directionally consistent across diabetes status, and larger changes were observed at higher baseline NT-proBNP; no formal interaction testing was performed. NYHA improvement was numerically higher (38% vs. 24%; P = 0.03), although the risk difference 95% CI included zero. The 6-MWD increased by + 40 +/- 15 m versus + 20 +/- 12 m (P = 0.04). Exploratory time-to-event analyses showed no statistically significant between-group differences over approximate to 4 weeks. Adverse events were mainly mild gastrointestinal symptoms.Conclusion:In this Indian real-world cohort, oral semaglutide was associated with lower NT-proBNP levels and early changes in functional measures over approximate to 4 weeks; these findings are hypothesis-generating and directionally consistent with international randomized controlled trials of subcutaneous semaglutide in HFpEF.
Transjugular intrahepatic portosystemic shunt (TIPS) is a key therapy for portal hypertension complications in Budd-Chiari syndrome (BCS). Intracardiac stent migration is rare and typically presents with arrhythmia or tricuspid regurgitation rather than hepatic encephalopathy (HE). A 35-year-old female with BCS underwent TIPS (February 2025) and presented in August 2025 with West Haven Grade II HE. ECG and cardiac examination were normal. Transthoracic echocardiography demonstrated migration of the TIPS stent into the right atrium (RA). She improved with standard HE therapies. Interventional radiology performed a parallel TIPS, leaving the migrated stent in situ, given no cardiac sequelae and likely stent adherence. Postprocedure contrast-enhanced computed tomography confirmed the correct position and adequate flow through the new shunt. She remained asymptomatic at 1-month follow-up. To the best of our knowledge, this is among the first reported cases where HE was the sentinel event revealing intracardiac stent migration. HE may be the first clinical clue to TIPS migration. In selected, asymptomatic RA migrations, conservative retention of the intracardiac stent with parallel TIPS to restore portal decompression is feasible, supported by established HE and TIPS literature.
Primary cardiac angiosarcomas are rare and highly aggressive malignancies that often present with nonspecific clinical features, leading to delayed diagnosis and poor outcomes. An 18-year-old male presented with constitutional symptoms and acute breathlessness and was found to have a large pericardial effusion with a right atrial mass. Initial imaging and transvenous biopsy were inconclusive. Surgical exploration and debulking were performed, and histopathological examination with immunohistochemistry confirmed the diagnosis of primary cardiac angiosarcoma. Despite postoperative multimodal therapy including chemotherapy and radiotherapy, the patient succumbed to the disease 3 months after surgery. Primary cardiac angiosarcoma should be considered in young patients presenting with unexplained pericardial effusion or right atrial masses. Early suspicion, multimodality imaging, and combined therapeutic approaches are crucial, although prognosis remains poor.
Guillain-Barr & eacute; syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy with a triad of progressive limb weakness, sensory abnormalities, and areflexia following an infection. Autonomic dysfunction occurs in two-thirds of patients and significantly influences prognosis. While most autonomic disturbances, such as blood pressure fluctuations and arrhythmias, are transient and improve with neurological recovery. Severe or persistent bradyarrhythmias are rare and potentially fatal. We present a case of GBS with long-term sinus node dysfunction requiring permanent pacemaker insertion following complete motor recovery. The patient had recurrent presyncope and marked sinus pauses on Holter monitoring without any reversible etiology. Electrophysiological evaluation supported the diagnosis of sick sinus syndrome (SSS) due to chronic autonomic dysfunction. An atrial-based AAIR pacemaker was inserted considering the patient's intact atrioventricular conduction and financial constraints. Electrophysiological evaluation supported the diagnosis of SSS. This case highlights the need for continuous cardiac monitoring in GBS, early recognition of autonomic complications, and timely intervention to prevent mortality. Cardiac monitoring should continue even after neurological recovery.
Background: Ischemic cardiomyopathy (ICMP) and Dilated cardiomyopathies (DCMP) impair right ventricular (RV) function through distinct mechanisms, yet comparative data remain limited. This study evaluated and compared RV function in ICMP and DCMP patients with left ventricular ejection fraction (LVEF <35%) using 2D transthoracic echocardiography. Materials and Methods: This prospective study included consecutive patients with ICMP or DCMP and LVEF < 35%. Comprehensive RV assessment included tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), Right Ventricular Myocardial Performance Index (RVMPI), and tissue Doppler S' velocity. Results: A total of 110 patients were evaluated (59.1% ICMP; 40.9% DCMP). LVEF was comparable between ICMP and DCMP (25.82 +/- 5.15% vs. 23.69 +/- 6.35%; P = 0.06). RV functional parameters including TAPSE (15.05 +/- 3.66 vs. 14.69 +/- 3.48 mm; P = 0.61), S ' velocity (9.17 +/- 1.65 vs. 8.54 +/- 1.89 cm/s; P = 0.06), FAC (34.01 +/- 9.10% vs. 33.04 +/- 11.34%; P = 0.64), and RVMPI (0.54 +/- 0.20 vs. 0.58 +/- 0.26; P = 0.40). RV dysplasia (RVD) was observed in 60.0% of ICMP and 73.3% of DCMP patients (P = 0.18), whereas RVSP was higher in DCMP (P = 0.003). LVEF was associated with TAPSE and S ' in DCMP but not ICMP. TAPSE independently predicted RV dysfunction in both groups, where RVMPI (beta = -1.1; 95% confidence interval: -2.05 to -0.14; P = 0.03) was predictive only in DCMP. Conclusion: RV dysfunction is commonly accompanies severe left ventricular impairment in both CMP, with higher burden in DCMP. TAPSE and S ' velocity associated with RVD, underscoring their prognostic relevance in advanced cardiomyopathy.
Objective: The objective of the study was to evaluate the association between left atrial volume index (LAVI) and in-hospital outcomes in patients with ST-elevation myocardial infarction (STEMI). This is the first prospective Indian study assessing in-hospital clinical outcomes using LAVI. Materials and Methods: This prospective observational study included consecutive STEMI patients who underwent transthoracic echocardiography within 24-72 h of admission. Patients were stratified by LAVI <32 mL/m(2) and >= 32 mL/m(2). Baseline characteristics, echocardiographic parameters, and in-hospital adverse events were compared between groups. Results: Of 110 STEMI patients, 80 had LAVI <32 mL/m(2) and 30 had LAVI >= 32 mL/m(2). Patients with higher LAVI had lower ejection fraction, higher E/e ' ratio, higher wall motion score index, and more frequent Killip class >= 2 at presentation. In-hospital complications, particularly arrhythmias (63.3% vs. 30.0%) and left ventricular systolic dysfunction, were more common in the LAVI >= 32 mL/m(2) group. Conclusion: Elevated LAVI is a simple, noninvasive, and easily reproducible echocardiographic marker associated with worse functional parameters and higher in-hospital complication rates. Incorporating LAVI into early risk stratification may facilitate timely identification of high-risk STEMI patients.
Background: Coronary artery disease (CAD) is a significant health burden worldwide, and risk stratification in myocardial infarction (MI) is paramount. Interatrial septal thickness (IAST) measured by echocardiogram may represent a simple, noninvasive marker of CAD. As such, the purpose of this study was to investigate the relationship between IAST and the level of CAD severity in patients with MI. Methodology: In this observational study, patients admitted for acute MI underwent transthoracic echocardiogram and coronary angiography during the same admission. IAST was measured by one experienced observer, and SYNTAX scores were calculated for all patients to account for coronary lesion complexity. Patients were classified by clinical status and by angiographic findings. Statistical analyses included t-tests for the comparisons of means, Spearman's correlation, and receiver operating characteristics (ROC) curve analysis for the measurement of diagnostic performance. Results: A total of 160 patients were enrolled (123 males, 37 females; mean age 60.2 years). Patients with triple-vessel disease and left main plus triple-vessel disease had higher mean IAST (11.38 mm and 11.68 mm, respectively), whereas single- and double-vessel disease showed lower values (8.47 mm and 8.73 mm, respectively). A statistically significant positive correlation was found between IAST and SYNTAX score (Spearman's rho =0.62, P < 0.00001). ROC analysis identified an optimal IAST cutoff value of 10.4 mm for predicting severe CAD (sensitivity-79.2% and specificity-69.2%). Conclusion: IAST (cutoff 10.4 mm) demonstrates a significant positive association with CAD severity and may serve as a potential non-invasive marker for early risk stratification in MI patients.
Takotsubo cardiomyopathy (TTC) is characterized by transient systolic dysfunction of the left ventricle in the absence of obstructive coronary artery disease, typically triggered by emotional or physical stress. A 73-year-old male presented with a scrotal abscess complicated by septic shock. On day 2 of hospitalization, he developed acute chest pain. Electrocardiography (ECG) showed ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in leads aVL and V1-V4, suggestive of inferior wall ST-elevation myocardial infarction (STEMI). High-sensitivity troponin T was elevated (50 ng/L), which was modest relative to the extent of ECG changes. Transthoracic echocardiography revealed left ventricular systolic dysfunction (left ventricular ejection fraction 40% by Simpson's biplane method) with hypokinesia of the mid-left ventricular segments and preserved basal and apical contractility. Emergency coronary angiography demonstrated angiographically normal epicardial coronary arteries with no evidence of obstructive disease, thrombus, or dissection. Left ventricular angiography revealed circumferential hypokinesia of the mid-ventricular segments with hypercontractile basal and apical segments, consistent with midventricular TTC. The patient was managed conservatively with antibiotics and supportive care, resulting in the complete resolution of ECG changes and normalization of left ventricular function. Midventricular TTC is a rare variant that can closely mimic inferior-wall STEMI. Recognition of this entity is essential to avoid inappropriate reperfusion therapy.
Mediastinal teratoma presenting with acute respiratory distress and superior vena cava (SVC) compression is rare. We report a case of a 2-year-old girl who presented with acute-onset respiratory distress and SVC compression caused by a large anterior mediastinal tumor. Imaging studies revealed a huge mass in the anterior mediastinum extending into the upper right hemithorax. The tumor was surgically excised and histopathologically identified as a mature teratoma. Postoperative recovery was uneventful, and the child remains symptom-free on follow-up. The diagnosis of mediastinal tumor must be considered in any preschool-age child with nonresolving cough, respiratory difficulty, or SVC syndrome.
Coronary artery anomalies are rare congenital conditions with a prevalence of <1% in the general population. We describe a 61-year-old male who presented with acute coronary syndrome (ACS) and Type A Wellens syndrome. Coronary angiography demonstrated an extremely rare anomaly in which all three coronary arteries originated from the right coronary cusp with separate ostia. Coronary computed tomography angiography (CCTA) further delineated a benign retroaortic course of the left anterior descending artery (LAD). Percutaneous coronary intervention was performed via a right transfemoral approach using a Judkins Right 7F catheter, achieving successful revascularization of the culprit LAD lesion. The patient recovered uneventfully and remained free of major adverse cardiac events at 6-month follow-up. This case underscores the procedural challenges posed by anomalous coronary anatomy and highlights the critical role of computed tomography imaging in defining the coronary course and guiding safe intervention. When an anomalous coronary origin is suspected during ACS evaluation, urgent CCTA may be useful to define the coronary course before revascularization in selected cases. The combination of all three coronary arteries arising from the right coronary cusp, along with a retroaortic LAD course, emphasizes the rarity and clinical relevance of this presentation.
Lutembacher syndrome, a rare combination of atrial septal defect (ASD) and mitral stenosis (MS), presents unique diagnostic and management challenges. We present an 18-year-old female with exertional dyspnea, volume-overload palpitations, and paroxysmal atrial tachyarrhythmia. Examination revealed the signs of increased pulmonary flow, a mid-diastolic murmur, and an ejection systolic murmur at the pulmonary area. Imaging demonstrated a nonrestrictive ostium secundum ASD with severe MS and pulmonary hypertension. The differential diagnosis, pathophysiological interplay, and management strategies, including considerations for percutaneous versus surgical correction, are discussed in detail, highlighting the teaching value of this classical lesion.
The renin–angiotensin system is crucial for maintaining blood pressure and fluid balance. Central to this system are the angiotensin receptors, type I (AT1R) and type II (AT2R), which mediate the effects of angiotensin II (Ang-II). AT1R, primarily expressed in cardiovascular cells, mediates most of the Ang-II’s physiological and pathological effects, including vasoconstriction, inflammation, and hypertrophy, contributing significantly to common cardiovascular problems such as hypertension, hypertrophic cardiomyopathy, coronary artery disease, ischemic cardiomyopathy, and dilated cardiomyopathy (DCM). In contrast, AT2R, though less prevalent, exhibits protective roles including anti-inflammatory and vasodilatory effects. The interplay between AT1R and AT2R is complex; while AT1R, when remains activated for a prolonged period, promotes pathogenic processes, AT2R often counteracts these effects. Therapeutically, angiotensin receptor antagonists that block AT1R or activate AT2R show promise in managing cardiovascular disorders. This review underscores the significance of AT1R and AT2R in the pathophysiology of cardiac diseases and the potential clinical benefits of targeting these receptors to mitigate disease progression.
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, making prevention a crucial strategy to reduce their impact. However, disparities in access to preventive healthcare disproportionately affect marginalized and underserved population. Barriers such as socioeconomic inequality, geographic limitations, and systemic inefficiencies hinder early detection, lifestyle interventions, and timely medical care. Limited healthcare infrastructure, financial constraints, and low health literacy further exacerbate these inequities, increasing the burden of CVDs. Addressing these challenges through policy reforms, digital health solutions, and strengthened primary healthcare is essential for improving cardiovascular outcomes. Key barriers to CVD prevention include socioeconomic disparities, geographic inaccessibility, and systemic inefficiencies such as healthcare shortages and policy gaps. Financial limitations and lack of health insurance restrict access to screenings and early interventions, while rural population face inadequate specialized care. Additionally, misinformation and low awareness contribute to poor health-seeking behaviors, delaying preventive measures. To bridge these gaps, universal healthcare coverage, telemedicine, community-based programs, and public awareness campaigns must be prioritized. Strengthening primary healthcare services and integrating cardiovascular care into national health systems will enhance early detection and preventive interventions. A multi-sectoral approach involving policymakers, healthcare institutions, and technology-driven solutions is crucial to ensuring equitable access to CVD prevention, ultimately reducing disease burden and improving global public health.
Amyloidosis is a multi-system disorder in which cardiac involvement often manifests with heart failure and/or arrhythmias. Recognition of cardiac amyloidosis is important as it is a potentially treatable cause of cardiomyopathy. While the approach to a case of suspected cardiac amyloidosis was discussed in a prior article, this one focuses on the management of its two main types (AL and ATTR). This is an area of active research with the advent of newer therapies such as RNA silencers and gene editing. We shall also discuss the management of heart failure and arrhythmias specific to amyloidosis.
