Background: Non-ST elevation myocardial infarction (NSTEMI) is a prevalent subtype of acute coronary syndrome. Accurate risk stratification is critical in guiding timely interventions and optimizing prognosis. Thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores are widely used for risk prediction. However, their comparative performance in real-world clinical practice remains underexplored. Objectives: The objective of this study was to compare the predictive accuracy of TIMI and GRACE risk scores for inhospital major adverse cardiac events (MACEs), including death, heart failure, stroke, and need for revascularization, in patients presenting with NSTEMI. Materials and Methods: A prospective observational study was conducted at a tertiary care centre in Bengaluru. Seventy eight patients diagnosed with NSTEMI were enrolled and evaluated using TIMI and GRACE risk scores at admission. Patients were followed throughout their hospital stay for the occurrence of MACE. The predictive ability of each score was assessed using receiver operating characteristic curve analysis and diagnostic accuracy metrics. Results: Among the 78 patients, the incidence of inhospital MACE was significantly higher in patients with TIMI ≥ 4 and GRACE ≥ 140. The GRACE score demonstrated superior predictive performance (area under the curve [AUC] =0.891; 95% confidence interval [CI]: 0.820–0.961) compared to the TIMI score (AUC = 0.777; 95% CI: 0.667–0.887). GRACE also showed higher specificity (83.92%), negative predictive value (87.03%), and overall accuracy (79.48%) in identifying high-risk patients. Mortality was significantly higher in the GRACE ≥ 140 group (20.83% vs. 0%; P = 0.002). Conclusion: TIMI and GRACE scores are valuable tools for risk stratification in NSTEMI. However, the GRACE score offers superior predictive accuracy for inhospital adverse outcomes and should be preferred for comprehensive risk assessment.
We had retrospective evaluation analysis of 136 Spontaneous Coronary Artery Dissection (SCAD), diagnosed from 21,007 coronary angiograms (CAGs) done over 159 months from our two tertiary care hospitals in our city. SCAD was diagnosed and confirmed by at least two senior consultants using cine of CAGs. We had a global incidence of 0.65%, mean age of 50.2 years, male predominant (92.6%) from two centers. Had varied clinical presentation and the majority were acute coronary syndromes. They also underwent two-dimensional echocardiography (2D echo) for left ventricular (LV) function assessment. CAG identifies a total of 148 SCAD lesions from 136 patients and the majority were left anterior descending (LAD) SCAD (78) and right coronary artery SCAD (43). Managed medically in 95 and revascularization in 41. Out of 41, 25 for per cutaneous intervention (PCI) and 16 for coronary artery bypass graft. Out of 25 PCI, 5 had direct PCI on SCAD vessel and 20 had PCI on non-SCAD vessels to improve collaterals and to relieve symptoms. No pregnancy-related SCAD or major adverse cardiac events (MACE) at 1 month were noted. We observed that there are many differences noted in world statistics. All are alive, no pregnancy associated SCAD or MACE, male and LAD SCAD lesion dominance, majority had normal-to-mild LV systolic dysfunction by 2D echo and managed medically. This probably explains ethical and geographical variations, diet, body mass index and many more. Higher detection rates likely reflect improved angiography quality, hardware, and operator expertise. Limitations include the absence of intra vascular ultra sonography and optical coherence tomography imaging.
Background: Fetal cardiac rhythm abnormalities affect approximately 2% of pregnancies, with a subset posing significant hemodynamic risks to the fetus. Timely identification and intervention are critical to optimizing outcomes. This study evaluates the types, associations, management, and postnatal outcomes of abnormal fetal cardiac rhythms at a tertiary care center in North India. Methodology: A prospective observational study was conducted at the Children’s Hospital, Bemina, from January 2023 to February 2025. All foetuses referred with suspected arrhythmias underwent detailed fetal echocardiography. Arrhythmias were classified as tachyarrhythmias, bradyarrhythmias, or ectopic beats. Maternal autoimmune status was assessed in relevant cases. Transplacental therapy (TPT), including digoxin, flecainide, and amiodarone, was administered for tachyarrhythmias. Steroids and hydroxychloroquine were used in autoimmune-mediated conduction abnormalities. Cases were followed until delivery and postnatally. Results: Thirty-seven fetuses with abnormal rhythms were evaluated. Premature artial contraction (PACs) were the most common(45.9%) followed by conduction defects(27%) and Supraventricluar Tachycardia and AF(18.9%). Structural heart defects were present in 16.2% of cases. TPT was successful in five of seven tachyarrhythmia cases. Immune-mediated AV block was noted in 60% of conduction abnormalities. Postnatal outcomes included healthy deliveries in most PAC cases, pacemaker insertion in one neonate with complete heart block, and intrauterine demise in three hydropic fetuses. Conclusion: Abnormal fetal cardiac rhythms can range from benign to life-threatening conditions. Prompt diagnosis with fetal echocardiography, maternal autoimmune screening, and targeted intrauterine management play pivotal roles in improving neonatal outcomes. Multidisciplinary care is essential for optimal perinatal management.
An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare but fatal congenital cardiovascular disease. In this condition, the left coronary artery originates from the pulmonary artery, whereas it should normally originate from the ascending aorta. This causes left ventricular dysfunction/insufficiency. It is asymptomatic in many cases and is missed during the initial months of life. Incidence is 1 in 300,000 live births and comprises about 0.25%–0.5% of congenital heart disease. In this article, we present the case of a 56-year-old adult who came with complaints of chest pain and exertional dyspnea. Systemic examination was normal. Electrocardiogram findings showed a left bundle branch block pattern. A transthoracic echocardiogram showed Left ventricular (LV) dysfunction along with papillary muscle echo bright due to infarction which made a suspicion of ALCAPA and was later confirmed by coronary angiography. ALCAPA is a clinical diagnostic challenge as it presents with similar complaints of common pediatric diseases such as bronchiolitis, failure to thrive, and cardiomyopathy. Usually, the majority of affected children remain undiagnosed and die within the 1st year of life, and only a few survive till adulthood; hence, it is of utmost importance to keep a watch for this condition for early diagnosis and surgical intervention, which will help in improving the prognosis.
ABSTRACT Background: Bradyarrhythmias constitute an important cause of hemodynamic instability, recurrent syncope, and sudden cardiac events, especially in aging population. Regional data from the Indian subcontinent, particularly from Kashmir, remain limited despite rising device implantation rates. Objectives: To describe the demographic patterns, clinical presentation, electrocardiography (ECG) characteristics, pacing strategies, and short-term outcomes of patients presenting with bradyarrhythmias at a tertiary cardiac center in Kashmir. Methodology: A prospective observational study was conducted over 2 years and included 723 adult patients presenting with clinically significant bradyarrhythmias. Data collected included demographics, comorbidities, presenting symptoms, ECG findings, device therapy, and in-hospital outcomes. As the study was descriptive in nature, inferential statistical testing was not performed. Results: The majority were older adults, with a slight male predominance. Complete heart block (≈58%) emerged as the most frequent bradyarrhythmia, followed by sick sinus syndrome (≈12%), second-degree atrioventricular (AV) block (≈11%), and bifascicular/trifascicular blocks. Syncope and presyncope were the most common symptoms. Dual-chamber pacing was used in approximately three-fourths of patients and single-chamber pacing in nearly one-fifth. Procedural complications were infrequent and mostly minor. In-hospital mortality was low and confined to those with significant comorbidities or advanced conduction disease. Conclusion: Bradyarrhythmias remain a major clinical burden in Kashmir, dominated by advanced AV block. Timely diagnosis and appropriate pacemaker implantation, primarily dual-chamber systems, yield excellent short-term outcomes. Strengthening referral pathways and early recognition at peripheral centers may further reduce morbidity.
Myocardial bridging is a congenital anomaly of the coronary arteries in which a segment of the artery runs within the heart muscle and is compressed during the contraction phase of the heart. This case report discusses a middle-aged woman with a history of severe rheumatic mitral stenosis who underwent open commissurotomy. The patient presented with dyspnea and palpitations. General examination revealed sinus tachycardia, a loud first heart sound, and a mid-diastolic murmur. Echocardiography revealed a normal left ventricular ejection fraction and severe rheumatic mitral stenosis. Coronary angiography revealed normal coronary arteries with myocardial bridges (MBs) in the mid-left anterior descending artery, distal left circumflex artery, and distal right coronary artery. These observations were confirmed by cardiac computed tomography. This case report contributes to the limited literature on multivessel MBs and highlights the importance of thorough diagnostic assessments to optimize individualized treatment plans for patients.
Background: Pulmonary endarterectomy (PEA) is the definitive or curative surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Despite global advancements, data from India remain limited. This study aims to evaluate the demographic, clinical, operative, and inhospital outcomes of patients undergoing PEA in an Indian tertiary care setting. Materials and Methods: This retrospective single-center observational study included 24 patients who underwent PEA between January 2022 and May 2024. Data on clinical presentation, comorbidities, imaging findings, intraoperative parameters, postoperative complications, and early outcomes were analyzed. Results: The mean patient age was 38.2 ± 11.4 years, with a male predominance (83.3%). Bilateral CTEPH was present in 91.7% of cases. Preoperatively, most patients were in the New York Heart Association (NYHA) Class II (62.5%), and 58.3% had right ventricular dysfunction. The mean cardiopulmonary bypass and circulatory arrest times were 178.7 ± 58.3 and 38.4 ± 19.9 min, respectively. Postoperative complications occurred in 25% of patients, including bleeding (12.5%), infection (12.5%), and cerebrovascular accident (8.3%). Reintubation was required in two patients and tracheostomy three patients. Five (20.8%) patients died, primarily due to right ventricular failure and multiorgan dysfunction. Among survivors, 77.8% improved to NYHA Class I at discharge. Conclusion: Despite the technical complexity and high perioperative risk, pulmonary thromboendarterectomy offers significant symptomatic relief and functional improvement in patients with operable CTEPH. Early referral, meticulous surgical technique, and multidisciplinary perioperative care are critical to optimizing outcomes, particularly in emerging programs in India.
Background: Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality, and optimal management requires the timely initiation and uptitration of guideline-directed medical therapy (GDMT). Despite strong recommendations, real-world achievement of target doses for core GDMT agents remains suboptimal. This study aimed to evaluate the implementation and impact of a structured GDMT protocol among patients admitted with HFrEF in a tertiary care setting. Methods: A prospective observational study was conducted over 18 months at the Department of Cardiology, Government Medical College, Kozhikode. Adult patients (≥18 years) with left ventricular ejection fraction < 40% and without significant valvular disease or reversible causes were consecutively enrolled. Patients were initiated on GDMT during hospitalization and followed up at 2 weeks, 4 weeks, and 6 months. Data on drug initiation, dose titration, New York Heart Association (NYHA) class, rehospitalization, and mortality were collected using a structured pro forma. Descriptive and inferential statistics were used to assess target dose achievement and clinical outcomes across four patient groups categorized by the number of drugs received. Results: Of the 98 patients enrolled, 41 (41.84%) received all four GDMT drugs (Group 1), of which 37 (90.24%) achieved target dose, while 26 (26.53%) received three drugs (Group 2), of which 22 (84.62%) received target dose, 20 (20.41%) received two drugs (Group 3), and 11 (11.22%) received only one drug (Group 4). Clinical improvement in NYHA class was significantly higher in Groups 1 and 2 (P < 0.001). Rehospitalization at 6 months was lowest in Group 1 (31.71%) and highest in Group 4 (72.73%). Mortality was significantly higher in Group 4 (54.54%), P < 0.001. Target dose achievement was strongly associated with improved functional class, lower rehospitalization, and reduced mortality. Conclusions: A structured, protocol-based GDMT implementation strategy during hospitalization and early follow-up significantly improved target dose achievement in HFrEF patients. Higher rates of target dose attainment were associated with better 6-month outcomes, including symptom improvement, fewer rehospitalizations, and lower mortality. These findings underscore the importance of early initiation and uptitration of GDMT to improve heart failure outcomes in routine clinical practice.
Background: Coronary artery disease (CAD) is the leading cause of mortality worldwide and increasingly affects younger individuals, posing a significant burden on public health systems. This study aims to evaluate the clinical, biochemical, and angiographic characteristics of premature myocardial infarction (PMI) in Egyptian patients aged ≤ 40 years and identify key associated risk factors. Methods: A multicenter, cross-sectional study enrolled 156 PMI patients and 247 age- and sex-matched healthy controls between January 2022 and December 2023. Clinical profiles, risk factors, anthropometric measures, laboratory markers, and coronary angiographic findings were assessed. Logistic regression analysis identified independent predictors of PMI. Results: Compared to controls, PMI patients had significantly higher body mass index (27.5 ± 4 vs. 25.0 ± 2.1 kg/m2, P < 0.001), prevalence of high-fat diet (67.9% vs. 29.6%), smoking (62.8% vs. 48.2%), diabetes (49.4% vs. 10.1%), dyslipidemia (59% vs. 10.5%), and obesity (35.9% vs. 8.5%), all P < 0.001. High-density lipoprotein ≤45 mg/dL (odds ratio [OR] = 13.37), dyslipidemia (OR = 12.22), triglycerides ≥130 mg/dL (OR = 7.03), diabetes (OR = 8.66), and obesity (OR = 6.03) were the strongest predictors of PMI. Angiographic findings revealed single-vessel disease in 41%, left main involvement in 20.5%, and nonatherosclerotic CAD in 9%. Inhospital mortality was 3.2%, and heart failure occurred in 30.8%. Conclusion: Premature CAD is no longer rare in young Egyptians. Early identification and aggressive management of modifiable risk factors – especially dyslipidemia, smoking, and obesity – are vital to reduce the clinical burden and improve prognosis in this vulnerable group.
ABSTRACT A 56-year-old male, known to be hypertensive and with a history of cerebrovascular accident, presented with palpitations. His electrocardiogram showed ventricular premature complexes, and he was referred to a cardiologist. Holter monitoring revealed nonsustained ventricular tachycardia (VT) runs. He had one episode of VT, which was reverted by amiodarone. Clinical examination revealed multiple active lymph nodes in the neck. An excision biopsy was performed, which was suggestive of tuberculous lymphadenitis. The patient received antituberculosis therapy for 6 months, after which repeat imaging showed complete resolution of both lymphadenopathy and clinical symptoms. This case describes a rare and underrecognized cause of ventricular arrhythmia that can be successfully treated.
Context: A major global health concern, metabolic syndrome (MetS) is linked to an increased risk of diabetes, cardiovascular disease, and early death. In high-risk groups, N-terminal pro-brain natriuretic peptide (NT-proBNP) has become a viable biomarker for subclinical cardiac dysfunction. Aim: To estimate serum NT-proBNP levels in patients with MetS and investigate their correlation with metabolic parameters and echocardiographic findings. Settings and Design: Hospital-based, analytical, and cross-sectional study was conducted in the department of general medicine, at a tertiary care teaching hospital from South India. Materials and Methods: There were 52 adult patients with MetS (American Association of Clinical Endocrinology, 2003 criteria) aged 18–65 years. ELISA was utilized to measure serum NT-proBNP. Echocardiographic, biochemical, and clinical parameters were recorded with the aim to evaluate the correlations with NT-proBNP levels. Statistical Analysis Used: Data were analyzed using the SPSS software version 24. Independent t-test, Chi-square/Fisher’s exact test, and Spearman’s correlation were applied. P <0.05 was considered statistically significant. Results: Most of the participants (96.2%) had NT-proBNP levels below 125 pg/ml. Elevated very low-density lipoprotein (VLDL) (P = 0.004) and left ventricular diastolic dysfunction (P = 0.002) were significantly correlated with NT-proBNP levels. Total cholesterol and NT-proBNP levels were found to be positively correlated (ρ =0.298; P = 0.032). There were no significant correlations found with low-density lipoprotein, triglycerides, fasting glucose, or left ventricular mass index. Conclusion: In MetS patients, NT-proBNP is correlated with early functional cardiac changes (LV diastolic dysfunction) and metabolic abnormalities (cholesterol and VLDL) but not with structural indices. In this population, it might function as a sensitive biomarker for early cardiovascular risk stratification.
Introduction: Hypertension is increasingly prevalent among young adults in India, with secondary causes playing a significant role in this demographic. Early recognition of the etiological and clinical spectrum is crucial for timely diagnosis and effective management. Objectives: To evaluate the clinical characteristics, etiological patterns, and biochemical profiles of young hypertensive patients, with focus on secondary hypertension and ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) profiles. Materials and Methods: This was a cross-sectional, observational study conducted in a tertiary care hospital in North India, involving 239 hypertensive patients aged 18–40 years. Data on demographics, clinical staging, body mass index (BMI), metabolic syndrome, lipid profiles, drug usage, target organ damage, and ABPM/HBPM were collected. Statistical analysis was performed using Chi-square and P values, with significance set at P < 0.05. Results: Of the 239 patients, 77.8% had primary and 22.2% had secondary hypertension. Secondary hypertension was significantly more common in younger age groups (P = 0.0005), and was associated with a higher requirement for multiple antihypertensive agents (P = 0.0005) and increased risk of target organ damage (P = 0.0005). Metabolic syndrome was significantly associated with higher BMI categories (P = 0.0001), as were parameters of dyslipidemia. Renal parenchymal disease (41.5%) was the most common secondary cause, followed by endocrine and renovascular disorders. ABPM revealed abnormal dipping patterns in over 50% of patients, with non-dipping status significantly associated with secondary hypertension (P = 0.0005). HBPM performed in the same cohort revealed white coat hypertension (n = 14, 21.5%) while masked hypertension was seen in 22 subjects (33.8%), in accordance with ABPM data. (κ = 0.82, P < 0.001). Conclusion: Secondary hypertension represents a substantial burden among young hypertensives and is often accompanied by greater disease severity, target organ damage, and ABPM/HBPM abnormalities. Comprehensive evaluation, including etiological screening and biochemical profile, should be emphasized in the diagnostic workup of young hypertensive individuals to optimize outcomes and prevent long-term complications.
Major aortopulmonary collateral arteries (MAPCAs) are nonregressed embryological connections present in patients with cardiac anomaly with compromised antegrade pulmonary flow such as tetralogy of Fallot. Depending on their angioarchitecture, they may be essential or nonessential and can affect the outcome of definite surgical repair in these patients in terms ranging from intraoperative difficulties to postoperative heart failure. Endovascular embolization of nonessential MAPCAs is a good option to manage these postoperative complications or for ease of doing surgery in a preoperative setting. Here is a case demonstrating preoperative endovascular embolization of nonessential MAPCAs with good surgical outcome.
Primary percutaneous coronary intervention (PCI) is the gold standard for treating acute myocardial infarction (AMI). Stent malapposition, a complication more common in AMI due to plaque disruption and thrombus burden, increases the risks of stent thrombosis and restenosis. Angiography often misses subtle malapposition due to its limitations. Optical coherence tomography (OCT), with high-resolution imaging, enhances detection and correction of stent malapposition. The case series presents four patients with proximal stent edge malapposition during primary PCI for AMI. Malapposition, undetected by angiography, was identified using OCT. Corrective measures, including postdilation with high-pressure balloons, were guided by OCT findings. OCT identified malapposition in all cases, leading to successful correction and optimal stent apposition. Follow-up showed no adverse events, confirming the role of OCT in improving outcomes by addressing angiography’s limitations. OCT is invaluable for detecting and correcting stent malapposition during PCI. Routine use of OCT, especially in complex cases, can optimize procedural outcomes and enhance patient safety.
Background: Coronary artery disease (CAD) is a leading cause of global morbidity and mortality. There is a need for noninvasive markers of subclinical atherosclerosis to improve early detection. Interatrial septal (IAS) thickness, a surrogate for epicardial adipose tissue, is a potential but less-studied marker. This study aimed to assess the utility of IAS thickness as a marker of atherosclerosis and in predicting the presence and severity of CAD. Materials and Methods: This cross-sectional study included 115 patients with no prior history of CAD, scheduled for noncoronary cardiac surgery, who underwent a preoperative coronary angiogram (CAG). IAS thickness was measured using two-dimensional echocardiography. The presence of atherosclerosis was confirmed by CAG, and the severity of CAD was quantified using the Gensini score. Data on traditional risk factors were collected. Statistical analysis included correlation, Chi-square tests, receiver operating characteristic (ROC) curve analysis, and binary logistic regression. Results: The mean age of the study population was 56.8 ± 9.9 years, and 63.5% had evidence of atherosclerosis on CAG. The mean IAS thickness was 6.9 ± 2.1 mm. A strong, significant correlation was observed between IAS thickness and the Gensini score (r = 0.823, P < 0.001). ROC curve analysis demonstrated that IAS thickness was an excellent predictor of atherosclerosis, with an area under the curve of 0.975. An optimal cutoff value of > 6 mm for IAS thickness yielded a sensitivity of 93.15% and a specificity of 97.62%. In a multivariate logistic regression model, after adjusting for age, diabetes, dyslipidemia, and low-density lipoprotein levels, IAS thickness remained the main significant independent predictor of atherosclerosis, with an odds ratio of 339.9 (P < 0.001). Conclusion: IAS thickness is a powerful, noninvasive, and independent marker for the presence and severity of CAD. An IAS thickness > 6 mm is a highly sensitive and specific indicator of underlying atherosclerosis. The routine measurement of IAS thickness through echocardiography can serve as a simple and valuable tool for cardiovascular risk stratification.
