Open Access Case Study

Tricuspid Valve Replacement in an Adult with Destroyed Tricuspid Valve and Refractory Right Heart Failure

Udaya Prashant Ponangi, Hemanth Kumar Kaulkantla, Koneti Nageshwar Rao, P. Kirshnam Raju, B. Soma Raju

Cardiology and Angiology: An International Journal, Page 134-139
DOI: 10.9734/CA/2014/9701

22 year old woman with no previous heart disease history, presented with progressive worsening of right heart failure symptoms due to severe tricuspid valve regurgitation which had become refractory to medical management. Echocardiogram revealed probable rare case of dysplastic tricuspid valve with large calcified mobile masses attached to leaflets. Calcified masses were thought to be due to healed vegetations from silent infective endocarditis of abnormal tricuspid valve which she had suffered in the past. There were no known acquired causes of tricuspid valve endocarditis. She had successfully undergone tricuspid valve replacement with bio-prosthetic valve along with a right atrial reduction surgery after which her heart failure symptoms improved markedly.


Open Access Minireview Article

Aortic Pathologies and Pregnancy: A Special Focus on Connective Tissue Disorders

Petrit Bara, Lidra Gjyli, Marsela Gega, Xhina Belshi, Gentian Vyshka

Cardiology and Angiology: An International Journal, Page 147-153
DOI: 10.9734/CA/2014/10425

Pregnancy represents a physiological status which, due to clear and typical hormonal and hemodynamic changes, is frequently accompanied by a high morbidity of aortic structures, in all of its segments. Such morbidity might become patent when a pre-gestational situation exists, especially with the mother suffering from connective tissue disorders. Nevertheless, morbid occurrences that will be met only during pregnancy are well known, with particular pathophysiological and etiological theories, as well as a diversity of treatments proposed in such an unusual setting. The authors discuss the main pathologies of aorta that are seen during pregnancy, from a theoretical point of view, and from a historical perspective as well. A special focus is made to the connective tissue disorders, and the theoretical considerations are illustrated with images of dissecting aneurysms of aorta.


Open Access Original Research Article

Prevalence and Effects of Various Risk Factors Influencing the Blood Pressure Values

Jaspinder Kaur, Sargun Singh, Kawaljit Kaur

Cardiology and Angiology: An International Journal, Page 118-133
DOI: 10.9734/CA/2014/9863

Aim: Hypertension is major cardiovascular risk factor contributing to all cause mortality. The present study was aimed to determine the impact of socio-demographic variables and risk factors on the blood pressures (BP) of the subjects.

Place and Duration of the Study: A cross sectional study was conducted at Ex-Servicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, India from June to Oct, 2013.

Methodology: All retired defense personnel and their family members (N= 351) who attended polyclinic during study period were recruited to assess physical activity, body mass index, dietary habits, alcohol, family history, sleep, stress, over the counter (OTC) medications, employment status, and education as determinants of BP. The results were analyzed by Chi Square test with statistically significance of P value <0.05.

Results: The frequency of high BP as per JNC VII guidelines was observed as 47.90% with higher range in females (51.19%) than males (48.80%). The frequency significantly increased with age >50years (88.08%; P<0.001), unemployment status (76.19%; P<0.05) and low education levels (37.50%; P<0.05). An association of high BP with inadequate sleep (35.11%; P<0.05), sedentary lifestyle (63.69%), alcohol (26.78%), positive family history (36.30%), stress (20.83%), non-vegetarian dietary habits (44.64%), increased BMI (67.26%; P<0.05) and OTC medications misuse (15.47%) was found. Half of the subjects were diagnosed with high BP for more than five years (49.40%), two-third had controlled (67.26%) and compliant (69.64%) status, and more than two-third had awareness about their diagnosis of high BP (83.60%). The uncontrolled status, non-compliance towards treatment, and low awareness level regarding high blood pressure values was found among 32.73%, 30.35% and 08.19% of subjects, respectively.

Conclusion: This rising frequency of high BP and its associated factors must be monitored, treated and controlled by appropriate preventive and therapeutic approaches including lifestyle modifications, Dietary Approach to Stop Hypertension, weight loss and maintenance, physical activity, stress management and pharmacotherapy.


Open Access Original Research Article

β-blockers in Post ST Elevation Myocardial Infarction Patient with Low Left Ventricular Systolic Function: A Retrospective Study at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Chandra Mani Adhikari, Sujeeb Rajbhandari, Dipanker Prajapati, Nagma Shrestha, Bibek Baniya, Amrit Bogati, Prakash Gurung, Suman Thapaliya

Cardiology and Angiology: An International Journal, Page 140-146
DOI: 10.9734/CA/2014/9571

Aims: Despite well developed guidelines in the management of ST elevation myocardial infarction with low left ventricular ejection fraction, β-blockers remain an underutilized therapy. We aim to assess the adherence of β-blocker use during the discharge in Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

Study Design:  Retrospective, Observational study.

Place and Duration of Study: Department of cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Between January 2012 to December 2012.

Methodology: Medical records of 160ST elevation myocardial infarction patients with left ventricular ejection fraction ≤40% and discharged from our centre were retrospectively reviewed regarding the use of β-blocker.

Results:  Among the 160 patients, 112 (70%) were males and 48 (30%) were females, mean age was 59.1±13.4 years. Anterior wall myocardial infarction followed by extensive anterior wall was the common in patient with low left ventricular ejection fraction after ST elevation myocardial infarction. Only in 67.5% patients β-blockers were prescribed. Metoprolol tartrate was the most commonly used β-blocker.

Conclusion: β-blocker use in patients ST elevation myocardial infarction patients with low left ventricular ejection fraction in our study is comparable to international studies. We still need some more effort to improve our prescription rate.


Open Access Original Research Article

Early Detection of Atherosclerosis in Primary School Children

Viljemka Nedog, Eva Lobnik, Anja Lobnik, Sebastjan Bevc

Cardiology and Angiology: An International Journal, Page 154-162
DOI: 10.9734/CA/2014/9958

Purpose: The aim of this study was to determine the correlations of age, sex, anthropometric measurements, pulse rate, blood pressure, and family history of cardiovascular disease with early atherosclerosis in children.

Methods: Between December 2011 and January 2012 we included 112 children of primary school »Osnovna šola Bojana Ilicha Maribor«, whose parents consented and signed the inform consensus. We made a questionnaire about cardiovascular diseases in child's family. We measured blood pressure, pulse rate, body height, weight, waist circumference. We performed ultrasound measurement of carotid artery intima-media thickness (IMT). The data were processed using the SPSS statistical program.

Results: Body mass index (BMI) (r=0.246; p<0.009), waist circumference (r=0.198; p<0.036) systolic (r=0.282; p<0.003) and diastolic blood pressure (r=0.282; p<0.003) were positively correlated with carotid artery IMT. In addition, those with family history of cardiovascular diseases had higher carotid artery IMT (p<0.0001) at baseline. A multivariable logistic regression analysis revealed that family history of cardiovascular disease was associated with carotid artery IMT (p<0.0001).

Conclusion: Higher levels of BMI, waist circumference, and arterial blood pressure were correlated with higher carotid artery IMT in children. In addition, the presence of family history of cardiovascular disease was independently associated with carotid artery IMT in children.