ABSTRACT Heart failure (HF) patients frequently have aberrant serum sodium levels, especially hyponatremia, which is closely linked to poor clinical outcomes, such as greater morbidity, longer hospital stays, and higher death rates. The renin–angiotensin–aldosterone system, arginine vasopressin, decreased renal perfusion, and neurohormonal activation are the main causes of the complex pathophysiology of hyponatremia in HF. The cornerstone of treatment is still conventional management techniques such as fluid restriction and loop diuretics, although these methods frequently only temporarily correct sodium imbalance and may even exacerbate maladaptive neurohormonal reactions. Therefore, it is necessary to develop effective therapeutic approaches that can address the progression of HF as well as related electrolyte imbalances. Regardless of diabetes status, sodium–glucose cotransporter-2 (SGLT2) inhibitors have shown notable reductions in hospitalization and cardiovascular mortality, making them a crucial part of guideline-directed therapy for HF. A growing body of research indicates that SGLT2 inhibitors may have positive effects on serum sodium balance in addition to their well-established cardioprotective and renoprotective advantages. These medications may help correct dilutional hyponatremia while preserving electrolyte balance more successfully than conventional diuretic therapy through processes such as osmotic diuresis, improved free-water clearance, and modulation of renal sodium handling. This review objectively assesses the available clinical data on the effect of SGLT2 inhibitors on serum sodium levels and investigates the underlying pathophysiological mechanisms of sodium abnormalities in HF. In addition, it investigates if these drugs’ therapeutic benefits go beyond standard management techniques in terms of enhancing sodium balance and overall clinical outcomes in HF patients.
ABSTRACT Apical hypertrophic cardiomyopathy (ApHCM), also referred to as Yamaguchi syndrome, is a distinct variant of hypertrophic cardiomyopathy characterized by localized hypertrophy of the left ventricular apex. It is classically associated with giant T-wave inversion in the precordial leads, with additional T-wave inversion in the inferior and lateral leads on electrocardiography. Because of its uncommon occurrence, the condition may remain unfamiliar to many emergency department (ED) physicians, and it can be easily overlooked during the evaluation of patients presenting with chest pain. We report the case of a 61-year-old male who presented to the ED with an acute-onset retrosternal chest pain and palpitations of 2 h duration. The ECG findings suggested acute coronary syndrome (ACS), but echocardiography and cardiac biomarkers indicated otherwise.
ABSTRACT Right ventricular pacing leads to nonphysiological ventricular activation and causes electrical dyssynchrony and adverse cardiac remodelling. Left bundle branch area pacing (LBBAP) responsible for physiological pacing strategy that preserves synchrony of ventricles by engaging the His–Purkinje system. The objective of the study was to evaluate the procedural feasibility and outcomes of LBBAP in patients undergoing dual chamber pacemaker implantation. In this single center, retrospective observational case series, seven patients undergoing dual chamber pacemaker implantation with LBBAP between January 2025 and January 2026 were included. Procedural success was defined as achievement of stable LBBAP with acceptable pacing parameters and significant QRS narrowing. Electrical parameters include pacing threshold, sensing amplitudes, and lead impedance, were assessed at implantation and prior to discharge. A total of seven patients underwent LBBAP. Successful LBBAP implantation was achieved in 6 of 7 patients (85.7%). The mean procedure time was 75 ± 15 min, with fluoroscopy time of 8 ± 3 min. LBBAP caused important QRS narrowing with stable lead parameters. Mean pacing thresholds of RA and RV were low, measuring 0.66 V in right atrium (RA) and 0.49 V in right ventricle (RV), showing stable lead activity with sufficient sensing and impedance values. No acute procedural complications, including lead dislodgement, cardiac perforation, or pneumothorax, were observed. LBBAP is a feasible and safe physiological pacing strategy in those patients undergoing dual chamber pacemaker implantation, demonstrating high procedural success and favourable short term electrical outcomes. Larger prospective studies are warranted to evaluate long term clinical benefits.
ABSTRACT Femoral arterial access remains indispensable for diagnostic and interventional cardiovascular procedures despite the growing adoption of transradial techniques. However, femoral access site complications such as hematoma, pseudoaneurysm, retroperitoneal hemorrhage, and arteriovenous (AV) fistula continue to contribute to procedural morbidity. Accurate arterial puncture and maintenance of stable vascular access are critical determinants of procedural safety. We describe a novel technique utilizing a radial artery puncture set, consisting of a 20G needle with an integrated microsheath, for femoral arterial access. In this prospective pilot case series, 10 consecutive patients undergoing coronary angiography, percutaneous coronary intervention, or balloon mitral valvotomy via femoral access were included. After successful femoral artery puncture, the micro-sheath was advanced into the arterial lumen to stabilize access before guidewire insertion and subsequent sheath upsizing. Femoral access was successfully achieved in all patients without crossover to conventional techniques. No access-site complications, including hematoma, pseudoaneurysm, AV fistula, retroperitoneal hemorrhage, or significant hemoglobin decline, were observed during hospitalization or at 30-day follow-up. The technique appeared feasible across a heterogeneous population, including elderly, obese, and anticoagulated patients. This approach may offer advantages over conventional and micropuncture techniques by improving needle stability and reducing repeated puncture attempts. Use of a radial artery puncture set for femoral access appears to be a simple, safe, and cost-effective alternative to standard femoral access techniques. Larger comparative studies are warranted to validate these preliminary findings.
