European Journal of Cardiovascular Medicine

Background: Apolipoprotein E (ApoE) is necessary for normal lipid metabolism. Deficiency of this protein hinders plasma clearance of both triglycerides and cholesterol. Lipids are, shunted through alternate metabolic pathways, thus resulting in abnormal mitochondrial function. Given the oxygen consumption required for normal heart function, the mitochondria are of particular importance and the preservation of their optimal function is critical. Methods: Using high-resolution respirometry (HRR) and immunoblotting to quantify mitochondrial oxidative phosphorylation (OXPHOS) capacity in permeabilised cardiomyocytes, the goal of this study was to investigate the effects of ApoE deficiency on energy metabolism in the hearts of young mice. Results: Our results demonstrate a reduced basal respiration (ADP restricted) in the ApoE-/- mice. This is furthermore translated to an increased efficiency of the mitochondria, as expressed by a higher respiratory control ratio in ApoE-/- mice. Conclusions: This indicates that early stages of ApoE deficiency positively affects oxidation and phosphorylation coupling within cardiac mitochondria. Our findings provide important information regarding the early phases of preferential lipid metabolism in cardiomyocytes and can help explain the benefits of short term high fat intake for prevention of development and progression of heart failure.

Background: Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation significantly complicates post-device management and has been shown to be associated with increased mortality. Pre-operative identification of patients who may develop post-LVAD RV dysfunction is challenging. This study was designed to evaluate pre-operative echocardiographic speckle tracking imaging as a predictor of post operative RV dysfunction. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement in a single center were studied. Pre- and post-operative clinical, hemodynamic, laboratory, and echocardiographic data were prospectively collected as part of an ongoing institutional LVAD database. RV strain parameters were measured retrospectively using off-line speckle- tracking analysis software. Results: Twenty five of 39 LVAD recipients developed acute RV failure during the early post-operative period. RV function in 14 of these recipients improved with inotropes and judicious adjustment of LVAD parameters. Eleven patients, however, expired despite aggressive medical therapy including 7 patients who underwent placement of an RVAD. These 11 individuals were identified as having significantly lower global RV strain prior to device placement (p<0.05). Seventy two percent of the patients with a peak longitudinal systolic RV strain higher than

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. The cardiovascular system is affected in this infection, with complications including myocardial injury, myocarditis, acute myocardial infarction, heart failure, dysrhythmias, and venous thromboembolic events. Current therapies for COVID-19 may interact with cardiovascular medications. Myocardial injury is relatively common in patients with COVID-19, accounting for 7%-23% of cases, and is associated with a higher rate of morbidity and mortality [1]. In patients with COVID infection clinical suspicion is necessary to diagnose myocarditis as an important complication of this infection. Here we present a patient who developed shortness of breath and orthopnea following sore throat and myalgia and was eventually treated with a diagnosis of myocarditis and discharged from the hospital in relatively good general condition.

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Introduction: Heart failure (HF) is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy. UA is the final product of purine metabolism and hypoxic states cause an elevation of the serum UA level. Cell death, tissue hypoxia, and impaired metabolism in HF increase XO activity, leading to an overproduction of UA. Aim: To study correlation of uric acid levels with ejection fraction in heart failure patients (both acute & chronic). Materials and Methods: This is an observational study conducted at tertiary care Teaching Hospital over a period of 1 year. All patients who are admitted with symptoms and signs of Heart Failure in the wards like Intensive Care Unit, Acute Medical Care, Intensive Cardiac Care unit, Medical Wards, Cardiac Wards both paid and general rooms were recruited in the study. The sample size was 100 patients after evaluation by clinical and 2D echocardiography findings. Patients with signs and symptoms of Heart Failure and by satisfying inclusion and exclusion criteria were recruited. Results: A total of 100 patients with heart failure and ejection fraction less than 50 who presented to the department of general medicine. 26 male patients had ACS as the precipitating cause of heart failure compared to 29 female patients. In the present study the range of uric acid was observed between 7.1 – 10 mg/dl, the mean uric acid levels were observed to be 8.6 ± 0.67. In the present study, the range of Ejection fraction was observed between 28 – 48%, the mean ejection fraction was observed to be 34.8 ± 6.65. In the present study, it was observed that there was a significant and inverse correlation observed between uric acid levels and ejection fraction r = -0.808 p<0.001. Conclusions: The analysis of correlation conclusively proves that when serum uric acid is more than 7 mg / dl, then either RWMA or Global hypokinesia positive OR LVEF < 50 % in heart failure patients. The analysis also proves that serum uric acid levels are more in the severe functional disability patients (NYH III AND IV). This implies that Uric acid levels can be used as a marker for cardiac

Background: The kidneys expel uric acid (UA), the byproduct of purine hydrolysis. The enzymes xanthine oxidase and xanthine dehydrogenase are in charge of the generation and breakdown of uric acid. Both enzymes participate in the production of oxygen free radicals, which increases oxidative stress, by catalysing the conversion of hypoxanthine to xanthine, which is the primary enzyme in purine metabolism

Background: Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses

Introduction: Cardiovascular disease is the most commonly diagnosed medical condition among patients aged 65 years and above and is a major global problem with an estimated worldwide prevalence of 38 million. The high morbidity and mortality rate associated with heart failure (HF) make it a challenging public concern with significant financial burden on healthcare. Patients with HF frequently present with multiple electrolyte abnormalities, hyponatremia, hypokalemia, and hypochloremia being the most common.  Aims: To assess the effect of admission serum chloride levels on the duration of hospital stay in decompensated heart failure patients and their correlation with serum sodium levels. Materials and Methods: The present study was a prospective observational single center carried out at tertiary care center in Ahmedabad, India. Patient’s demographic, clinical and laboratory data was collected from June 2020 till May 2021.  Result: In the present study, 60 patients were included. It was observed that serum chloride level was less than 96 mEq/L in 40%, 96 to 101 mEq/L in 35% and more than 101 mEq/L in 25% Conclusion: Our findings highlight the clinical significance of chloride, a routinely measured electrolyte. Given the critical role of chloride in a number of regulatory pathways central to heart failure, it is possible that serum chloride may represent a therapeutic target rather than simply a marker of disease severity

Background: It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause. Cardiovascular diseases are showing an increase among the Indian population. There has been a rapid and significant growth in the measurement of quality of life as an indicator of health outcomes in patients with CVD. In the clinical course of cardiovascular diseases, the interaction between stress and its impact on quality of life will alter and aggravate theclinical condition. Thus, an improvement in health-related quality of life is considered to be important as a primary outcome and overall therapeutic benefit. Most of the patients cannot cope with the stress due to the burden of cardiovascular disorder and require psychiatric intervention. This study will be focusing on the psychological problems faced by these patients and suggest a plan for improving their quality of life. Aims: To assess the quality of life in patients with known cardiovascular disorders i.e. hypertension, congestive cardiac failure and coronary artery disease. Methods: Patients attending Medicine OPD/IPD with a diagnosis of Hypertension, Congestive Cardiac Failure or coronary artery disease who satisfy the inclusion criteria will be selected. Socio-demographic data will be recorded via semi-structured proforma and the WHO Quality of Life Scale (WHOQOLBREF) will be applied. The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 120 patients, 40 patients were selected in each diagnosis of hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The overall mean (SD) HRQOL was observed as 54.65 ± 14.23 with a range between 18.75-81.5. Among them, domain 4 has been observed with the highest score of 14.62 ± 2.3 and 66.54 ± 14.31 with 4-20 TS and 0-100 TS. However, the HRQOL distribution was varied as per different cardiovascular disorders, like highest mean ± SD score was observed with CHD (57.43 ± 13.33), followed by HTN (56.1 ± 14.66) and CAD (50.42 ± 14.04). Conclusion: Cardiovascular disorders are an important public health problem with a significant psychological impact and impact on the QoL of patients. There is a slight male preponderance observed in patients with cardiovascular disorders. QoL was affected in patients with cardiovascular disorders with psychological and physical health domains being primarily affected.

Sigmoid volvulus is a rare but potentially life-threatening condition caused by abnormal changes in the sigmoid colon surrounding the mesentery. The purpose of this article is to determine the trunk length of the unchecked S-bracket. Methods: This study was a case-control study conducted in two tertiary teaching hospitals in central India. Patients included patients 18 years of age or older with surgically proven sigmoid volvulus; controls included people aged 18 years or older who had undergone other surgeries that did not involve the colon, sigmoid, or rectum. Results: Intraoperative sigmoid measurements, including midsigmoid root width and midsigmoid length. Observations and results: A total of 30 cases and 30 controls were included. The sigmoid colon was longer and wider in the subjects than in the control group. However, mean sigmoid root width was similar between groups. These findings support that sigmoid torsion results from broad-based rotation of a long and wide midsigmoid colon. This is the first adequately controlled study to examine the anatomy of sigmoid torsion and provides strong evidence to confirm previous theories about the anatomical basis of sigmoid torsion.

Background: Pulmonary hypertension is a mean pulmonary artery pressure at rest of 20 mm Hg or more. It is considered to be the key intermediate patho phenotype leading to right sided congestive heart failure. subclinical pathological changes to cardiovascular function caused by untreated PH are associated with higher morbidity. Methodology- The study was conducted at a tertiary care hospital for period of 2 years, in the Department of Pulmonary Medicine & Cardiology. 50 patients fulfilling the inclusion and exclusion criteria were included in the study. All patients had two-dimensional and M-mode echocardiography and etiological causes for the newly diagnosed PH were identified. Details were obtained regarding the clinical profile of patients with PH. Results- Majority 44% of the patients were in the age group of 56-65 years. The mean heart rate of the patients was 90+12 per minute, the mean SBP of the patients was 132 + 22 mm of Hg, and the mean DBP of the patients was 77 + 12 mm of Hg. Majority of the patients had COPD. About 56 %of the patients had abnormal CT scan of the chest. 4 % of the patients had abnormal echocardiogram (transthoracic). Conclusion- Moderately pulmonary hypertension is the common type of PH. The right ventricular systolic pressure in ECHO help in diagnosis of PH and even in differentiation between various PH severity.

Background: Cardiorenal syndrome type 1 (CRS1) represents a critical medical condition characterized by the rapid deterioration of cardiac function leading to acute kidney injury (AKI), posing significant healthcare challenges. Understanding this complex syndrome is crucial for improving patient care. Material and Methods: We conducted a one-year cross-sectional observational study at the Department of Medicine, Indira Gandhi Medical College, Shimla, enrolling consecutive patients with acute heart failure (AHF). We defined CRS1 as the rapid worsening of cardiac function leading to AKI and employed the Framingham Criteria for HF diagnosis. AKI was assessed using the AKIN classification. Various clinical, laboratory, and echocardiographic parameters were examined, and statistical analysis was performed. Results: Among the 92 AHF patients, 15 (16.3%) met the criteria for CRS1, while 77 (83.7%) did not experience kidney injury (NCRS1). Shortness of breath was the most common presenting symptom (93.47%). Patients with CRS1 had significantly lower total leukocyte counts (TLC) but no significant differences in other hematological or biochemical parameters. Dilated cardiomyopathy (DCMP) was a significant predisposing factor for CRS1, while other factors, including smoking, diabetes, and hypertension, did not contribute significantly. Medications for AHF management showed no significant impact on CRS1 development. Patients with CRS1 had higher mortality rates and longer hospital stays, with DCMP and Rheumatic Heart Disease (RHD) being major contributors to mortality. Conclusion: CRS1 is more prevalent in females and the elderly, presenting with shortness of breath and often triggered by infections. Lower TLC and DCMP are associated with CRS1 development. Smoking, diabetes, and hypertension appear unrelated to CRS1. Medications for AHF management showed no significant influence. DCMP emerges as a key underlying etiology, with CRS1 patients experiencing higher mortality rates and extended hospital stays, highlighting the need for tailored management strategies.

Introduction: "Dilated Cardiomyopathy (DCMP)" is characterized by enlargement of one or both Ventricles and is accompanied by impaired LV function.. The causes can be primary (idiopathic) or secondary. Heart failure (HF) is a complex clinical syndrome resulting from the inability of the heart to pump resulting in inadequate metabolic demands of the tissues, or do so only with elevated filling pressures. Common symptoms are Dyspnea, fatigue, edema, syncope, and dysrhythmias. Heart Failure (HF) is predominantly a disorder of the elderly with rates increasing exponentially with time.  Aims and objectives: The objective of this study is to examine and record the clinical characteristics of individuals diagnosed with “Dilated Cardiomyopathy (DCMP”). Method: This retrospective observational study was conducted from September 2022 to August 2023 and involved 400 consecutive dilated cardiomyopathy patients. Patient examinations included clinical, ECG, radiography, and echocardiographic. Echocardiography criteria for impaired left ventricular systolic performance were ejection fraction below 45%, regional wall motion abnormalities, global hypokinesia of LV, heart chamber dilatation without valvular or congenital heart problems, and end-diastolic dimension above 3 cm per body surface area. Result: Smoking, alcoholism, Diabetes and hypertension were the leading risk factors in developing HF. Breathlessness(82.25%), swelling of the feet (50%) and palpitation (48%) were the most common symptoms observed in the patients. Edema of feet (50%), basal crepts (50.5%), raised and Jugular Venous Distention (JVD) (44.75%) were the leading signs in the patients. Chest X-ray (CXR) findings indicate that 62.75%  to 70% of the patients reported with increased Cardiothoracic ratio. ECG findings were : 59.5% had normal QRS axes, 25.5% had LAD, 15.00% had RAD. Common arrhythmias included sinus tachycardia (30.00%), ectopic beats (30.5%), AFib (21.75%), VT (8.00%), SVT (9.25%). LBBB was at 6.75%, RBBB at 3.00%. LA enlargement was 45.75%, RA 19.5%. LVH was present in 12.5% (left), 8.00% (right), and 3.00% (both). Patients with impaired cardiac function had an average EF% of 34.4 ± 6.03 (range: 20-45). LVDD and LVSD measures were 5.53 ± 0.74 cm and 4.46 ± 0.75 cm. Mitral regurgitation (MR) was present in 82%, TR in 14.00%. Wall motion abnormalities were widespread (97.25%). Pericardial effusion was found in 5.7% of patients. Moderate to severe Pulmonary artery hypertension was found in 19.5% Conclusion: The study has concluded that “dilated cardiomyopathy (DCM)” is mainly a disease of middle and elderly people with a higher prevalence among males. Pulmonary hypertension and very low ejection fraction was associated with adverse outcome.

Background: It has recently been demonstrated that vitamin D, long thought to be a hormone that regulates calcium and phosphate, is essential for the treatment of a number of non-skeletal illnesses, including cardiovascular disease. Numerous research have been conducted on the connection and potential causal involvement of vitamin D in cardiovascular diseases and the well-known risk factors associated with them. There aren't many research conducted in this region of the world, though. This study's primary goal was to measure the 25-hydroxyvitamin D levels in heart failure patients. Methods: This was a institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from March 2021 to May 2022. Total 100 patients with heart failure and fulfilled the inclusion criteria were included in this study data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism version 5. Result: In present study maximum participants 57 (57%) were from the age group of 61-80 years. Mean age of the participants was 65.38±13.7656l. In our study, 46 (46.0%) patients were Normal BMI, 14 (14.0%) patients were Obese BMI and 40 (40.0%) patients were Overweight BMI. In the present study 100 (100%) of the participants had Exertional Dyspnoea followed by PND and fine crepts 79 (79%) each. Vitamin D ≤30 was present in 88 (88%) off study population and >30 was present in 12 (12%) of study population.  Conclusion: In our study we found that 88 out of 100 study participants were Vit D deficient. It was also found that, 25(OH) Vit D levels had negative correlation with LVEF

Background and Aim: Diastolic heart failure is a common yet difficult to identify condition. The study's goal was to investigate and link NT-proBNP levels with four classes (grade I to grade IV) of diastolic dysfunction as measured by echocardiography. All patients underwent a thorough clinical examination, blood biochemistry, electrocardiography, chest X-ray, echocardiography, and plasma NT-proBNP testing. Material and Methods: The current study was carried out on 50 DHF patients enrolled from outdoor and indoor patients in the Department of Medicine, Tertiary Care Teaching Institute of India over a one-year period. Clinical assessment and echocardiography were performed on the patients. The autoanalyzer was used to estimate NT-proBNP utilising the electrochemiluminisense method. Echocardiography was used to classify patients into different levels of diastolic dysfunction. Results: The mean levels of NTproBNP in individuals with systemic hypertension were statistically significant (p0.05) higher than in non-hypertensive patients in the current investigation. NT-proBNP levels were observed to be statistically greater in LVH participants compared to those without LVH. (p≤0.05) In the current study of 50 patients with diastolic heart failure, 36 patients (72%) had grade I diastolic dysfunction, 9 patients (18%) had grade II diastolic dysfunction, 3 patients (6%) had a grade III diastolic dysfunction, and 2 patients (3%) had a grade IV diastolic dysfunction. Conclusion: Serum NT-proBNP levels give reliable diagnostic accuracy for detecting diastolic heart failure, and they correlate well with increasing degree of diastolic dysfunction as measured by a well-established modality of echocardiography. In symptomatic individuals, NT-proBNP can accurately detect the presence of isolated diastolic dysfunction and is a valuable diagnostic for ruling out patients with impaired exercise tolerance of non-cardiac origin.

Background: Transcatheter Aortic Valve Implantation (TAVI) in a nonagenarian is a challenge and is usually performed under Monitored Anesthesia Care (MAC). Combining TAVI and Percutaneous Coronary Intervention (PCI) is associated with an increased risk of mortality. In this case report, we explore the challenges and strategies involved in successfully performing concomitant TAVI and PCI in a nonagenarian patient with Acute Decompensated Heart Failure (ADHF) and concurrent delirium under General Anaesthesia (GA). Notably, there are no documented cases in the existing literature that mirror the intricacies of this case, making it the first reported instance under GA in India.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Background: Coronary Artery Disease (CAD) is one of the topmost causes of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serioustype of CAD. Fibrinogen is an important factor expressed in response to systemic inflammatory and hemorheological alterations. Albumin is an important mediator of plateletinduced coronary artery constriction. Hypoalbuminemia may increase blood viscosity and can alter endothelial function. Fibrinogen-Albumin Ratio (FAR) addressing such pathophysiology of STEMI may provide additional information. This study aims to determine FAR in STEMI patients, correlate FAR with Gensini score based on coronary angiography and predict adverse outcomes of STEMI based on FAR values.  Methods: A cross sectional study in 51 patients with STEMI was conducted over one and a half yearsfrom March 2021 to August 2022. Eligible patients undergoing primary percutaneouscoronaryintervention was subjected to clinical history, physical examination, andinvestigations as per the structured proforma. Categorical data has been represented in theform of frequencies and proportions. Chi-square test or Fischer’s exact test was used as testof significance for qualitative data. Correlations were performed with Pearson Correlationcoefficient. We determined the severity of coronary artery disease based on Gensini scoringsystem. FAR values were correlated with the Gensini score. P-value of <0.05 was considered as statistically significant.  Results: In this study most of the cases (35.3%) were in the age group of 51-60 years with a mean age of 52 ± 14 years, 78.4% were males, 21.6% were females. About 39.2% were found to have single vessel disease, 33.3% had double vessel disease and 27.5% had triple vessel disease. About 60.8% had developed adverse outcomes predominantly heart failure. There was a Positive weak correlation between FAR and Gensini score (Pearson correlation; r = 0.148, P = 0.300) which was not statistically significant. The area under the receiver operating characteristic curve (AUC) for FAR in predicting the outcome is 0.595 (95% CI: 0.449 to 0.730, P = 0.246), with a cut-off of 0.063, with a sensitivity of 70% and specificity of 51.6%.  Conclusion: FAR may not be a substitute for coronary angiography in determining the severity of CAD, butit has some positive correlation with the angiographic severity measured by Gensini score. Though it is not statistically significant, however it can be used as an add-on biomarker along with other parameters in determining the severity of CAD. It is a non-invasive feasible test thatcan be done in a primary or secondary health centre for identifying patients who are at high risk of developing cardiovascular events and initiating appropriate measures.

Background:  As we all know that liver has been called the custodian of milieu interior, as such any form of liver disorder will result significant effect on homeostasis and also, numerous pathologies of other systems can affect either directly or indirectly 
on liver. Both acute and chronic heart failure may result in abnormalities of liver. Liver receives 25% of cardiac output, a huge percentage of cardiac output, so fall in cardiac output will result in hepatic hypo perfusion.  Therefore our study was planned to 
evaluate the abnormalities of liver function and its role on assessment of prognosis in Congestive Cardiac Failure patients in our setup. Research Question: What are the abnormalities of various liver function tests in Congestive cardiac failure patients?  The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Eluru, Andhra Pradesh. A one year observational study was conducted during the period from October 2022 to September 2023 on about 75 Congestive cardiac failure cases of varied etiology admitted during the above period in the department of General Medicine by studying their socio demographic profiles, associated causes for Congestive cardiac failure, assessment of liver function by conducting various biochemical tests and the prognosis of the disease etc. and about 20 healthy individuals were taken as controls for comparison of data.  Results: Among the total study subjects ( CHF cases ) males were 58.6% and females  were 41.3% and among controls it was 60% & 40% and regarding age among cases maximum were found between 41 – 70 years age group. And also with regard to etiological cause of CHF Coronary Atherosclerotic Heart disease accounted for 73% followed by RHD 72% Cardiomyopathy 71%, Cor pulmonale 69% and Hypertensive heart disease 57% were observed and with regard to Prognosis out of total 75 cases about 53(71%) of cases were showed abnormal LFT and out of this total about 47 cases showed remission and 44 got responded towards reduction of serum bilirubin on remission. And about 6 showed exacerbation among total 75 cases. Related to LFTs Sr bilirubin, AST, ALT, SAP has showed significant increased levels and Sr albumin showed mild rise in this study

Background: Dengue fever, a mosquito-borne viral infection caused by the dengue virus, presents a significant public health challenge, particularly in tropical and subtropical regions. While primarily known for its febrile and hemorrhagic manifestations, dengue fever can also lead to severe cardiac complications. This study aims to systematically investigate the incidence, clinical profile, and outcomes of cardiac complications in patients with dengue fever, providing critical insights into their management and prognostication. Materials and Methods: This prospective observational study was conducted at Patna Medical College and Hospital, Patna, from January to November 2023. It included 78 patients with a confirmed diagnosis of dengue fever, excluding those with pre-existing cardiac conditions. Detailed clinical assessments, electrocardiographic (ECG) monitoring, and echocardiographic evaluations were performed to identify cardiac complications. Routine laboratory investigations included cardiac biomarkers such as troponin I and creatine kinase-MB (CK-MB). Data were analyzed using SPSS software version 25, with logistic regression analyses to identify potential risk factors. Statistical significance was set at p<0.05. Results: The study included 78 patients with an average age of 35.4 ± 15.2 years; 66.7% were male. Cardiac complications were observed in 19.2% of patients, including myocarditis (7.7%), arrhythmias (5.1%), pericarditis (3.8%), and heart failure (2.6%). Patients with cardiac complications were more likely to have hemorrhagic manifestations (53.3% vs. 19%, p=0.018) and shock (33.3% vs. 7.9%, p=0.011). ECG abnormalities, such as arrhythmias and conduction defects, and echocardiographic findings, including reduced left ventricular ejection fraction and pericardial effusion, were prevalent. Elevated troponin I and CK-MB levels were noted in 66.7% and 53.3% of patients with cardiac complications, respectively. These patients had longer hospital stays (12.5 ± 4.2 days vs. 8.3 ± 2.1 days, p<0.001), higher intensive care needs (66.7% vs. 12.7%, p<0.001), and increased in-hospital mortality (13.3% vs. 1.6%, p=0.032). Conclusion: Cardiac complications in dengue fever are associated with significant morbidity and mortality. Hemorrhagic manifestations and shock are strong predictors of cardiac involvement. Routine cardiac monitoring using ECG and echocardiography, alongside the measurement of cardiac biomarkers, is essential for early detection and management. Addressing these complications promptly can improve patient outcomes and reduce the disease burden.

Background: Anaemia is a medical disorder that is defined by a decrease in the amount of red blood cells and a lower concentration of haemoglobin in the bloodstream. Anaemia is a widely acknowledged factor that worsens myocardial ischaemia when there is limited coronary reserve. Anaemia has been demonstrated to be a distinct risk factor for unfavorable cardiovascular outcomes in population cohorts of patients with heart failure. Objective: To determine the relationship between in-hospital outcome of patients with ACS and anemia. Methodology:  Prospective, Observational study was carried out in the Department of Cardiology, Northeast Medical College, Sylhet, Bangladesh. Considering the inclusion and exclusion criteria, patients who were admitted with acute coronary syndromes with low hemoglobin level was taken as study population. The study population were divided into two groups in the basis of hemoglobin level in group-I baseline hemoglobin ≤12 gm/dl as anemic and in group-II baseline hemoglobin >12gm/dl non anemic. Results: Majority patients were belonged to age group 61-70 years in both groups, 7(33.3%) in group I (Anemic) and 10(33.3%) in group II (Non-Anemic). 25(75.76%) had complications developed in group I and 14(42.4%) in group II, which was significantly associated with between two groups (p<0.05). A subject with Hb (≤12 mg/dl) compared to Hb (>12 mg/dl) was 16.289 (95% CI 1.889 to 98.445%) times more likely to have developed complications. Which was statistically significant (p<0.05). A subject with ejection fraction (<45%) compared to ejection fraction (>45%) was 8.221 (95% CI 1.107 to 61.043%) times more likely to have developed complications. Recurrent angina was found 13(61.9%) in group I and 5(15.2%) in group II. Conclusion: Major adverse cardiovascular events in individuals with all ACS types are strongly and independently predicted by anaemia. Low haemoglobin ACS patients have a worse clinical prognosis

Aim: To assess risk factors associated with cardiac complications after total joint arthroplasty (TJA) of the hip and knee. Methodology: Thirty-two patients, aged 25 to 70 years who underwent total joint  arthroplasty (TJA) and experienced a cardiac complication during the post operative period (myocardial infarction [MI], congestive heart failure [CHF], unstable angina, arrhythmia, symptomatic hypotension, or pulmonary embolism ) were put on group I and group II had healthy controls consisted of those who had a total joint arthroplasty (TJA) and did not experience a cardiac complication during the post operative period. Risk factors were identified in both groups. Follow-up period up to ninety days. Results: Age group 25-35 years had 3, 36-45 years had 5, 46-55 years had 10 and 56-70 years had 14 patients. The difference was significant (P< 0.05). Age >65 years [OR:1.78 (95%CI: 1.1-3.9)], history of arrhythmia [OR: 2.4 (95%CI: 1.7-4.2)], history of CAD, MI, CHF, and/or valvular heart disease [OR:2.3 (95%CI:1.5-3.8)], and revision surgery [OR:2.3 (95%CI:1.7-2.7)] were independent predictors of postoperative cardiac complications. Conclusion: Risk factors associated for cardiac complications after total joint arthroplasty of the hip and knee includes increasing age, underlying heart disease, and history of heart disease. Further assessment is necessary for  total joint arthroplasty in relation to other risk factors, including as obesity and hypertension, which are frequently linked to an increased risk in non-cardiac surgery.

Background: Heart failure with reduced ejection fraction (HFrEF) poses a significant global public health challenge, characterized by frequent episodes of acute decompensation that necessitate hospitalization and carry high morbidity and mortality risks. In India, the rising prevalence of HFrEF underscores the need to identify context-specific triggers of acute decompensation to develop targeted interventions for improving patient outcomes. Material & Methods: This hospital-based, observational study analyzed triggers of acute decompensation in 336 HFrEF patients admitted to two tertiary care hospitals in India from January to April 2024. Data were retrospectively extracted from medical records, including demographic information, clinical characteristics, and details on decompensation triggers. Outcomes recorded were length of hospital stay, in-hospital mortality, and ICU admission. Statistical analysis involved chi-square tests, t-tests, and multivariate logistic regression. Results: The mean age of the patients was 65.3 years, with 60.1% being male. Common triggers included excessive salt and water consumption (30.1%), non-adherence to medication (25%), acute infections (19.9%), myocardial ischemia (17.6%), and systemic hypertension (14.9%). The mean hospital stay was 7.2 days, in-hospital mortality was 7.4%, and 20.2% required ICU admission. Excessive salt and water consumption and non-adherence to medication were significantly associated with ICU admission (p < 0.001). Independent predictors of in-hospital mortality included age (OR: 1.05, p < 0.001), excessive salt and water consumption (OR: 2.5, p = 0.007), non-adherence to medication (OR: 2.1, p = 0.021), and renal failure (OR: 3.0, p = 0.005). Conclusion: This study identifies critical triggers of acute decompensation in HFrEF patients, particularly dietary non-compliance and medication non-adherence. Emphasizing patient education and adherence support is essential for managing heart failure effectively. Addressing these factors through comprehensive care plans can reduce hospitalizations and improve patient outcomes. Future research should validate these findings through prospective studies and explore tailored interventions to mitigate the risks associated with acute decompensation.

Introduction:   Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in CKD patients. Understanding the cardiovascular outcomes in this population is crucial for developing effective prevention and management strategies. Objective: This study aims to evaluate the incidence and determinants of cardiovascular events in patients with CKD at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India, over a period from June 2018 to December 2023. Method: An observational cohort study was conducted with a sample size of 68 CKD patients. Data were collected on traditional and non-traditional cardiovascular risk factors, and patients were followed to document major cardiovascular events such as myocardial infarction, stroke, and heart failure. Statistical analyses included the calculation of incidence rates and multivariate regression to identify independent predictors of cardiovascular outcomes. Results: During the study period, 23.5% of the patients experienced a major cardiovascular event. The incidence rates of myocardial infarction, stroke, and heart failure were 10.3%, 5.9%, and 7.3%, respectively. Significant predictors of cardiovascular events included hypertension (p < 0.01), dyslipidemia (p < 0.05), and elevated levels of inflammatory markers (p < 0.01). CKD progression was also strongly associated with increased cardiovascular risk (p < 0.01). Conclusions: The findings highlight a high incidence of cardiovascular events among CKD patients and underscore the importance of comprehensive cardiovascular risk management in this population. Early identification and intervention for modifiable risk factors are essential to improve cardiovascular outcomes in CKD patients

Introduction:  Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure with dysfunction of the left ventricle (LV). Intense physical and emotional stress has been identified as the most common trigger factor [1, 2]. A fear about upcoming surgical procedure, the operation itself or the administration of drugs that mimic stress hormones may cause this syndrome [2, 3]. In this case, we will present a case of severe takotsubo syndrome related to haemodynamic consequences of cardiac tamponade and rescue procedures

Introduction: HF occurs in a mid-range ejection or moderately decreased ejection fraction. HFmrEF falls between 40 and 49%. An intermediate clinical entity, it is separate from HFpEF and HFrEF, yet it overlaps with both of these conditions. Methods: Record of A total 165 patients analysed for this study. Researchers compared individuals with heart failure who had varying ejection fractions via the use of a retrospective cohort study. This paper investigates the epidemiology, clinical features, prognosis, and management of HFmrEF. Results: The findings indicate that individuals with HFmrEF, which account for 10–25% of all occurrences of heart failure, have clinical characteristics that are a combination of HFpEF and HFrEF, and they have a high incidence of ischemic heart disease. It is important to note that while HFmrEF has a reduced risk of cardiovascular events compared to HFrEF, it has a risk of non-cardiovascular adverse events that is comparable to or even greater. Therapeutic responses point to the possibility of the effectiveness of medications that are HFrEF, such as inhibitors. Conclusion: HFmrEF is a helpful clinical category that brings to light the need of individualized research and treatment methods by emphasizing the need for such tactics. The phrase "mildly diminished EF" is more accurate in describing its features and provides support for treatment strategies that are more focused.

Introduction: COPD, as defined by GOLD 2023, is a lung condition that is characterised by chronic respiratory symptoms such as dyspnoea, cough, expectoration, and exacerbations. These symptoms are caused by abnormalities in the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema), which result in persistent and often progressive airflow obstruction (1). Airflow blockage is characterised by a forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) of less than 0.70. FEV1 is classified as Mild when it is greater than 80% of the predicted value, Moderate when it is between 50% and 80% of the predicted value, Severe when it is between 30% and 50% of the projected value, and Very Severe when it is less than 30% of the predicted value. In 2019, Chronic obstructive pulmonary disease (COPD) resulted in 3 million fatalities globally, making it the third most common cause of death (2). Cardiovascular diseases (CVDs) are a major health issue that often occurs alongside chronic obstructive pulmonary disease (COPD) and greatly increases the chance of death (3). Ischaemic heart disease (IHD), heart failure, and arrhythmias are often observed as cardiovascular diseases (CVDs) in patients with chronic obstructive pulmonary disease (COPD). The incidence rates of ischaemic heart disease (IHD), heart failure, and arrhythmias in individuals with chronic obstructive pulmonary disease (COPD) range from 19% to 61%, 11% to 31%, and 9% to 16%, respectively, depending on the specific characteristics of the research population (4,5,6). The prevalence of cardiovascular disease (CVD) was much greater in patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. Specifically, 59.7% of COPD patients had CVD, while only 28.5% of non-COPD patients had CVD (7). COPD can cause a range of abnormalities in the structure and blood flow of the heart, which can in turn affect several aspects of the electrocardiogram (ECG). The main causes of ECG changes in patients with COPD are increased airway obstruction, higher pressure on the right side of the heart, displacement of the diaphragm due to excessive inflation of the lungs, rotation of the right side of the heart in a clockwise direction, and changes in body mass index that are associated with clockwise rotation of the QRS-vector in the front of the heart(8,9). The objective of our study was to examine the alterations in electrocardiography among patients with chronic obstructive pulmonary disease (COPD) and to establish a correlation between ECG findings and the severity of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria. Materials And Methods: This is a cross sectional, observational study done in patients who attended OPD and admitted in wards in department of General Medicine and department of Pulmonary Medicine in Maharajah Institute of Medical Sciences, Vizianagaram. Results: In our study most of the patients belong to age group of 51-70 years (73.2%), most common in 61- 70 years (38.6%) with male preponderance (85.3%). 59 of 64 males were smokers and 4 of 11 females has history of smoking. Conclusion: COPD is a common condition in patients with smoking and is associated with ECG abnormalities. RAD (Right Axis Deviation) is the most common ECG change observed in the study.  As the severity of the disease increases, ECG abnormalities become more common. All patients should undergo ECG to prevent cardiovascular morbidity and mortality.

Introduction- Mitral stenosis (MS) is the most common valve disease seen as a sequel of rheumatic fever and usually presents with exertional dyspnoea and right-side heart failure and pulmonary arterial hypertension. Normal Left Atrial function consists of reservoir, conduit and pump function. To assess the outcomes of successful BMV on LA functions in patients with isolated severe rheumatic MS in sinus rhythm over a period of one year follow up. Material & Methods: Prospective observation study done on patients with severe mitral stenosis with suitable valve morphology who are undergoing PTMC. Thorough history taking, full clinical examination, 12 lead ECG, full 2D, M mode & Doppler transthoracic echocardiographic and transesohageal echocardiography study in standard views. Observation & Results: Peak atrial longitudinal stain improved significantly over a period of 12 months. LA dimension also reduced immediately 24 hr after BMV from 42.4 ± 7.6mm to 41.1±5.4. LA volume also reduced significantly 24 hr post bmv (P value-< 0.033) and during 1 month (P value-< 0.021) and 12 months follow up (P value-< 0.011). MVA by planimetry increased significantly from pre BMV value of 0.89±0.11 cm2 to 1.83±0.3 cm2 at 24 hr post BMV. Conclusion: All Left atrial parameters in terms of mitral valve area, left atrial volume index, mean gradient across mitral valve, pulmonary artery systolic pressure has shown significant improvement. However larger study is needed to confirm our findings.

Background: Liver cirrhosis significantly affects health outcomes, with rising cases linked to nonalcoholic steatohepatitis (NASH) in addition to chronic alcohol abuse. "Cirrhotic cardiomyopathy" is defined by systolic and diastolic dysfunction along with electrophysiological abnormalities, absent other cardiac disease. Patients are at risk of heart failure under stress, diagnosed through electrocardiography, 2D echocardiography, and biomarkers such as BNP. Key diagnostic indicators include a resting ejection fraction < 55%, diminished cardiac output under stress, and an E/A ratio < 1.0, while additional supportive features like electrophysiological changes and elevated biomarkers may be helpful but are not required. Methods: This cross-sectional study at Dr. PSIMS & RF Hospital included 50 cirrhosis patients, assessed using Child-Pugh and MELD scores. Evaluations included QTc interval assessment, 2D echocardiography, and cirrhotic cardiomyopathy criteria from the 2005 World Congress of Gastroenterology, Montreal. Inclusion criteria were hospitalized patients with cirrhosis, while those under 18 years of age, with COPD, or with co-existing heart disease were excluded. Statistical analysis used SPSS version 21, with significance set at p < 0.05. Results: Patients with QTc intervals ≤ 440 ms generally exhibited better liver function, with 65.5% in Child-Pugh Class A and 37.9% with MELD scores ≤ 9. Conversely, those with QTc intervals > 440 ms often had more severe liver impairment, with 71.4% in Child-Pugh Class C and 42.9% with MELD scores ≥ 30, showing significant differences (p < 0.05). Ejection fractions > 55% were associated with better liver function, while ejection fractions ≤ 55% indicated more severe impairment, with significant differences (p < 0.05). Cardiac parameters, including right atrial size, left atrial size, and ejection fraction, differed significantly across Child-Pugh classes, with Class C patients having larger right and left atrial sizes and lower ejection fractions compared to Classes A and B (p < 0.05). Conclusion: In conclusion, the study reveals that in liver cirrhosis patients, prolonged QTc intervals are strongly correlated with Child-Pugh and MELD scores, while an ejection fraction ≤ 55% indicates more severe impairment, highlighting the critical need for continuous cardiac monitoring.

Background: Myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved. The loss of viable myocardium initiates a process of adverse left-ventricular remodeling leading to heart failure. Cardiac transfer of Bone marrow and human peripheral blood mononuclear cells (PBMNCs) -derived stem cells can have a favorable impact in patients with myocardial infarction. Objectives: To study transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) in patients with Myocardial infarction with its safety and feasibility. Methods: It is ist prospective pilot study from the region with six months of follow-up. 10 Patients of ST-elevation acute anterior wall Myocardial infarction with occlusion of left anterior descending were taken for Echocardiography (2 blind operators) before coronary intervention. Percutaneous coronary intervention of left anterior descending (LAD) by drug eluting stent followed by intracoronary infusion of PBMNCs was done. 10 patients of acute anterior wall myocardial infarction were taken as control in whom only LAD stenting was done. PBMNCs suspension was infused distally to the occluding balloon through the central port of the balloon catheter. This maneuver was repeated 4 times to accommodate infusion of the total 20-ml cell suspension, interrupted by 2-3 minutes of reflow by deflating the balloon to minimize extensive ischemia. Left ventricular functions were compared at base line and after six months of follow up by blinded operators. Results: Demographic variables, clinical variables and left ventricular systolic functions at base line were comparable. After Six months of follow up in both case and control group there was improvement in left ventricular functions. But there was more improvement in Left ventricular functions in cases where intracoronary stem cell therapy was given in addition to LAD stenting as compared to control group. Increase in Ejection fraction and wall motion score index was statistically significant (P-value <0.05) in stem cell therapy group. Conclusion: Intracoronary PBMNCs infusion is a less invasive, more feasible, safer and a novel therapy for acute myocardial infarction patients who have depressed cardiac function. It causes significant improvement in parameters of left ventricular functions especially Ejection fraction and wall motion score index which are most important prognostic factor in myocardial infarction patients.

Introduction: Acute myocardial infarction (MI) is the leading cause of death in globally. Electrocardiogram (ECG) is a pivotal tool for risk stratification due to its affordability, non-invasiveness, and rapid results. The Tpeak-Tend interval shows how repolarization propagates throughout the myocardium and has been linked to dangerous ventricular arrhythmias and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Objective: To study the role of Tpeak-Tend/QT interval ratio as a predicator of in-hospital MACE in patients with STEMI. Methodology: This cross-sectional study was conducted at a tertiary care hospital between September 2022 and February 2024. A total of 87 patients were enrolled, of which 79 patients with STEMI presentation who met the inclusion criteria were included. Further the Tpeak-Tend/QT ratio was calculated, those with Tpeak-Tend/QT ratio < 0.3 were grouped as Group A (n=32), and those with ratio > 0.3 were in group B (n=47) Results: Out of 79 patients in this study, male gender was predominant, in group A, 23 of 32 patients and in group B, 32 of 47 patients were male. The most common age group noted in Group A was 60-70 years and in group B it was 50-60 years. Chest discomfort was the most common presenting symptom in 27 out of 32 patients in group A and 44 out of 47 patients in group B. Further in these patients the occurrence of in-hospital MACE was analysed, it was observed that the commonest MACE was heart failure, seen in 4 of 32 patients in group A and 16 of 47 patients in group B. Conclusion: The study showed a statistically significant correlation (P value = 0.03) between the incidence of in-hospital MACE in STEMI patients and a high Tpeak-Tend/QT ratio (>0.3). Hence Tpeak-Tend/QT ratio > 0.3 on a 12-lead ECG is a non-invasive and dependable predictor of MACE.

Introduction: Both community residents and hospitalized patients are impacted by the electrolyte imbalance known as hyponatraemia. Growing older is correlated with a higher risk of hyponatraemia, which is a potent independent risk factor for the condition. Aims: To investigate the clinical characteristics of hyponatremia in senior hospital patients. To investigate the cause of hyponatremia in senior hospital patients. To evaluate the hyponatremia correction response. Materials & Methods: The research took place at Katihar Medical College and Hospital from July 2022 to December 2023, spanning duration of 1.5 years. This study comprised 80 patients hospitalized to the medicine ward of the Department of Medicine at Katihar Medical College and Hospital in Katihar, Bihar, who were 60 years old or older and had serum sodium levels below 135 meq/litre. Result: Hyponatremia in patients can have several causes, but the most common one is inadequate intake (37.5%), followed by congestive heart failure (35.0%). About a quarter of cases involve vomiting, while about a third have SIADH, or syndrome of inappropriate antidiuretic hormone secretion. Hyperglycemia and diarrhea occur in 6.2% of cases. Hypothyroidism affects 5% of cases and chronic liver disease 2.5% of instances, dehydration 3.7% of cases, and idiopathic 5.0% of cases round out the total. Conclusion: According to the findings of my prospective study, elderly hospitalized patients frequently have hyponatremia, a common electrolyte imbalance.It affects all sexes, albeit males are more prone to suffer it. Those with symptoms had critically low salt levels, even though the majority of patients did not exhibit any. The most often reported symptoms were postural dizziness, abnormal behavior, and lethargy.

Heart failure (HF) is a significant cardiovascular condition associated with high morbidity and mortality. Iron deficiency is prevalent among HF patients and has been linked to worsened outcomes. Recent studies suggest that correcting iron deficiency may enhance functional capacity and reduce hospitalizations. Additionally, red cell distribution width (RDW) has emerged as a cost-effective prognostic marker in HF. This study aims to explore the relationship between iron parameters—including serum ferritin, total iron-binding capacity (TIBC), and RDW—and the severity of heart failure in patients diagnosed with heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).  Material and Methods: A cross-sectional study was conducted at a tertiary care center, enrolling 180 adult patients diagnosed with heart failure through echocardiography. Data on demographics, clinical history, symptoms, and iron profiles (serum iron, ferritin, TIBC, and RDW) were collected. The severity of heart failure was classified using the New York Heart Association (NYHA) criteria. Statistical analysis was performed using SPSS version 21.0, with descriptive statistics, ANOVA, and Student’s ttests applied to assess significant differences.  Results: The cohort had a mean age of 58.36 years, with 62.8% diagnosed with HFrEF. Serum iron, ferritin, and TIBC levels significantly decreased with increasing severity of HF (p < 0.05). RDW exhibited a notable upward trend correlating with NYHA classification (p < 0.001). There were no significant differences in TIBC and unsaturated iron-binding capacity across severity levels. A significant negative correlation was observed between patient age and RDW (r = -0.316, p < 0.003).  Conclusion: The findings highlight that heart failure is associated with significant alterations in serum iron parameters, especially as HF severity increases. RDW serves as an effective and economical prognostic marker, suggesting that screening for iron deficiency in HF patients may improve clinical outcomes and reduce rehospitalization rates.

Sleep disorders, encompassing conditions such as obstructive sleep apnea (OSA), insomnia, restless leg syndrome (RLS), and circadian rhythm disturbances, have emerged as critical contributors to cardiovascular disease (CVD) risk, which remains a leading cause of global mortality and morbidity. These disorders disrupt the restorative functions of sleep, initiating a cascade of physiological changes including heightened sympathetic nervous system activation, systemic inflammation, oxidative stress, hormonal imbalances, and metabolic dysregulation. Such disruptions significantly exacerbate cardiovascular risk factors, including hypertension, atherosclerosis, arrhythmias, and heart failure. The bidirectional relationship between sleep disorders and cardiovascular health highlights the need for comprehensive management strategies that integrate sleep health into broader preventive care frameworks. This systematic review synthesizes findings from 29 studies to explore the underlying mechanisms linking sleep disorders to cardiovascular outcomes, evaluate the effectiveness of current therapeutic interventions, and identify challenges in diagnosing and managing these conditions. Using a PRISMA-based methodology, the review emphasizes the role of sleep disorders as both independent risk factors and contributors to the progression of existing cardiovascular conditions. Evidence suggests that interventions such as continuous positive airway pressure (CPAP) therapy for OSA and cognitive-behavioral therapy for insomnia (CBT-I) can mitigate cardiovascular risks, but challenges related to adherence, access, and awareness remain significant barriers. Sleep disorders such as insomnia, narcolepsy, RLS, and OSA significantly impair heart health by disrupting the sleep cycle, increasing cardiovascular stress, and promoting metabolic dysregulation. Despite advancements in understanding the relationship between sleep disorders and cardiovascular health, critical gaps in knowledge persist, particularly regarding the long-term impact of therapies, the role of emerging technologies, and the implications of genetic and environmental factors. By addressing these gaps and promoting multidisciplinary approaches to care, integrating sleep health into cardiovascular risk management can significantly reduce the burden of disease. The findings underscore the urgent need for public health initiatives, policy interventions, and innovative research to address the dual burden of sleep disorders and cardiovascular diseases, ultimately improving population health outcomes.

Aim: To assess the effectiveness of a hybrid cardiac rehabilitation program on the quality of life and cardiovascular risk factors in heart failure subjects. Objectives: 1. To determine the effect of a cardiac rehabilitation program on cardiovascular risk factors and bio-physiological parameters in heart failure patients. 2.To determine the effectiveness of a cardiac rehabilitation program on health-related quality of life in heart failure subjects. 3.To assess the effect of a cardiac rehabilitation program on functional capacity in heart failure subjects. Need of the Study: While previous studies have largely focused on the effect of cardiac rehabilitation on morbidity, mortality, and re-hospitalization, there is limited research on its impact on quality of life, functional capacity, and independence in activities of daily living in heart failure patients. Furthermore, most data are derived from center-based programs, which pose practical limitations for rural populations. This study aims to develop a simple, easily implementable hybrid (canter- and home-based) cardiac rehabilitation program with tele-consultations and outpatient follow-ups. Methods: A total of 102 subjects were initially enrolled, with 100 completing the study. Descriptive statistics were used to evaluate variables such as age, SPO2, SBP, DBP, resting pulse, BMI, LDL, HDL, RBS, 6MWT, and various health-related quality of life parameters before and after the intervention. Results: Post-intervention results showed significant improvements in several key areas:SPO2: Increased from a mean of 88.60 ± 2.71 to 96.38 ± 1.95 (p=0.000).SBP: Decreased from 122.00 ± 16.58 to 114.80 ± 11.05 (p=0.000).6MWT: Improved from 502.95 ± 69.13 meters to 514.71 ± 66.31 meters (p=0.000).PCS: Increased from 23.83 ± 3.63 to 149.50 ± 3.49 (p=0.000).MCS: Improved from 29.40 ± 5.36 to 73.50 ± 5.44 (p=0.000).Statistically significant reductions were observed in smoking (p=0.001) and alcohol consumption (p=0.001) post-intervention. There were no significant changes in DBP, resting pulse, BMI, LDL, HDL, or RBS. Conclusion: The hybrid cardiac rehabilitation program significantly improved SPO2 levels, SBP, 6MWT performance, and health-related quality of life (both PCS and MCS). Additionally, there was a notable reduction in smoking and alcohol consumption among participants. These findings suggest that hybrid cardiac rehabilitation can effectively enhance the quality of life and reduce cardiovascular risk factors in heart failure patients, making it a viable option for both urban and rural populations.

Introduction: Primary percutaneous intervention is the preferred treatment for ST-elevation myocardial infarction. Even after the restoration of epicardial flow graded as thrombolysis in myocardial infarction flow (TIMI) after percutaneous coronary intervention, microvascular obstruction can occur, which in turn leads to poor left ventricular function. The main cause of microvascular obstruction is atheromatous microparticle embolization within the culprit artery causing increased infarct size, mortality, and positive remodeling of the heart, which leads to overt heart failure and increased mortality. Objective: To determine the association between Myocardial Blush Grade (MBG) post-PCI and Left Ventricular Ejection Fraction in patients with ST-Elevation Myocardial Infarction. To investigate the relationship between Myocardial Blush Grade and adverse cardiovascular outcomes (e.g., heart failure, recurrent infarction, mortality) in STEMI patients.  To determine predictors of myocardial recovery: Identify factors associated with favourable myocardial recovery, including procedural characteristics, patient demographics, and comorbidities, to better understand the determinants of post-PCI left ventricular function. Methods: The data will be analysed using IBM SPSS software version 26.0. For analysis of groups in the study, MBG ≥2 was considered as ‘high’ grade whereas MBG <2 was considered as ‘low’ grade. Descriptive statistics will be used to describe variables such as gender.  Mean and standard deviation will be used for calculating variables such as age and ejection fraction. Chi-square test will be used to compare the clinical characteristics of the high and low MBG groups. Independent samples t-test will be used to determine if differences between TIMI score and MBG will be significant with respect to age.  Risk ratios will be calculated for adverse outcomes and improved LVEF with respect to MBG. Logistic regression analysis will be performed to determine the confounders of the study. Result: MBG may be considered as an additional angiographic parameter to define angiographic success and also better prognosticate patients and decide on management plans to improve long-term patient outcomes. The study findings may contribute to risk stratification models, helping clinicians tailor interventions and improve outcomes for STEMI patients. Conclusion: In the present study, we found a significant association between MBG and TIMI, suggesting that MBG can predict adverse events after thrombolysis/PTCA in those with ACS. However, we found no association between age, gender, co-morbidities or EF.

Background: The MPI is a composite measurement of systolic and diastolic dysfunction that has demonstrate the predict congestive heart failure. This study was correlated the myocardial performance (TEI) index and LV function by Simpsons method in EF <35% patients and to evaluate its efficiency by echocardiography. Method: The myocardial performance is obtained by measuring IVRT, IVCT, ET using pulse wave doppler and LV function is assessed using Simpsons method in apical 4 chamber view using GE VIVID S5 and ESAOTE. Result: The myocardial performance functional parameters were significantly correlating with LV function value of EF <35% patients. Conclusion: MPI is a sensitive indication of total cardiac dysfunction in patients with congestive heart failure.

Introduction: Pleural effusion is the abnormal accumulation of fluid in the pleural space. Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption. Pleural effusion may develop when there is excess pleural fluid formation (from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity) or when there is decreased fluid removal by the lymphatics The pleural effusion is associated with the history of suffering of mankind. It is a common medical problem encountered by the doctors across the globe. It is a manifestation of respiratory as well as systemic diseases.Materials and Methods This is a Descriptive, observational single centre study was conducted in the department of General Medicine, Sri Siddartha medical college and hospital, Tumkur, Karnataka over a  period of one year. Cases of pleural effusion admitted under Medicine department. Patients of either sex above 12 years of age with pleural effusion supported by X ray chest with of tuberculous and nontuberculous origin were included. Patients meeting the diagnostic criteria of more than one categories, pleural effusions of undetectable or obscure origin, obvious haemothorax secondary to trauma were excluded. Results  In the study, among exudative pleural effusion, 10(20%) patients were tubercular,13(26%) had malignancy,4(8%) had empyema,4(8%) had connective tissue disorders,1(2%) had pancreatitis. Among transudative pleural effusion 6(12%) had congestive heart failure,6(12%) had chronic kidney disease,3(6%) had chronic liver disease, 3(%6) had nephrotic syndrome. In TB, 9 (90%) patients pleural fluid glucose >60mg/dl, 3 (30%) had <60mg/dl. In empyema all cases had glucose<60mg/dl and in malignancy 12 (93%) patients had PF glucose >60mg/dl and 1 (7%) had <60mg/dl. In CTD all cases had PF glucose >60mg/dl. In acute pancreatitis, 1(100%) had PF glucose <60mg/dl and 78% of all transudative pleural effusion were having PF glucose >60 mg/dl. Conclusion The study was single institutional, observational study. The study was focusing on efficacy of pleural fluid cholesterol and its ratio to serum level in distinguishing exudates from transudate

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) poses a significant clinical challenge due to its complex pathophysiology and increasing prevalence, particularly among older adults. Despite normal or near-normal left ventricular ejection fraction, patients exhibit heart failure symptoms such as dyspnea and fatigue. HFpEF is commonly associated with comorbidities like hypertension, diabetes, and obesity, which complicate management and contribute to poor prognosis. Methods: A descriptive observational study was conducted over two years at a tertiary care hospital in Chhattisgarh. The study included 100 adult patients diagnosed with HFpEF, defined by symptoms of heart failure, left ventricular ejection fraction (LVEF) ≥ 50%, and without evidence of structural or cardiovascular heart disease. Clinical evaluation, laboratory tests, and imaging studies, including echocardiography, were performed to assess cardiac function. Statistical analysis was conducted using descriptive statistics, t-tests, and chi-square tests. Results: The study participants had a mean age of 56.72 years, with a balanced gender distribution. Fatigue (87%) and dyspnoea (82%) were the most common symptoms. Hypertension (88%) and diabetes (67%) were prevalent comorbidities. The mean ejection fraction was 54.53%, with mild diastolic dysfunction observed in 78% of patients. Conclusion: HFpEF primarily affects older adults with significant comorbidities, notably hypertension and diabetes. Although ejection fraction remains normal, mild diastolic dysfunction is common. These findings emphasize the need for comprehensive management strategies focusing on symptom relief and comorbidity control to improve patient outcomes.

Introduction Heart failure (HF) is as a clinical condition explained by current or previous complaints like breathlessness, ankle swelling, and tiredness, along with signs like elevated JVP, pulmonary crepitation’s, and peripheral oedema, all of which are caused by an anatomical and/ or physiological cardiac abnormality and confirmed by at least 1 of the following: raised BNP levels or verifiable evidence of respiratory, cardiac or systemic congestion Materials And Methods This is a observational study was conducted in the Department of General Medicine, Mahavir Institute of Medical Sciences. Two hundred twenty patients who were admitted to the ICU and who underwent the measurement of serum UA were enrolled in this study. AHF was defined as either new-onset HF or the decompensation of chronic HF with symptoms sufficient to warrant hospitalization. HF was diagnosed according to the Framingham criteria for a clinical diagnosis of HF, based on the fulfilment of two major criteria or one major and two minor criteria. Results  Age was not significantly associated with uric acid levels (P=0.153). However, a trend was observed where patients aged 71-80 years had the highest proportion of high uric acid (75%), while those aged 41-50 years had a lower proportion (28.57%). Men and women had similar uric acid levels (P=0.550). Patients with COPD, dilated cardiomyopathy, and coronary artery disease had slightly higher uric acid levels, but the association was not statistically significant. Among co-morbidities, diabetes, hypertension, smoking, and alcohol consumption were not significantly different between high and low uric acid groups. However, patients with high uric acid had significantly higher rates of ICU admission (93.55%) and mortality (94.40%), suggesting a strong association between elevated uric acid and worse clinical outcomes. Conclusion This study confirms that elevated serum uric acid is an independent predictor of worse clinical outcomes in CHF. Patients with higher UA levels have more severe disease, increased ICU admission, and significantly worse survival rates. Given these findings, uric acid measurement should be integrated into routine CHF risk stratification. Future research should explore whether lowering UA can directly improve patient outcomes and reduce cardiovascular mortality.

Background: Introduction: Airway procedures involving direct manipulation can trigger powerful reflexes that cause significant cardiovascular changes, particularly dangerous for patients with pre-existing cardiac, hypertensive, or neurological conditions due to the risk of myocardial ischemia, heart failure, or elevated intracranial pressure. For optimal patient outcomes, laryngoscopy should provide clear glottic visualization, enable precise endotracheal tube placement, minimize physical trauma, and reduce procedure duration - objectives that research shows are increasingly achievable through video laryngoscopy technology, which has demonstrated superior visualization and higher success rates compared to conventional methods. Aim And Objectives: To compare the total time taken for endotracheal intubation (in seconds) in adult patients and the hemodynamic stability during and after insertion of endotracheal tube in adult patient. Materials and Methods: After taking the institutional approval for the study, age 18-60 year, posted for elective surgeries undergoing general anaesthesia were equally divided into 2 groups, 30 patients each after taking written informed consent from patient in their own vernacular language. Group M (n=30) - Conventional Macintosh laryngoscope group. Group G(n=30) – McGrath MAC video laryngoscope group. Results: Patients in all two groups were comparable with Intubation criteria, mean pulse rate, SBP, DBP, mean ABP by using unpaired t-test. The mean difference was found statistically significant with P<0.05. No major complication were reported in patients of any of the group. Conclusion: This study it is concluded that Mcgrath MAC Video laryngoscope provides easier intubation and provide better hemodynamic as compared with Macintosh laryngoscope. And total duration of intubation is less with Mcgrath MAC Video laryngoscope than with Macintosh laryngoscope.

Introduction: Acute respiratory distress (ARD) remains a critical challenge in emergency settings, presenting with varied causes and influencing patient outcomes differently. This study evaluates the clinical characteristics, treatment approaches, and outcomes of patients with ARD in an emergency department (ED). Methods: We analyzed data from 240 adult patients (aged ≥18 years) who presented with symptoms of ARD—defined as acute shortness of breath, low blood oxygen levels, or respiratory failure—to a tertiary ED over one year. Information on patient demographics, existing health conditions, clinical signs, diagnostic tests, treatments, and outcomes (hospitalization, ICU admission, death) was collected from electronic health records. Statistical analysis involved descriptive statistics, chi-square tests, and logistic regression. Results: Patients (average age 62.4 ± 15.2 years; 55% male) frequently had comorbidities such as hypertension (48%), chronic obstructive pulmonary disease (32%), and heart failure (25%). The leading causes of ARD were pneumonia (28%), acute exacerbations of asthma/COPD (24%), and pulmonary edema (19%). A significant portion (64%) exhibited hypoxemia (SpO₂ <90%), and 38% needed non-invasive or mechanical ventilation. The hospitalization rate was 82%, with 26% requiring ICU care. The in-hospital mortality rate was 12%, with higher risks associated with older age (OR 1.05, 95% CI 1.01–1.09), septic shock (OR 3.2, 95% CI 1.4–7.1), and multiorgan failure (OR 4.8, 95% CI 2.1–11.0). Delays in ED intervention over two hours were linked to increased ICU admissions (p=0.03). Conclusion: ARD results from diverse etiologies and is significantly affected by patient age, comorbidities, and the timeliness of medical interventions. Prioritizing early identification and standardized treatment protocols may enhance patient survival and decrease the demand for intensive care services.

Background: Regular puncture for dialysis, treatment with anticoagulation and abnormal hemodynamics make infections, hematoma, thrombosis, limb oedema, cellulitis of limb, bleeding, pseudoaneurysms and true aneurysms a relatively common complication in patients with arteriovenous fistula (AVF) for hemodialysis. Aims: We aim to describe the presentations, treatment modalities and probable causative factors of true and pseudo aneurysms in CKD patients with arteriovenous access.Materials and Methodology: It was a retrospective observational study in the Department of Cardiothoracic and Vascular Surgery at IPGMER And SSKM Hospital, Kolkata, during the period July 2022 to July 2024. Results: In our study, 34.03% patients were in the age group 51-60 and 23.15% were in the age group 41-50. Of those studied, 61.4 % were male, the rest were female. All the patients had Stage V CKD. 68.77% patients had aneurysms of the brachiocephalic fistula while the rest had aneurysms of the radiocephalic fistula. Among comorbidities, 67.01% patients had Type 2 diabetes mellitus (T2DM), 86.31% patients were hypertensive, 64.21% patients had peripheral arterial disease, 36.14% patients had heart failure, 82.80% patients had dyslipidemia.In our study, 108 (37.80%) patients had Type Ia aneurysm, 142 (49.82%) had Type Ib aneurysm, 21 (7.36%) had Type IIa aneurysm, 14 (4.91%) had Type IIb aneurysm. 44.91% patients who presented were asymptomatic, while 40% presented as bleeding fistula and 15.09% presented as hematoma. Among treatment modalities undertaken, ligation of fistula was done for a significant 77.55% of cases, excision of aneurysm and repair for 16.84% and endovascular repair was done for 5.61 % of patients. Conclusions: Frequent monitoring of the arteriovenous access, avoiding repeated punctures in same site for dialysis, regular dressing and antibiotics to prevent infection may help identify and prevent aneurysms early and provide prompt treatment to avoid potentially fatal consequences like rupture, hemorrhage, thrombosis and stenosis. To determine the ideal treatment strategy and the appropriate time for intervention, studies outlining the etiology, natural history and development of aneurysms are necessary.

Background:  Sepsis-related mortality remains high due to delayed diagnosis and suboptimal treatment strategies. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a known marker which prognosticates heart failure, but its role in sepsis prognosis is less explored. Objectives: This study aimed to evaluate the prognostic significance of NT-proBNP levels as an in-hospital severity indicator in patients with sepsis. Methods: This hospital-based prospective cross-sectional study was carried out at Silchar Medical College and Hospital, Assam, over one year, including 100 patients diagnosed with sepsis. Patients were assessed for demographic details, clinical parameters and laboratory investigations, including NT-proBNP levels, measured using the VITROS 5600 autoanalyzer. The primary result measured was in-hospital mortality at the end of 28 days. The prognostic value of NT-proBNP was compared with other clinical parameters and SOFA scores. Results: The study population comprised 49% males and 51% females, with no significant gender differences in outcomes. Elevated NT-proBNP levels were correlated with higher mortality, with non-survivors showing mean levels of 32,630.83 pg/mL compared to 9,005.16 pg/mL in survivors. Elevated NT-proBNP levels were linked with higher SOFA scores and greater severity of organ dysfunction. The ROC curve for NT-proBNP demonstrated an AUC of 0.84, indicating good predictive power. Logistic regression analysis confirmed NT-proBNP and SOFA scores as significant predictors of mortality, with each unit increase in SOFA score increasing odds of mortality by approximately 70% (p < 0.001). Conclusions: NT-proBNP levels are a valuable prognostic marker for assessing the severity and predicting outcomes in septic patients. Integrating NT-proBNP measurements into clinical practice can enhance early risk stratification, allowing for timely therapeutic strategies to enhance sepsis patient outcomes.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized for its ability to capture circadian variations in blood pressure, which are pivotal for managing patients with acute heart failure (AHF). This observational study investigates the utility of ABPM in a clinical setting to correlate blood pressure patterns with clinical outcomes in patients admitted with AHF. Methodology: This prospective observational cohort study was conducted at a tertiary care center, encompassing a sample of 100 patients diagnosed with AHF. ABPM was employed 24 hours prior to discharge post initial stabilization to monitor blood pressure fluctuations over a 24-hour period. Data were analyzed to correlate these fluctuations with clinical parameters including heart failure severity and cardiac structural changes, as evidenced by echocardiographic data. Results: The study findings highlighted that NYHA Class III or IV at admission was significantly higher in HFmrEF risers (96.2%) compared to non-risers (88.9%) (p = 0.02).  ABPM measurements showed that HFpEF patients had the highest average 24-hour SBP (124.9 ± 17.8 mmHg), followed by HFmrEF (112.4 ± 15.2 mmHg) and HFrEF (102.8 ± 13.9 mmHg). HFpEF patients had the highest prevalence of nocturnal hypertension (52.7%), followed by HFmrEF (34.1%) and HFrEF (27.4%). The differences were significant (p=0.01). The differences in LVEF between the AHF groups were statistically significant, with HFpEF showing the best heart function and HFrEF showing the worst. Conclusion: ABPM provides valuable insights into the prognostic implications of blood pressure variability in patients with AHF. The data suggests that ABPM should be considered as part of the routine assessment in AHF patients to better tailor therapeutic interventions and potentially improve clinical outcomes.

Background: Transfusion of blood and its products is one of the important pillars in the treatment of patient in Emergency Department. Methods: The study is Cross Sectional study over a period of 12 months from March 2021 to February 2022. A total of 348 cases were assessed from Emergency Department (Casualty) of SAIMS Hospital, Indore. Results: Out of 348 cases,most common indication for transfusion was massive blood loss due to roadside accident in 167(47.98%) patients, followed by heart disease patient on antiplatelet medication in 128(36.78%) patients followed by Hemato-oncological disease patients 31(8.9%) and then patients with chronic anemia 22 (6.33%).180(51.72%)patients received RCC transfusion, 105(30.17%)patients received platelet transfusion and 63(18.10%)patients received FFP transfusion. The most common indication for RCC transfusion was Anaemia due to massive blood loss, for PC transfusion was Thrombocytopenia due to Heart failure and DIC and for FFP is Hypoproteinemia. Transfusion was done in patients with Hb <7g/dl even if they had no co-morbidities. Patients with co-morbidities transfused at Hb between 7-10g/dl. 267(76.72%) patients had a pre-transfusion Hb of 5-7g/dl, 73(20.97%) patients had pre-transfusion Hb of 8-10 g/dl and 8(2.29%) patients had a Hb of 11-12 g/dl. Most of the patients Post Transfusion Hb were around 11-12 g/dl. When patients pre-transfusion Hb was 5-7 g/dl, 3-4 units of RCC transfused and when it was 8 -10 g/dl,2-3 units of RCC transfused. Conclusion: For better utilisation and to reduce wastage of blood and blood products, a protocol has to be formulated.

Background: Thyrotoxicosis is a clinical syndrome caused by excessive circulating thyroid hormones, leading to a hypermetabolic state. This study aims to evaluate the clinical profile of thyrotoxicosis patients and review its various etiologies. Methods: A prospective study was conducted on 50 patients of either sex, age more than 12 years, who fulfill the criteria for diagnosis of hyperthyroidism. A detailed clinical examination, routine investigations, thyroid profile, ultrasound of the neck, and thyroid scans were performed as needed. Results: Thyrotoxicosis was more prevalent in the younger population (<40 years), with a mean age of 41.12 years. A female predominance was observed. The most frequently reported symptoms included palpitationss, hand tremors, weight loss, nervousness, and dyspnea. Cardiovascular manifestations were common, with palpitations, dyspnea, arrhythmia, and heart failure being the most frequently observed. Tachycardia and atrial fibrillation were the most prevalent cardiovascular signs. Electrocardiographic changes correlated with thyroid hormone levels, indicating that increased Free T3 and Free T4 levels and decreased TSH levels were directly associated with heart rate and rhythm changes. Additionally, 32% of patients had elevated pulmonary hypertension, which showed potential reversibility with anti-thyroid treatment. Conclusion: Early diagnosis and identification of the etiology of thyrotoxicosis may help in reversing the condition and preventing complications. Appropriate treatment strategies should be implemented to manage cardiovascular manifestations and other systemic complications associated with thyrotoxicosis.

Introduction: Heart failure (HF) remains a significant cause of morbidity and mortality worldwide. This study explores the association between proportional pulse pressure (PPP) and the severity of HF categorized by left ventricular ejection fraction (LVEF) using echocardiography. Material and Methods: The study included a sample size of 92 patients, with findings indicating a statistically significant relationship between lower PPP and reduced LVEF. PPP was found to be an effective non-invasive marker of arterial compliance and cardiovascular function, particularly in patients with heart failure with reduced ejection fraction (HFrEF). Patients with a lower PPP exhibited higher levels of cardiac dysfunction, indicating that PPP could be a useful tool for risk stratification and prognosis determination. Results: The study highlights that patient with reduced LVEF consistently demonstrated lower PPP values, with a significant inverse correlation between these two parameters (p < 0.001). The results suggest that proportional pulse pressure can serve as a cost-effective and reliable parameter in assessing heart failure severity, particularly in resource-limited settings where access to advanced diagnostic tools such as echocardiography is limited. Conclusion: Given its simplicity and ease of measurement, PPP could be incorporated into routine clinical practice to enhance early detection and improve treatment strategies for HF patients. Future research should explore the longitudinal impact of PPP measurements on HF management and outcomes.

Background: Dilated cardiomyopathy (DCM) is a primary myocardial disease with dilation of the left ventricle and systolic dysfunction, resulting in high morbidity and mortality. The purpose of the present study was to compare the clinical, echocardiographic, and electrocardiographic profiles of patients with DCM. Methods: A prospective observational study was carried out for one year in the Department of General Medicine, SVRRGGH, Tirupati. Sixty patients diagnosed with DCM according to clinical, echocardiographic, and electrocardiographic criteria were recruited. Demographic data, clinical presentation, electrocardiographic findings, echocardiographic indices, and risk factors were recorded and analyzed through SPSS version 20. Results: The study population consisted mainly of males (63%) aged 53.2 years on average. The most frequent symptoms were dyspnea (100%), easy fatigability (83%), and pedal edema (70%). Echocardiography showed severe left ventricular dilatation (mean LVIDd: 60.81 mm) with decreased ejection fraction (mean EF: 28.6%). Valvular regurgitation (64%), pericardial effusion (30%), and pulmonary hypertension (24%) were common. Electrocardiography demonstrated left axis deviation (46%), left ventricular hypertrophy (38%), and increased QRS duration (>0.10 sec) in 67% of the cases. Alcoholic DCM was responsible for 15% of the cases. Conclusion: DCM occurs mostly in elderly individuals with a male predominance and marked functional impairment. Echocardiographic evidence of left ventricular enlargement and decreased ejection fraction are important prognostic determinants. Prompt recognition and control of modifiable risk factors, including alcohol intake, may enhance patient outcomes.

Background: Heart failure (HF) is a major cause of morbidity and mortality worldwide, with recurrent hospitalizations imposing a significant healthcare and economic burden. Identifying risk factors associated with frequent hospitalizations may aid in optimizing management strategies. Methods: This prospective observational study was conducted at a tertiary care center in Maharashtra, enrolling 150 patients with HF. Baseline characteristics, comorbidities, laboratory parameters, echocardiographic findings, medication adherence, and triggers for decompensation were analyzed. Patients were categorized into recurrent HHF (≥2 hospitalizations) and non-recurrent HHF (≤1 hospitalization) groups. Statistical analyses, including logistic regression, were performed to identify independent predictors of recurrent HHF. Results:  Recurrent HHF was observed in 46 (30.7%) patients. Independent predictors of recurrent HHF included lower left ventricular ejection fraction (LVEF) (OR: 1.12 per 5% decrease, p=0.002), chronic kidney disease (OR: 2.45, p=0.005), atrial fibrillation (OR: 2.17, p=0.03), NTproBNP ≥ 3000 pg/mL (OR: 1.89, p=0.02), poor medication compliance (OR: 2.78, p=0.003), lack of diuretic use (OR: 2.31, p=0.008), and absence of beta-blocker therapy (OR: 1.96, p=0.02). Mortality was significantly higher in the recurrent HHF group (17.4% vs. 1.0%, p=0.001). Conclusion:  Recurrent HF hospitalizations are associated with multiple clinical and therapy related factors, including lower LVEF, comorbidities, elevated NTproBNP, and poor adherence to HF therapy. Targeted interventions focusing on optimizing guideline-directed medical therapy, improving medication adherence, early risk stratification and preventing triggers for decompensation may help reduce hospital readmissions and improve patient outcomes.

Background: Acute Myocardial Infarction (AMI) remains a major global health burden, with early risk stratification playing a critical role in optimizing patient outcomes. Admission hyperglycemia in non-diabetic individuals has emerged as a potential prognostic marker, though its clinical implications remain unclear. Objectives: This study aims to evaluate the prognostic significance of admission hyperglycemia in non-diabetic patients with AMI, assessing its impact on in-hospital mortality and major adverse cardiac events (MACE). Methods: An observational study was conducted at a tertiary care hospital over 24 months, enrolling 260 non-diabetic patients with AMI. Admission blood glucose levels were measured, with hyperglycemia defined as ≥140 mg/dL. Patients were categorized into normoglycemia and hyperglycemia groups. Baseline characteristics, inflammatory markers, cardiac function, and clinical outcomes were analyzed. Statistical comparisons were performed using t-tests, chi-square tests, and logistic regression analysis. Results: The hyperglycemia group had significantly higher levels of inflammatory markers (C-reactive protein and white blood cell count) and greater myocardial injury (elevated troponin I and CK-MB) compared to the normoglycemia group (p < 0.05). Left ventricular ejection fraction was significantly lower in hyperglycemic patients (45.8% vs. 51.4%, p < 0.001). In-hospital mortality was notably higher in the hyperglycemia group (16.9% vs. 6.2%, p = 0.009), along with an increased incidence of heart failure, arrhythmias, cardiogenic shock, and reinfarction (p < 0.05 for all). Patients with hyperglycemia also had a longer hospital stay (7.3 ± 3.2 days vs. 5.7 ± 2.1 days, p = 0.004). Conclusion: Admission hyperglycemia in non-diabetic AMI patients is associated with increased myocardial injury, a heightened inflammatory response, and poorer clinical outcomes, including higher in-hospital mortality and MACE. These findings highlight the need for early recognition and potential interventions targeting stress hyperglycemia in this patient population.

Background: Dizziness is a pretty common complaint, and while doctors often think about heart issues particularly in patients who are already diagnosed with cardiac conditions, but when patients with heart disease feel dizzy, there are plenty of other potential causes. This study looks into those other causes of dizziness in cardiac patients who came to hospitals in a rural part of Jammu and Kashmir (J&K), India. Methods: We reviewed medical records of cardiac patients who showed up at Govt. Medical College Doda in remote area of J&K, complaining of dizziness, between January 2019 and December 2023. We collected information like their age, sex, heart diagnoses, non-heart-related causes of dizziness, and what the doctors found. We used some basic statistical methods to analyze the data, and we also compared our findings with what other studies have reported. Results: Over those 5 years, 2476 cardiac patients came to the hospitals because of dizziness. Their average age was 47.5 years and about 53% were female. The most common heart problems were Hypertension, coronary artery disease, heart failure, and cardiac arrhythmias. In a pretty significant number of these patients—around 1039 (42%)—the dizziness wasn't due to their heart. The most frequent non-cardiac causes were:

• Vestibular disorders: 280 (26.94%) Benign Paroxysmal Positional Vertigo (BPPV): 145 (13.95%), Meniere's disease 83 (7.99%), Vestibular Neuritis: 52 (5%).
• Medication-related: 218 (20.98%) Diuretics: 135 (12.99%), Beta-blockers:83 (7.98%).
• Neurological disorders: 177 (17.03%) (Peripheral Neuropathy: 114 (10.97%), Migraine: 63 (6.06%).
• Psychogenic factors: 135 (12.99%) anxiety disorder 83 (7.98%), Depression 52 (5%).
• Metabolic disorders: 11 (10.87%) (Anemia: 73 (7.02%), Hypoglycemia: 41 (3.95%).
• Cervical spine issues: 116 (11.36%).

Conclusion: Non-cardiac causes of dizziness are quite common in cardiac patients in this rural part of J&K. Inner ear problems and medication side effects were particularly frequent. Neck issues also seem to be a factor. These results suggest that when cardiac patients have dizziness, doctors really need to consider all the possible reasons, not just their heart condition. More in-depth studies with larger numbers of patients would help to confirm these findings and figure out who might be more at risk

Introduction: Heart failure is a complex clinical syndrome characterized by the heart's inability to adequately pump blood to meet the body's demands. It is associated with significant morbidity, mortality, and healthcare costs. The presence of AF in heart failure patients further exacerbates the clinical course, leading to worse outcomes and increased hospitalizations. Aims: To evaluate LA and RA remodelling in AF using TTE-derived global Left atrial reservoir strain and RA Volume according to rhythm outcome at mid-term follow up and to correlate with heart failure. Materials and Methods: This is a prospective observational and corelational design. The study was conducted in Cardiology Department, IPGMER and SSKM Hospital and study duration was June 2021 to June 2022, first 12 months. The sample size of this study is 50 patients. Result: The comparison of artial volume at baseline and at 6 month follow up among AF-SR and AF-AF group. Above analysis we found between M0 (baseline) and M6 (at 6 month follow up), in the AF-SR group, there a significant decrease in RA Volume (p value = <0.0001), and LA volume (p value = <0.0001). There were no significant differences with regard to these variables in the AF-AF group though the RA and LA volume increases at 6 months (M6) in comparison to baseline (M0). Conclusion: In conclusion, two-dimensional strain echocardiography provides valuable insight into biatrial remodeling in atrial fibrillation. It effectively assesses atrial strain and function, highlighting their correlation with heart failure. This technique enhances our understanding of atrial dynamics, potentially guiding clinical management and improving patient outcomes in atrial fibrillation-related heart failure.

Introduction: The left atrium (LA) plays a crucial role in cardiac hemodynamics, functioning as a reservoir, conduit, and booster pump during the cardiac cycle. Left atrial dysfunction is associated with a wide range of cardiovascular diseases, including atrial fibrillation, heart failure, and valvular heart disease, and serves as an important predictor of adverse cardiovascular outcomes. Aims: This study aims to evaluate changes in LA reservoir function and volume following PBMV, using PALS as a key echocardiographic parameter. Understanding these changes could improve the assessment of post-procedural hemodynamic improvements and long-term atrial function, ultimately aiding in risk stratification and management of patients undergoing PBMV. Materials & Methods: The present study was a Prospective cohort study. This Study was conducted from One year. Total 36 patients were included in this study. Result: The study compared baseline characteristics among patients with mitral stenosis (MS, n = 17), mitral regurgitation (MR, n = 19), and healthy individuals (n = 16). The mean body surface area (BSA) was similar across groups (MS: 1.6 ± 0.1 m², MR: 1.7 ± 0.1 m², Healthy: 1.7 ± 0.1 m²). Patients with MR were slightly older (49 ± 13 years) compared to those with MS (42 ± 12 years) and healthy controls (41 ± 13 years). Conclusion: We concluded that, percutaneous balloon mitral valvuloplasty (PBMV) significantly improves left atrial (LA) reservoir function and reduces LA volume in patients with mitral stenosis. Assessment using peak atrial longitudinal strain (PALS) demonstrates enhanced LA compliance and function post-procedure.

Background: Heart failure with reduced ejection fraction (HFrEF) is a chronic condition that greatly influences myocardial function. Traditionally, left ventricular ejection fraction (LVEF) was utilized to measure cardiac performance, but global longitudinal strain (GLS) analysis has emerged as a more sensitive and reliable measure of systolic dysfunction overcoming the limitations of LVEF. Azmarda (innovator Sacubitril/valsartan), is a supramolecular cocrystal complex and has displayed significant efficacy in treating patients with HFrEF. However, the clinical effectiveness of Azmarda compared to the Generic sacubitril/valsartan formulations remains unexplored. Objective: Therefore, the current study aims to compare the efficacy and safety of Azmarda with generic sacubitril/valsartan in patients with HFrEF, by assessing the GLS score and Time to Peak (TTP). Methods:  A prospective, randomized, crossover, study was performed with 12 patients with HFrEF. Eligible patients were randomly assigned to either Azmarda or Generic sacubitril/valsartan for 8 weeks, followed by the crossover to the alternate formulation for another 8 weeks. GLS and TTP scores were measured from baseline to weeks 4, 8, 12, and 16. Safety assessments were conducted throughout the duration of the study. Results: Patients treated with Azmarda demonstrated a larger improvement in GLS scores compared to the patients treated with generic formulation at weeks 4, 8 12, and 16. The change in GLS score from baseline to week 8 was significantly higher in the Azmarda group (-1.7% vs. -0.5%, p<0.05) than in the generic group. These improvements were consistent, sustained, and significantly greater after the cross-over period. No serious adverse events occurred during the study, and both formulations were well-tolerated. Conclusion:  This study establishes the superiority of Azmarda manufactured by unique co-crystal technology over generic formulation while displaying enhanced LV reverse remodeling in HFrEF patients and further highlight the value of GLS as a sensitive and reliable parameter for early detection of left ventricular systolic dysfunction. However further studies with larger cohorts and long-term follow-up are required to confirm the long-term clinical benefits.

Background: Hypertensive heart disease (HHD) results from prolonged systemic hypertension and leads to structural and functional cardiac changes such as left ventricular hypertrophy (LVH), concentric remodeling, and subclinical systolic dysfunction. Echocardiography remains the primary imaging tool for evaluating cardiac structure and function, while chest X-ray (CXR) provides supportive information on cardiac size and pulmonary congestion. This study aimed to assess echocardiographic and chest X-ray findings in patients with HHD and examine their correlation with clinical parameters including duration of hypertension, blood pressure control, comorbidities, and biochemical markers. Materials and Methods: A prospective observational study was conducted on 100 hypertensive patients at the Departments of Medicine and Radiology, Mamata Medical College, Khammam. All participants underwent detailed clinical evaluation, laboratory investigations, transthoracic echocardiography, and standard posteroanterior chest X-ray. Key imaging parameters included left ventricular mass index (LVMI), global longitudinal strain (GLS), ejection fraction (EF), cardiothoracic ratio (CTR), pulmonary vascular congestion, and aortic unfolding. Statistical analysis involved correlation, group comparison, and regression analyses to explore associations with clinical variables. Results: The mean LVMI was 110 ± 15 g/m², GLS was -17 ± 1.5%, and EF was preserved at 55 ± 5%, indicating early systolic dysfunction. Chest X-ray findings showed cardiothoracic ratio >0.50 in 40% of patients, pulmonary congestion in 28%, and aortic unfolding in 35%. Duration of hypertension showed a strong correlation with LVMI (r = 0.68, p < 0.001). GLS was significantly lower in smokers (p = 0.02), and patients with diabetes and dyslipidemia had higher LVMI and lower EF. BMI was identified as a predictor of reduced EF (p = 0.02), and systemic abnormalities were more frequent in patients with prolonged hypertension and comorbidities. Conclusion: Echocardiography and chest X-ray are effective, accessible tools for evaluating hypertensive heart disease. Clinical variables such as long-standing hypertension, poor blood pressure control, diabetes, dyslipidemia, and smoking are closely associated with structural and functional cardiac alterations. Early identification of subclinical dysfunction through these imaging modalities can guide timely interventions to prevent progression to heart failure.

Background: Acute decompensated heart failure (ADHF) and community acquired pneumonia may have similar presentation of acute dyspnea initially and hence making a definitive diagnosis of primary cause can be difficult. Patients are concurrently treated for suspected pneumonia. Present study was aimed to find out the rational use of antibiotic given in acute heart failure as well as study of total duration and de-escalation of antibiotics in acute heart failure. Material and Methods: This was prospective observational study conducted in patients of Age >18 to 75 years, who presented to emergency room with dyspnea, suspected or known heart failure. Results: In present study, among 100 patients, most common age of presentation in the study was 51-55 years (31%), proportion of males and females in the study were almost equal which was 52% and 48% respectively. Oxygen requirement at admission and after 48 hours of admission were found to be statistically significant. P value <0.0001. A significant fall was noted in TLC/(mm)3 when compared at admission and after 48 hours of admission, difference was statistically significant. It was observed that maximum duration of antibiotic given to the patients were of 8 days and minimum of 2 days. The observed mean of total duration of antibiotic was 5.37±2.62 days. It was observed that there was no restarting of antibiotic in patients who were stopped after 48 hours. It was observed that maximum duration of hospital stay in patients were of 9 days and minimum duration of 3 days. The observed mean of hospital stay was 5.64±1.21 days. Out of 100 patients included in study were 90 were discharged, 10 patients expired. Conclusion: All patients despite low probability of infection received antimicrobial therapy. The mean duration of antibiotic study patients was of 5 days.

Background: Cirrhosis is a chronic liver condition characterized by hepatic fibrosis, anatomical distortion, and compromised liver function. Autonomic dysfunction (AD) is a significant concern due to its impact on cardiovascular stability, hemodynamic modulation, and patient prognosis. AD is characterized by irregularities in heart rate variability, impaired blood pressure management, and abnormal reflex reactions, which can increase the risk of cardiac events. Cirrhotic cardiomyopathy, characterized by compromised ventricular contractility and electromechanical dysfunction, is linked to autonomic abnormalities. ECG and ECHO are vital tools for assessing heart function in cirrhosis patients, revealing anatomical and functional heart alterations. Objective: This study aims to evaluate autonomic dysfunction in individuals with liver cirrhosis, its impact on ECG abnormalities, heart rate variability, blood pressure regulation, and cardiovascular reflexes, and its influence on various Child-Pugh and MELD score groups. It also seeks to identify potential predictors of autonomic dysfunction in cirrhosis, which could aid in early risk assessment and therapeutic management. Methods: A retrospective analysis was performed on clinical data from 100 patients admitted with cirrhosis over an 18-month period, from May 2023 to December 2024, at Shri B M Patil Medical College and Research Center, Vijayapura, where the data was collected. The information gathered included the patient's demographics, clinical conditions at admission, ECG results (QTc interval), echocardiographic results, and signs of autonomic dysfunction. Results: The study examined the age distribution and physiology of patients with heart conditions, focusing on 20-60-year-olds. Pulse rates were categorized into three ranges: 81-100 bpm, 60-80 bpm, and 101-130 bpm. The Valsalva maneuver showed a similar distribution, with 52% falling in the 81-100 bpm range and 36% in the 60-80 bpm range. Blood pressure was measured using a blood pressure cuff, with higher pressure indicating a higher risk of heart failure. The study also examined blood pressure readings under three conditions: Supine BP (lying down), Standing BP, and Hand Grip BP. The Child-Pugh classification assessed the severity of chronic liver disease, with the mean age group mostly middle-aged. The study found a strong link between autonomic dysfunction, cardiovascular abnormalities, and liver disease progression. Conclusion: The study reveals a significant gender disparity in the population, with 95% being males. Cardiovascular assessments show normal physiological responses, but some individuals show signs of autonomic dysfunction. ECG analysis reveals abnormalities in sinus rhythms, highlighting the need for continuous monitoring. Liver function assessments reveal a high prevalence of severe liver disease, necessitating urgent medical interventions. Early detection and management of these health issues are crucial for improving health outcomes. Future research should focus on lifestyle modifications, targeted treatments, and long-term monitoring.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing clinical challenge globally, especially among elderly patients with multiple comorbidities. Indian data on its clinical profile and outcomes remain limited. Aim: To evaluate the clinical characteristics and short-term outcomes of patients diagnosed with HFpEF in a tertiary care hospital. Methods: A prospective observational study was conducted on 100 patients with HFpEF (LVEF ≥ 50%). Clinical presentation, comorbidities, echocardiographic findings, and 30-day outcomes were recorded and analyzed using descriptive and inferential statistics. Results: HFpEF was more common in elderly females (mean age 66 years). Hypertension (82%), diabetes (61%), and obesity (66%) were the most prevalent comorbidities. Echocardiography showed diastolic dysfunction, left atrial enlargement (64%), and LV hypertrophy (57%). At 30 days, 84% improved symptomatically, while 11% were readmitted, and 5% died, with worse outcomes among those with diabetes, atrial fibrillation, and CKD (p < 0.05). Conclusion: HFpEF patients frequently present with multiple comorbidities that contribute to early adverse outcomes. Targeted management of risk factors and structured follow-up are crucial for improving prognosis in these patients.

Background: CA125 (Cancer Antigen 125) is a tumor marker associated with ovarian cancer. It is gradually becoming apparent that it is also elevated in various conditions associated with inflammation or fluid overload. Similar to heart failure patients (Núñez et al., 2016),1 in chronic kidney disease patients on hemodialysis, who experience both fluid overload and inflammation, CA125 may potentially serve as a prognostic marker. Experimental evidence demonstrates that mechanical stretch directly upregulates expression of “MUC16” , the gene for CA125, secreted from mesothelial cells (Huang et al., 2013),2 providing a mechanistic basis for CA125 elevation in volume overload states. Objective: To investigate the correlation between CA125 levels and routine biochemical parameters (albumin and sodium) in maintenance hemodialysis patients, explore its potential as an early warning biomarker for patients at risk of developing hypoalbuminemia, and to explore gender-based differences in these relationships. Methods: This cross-sectional study analyzed 122 maintenance hemodialysis patients at a tertiary care government hospital in Eastern India. Complete data for CA125, albumin, and sodium was available for 87 patients. Serum albumin and sodium were measured using Beckman Coulter AU480, while CA125 was measured by chemiluminescent immunoassay. Statistical analysis included correlation analysis and ANOVA using R software version 3.6.1. To assess the diagnostic value of CA125 in identifying hypoalbuminemia, an analysis using receiver operating characteristic (ROC) curves was conducted (4.0 g/dL based on KDOQI). Multiple regression examined factors independently associated with log(CA125).A Results: The study population had a mean age of 47.9 ± 12.8 years with balanced sex distribution (M:F ratio 1.1:1). CA125 showed a log-normal distribution (p<10⁻¹⁶) with median 12.45 U/ml. Albumin demonstrated significant negative correlation with log CA125 (r=-0.47, p=0.000006). Among patients with elevated CA125 (>35 U/ml), 22.2% (4/18) had hypoalbuminemia (<3.5 g/dl) compared to only 1.4% (1/69) in those with normal CA125 (p<0.05). The albumin-sodium correlation was positive overall (r=0.20, p<0.00001) but showed progressive strengthening across CA125 tertiles, with only the high CA125 group showing significant correlation. Patients with hypoalbuminemia or hyponatremia had 5-fold higher mean CA125 (129.8 vs 26.1 U/ml). Gender analysis revealed stronger albumin-sodium correlation in females (r=0.35) compared to males (r=0.12). ROC analysis revealed that CA125 had excellent diagnostic accuracy for predicting hypoalbuminemia (<4.0 g/dL), with an AUC of 0.861 (95% CI: 0.791-0.932, p<0.001). The optimal cutoff value of 12.25 U/ml yielded a sensitivity of 77.1% and specificity of 80.7%. In multiple analysis, albumin remained significantly associated with log(CA125) after adjusting for confounders. Conclusion: High CA125 levels in hemodialysis patients correlate with dysregulation of albumin and sodium homeostasis, suggesting its potential as an early warning biomarker rather than a diagnostic replacement for albumin. CA125 reflects underlying pathophysiological processes (mesothelial stress, inflammation, volume overload) that precede overt hypoalbuminemia, making it valuable for risk stratification and targeted intervention. The stronger correlations observed in females warrant further investigation into gender-specific applications of CA125 monitoring in dialysis patients.

Background: Optimal blood pressure (BP) targets in hypertensive patients remain a matter of debate. This study compares the effectiveness of intensive BP control (target systolic BP <120 mmHg) versus standard BP control (target systolic BP <140 mmHg) in reducing cardiovascular events. Methods: A prospective, multicenter, randomized controlled trial enrolled 2,500 adults with hypertension aged 50 years or older and at increased cardiovascular risk. Participants were randomized to intensive or standard BP treatment arms and followed for a median of 4.5 years. The primary composite endpoint was myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death. Results: The intensive treatment group had a significantly lower incidence of primary cardiovascular events (4.8%) compared to the standard group (6.9%) (HR 0.68; 95% CI, 0.54–0.85; p<0.001). However, serious adverse events such as hypotension and acute kidney injury were more frequent in the intensive group. Conclusion: Intensive BP control provides a greater reduction in cardiovascular events in high-risk hypertensive patients, but with a higher risk of adverse effects. Individualized treatment decisions are warranted.

Background: Stress hyperglycemia is common in patients presenting with ST-elevation myocardial infarction (STEMI). However, single admission glucose fails to differentiate acute stress hyperglycemia from chronic poor glycemic control. The glycemic gap, defined as the difference between admission plasma glucose and estimated average glucose derived from HbA1c, has emerged as a potentially superior prognostic marker. Aim of the study: The aim of this study was to evaluate the association between glycemic gap and the development of in-hospital heart failure and mortality among patients presenting with their first episode of acute STEMI. Methods: This cross-sectional comparative type of observational study was conducted in Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh, during the period from October, 2019 to March, 2021. This study included 287 patients admitted with first STEMI. Patients were divided into two groups: Group-I included patients with glycemic gap level >40 mg/dl and Group-II included patients with glycemic gap level ≤40 mg/dl. Result: Patients with glycemic gap >40 mg/dl had significantly higher mean admission blood glucose and glycemic gap values. Heart failure incidence was significantly higher in the high glycemic gap group (60.2% vs. 28.3%, p<0.001), as was cardiogenic shock (35.16% vs. 17.75%, p<0.001) and in-hospital mortality (13.28% vs. 5.66%, p=0.025). Pearson correlation showed a positive relationship between glycemic gap and both heart failure and mortality. Conclusion: This study demonstrates that an elevated glycemic gap is significantly associated with higher rates of in-hospital heart failure, cardiogenic shock, and mortality among first ST-elevation myocardial infarction (STEMI) patients.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice, affecting millions worldwide. Its prevalence increases with age and is frequently associated with comorbid conditions such as hypertension, heart failure, diabetes mellitus, and vascular disease. One of the most serious complications of AF is the increased risk of thromboembolic events, particularly ischemic stroke, which can lead to significant disability or death. Patients with AF are estimated to have a fivefold increased risk of stroke compared to those without the arrhythmia. Method This prospective observational cohort study was conducted at the District Teaching Hospital, Koppal, over a period of 18 months from July 1st, 2023, to December 31st, 2024, with a total sample size of 50 patients. Adult patients aged over 18 years, diagnosed with atrial fibrillation (AF), who were admitted to KIMS, Koppal and provided informed consent, were included in the study. The inclusion criteria comprised patients with AF undergoing cardioversion, with available data on recurrence of AF and CHA₂DS₂-VASc score, while those with atrial arrhythmias other than AF or with hemodynamically unstable conditions were excluded. Results: The study revealed that 56.0% of AF patients were aged 65–74.9 years, with a slight female predominance (56.0%) and prevalent comorbidities including heart failure (60.0%), hypertension (56.0%), and chronic obstructive pulmonary disease (COPD) (36.0%). The CHA₂DS₂-VASc score stratified 82.0% of patients as high risk, 14.0% as moderate risk, and 4.0% as low risk, with a sensitivity of 87.21% (95% CI: 76.23%–88.42%), specificity of 83.32% (95% CI: 74.23%–89.21%), PPV of 87.50% (95% CI: 73.23%–92.03%), NPV of 63.20% (95% CI: 54.12%–80.21%), and diagnostic accuracy of 85.71% (95% CI: 76.32%–94.29%). ROC curve analyses demonstrated good discriminatory power, with AUCs of 0.823 (95% CI: 0.521–0.974; p = 0.002) for mortality, 0.718 (95% CI: 0.613–0.783; p < 0.001) for systemic embolism in females, and 0.737 (95% CI: 0.621–0.797; p < 0.001) in males, with optimal cut-off scores of 4 and 5. Conclusion: This clinical study demonstrates that the CHA₂DS₂-VASc score is a highly effective tool for risk stratification in patients with atrial fibrillation (AF) attending a tertiary care hospital, showing high sensitivity (87.21%) , specificity (83.32%) , and overall diagnostic accuracy of 85.71% in predicting stroke, thromboembolism, and mortality.

Background: Heart failure is often complicated by renal dysfunction and lipid abnormalities, conditions that frequently share underlying risk factors such as hypertension, diabetes, and obesity. Heart failure and renal dysfunction are closely interlinked due to their common underlying risk factors like hypertension, diabetes mellitus and age. Dyslipidemia characterized by abnormal levels of cholesterol and triglycerides are prevalent in patients with heart failure due to shared risk factors like obesity, diabetes mellitus, and metabolic syndrome. Objective:  This study aimed to assess the relationship between serum lipid profiles and renal dysfunction in individuals newly diagnosed with heart failure at a tertiary care hospital in Gujarat. Methods:  A total of 168 patients diagnosed with heart failure were enrolled in a cross-sectional study conducted at GMERS Medical College and Hospital, Gotri, Vadodara. Renal function was evaluated using the Cockcroft-Gault equation, while lipid abnormalities were identified based on established clinical criteria. Data analysis was performed using SPSS software, with a p-value of less than 0.05 considered statistically significant. Results:  Among the participants, 47.02% were found to have renal dysfunction, and 51.79% had dyslipidemia. Notably, 72.15% of those with renal impairment also exhibited lipid abnormalities. A statistically significant association was observed between renal dysfunction and dyslipidemia (χ² = 24.77; p < 0.00001). Common comorbid conditions included hypertension and diabetes, and most patients were classified as overweight or obese. Conclusion:  The study findings suggest a strong association between renal dysfunction and dyslipidemia in heart failure patients. Monitoring lipid profiles may play a critical role in identifying patients at greater risk for renal complications, potentially guiding more targeted interventions.

Introduction: Right ventricular dysfunction (RVD) is increasingly recognized in heart failure with preserved ejection fraction (HFpEF) and may impact prognosis. This study was aimed to assess the prevalence of RVD in HFpEF patients and its association with clinical outcomes. Methods: The current prospective observational study was done on of 100 HFpEF patients. Clinical, biochemical, and echocardiographic parameters, including TAPSE, FAC, and PASP, were evaluated. Patients were categorized into RVD and non-RVD groups and compared for clinical features, hospital stay, and one-month mortality. Results: RVD was present in 41% of patients. Age, gender, BMI, and comorbidities were similar between patients with and without RVD. RVD patients had lower EF, TAPSE, and FAC, and higher PASP. RVD was associated with longer hospital stay (7.3 vs. 5.4 days) and more mortality (8 of 13 deaths). Conclusion: RVD is common in HFpEF and is linked to worse short-term outcomes. Routine assessment of RV function may aid in risk stratification and management of HFpEF.

Background: Chronic obstructive pulmonary disease (COPD) is a prevalent and progressive respiratory disorder often complicated by coexisting cardiovascular conditions such as left ventricular failure (LVF). The clinical overlap in symptoms between acute exacerbation of COPD (AECOPD) and heart failure poses diagnostic challenges. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) has emerged as a potential biomarker for distinguishing cardiac involvement in such patients. Objectives: To assess serum NT-pro-BNP levels in elderly patients with AECOPD and compare levels between those with and without concurrent LVF, and to explore the relationship of NT-pro-BNP with COPD severity. Materials and Methods: A prospective observational study was conducted over one year in the internal medicine department of SMS Hospital, Jaipur. Eighty patients aged ≥60 years were enrolled and divided into two groups: AECOPD with LVF (cases, n=40) and AECOPD without LVF (controls, n=40). All patients underwent spirometry, NT-pro-BNP testing, and echocardiography. Clinical, biochemical, and pulmonary function data were analyzed using appropriate statistical tools, with significance set at p<0.05. Results: The mean age of cases and controls was comparable (66.1 ± 3.45 vs. 66.2 ± 4.6 years; p=0.9882). NT-pro-BNP levels were significantly higher in cases (13,373.8 ± 8,319.7 pg/mL) compared to controls (1,135.15 ± 986.4 pg/mL; p<0.0001). Severe pulmonary restriction was more prevalent in cases (57.5%) than in controls (37.5%) though not statistically significant (p=0.1458). Most patients with elevated NT-pro-BNP were in GOLD stage 2 (87.88%) or stage 3 (12.12%) of COPD. Conclusion: Serum NT-pro-BNP levels are significantly elevated in elderly AECOPD patients with LVF, supporting its role as a useful biomarker for identifying cardiac dysfunction in this population. NT-pro-BNP may aid in disease severity assessment and guide early intervention strategies in clinical practice.

The common haematological condition known as iron deficiency anaemia IDA is characterised by low iron stores that prevent the generation of enough red blood cells, which lowers haemoglobin levels and impairs oxygen transport. The aim of this study is to address the gap in existing research by investigating the clinical, ECG, and echocardiographic parameters in patients with iron deficiency anemia. Investigation such as Hemogram, peripheral smear, red cell indices, Serum ferritin, Electrocardiogram and Echocardiography was done. Patients with iron deficiency anemia underwent 2D ECHO evaluation, determining parameters like LV mass, relative wall thickness, concentration and eccentric hypertrophy, HFrEF and HFpEF. Iron deficiency anemia IDA is more prevalent in females and has a greater influence on left ventricular mass. Severe IDA leads to increased left ventricular mass with eccentric hypertrophy more common. Echocardiography shows hemodynamic changes associated with IDA which improves oxygen delivery. Severe IDA causes high heart rate and stroke volume leading to increased cardiac output. Anemia and systolic blood pressure are the most modifiable risk factors for LV hypertrophy.

Background: Acute coronary syndromes (ACS) are an emerging epidemic in India, driven by the rising prevalence of risk factors such as obesity, diabetes, hypertension, and dyslipidemia. Elevated red cell distribution width (RDW) has been identified as a strong predictor of mortality and major adverse cardiac events (MACE) in patients with acute myocardial infarction. Objectives: To determine RDW levels in patients with ACS and evaluate their association with mortality and major adverse cardiac events. Methods: This prospective study included 100 patients with ACS admitted to the Department of General Medicine, MIMS, Mandya. Baseline evaluation included a detailed history, risk factor assessment, clinical examination, and laboratory investigations—RDW, complete hemogram with peripheral smear, creatine phosphokinase-MB, troponin I, fasting lipid profile, liver and renal function tests, random blood sugar, and thyroid function tests—along with electrocardiography and echocardiography. Patients were followed for three months, during which repeat hospitalizations, mortality, and post-ACS cardiac status were recorded. Survivors underwent repeat electrocardiography and echocardiography. Results: Chest pain was the most common presenting symptom. The major risk factors identified were diabetes, hypertension, dyslipidemia, smoking, and alcohol use. Of the 100 patients, 31 had STEMI, 55 had NSTEMI, and 14 had unstable angina. Among 36 patients with arrhythmia, 32 had elevated RDW. All 36 patients who experienced repeat angina had elevated RDW. Of 38 patients with heart failure, 37 had high RDW. All three patients who died during follow-up had elevated RDW. Conclusion: RDW is a simple, cost-effective, and readily available parameter that can serve as a valuable adjunct in diagnosing ACS and predicting prognosis. Elevated RDW levels are strongly associated with adverse outcomes, including arrhythmia, recurrent angina, heart failure, and mortality, and may help guide timely medical or surgical interventions.

Background: Hypertension is a major public health problem, and uncontrolled blood pressure is strongly linked to end-organ damage, including coronary artery disease (CAD), congestive heart failure (CHF), left ventricular hypertrophy (LVH), stroke, and peripheral vascular disease. Microalbuminuria is common in established hypertension and serves as an early predictor of cardiovascular dysfunction. Screening for urinary albumin excretion enables early identification of high-risk individuals, facilitating timely interventions to reduce cardiovascular risk. Objectives: To determine the prevalence of microalbuminuria in non-diabetic essential hypertensive patients, evaluate its association with left ventricular mass index (LVMI), and assess correlations with duration of hypertension. Methods: This cross-sectional descriptive study included 100 patients attending the OPD and IPD of the Department of General Medicine, MIMS, Mandya, who met the inclusion and exclusion criteria. Baseline investigations, including urine microalbumin estimation and echocardiography, were performed. Statistical analyses were conducted to assess associations and correlations. Results: Microalbuminuria was present in 32% of participants, with a 90.6% prevalence among those with LVH. Duration of hypertension was significantly associated with microalbuminuria (p < 0.001). LV mass showed a strong positive correlation with microalbuminuria (r = 0.639, p = 0.017). Urinary creatinine levels were significantly higher in patients with microalbuminuria (p = 0.001). The albumin-to-creatinine ratio (ACR) demonstrated a strong positive correlation with microalbuminuria (r = 0.718, p < 0.001). Conclusion: Microalbuminuria shows a strong association with LVH, duration of hypertension, urinary creatinine, and ACR, indicating its potential as an early marker for predicting cardiovascular risk and related complications in essential hypertension.

Pulmonary arterial hypertension (PAH) is a progressive condition characterized by elevated pulmonary artery pressure, which can lead to right heart failure if left untreated. Emerging evidence suggests a potential link between PAH and hematological deficiencies, particularly iron deficiency anaemia (IDA) and vitamin B12 deficiency anaemia. This study aims to evaluate the prevalence of PAH among patients diagnosed with IDA and vitamin B12 deficiency anaemia. Through a systematic analysis of clinical data, we assess the impact of these deficiencies on pulmonary vascular physiology. The findings may provide insights into potential pathophysiological mechanisms and suggest considerations for early intervention. Our study evaluated 850 patients diagnosed with IDA and vitamin B12 deficiency. A total of 500 patients had IDA, and 350 had vitamin B12 deficiency. The prevalence of PAH was found to be significantly higher in the anaemic cohort than in the general population. PAH was diagnosed in 17% of IDA patients and 12% of vitamin B12 deficient patients. The study also identified significant gender-based differences, with females exhibiting a higher prevalence of PAH. Additionally, statistical correlations between haemoglobin levels, ferritin, and pulmonary arterial pressures further support a mechanistic relationship between anaemia and PAH.

Background: Regular exercise elicits profound cardiovascular adaptations, spanning molecular signaling, structural remodeling, and functional enhancements, which collectively improve aerobic capacity, vascular health, and resilience against cardiovascular diseases. These adaptations vary significantly by training modality—endurance (e.g., running, cycling), resistance (e.g., weightlifting), high-intensity interval training (HIIT), or combined approaches—due to distinct hemodynamic and metabolic demands. Despite growing research, a comprehensive synthesis comparing these modalities in humans, particularly integrating molecular mechanisms with structural and functional outcomes, is limited. This systematic review aims to elucidate modality-specific effects to guide evidence-based exercise prescriptions for healthy and clinical populations, such as those with heart failure or hypertension. Methods: We conducted a systematic review following PRISMA 2020 guidelines, searching PubMed, Scopus, Web of Science, and Google Scholar from inception to August 2025. Inclusion criteria encompassed peer-reviewed randomized controlled trials (RCTs) or meta-analyses in English, involving human adults (>18 years), with exercise interventions lasting ≥4 weeks, comparing at least two training modalities (endurance, resistance, HIIT, or combined), and reporting molecular (e.g., gene expression), structural (e.g., hypertrophy), or functional (e.g., VO2max) cardiovascular outcomes. Exclusion criteria included animal studies, acute exercise protocols, non-cardiovascular outcomes, and non-comparative studies. Meta-analysis was planned using random-effects models if data homogeneity permitted. Results: From 1,256 unique records, 842 were screened by title and abstract, 156 full-texts assessed, and 28 human studies included (22 RCTs, 6 meta-analyses; ~4,500 participants). Endurance training induced eccentric left ventricular hypertrophy (LV mass increase of 15–25%), upregulated PGC-1α (30–50%), and improved flow-mediated dilation (FMD; 20–30%). Resistance training promoted concentric hypertrophy (wall thickness ↑10–20%), activated PI3K/Akt (15–25%), and reduced blood pressure (3–5 mmHg). HIIT enhanced VO2max (20–30%) and AMPK activation (SMD 1.5–2.0). Combined training reduced vascular stiffness (pulse wave velocity ↓1–2 m/s) and amplified eNOS expression (SMD 1.3–1.9). Molecularly, endurance and HIIT increased miR-222 (25–40%), while resistance reduced C/EBPβ. Structurally, endurance and HIIT increased capillary density (10–15%). Functionally, cardiac output rose 4–8-fold, with resting bradycardia (↓30–40 bpm) and stroke volume ↑10–20%. HIIT outperformed endurance in heart failure (ejection fraction ↑5–10%). Males showed greater hypertrophy; females had better vascular responses.

Introduction: Diastolic dysfunction (DD) is a prevalent cause of heart failure with preserved ejection fraction, and conventional echocardiographic parameters have recognized limitations in early detection. Left atrial strain (LASr) measured by two-dimensional speckle-tracking echocardiography is emerging as a sensitive marker of impaired diastolic function. Aim: To evaluate left atrial strain as a predictor of diastolic dysfunction in patients undergoing echocardiographic assessment. Methods: In this cross-sectional study, 120 adult patients with preserved left ventricular ejection fraction (≥50%) and sinus rhythm underwent transthoracic echocardiography. Conventional diastolic parameters were assessed as per ASE/EACVI 2016 guidelines. LASr, conduit strain (LAScd), and contraction strain (LASct) were measured using apical four-chamber speckle-tracking analysis. Diastolic dysfunction was graded from 0 (normal) to III (severe). Statistical analyses included t-tests, chi-square tests, correlation analysis, and ROC curve evaluation. Results: Diastolic dysfunction was present in 43.3% of patients (n=52). Mean LASr was significantly lower in the DD group compared to those without DD (21.6 ± 5.4% vs 37.8 ± 6.2%; p<0.001). LASr <24% predicted DD with an odds ratio of 23.65 (95% CI: 8.76–63.89, p<0.001). LASr showed a strong negative correlation with DD severity (Spearman’s ρ=−0.82, p<0.001), decreasing progressively from normal to Grade III dysfunction. Conventional indices (E/A ratio, e′ velocities, E/e′, TR velocity, LAVI) also differed significantly between groups, while LVEF remained preserved. Conclusion: Left atrial reservoir strain is a strong, independent echocardiographic predictor of diastolic dysfunction and its severity in patients with preserved ejection fraction, offering added diagnostic value alongside conventional parameters. Incorporating LASr into routine echocardiographic evaluation may improve early detection and grading of diastolic dysfunction.

Background: Type II diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD), with dyslipidemia and subclinical myocardial dysfunction contributing significantly to morbidity and mortality. Early detection of structural and functional cardiac changes in asymptomatic patients is crucial for timely intervention. The study aimed to evaluate the prevalence of dyslipidemia and echocardiographic abnormalities in patients with T2DM and to analyze their correlation with glycemic indices and metabolic risk factors. Methods: A cross-sectional study was conducted on 136 T2DM patients at Sri Aurobindo Medical College, Indore. Demographic, anthropometric, biochemical, and lipid parameters were recorded. All participants underwent 2D echocardiography, including LVEF, LVMI, E/A ratio, and GLS assessment. Correlations between metabolic markers and echocardiographic parameters were analyzed using Pearson’s correlation coefficient. Results: The mean age of participants was 52.18 ± 9.62 years; males constituted 55.9%. Overweight (51.5%) and obesity (32.4%) were highly prevalent. Dyslipidemia was common, with elevated TC, LDL-C, and TG and reduced HDL-C (P < 0.0002). Echocardiography showed preserved mean LVEF (56.2 ± 4.8%), increased LVMI (178.4 ± 21.3 g/m²), reduced E/A ratio (0.85 ± 0.19), and impaired GLS (–18.5 ± 2.1), indicating early structural and functional changes. HbA1c correlated strongly with E/A ratio (r = –0.792) and GLS (r = –0.681), while TC correlated moderately with LVMI (r = 0.541). BMI showed only weak associations with cardiac indices. Conclusion: Subclinical echocardiographic abnormalities and dyslipidemia are common in asymptomatic T2DM patients. Poor glycemic control and dyslipidemia are the strongest predictors of diastolic dysfunction and ventricular remodeling. Incorporating advanced echocardiographic techniques, alongside aggressive management of glycemia and lipid levels, may aid in early identification and prevention of diabetic cardiomyopathy and progression to overt heart failure

Introduction: Inherited cardiomyopathies are a diverse group of myocardial disorders that primarily affect the structure and function of the heart muscle. These include hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), and restrictive cardiomyopathy (RCM), which often result from mutations in genes encoding sarcomeric, cytoskeletal, desmosomal, or mitochondrial proteins.  Aims: The primary aim of this review is to explore the current role and clinical relevance of genetic testing in inherited cardiomyopathies. It seeks to assess how genetic insights contribute to diagnosis, influence clinical management, and improve familial risk assessment, while also addressing the limitations and ethical concerns surrounding genetic testing in this context. Objectives: This review aims to evaluate the current role and clinical relevance of genetic testing in inherited cardiomyopathies. It highlights the diagnostic benefits, implications for patient care, family cascade screening, reproductive counseling, and the integration of genetic information into personalized medicine approaches. Methods: An extensive literature review was conducted using PubMed, Scopus, and relevant clinical guidelines from the American Heart Association (AHA), European Society of Cardiology (ESC), and Heart Rhythm Society (HRS). Emphasis was placed on studies addressing the diagnostic yield, clinical impact, and ethical considerations of genetic testing in cardiomyopathy patients. Results: In this study of 100 patients with inherited cardiomyopathies, the average age was 42.6 years, with a slight male predominance. A positive family history was present in 37% of patients, strongly associated with mutation detection (p = 0.001). Hypertrophic cardiomyopathy (HCM) was the most common subtype (40%), and had the highest mutation rate (70%, p = 0.002), mainly involving MYH7 and MYBPC3 genes. At 12-month follow-up, ICD implantation was significantly higher in mutation-positive patients (p = 0.045), while sudden cardiac death and heart failure hospitalizations were not significantly different. Conclusion: Genetic testing plays a pivotal role in the modern evaluation and management of inherited cardiomyopathies. It enables precision diagnostics, improves family risk assessment, and facilitates early interventions. To maximize its clinical utility, integration of genetic testing into cardiology practice requires a multidisciplinary approach involving genetic counselors, cardiologists, and molecular pathologists. Future research into genotype-phenotype correlations and long-term outcome studies is essential to further personalize care and expand our understanding of these complex disorders.

Objective: This study aimed to evaluate left ventricular (LV) systolic function in heart failure patients by assessing the correlation between Mitral Annular Plane Systolic Excursion normalized to LV length (MAPSE/L) and Global Longitudinal Strain (GLS). The hypothesis proposed that MAPSE/L could serve as a practical and reliable echocardiographic parameter for LV function assessment. Methods: A prospective observational study was conducted on 42 adult patients with LV dysfunction admitted to the Cardiac ICU, Emergency Room, or Cardiac OPD. Echocardiographic measurements included MAPSE, LV diastolic length, ejection fraction (EF), and GLS. MAPSE/L was calculated by dividing MAPSE by LV length. Pearson correlation analysis was performed using SPSS 26.0 to examine the relationship between MAPSE/L and GLS. Results: The study population comprised predominantly males (83.3%), with a majority aged 51–60 years (42.9%). LV dysfunction severity was distributed as mild (40.5%), moderate (38.1%), and severe (21.4%). MAPSE/L demonstrated a strong correlation with GLS (correlation coefficient: 0.778, p < 0.001). Similarly, MAPSE alone showed a strong correlation with GLS (correlation coefficient: 0.80, p < 0.001). The average MAPSE/L value was 0.13 ± 0.03, with variations observed across different MAPSE ranges. EF also correlated well with GLS (correlation coefficient: 0.70, p < 0.001). Conclusion: The findings indicate a robust correlation between MAPSE/L and GLS, suggesting that MAPSE/L is a viable and straightforward parameter for assessing LV longitudinal systolic function in heart failure patients. Despite advancements in echocardiographic technologies, MAPSE/L remains a valuable tool for routine clinical evaluation due to its simplicity and reliability