European Journal of Cardiovascular Medicine

Background: Radical nephrectomy with inferior vena cava (IVC) thrombectomy is a complex surgical procedure associated with significant hemodynamic instability due to major vascular manipulation. Limited data are available on intraoperative hemodynamic trends and anesthetic implications, particularly in the Indian population. Methods: This retrospective observational study included 23 patients who underwent radical nephrectomy with IVC thrombectomy between January 2015 and December 2025 at a tertiary care center. Hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and stroke volume variation (SVV) were recorded at six predefined surgical phases. Statistical analysis was performed using repeated measures ANOVA or Friedman test, with p < 0.05 considered significant. Results: Significant hemodynamic variations were observed across surgical phases (p < 0.001). During IVC clamping, MAP decreased (58.9 ± 9.5 mmHg) and CO reduced (4.01 ± 0.85 L/min), while SVR increased (1829 ± 165 dynes·sec/cm⁵) and SVV rose (21.3 ± 5.4%). Following clamp release, MAP (101.9 ± 9.8 mmHg) and CO (6.06 ± 0.75 L/min) increased significantly, while SVR and SVV decreased. Mean blood loss was 1450 ± 520 mL, and 82% patients required transfusion. Two patients developed acute kidney injury, and two deaths occurred due to postoperative pulmonary embolism. Conclusion: IVC thrombectomy is associated with marked hemodynamic fluctuations, particularly during clamping and declamping. Advanced hemodynamic monitoring and vigilant anesthetic management with timely vasopressor support are essential to maintain cardiovascular stability and improve perioperative outcomes.

Background: Perioperative cardiac events remain a major cause of morbidity and mortality in patients undergoing non-cardiac surgery. Dobutamine Stress Echocardiography (DSE) is a well-established non-invasive modality for detecting inducible myocardial ischemia and assessing perioperative cardiac risk.  Objective: To evaluate the diagnostic utility and prognostic value of DSE in preoperative cardiac risk stratification in patients undergoing non-cardiac surgery at a tertiary care centre. Methods: This retrospective observational study included patients referred for preoperative cardiac evaluation who underwent DSE. Baseline clinical data, DSE findings, and perioperative outcomes were analyzed. Patients were followed for perioperative and short-term cardiac events. Results: A total of 200 patients were included. DSE was negative in 193 patients (96.5%), positive in 3 (1.5%), and inconclusive in 5 (2.5%). Target heart rate was achieved in 98.5% of patients. Among those undergoing further evaluation, significant coronary artery disease (CAD) was identified in a minority. Perioperative cardiac events were rare, with only one fatal NSTEMI reported. The negative predictive value of DSE approached 99%. Conclusion: DSE is a safe and highly reliable modality for preoperative cardiac risk assessment. A negative DSE effectively predicts low perioperative cardiac risk, helping avoid unnecessary invasive procedures.

Background: Hypertension in the elderly is associated with increased cardiovascular risk, and masked hypertension often remains undetected with office blood pressure (BP) measurements alone. This study aimed to evaluate the role of home BP monitoring in identifying hypertension patterns and predicting cardiovascular outcomes in treated elderly patients. Methods: This hospital-based observational study included 106 treated hypertensive patients aged ≥60 years attending OPD and IPD at RKDF Medical College Hospital and Research Centre. Demographic data, cardiovascular risk factors, and BP measurements were recorded. Patients were classified into controlled, masked, sustained, and white coat hypertension based on office and home BP readings. Participants were followed for cardiovascular outcomes, and hazard ratios were calculated to assess risk. Results: The majority of participants were aged 60–69 years, with male predominance (60.4%). Controlled hypertension was observed in 45.3% of patients, while masked hypertension was present in 28.3%. Home BP readings were higher than office measurements. Sedentary lifestyle (41.5%) and dyslipidemia (37.7%) were the most common risk factors. Patients with masked hypertension showed a significantly higher incidence of left ventricular hypertrophy (33.3% vs 12.5%, p=0.01) and coronary artery disease (26.7% vs 12.5%, p=0.04). Masked hypertension was associated with a two-fold increased risk of cardiovascular events (HR 2.05, p=0.01). Increasing home systolic and diastolic BP were significant predictors of cardiovascular risk. Conclusion: Home BP monitoring is essential for detecting masked hypertension and improving cardiovascular risk prediction in elderly hypertensive patients.

Introduction:  Acute myocardial infarction is a public health problem in developed and developing countries. Previously seen in older age group, now has become commoner in younger age groups also. Aims & Objectives:The primary objective of this study is to characterize the clinical presentation, cardiovascular risk factors profile and coronary angiographic patterns in young adults less than 40 years presenting with ST elevation Myocardial Infarction (MI).Materials and Methods: In the present study we are analysing 50 patients with ST elevation MI in a tertiary care hospital, demographic variables, angiographic profiles and outcomes.Results: In our study, there were 26 patients diagnosed with Anterior wall MI having LAD involvement. 13 patients with Inferior wall MI, with RCA as the culprit artery. 4 patients had double vessel disease with LCX and LAD involvement, and one patient had triple vessel disease. This infers that the Anterior wall MI is more common in young MI group (<40 years), Inferior wall MI being next common with few Lateral wall MI with LCX as culprit artery. In our study, there were 10 Diabetics, 12 Hypertensives, 21 Smokers, & 24 alcoholics with overlapping risk factors. Focused public health initiatives, early screening for cardiovascular risk factors, and tailored preventive strategies are imperative to curb the rising burden of premature coronary artery disease in this population. Larger, multicentre studies with long-term follow-up are warranted to further elucidate outcomes and refine management approaches for young patients with STEMI. Conclusion: Young STEMI patients constitute a significant and vulnerable subgroup with unique clinical and angiographic characteristics.