Background Coronary stent infection with pseudoaneurysm is an exceptionally rare but life-threatening complication of percutaneous coronary intervention requiring emergency management. Case Presentation A 52-year-old man with diabetes and hypertension underwent percutaneous coronary intervention to the proximal left anterior descending artery for anterior wall myocardial infarction. Weeks later, he presented with fever and dyspnea. Computed tomography angiography revealed complete left anterior descending stent occlusion and a large pseudoaneurysm communicating with the distal left anterior descending, acting as its sole perfusion source. He developed hemopericardium and tamponade, necessitating emergency drainage and on-pump coronary artery bypass grafting with a saphenous vein graft to the left anterior descending, stent removal, and proximal left anterior descending ligation. The patient had an uneventful recovery. Conclusions Clinicians must be vigilant about post-percutaneous coronary intervention fever. Early imaging, clinical suspicion, and timely intervention are life-saving.
Intravenous immunoglobulin is frequently used in the treatment of autoimmune and hematologic disorders. While generally well tolerated, intravenous immunoglobulin administration can rarely precipitate serious cardiovascular events, including acute coronary syndrome, particularly in patients with preexisting atherosclerotic disease. We report the case of a 61-year-old woman with systemic lupus erythematosus, prior coronary artery disease, and immune thrombocytopenic purpura who developed non-ST elevation myocardial infarction following high-dose intravenous immunoglobulin therapy. Coronary angiography revealed critical stenoses in the left anterior descending and left circumflex arteries, and successful percutaneous coronary intervention was performed. This case highlights the importance of careful cardiovascular assessment prior to intravenous immunoglobulin initiation in high-risk individuals and the need for monitoring for ischemic symptoms during infusion in susceptible populations.
Cardiac cephalalgia is a rare and underrecognized manifestation of myocardial ischemia that may present without typical chest pain, leading to diagnostic delay. We report a 52-year-old gentleman who presented with a 4-day history of persistent holocranial headache without prior comorbidities. He was prescribed antihypertensives based on a single reading of high blood pressure. However, the persistence of symptoms prompted further assessment. Electrocardiography and positive troponin I confirmed an inferoposterior ST-elevation myocardial infarction. Neuroimaging was unremarkable. Coronary angiography revealed a left-dominant system with occlusion of the left posterolateral branch, for which urgent percutaneous coronary intervention with stenting was performed. The patient’s headache resolved completely within 2 h postrevascularization, confirming the diagnosis of cardiac cephalalgia. This case highlights the importance of considering cardiac causes in atypical headache presentations. Early recognition is critical, as misdiagnosis may delay lifesaving treatment and expose patients to contraindicated therapies such as vasoconstrictive agents.
Right ventricular function has historically received less attention than left ventricular function. Yet, emerging evidence highlights its crucial prognostic role in various cardiovascular diseases, including acute myocardial infarction, pulmonary hypertension, pulmonary embolism, and congenital heart disease. Advances in echocardiography, particularly two-dimensional speckle-tracking echocardiography, have enabled quantitative assessment of right ventricular global longitudinal strain and right ventricular free-wall longitudinal strain, providing greater sensitivity for detecting subclinical right ventricular dysfunction than conventional indices, such as tricuspid annular plane systolic excursion or fractional area change. This review will provide methodology, normal reference values, and clinical applications of right ventricular global longitudinal strain, specifically for the Indian context. It incorporates recent Indian studies across acute myocardial infarction, valvular heart disease, cardiac surgery, heart failure with preserved ejection fraction, and diabetes mellitus. International data provide a comparative context, revealing significant gaps in population-specific normative data for India. Technical challenges, including vendor variability, load dependency, and imaging quality limitations, are discussed alongside emerging technologies such as 3D speckle-tracking, artificial intelligence integration, and telemedicine applications. The review concludes with recommendations for establishing India-specific reference ranges, developing comprehensive training programs, and conducting large-scale prospective outcome studies to facilitate routine clinical integration of right ventricular strain imaging across India’s diverse healthcare landscape.
Background Balloon dilation is an established option for selected left heart obstructive lesions in infants, traditionally using low-profile, low-pressure balloons. Experience with high-pressure, rapid-exchange systems such as the Aviator Plus in this age group remains limited. Objective To describe feasibility, procedural performance, and early outcomes of off-label balloon dilation using the Aviator Plus platform in infants with coarctation of the aorta or valvular aortic stenosis. Methods A retrospective review was performed of infants undergoing Aviator Plus balloon dilation between April 2024 and July 2025. Clinical features, procedural details, and follow-up outcomes were summarized descriptively. Results Four infants (mean age 5.5 months; mean weight 5.87 kg) underwent intervention: three with native coarctation of the aorta and one with severe aortic stenosis. One coarctation of the aorta patient had significant left ventricular dysfunction; the aortic stenosis patient had moderate mitral regurgitation. Balloon dilation used a single 6 × 20 mm balloon in two cases and sequential 6 × 20 mm and 7 × 20 mm balloons in two. All procedures produced immediate gradient reduction. During a mean 8.5-month follow-up, one infant with aortic stenosis died from progression of mitral regurgitation and intercurrent infection, and one coarctation of the aorta patient required surgical repair for re-coarctation. The remaining infants maintained gradient relief with preserved ventricular function. Conclusions This early experience suggests that the Aviator Plus balloon can be a feasible off-label option for carefully selected infants with left heart obstruction, particularly where pediatric-specific balloons are limited. Larger series with extended follow-up are needed to define long-term outcomes.
Background The coronary artery calcium score is widely used to assess the extent of coronary atherosclerosis and future cardiovascular risk. Red cell distribution width and the uric acid–albumin ratio have been associated with inflammatory activity and adverse cardiovascular outcomes, but their association with coronary artery calcium burden is still not clearly established. The present study evaluated the relationship between red cell distribution width, uric acid-to-albumin ratio, and coronary artery calcium score in patients undergoing coronary computed tomography angiography for suspected coronary artery disease. Methods We conducted a hospital-based, cross-sectional observational study involving 250 patients presenting with symptoms suggestive of coronary artery disease who underwent coronary computed tomography angiography. Coronary calcium score was determined using the Agatston scoring system, and patients were grouped into low (<100) and high (≥100) coronary artery calcium score categories. Red cell distribution width-coefficient of variation, red cell distribution width-standard deviation, serum uric acid, albumin, and uric acid-to-albumin ratio were measured. Correlation analysis and logistic regression models were applied to identify factors associated with an elevated coronary calcium score. Results Sixty-five patients (26%) had a high coronary artery calcium score. Patients with elevated calcium scores were generally older and more frequently had hypertension, diabetes mellitus, a smoking history, and male predominance. Higher pulse rate, blood pressure, leukocyte count, lower albumin levels, and reduced ejection fraction were also observed. The Framingham Risk Score increased with the coronary artery calcium score. Red cell distribution width-coefficient of variation and red cell distribution width-standard deviation showed no significant association with coronary artery calcium score. Uric acid levels were similar between groups, while the uric acid-to-albumin ratio showed a weak positive correlation ( r = 0.132, P = .04) without independent predictive value. Older age, hypertension, and reduced ejection fraction independently predicted a high coronary artery calcium score. Conclusion Coronary artery calcium score remains superior for assessing atherosclerotic burden and risk stratification. Red cell distribution width showed no association, and uric acid-to-albumin ratio demonstrated only a weak, non-independent correlation.
Background Valvular heart disease (VHD) is a growing global health problem. Artificial intelligence (AI) models show promise for improving their diagnosis and management, but their black box nature limits transparency, making doctors hesitant to trust them. Explainable AI (XAI) aims to address this, but its application in VHD has not been systematically mapped. Methods We conducted a systematic review, searching for studies that applied XAI techniques to any type of VHD. From 374 records, 52 studies were included. Data were extracted on VHD types, AI/XAI methods, and the evaluation of explanations. Results Most research has focused on aortic stenosis and mitral regurgitation, using either structured patient data or imaging like echocardiograms. Shapley Additive Explanations was the dominant XAI method (66% of the studies), primarily for feature importance ranking. Although model performance was often strong, rigorous evaluation of explanations was rare. Only a few studies involved clinicians in assessing usefulness or used quantitative metrics to test reliability. Conclusion XAI is an active area of research in VHD, mainly for feature attribution. However, the field is still developing. To make XAI truly useful, future work must move beyond explanation generation to validating it with clinicians and ensuring they are stable and trustworthy across different patient populations.
We report the case of a 37-year-old woman with no prior comorbidities who presented with progressive breathlessness, cough, and fever. Clinical examination revealed icterus and bilateral pitting pedal edema. The patient had palpable axillary, cervical lymphadenopathy, and thyromegaly. Cardiovascular examination showed elevated jugular venous pressure with muffled heart sounds, suggestive of cardiac tamponade physiology. Further evaluation confirmed acute cardiac tamponade secondary to pericardial effusion in the setting of Graves’ disease. This presentation is rare and potentially life-threatening if not recognized and managed promptly. This case highlights an unusual cardiac manifestation of Graves’ disease and underscores the importance of considering endocrine etiologies, particularly thyrotoxicosis, while evaluating patients with pericardial effusion and cardiac tamponade.
Transcatheter aortic valve replacement has been established as an advanced therapeutic modality for severe aortic stenosis. Despite procedural advancements, anatomical variations may hinder successful prosthetic valve delivery in certain cases. Delivering a relatively bulky prosthesis through a constricted and extensively stenosed surgical bioprosthetic valve remains challenging. Such cases require alternative procedural strategies to enable smooth device navigation. In this case, the presence of a surgical tissue prosthesis with a Dacron conduit resulted in stacking of the delivery system within the aortic arch. An anchor balloon (20/45 mm) over a buddy wire was used to assist in guidewire compression and effective valve advancement.
Coronary artery anomalies are uncommon and are most frequently identified incidentally during coronary angiography. Among these, the presence of a dual left anterior descending artery is relatively frequent, with an incidence of around 1%, whereas a double right coronary artery is uncommon. We describe the case of a 63-year-old male who presented with Class III angina. Coronary angiography revealed complex multivessel coronary artery disease with dual left anterior descending artery (Type A.2.1.2) and double right coronary artery (Type G2). The patient underwent coronary artery bypass grafting performed with the aid of cardiopulmonary bypass. Complete myocardial revascularization was performed by anastomosing the left internal mammary artery to the septal left anterior descending artery, along with reversed saphenous vein grafts to obtuse marginal branches 1 and 2, and the second right coronary artery. This case underscores the simultaneous presence of two rare coronary anomalies in a single patient undergoing surgical coronary revascularization. To the best of our knowledge, this may be the first reported case to undergo surgical revascularization. Recognition of such variants is essential to ensure complete revascularization and prevent postoperative ischemia.
Background Cardiovascular disease is the foremost basis of mortality and disability throughout the world, contributing to 40% of fatalities per year. Primary causes of cardiovascular diseases are ischemic diseases, heart stroke, myocardial dysfunction/cardiomyopathy, and atherosclerosis. The use of plant-based compounds as natural therapeutics is gaining importance in recent times. Andrographolide, a diterpenoid, has anti-inflammatory and anti-oxidative stress effects in a dose-dependent manner. Methodology In this study, we evaluated the modulatory effects of andrographolide on inflammatory cytokines, stress response regulators, and matrix metalloproteinases under oxidative (H 2 O 2 ) and disease-mimicking stress conditions. Results Our data reveal that andrographolide exerts a dual role, amplifying pro-inflammatory TNF-α while suppressing IL-6 and IL-10 and restoring IL-12 and TGF-β levels, suggesting a complex interplay between pro- and anti-inflammatory pathways. Additionally, andrographolide attenuates stress-associated HSP-27 and nuclear factor kappa-light-chain-enhancer of activated B cells activation, while enhancing RBFox1 and mitochondrial regulators such as SIRT-3, underscoring its potential to modulate both inflammatory and stress-adaptive responses. Notably, andrographolide robustly suppresses MMP1 but differentially regulates MMP3, MMP7, and MMP9, indicating selective control over extracellular matrix remodeling under stress. In summary, andrographolide demonstrates a multifaceted regulatory profile that simultaneously engages and dampens inflammatory and stress pathways while strategically directing extracellular matrix remodeling. Conclusion These insights warrant further investigation into the mechanistic roles of andrographolide in inflammation resolution, tissue repair, and possibly the prevention of fibrosis. The co-treatment with andrographolide shows promising modulatory potential, though its molecular actions require further probing. These findings lay the groundwork for more in-depth mechanistic studies and the development of potential cardioprotective strategies.
Quadricuspid valve is an extremely rare congenital cause of aortic regurgitation (AR). There are seven types of valves based on the size of the four cusps. They are associated with septal defects and ostial coronary abnormalities, which have important treatment implications. Ross procedure is a viable treatment option in young patients who present without aortopathy.
Ruptured sinus of Valsalva aneurysms are rare congenital anomalies that can lead to significant hemodynamic compromise, thus requiring urgent intervention. This case series describes three successful transcatheter closures of large ruptured sinus of Valsalva defects (>10 mm) using dual-device deployment techniques when single devices failed due to prolapse or residual shunts. Cases involved ruptured sinus of Valsalva from the noncoronary cusp to the right atrium and the right coronary cusp to the right ventricular outflow tract, with complete occlusion achieved using combinations of Cocoon duct occluders and muscular ventricular septal defect occluders, demonstrating the feasibility and safety of percutaneous approaches in suitable anatomies.
The etiology of aortic stenosis can vary from congenital abnormalities of the aortic valve and acquired causes, such as rheumatic heart disease, to degenerative aortic valve disease. In this report, we describe a distinct morphological feature of the aortic valve causing severe stenosis with aortopathy in a middle-aged man.
This randomized controlled trial investigated whether an internally validated animated video, added to standard consent, improves patient understanding and satisfaction before elective percutaneous coronary intervention. Adults scheduled for percutaneous coronary intervention were randomized to receive either standard consent or standard consent plus an internally validated, local language animated video. Patient understanding and satisfaction were assessed using validated questionnaires and a visual analog scale, respectively. The intervention group demonstrated significantly higher knowledge scores and satisfaction, with no significant influence from socio-economic or educational status. This study supports implementing animated videos to enhance patient comprehension, satisfaction, and bridging the health care gap.
We present the case of a patient with chest pain whose history suggested vasospastic angina. Despite the absence of ischemic electrocardiographic changes, the patient underwent coronary angiography, which showed no atherosclerotic lesions but a diffuse stenosis of the right coronary artery that was resolved promptly by intracoronary nitrate injection, therefore confirming spasm. Angiography also showed a straight vessel in the posterior atrioventricular sulcus, which was recognized as an intercoronary communication that connected the right coronary artery with the left circumflex artery and enabled bidirectional flow. The intercoronary communication likely served to partially protect the right coronary artery-dependent myocardium from ischemia during spasm. This case highlights the significance of a detailed history in constructing an investigation plan in order to make the correct diagnosis. By precluding concurrent ischemic electrocardiographic changes, the intercoronary communication made the diagnosis more challenging.
Bioresorbable vascular scaffolds offer temporary mechanical support and local drug delivery to coronary arteries, ultimately restoring native vessel physiology after resorption. This case describes a 62-year-old man who underwent percutaneous coronary intervention with a second-generation sirolimus-eluting MeRes100 scaffold for significant proximal left anterior descending artery stenosis. Four years post-implantation, the patient remained asymptomatic but presented with intermittent, atypical chest pain. Coronary computed tomography angiography revealed complete scaffold resorption and preserved vessel patency, though interpretation was complicated by blooming artefacts from residual metallic markers. Second-generation scaffolds like MeRes100 show improved mechanical properties, predictable bioresorption profiles, and excellent clinical outcomes, including low rates of thrombosis and restoration of vasomotion. This case highlights both the long-term safety and efficacy of MeRes100 and the limitations posed by imaging artefacts, emphasizing the need for cautious computed tomography interpretation after scaffold resorption.
Background Low-density lipoprotein cholesterol is one of the prime atherogenic factors, and statins are used to reduce low-density lipoprotein cholesterol. However, concerns about misuse and adverse effects regarding statins have risen lately. This study aims to assess the statin prescription practice and the perceptions about guidelines among doctors in Tamil Nadu. Methods A cross-sectional, questionnaire-based survey of physicians practicing in Tamil Nadu was conducted from January 2024 to September 2024. Physicians who have prescribed statins in the past 3 years were included in the study through a voluntary opt-in sampling technique. The estimated sample size was 185. Required permissions and consents were obtained from the ethical committee and individual participants. Results The participants had a mean age of 31.5 years, with 62.2% having under 6 years of experience. Although 58.4% were aware of the American College of Cardiology/American Heart Association guidelines, only 5.9% agreed; for the Lipid Association of India, 18.9% were aware, with 2.7% in agreement. Over the past 6 months, 84.8% had modified their statin prescriptions. Atorvastatin was the most commonly prescribed statin. While 85.4% had encountered statin intolerance, only 12.9% were aware of the reporting system, and merely 3.2% had reported such cases, despite frequent observation of side effects, like myopathy (22.2%) and myalgia (8.6%). Conclusions The study reveals a gap in physicians’ awareness and application of statin guidelines, with low adherence, inconsistent risk assessment, and dosing practices. It recommends developing ethnicity-specific risk tools and strengthening national guidelines for consistent, evidence-based dyslipidemia management.
Background Psychological distress, maladaptive illness perceptions, and reduced quality of life are common following acute myocardial infarction (AMI) and may negatively influence recovery and treatment adherence. Mindfulness-based cognitive therapy (MBCT) has demonstrated benefits for emotional regulation; however, evidence for internet-based brief MBCT (B-MBCT) interventions in post-AMI populations remains limited. The present study examined the preliminary effectiveness and feasibility of an internet-based B-MBCT intervention in improving psychological outcomes following AMI. Methods This pilot randomized controlled trial included 18 medically stable post-AMI participants with mild to moderate depressive symptoms. Participants were randomly allocated to an internet-based B-MBCT plus treatment-as-usual (TAU) group or a TAU-only group. The intervention consisted of 8 weekly online sessions. Outcomes were assessed at baseline and post-intervention using the Depression Anxiety Stress Scale-21 (DASS-21), Brief Illness Perception Questionnaire, Five Facet Mindfulness Questionnaire-15, and MacNew Quality of Life Questionnaire. Results Compared with TAU, the intervention group demonstrated significantly greater reductions in depression, anxiety, stress, and illness perception, along with significant improvements in mindfulness skills and quality of life ( P < .05). Effect sizes were large across outcomes ( η ² = 0.59-0.94). Conclusion Internet-based B-MBCT appears feasible and shows promising preliminary effectiveness for improving psychological outcomes following AMI. Larger randomized trials are required to confirm these findings.
Background Silent atrial fibrillation is a common problem that often goes undetected, owing to its asymptomatic presentation. Electrocardiography is utilized to diagnose subclinical atrial fibrillation; however, it is limited by its reliance on human interpretation. To overcome this limitation, artificial intelligence has recently been integrated into the conventional electrocardiogram, facilitating earlier and more precise detection. Objective This review analytically discusses the current literature associated with the advantages and drawbacks of artificial intelligence in electrocardiography, providing insight into the algorithms, practical applications, and overall effectiveness as an alternative to the standard 12-lead electrocardiogram. Results Artificial intelligence-enhanced electrocardiography has displayed consistently promising results from its high sensitivity and specificity in detecting asymptomatic atrial fibrillation, as evidenced by its clinical validation and real-world applications. Neural network-based models detecting subtle waveform abnormalities have shown a more accurate interpretation of an electrocardiogram than a typical physician and potential integration with wearable devices to support real-time monitoring. However, significant barriers remain, including systemic algorithmic bias related to age, sex, and race, as well as certain technical limitations. Conclusion The use of artificial intelligence in electrocardiography demonstrates a strong potential for improving silent atrial fibrillation detection and providing timely intervention. While artificial intelligence is highly efficient for early intervention, it is currently best utilized as a clinical addition rather than a replacement for traditional care. Finally, the clinical utility of these models needs to be solidified by prospective randomized controlled trials to further establish their impact.
