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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 3 | Issue 2
Page Nos. 49-88

Online since Friday, January 21, 2022

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EDITORIAL  

Drug treatment of cardiac failure p. 49
Govindan Vijayaraghavan
DOI:10.4103/ACCJ.ACCJ_23_21  
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OPINION Top

Ischemic preconditioning for the treatment of COVID-19: Not only protection from cardiac ischemia p. 51
Elpidio Santillo
DOI:10.4103/ACCJ.ACCJ_34_20  
Ischemic preconditioning (IPC) is an innate mechanism of tissue protection from ischemia, which is easily replicable in clinical settings in the form of remote IPC. The final protective effect of IPC comprises the induction of favorable anti-inflammatory and anti-thrombotic molecular pathways. Recent studies on humans have confirmed that IPC protocols may exert cardioprotective actions. Moreover, IPC was also found to be capable of reducing surgical lung injury through the contrast of inflammatory response. Hence, IPC seems an ideal candidate to be tested as an innovative therapeutic weapon against a disease as coronavirus disease 19 (COVID-19), in which inflammation plays a key role. Interestingly, the use of IPC protocols for COVID-19 patients, beyond the potentiality of reducing the cardiologic complications, could also prove useful for the attenuation of inflammatory phenomena that characterize the course of coronavirus disease.
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REVIEW ARTICLE Top

Aortic stenosis: From diagnosis to treatment: A review (2021 update) Highly accessed article p. 54
Joud Al Balool, Rajesh Rajan, Mohammed Al Jarallah, Raja Dashti, Khalid Al Mulla, Retaj Al Haroun, Zhanna Davidovna Kobalava
DOI:10.4103/ACCJ.ACCJ_19_21  
As the aging population increases, a concurrent rise in the incidence of aortic stenosis (AS) is projected. Early recognition and diagnosis of AS are cardinal in preventing the progression of the disease into its more fatal effects. Precision in diagnosis and risk stratification is paramount, as therapy can be opted accordingly. Current therapeutic advances aim to target an elderly population with minimally invasive procedures such as transcatheter aortic valve replacement (TAVR), transforming conventional management in a more at-risk population. Despite dismal outcomes without treatment, therapy in the form of surgical aortic valve replacement or TAVR is proven to improve survival in cases of AS, with such therapeutic benefit being observable at the extreme end of the spectrum with inoperable cases. In this review, we will address the latest recommendations and guidelines on AS, with emphasis on diagnosis and treatment.
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ORIGINAL ARTICLES Top

Trends in cardiac care utilization under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, India p. 63
Parul Naib, Pulkit Kumar, Sudha Chandrashekar, Owen Smith, Sheena Chhabra
DOI:10.4103/ACCJ.ACCJ_2_21  
Background: Ayushman Bharat, the flagship scheme of the Government of India, was launched in September 2018 to achieve the vision of universal health coverage in India. Objectives: One of the important components of Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna (PM-JAY) that provides a benefit cover of INR 5 lakhs per family per year for secondary and tertiary care hospitalization. Methods: The present study explores key trends in the utilization of cardiac care packages under the Ayushman Bharat AB PM-JAY. This would have an implication in making cardiac care more accessible by bridging the existing gaps in cardiac care delivery under PM-JAY. All cardiac claims under PM-JAY were analyzed for a period of 17 months (from the inception of the scheme in September 2018 to February 2020). Results: The analysis shows that claims from cardiac (cardiology as well as cardiothoracic and vascular surgery) specialty accounted for 5% of the total PM-JAY claim volume, however, it shares in the total claim volume. It was significantly higher at 26% indicating that a very high proportion of the scheme was utilized to provide free cardiac care to beneficiaries coming from the poorest segment of the population. Conclusion: The analysis also indicates significant variation in the supply of the cardiac facilities and the need to further develop health infrastructure for cardiac care, particularly in certain states where the supply is found to be inadequate.
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Prediction of cardiovascular risk among healthcare professionals using atherosclerotic cardiovascular disease risk score in a tertiary care hospital in Aurangabad, India p. 69
Manjiri R Naik, Rohit Manoj Jacob, Sanjana P Reddy
DOI:10.4103/ACCJ.ACCJ_18_21  
Background: The current scenario of long working hours, sedentary lifestyle, and occupational stress has led to an increased prevalence of noncommunicable risk factors among the medical fraternity. Hence, determining the risk of developing atherosclerotic cardiovascular disease (ASCVD) has become highly essential to curb the predisposing factors leading to it. Objectives: The objectives of the study are to cluster the cardiovascular risk factors among healthcare professionals and to estimate the ASCVD Risk Score among healthcare professionals of a teaching hospital in Aurangabad. Methods: A population of 200 subjects were considered for the study. Cardiovascular risk factors such as age, race, gender, diabetes mellitus, antihypertensive medications, dyslipidemia, alcohol consumption, smoking, family history of hypertension, physical activity, waist circumference (central obesity), obesity, and stress/mental status were studied. Assessing each of its prevalence to predict the risk of cardiovascular disease using ASCVD Risk Score formed the crux of the study. Results: On assessing the risk factors in all subjects, it was found that type 2 diabetes mellitus (34.6%), dyslipidemia (32%), and hypertension (22.09%) were predominantly seen among majority of the healthcare professionals. The average lifetime ASCVD Score among healthcare professionals was 57.8%. It was observed that as age advances, the risk of developing an ASCVD also increased. Conclusion: Utilizing a simple tool such as the ASCVD Risk Score Calculator can not only predict the risk of ASCVD but can also help initiate preventive strategies and prolong the life of a medico!
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Effect of antihypertensive drugs on circadian variation of blood pressure measured by ambulatory blood pressure monitoring in controlled hypertensive individuals p. 72
Anand Nikalje, Rohit Jacob Manoj
DOI:10.4103/ACCJ.ACCJ_1_21  
Background: Rewinding back a 100 years ago, Riva Rocci introduced the meticulous way of measuring blood pressure (BP) in clinical practice. With recent years, ambulatory BP monitoring came into existence which is still not used routinely in the management of hypertension. This thought led to the commencement of our study to analyze the variations in ambulatory BP recording over a 24-h cycle. Objectives: The objectives of the study are to determine the BP differences throughout the circadian cycle and to analyze the variations in circadian rhythm due to various antihypertensive drugs. Methods: On the first visit to the Medicine Outpatient Department, patient's medical history was recorded. Three readings of office BP were recorded using a sphygmomanometer. The patient was then provided with the ambulatory BP monitoring device, sent home and asked to follow-up after 24 h and the report was recorded. Results: On comparing the nocturnal pattern among candidates taking single versus combination drug, the dip was found to be in 31.7% in patients on single drug compared to 38.6% combination therapy. The surge in BP was seen in 56.8% of patients on single-drug therapy compared to 43.3% patients on combination drug therapy. Conclusion: Single-drug therapy for hypertension did not show a significant nocturnal pattern compared to the combination drug therapy for hypertension. The presence of the risk factors such as obesity smoking, dyslipidemia, diabetes mellitus, hypothyroidism, family history, and chronic kidney disease showed a presence of dipping and nondipping pattern in BP.
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Comparison of adverse events between ramipril and perindopril in contemporary cardiac practice p. 77
Ramesh Sankaran, Nagendraboopathy Senguttuvan, Thoddi Ramamurthy Muralidharan, Vinodkumar Balakrishnan, Shanmugasundaram Sadhanandham, Manokar Panchanatham, Jayanthy Venkata Balasubramaniyan, Preetham Krishnamurthy, Phulgun Badimela
DOI:10.4103/ACCJ.ACCJ_12_21  
Background: Angiotensin-converting enzyme inhibitors (ACEIs) are extensively used for the treatment and management of cardiovascular diseases. Although ACEIs are a well-tolerated medication in high percentage of patients, around 30% can develop adverse reactions like dry cough. Objective: The objective of the study was to capture the incidence of cough in patients with cardiovascular diseases that were prescribed with perindopril and ramipril in an Indian tertiary care hospital. Methods: In this observational study, the incidence of cough in patients with cardiovascular diseases that were prescribed with perindopril and ramipril was estimated. Results: A total of 223 patients were enrolled in this study. Around 50.67% patients received ramipril; among them, 6.02% received 1.25 mg, 78.95% received 2.5 mg, and 13.53% received 5 mg of ramipril. Around 35.9% (n = 80) patients received perindopril. In perindopril group, 31.3% of the patients received 2 mg dose and 68.8% of patients received 4 mg dose. Among perindopril group, the incidence of cough was observed in 10% (n = 8) of the patients, whereas in ramipril group, it was 19.55% (P = 0.00136). Due to cough, in perindopril group, 6.3% (5/80) of the patients discontinued treatment whereas in ramipril group, 9% (12/133) of the patients discontinued treatment medication. Conclusions: Our study has demonstrated that perindopril has been associated with a relatively low incidence of cough compared to ramipril.
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CASE REPORTS Top

A rare case of patent foramen ovale occluder embolization: A sneaky clinical presentation p. 81
Luca Allievi, Amedeo Bongarzoni, Guido Tassinario, Barbara Conconi, Gabriele Tumminello, Stefano Carugo
DOI:10.4103/ACCJ.ACCJ_11_21  
Patent foramen ovale (PFO) is a common congenital defect in adults; its closure with an occluder device is usually a safe procedure. However, a rare and potentially fatal complication is the device embolization. We report a case of a 52-year-old man with bicuspid aortic valve and surgically corrected aortic coarctation, in which a PFO occluder device migrated to the abdominal aorta. We recommend paying attention to the risk factors before the intervention (PFO characteristics and multiple congenital defects) and to the clinical-echocardiographic follow-up, to prevent, recognize, and treat this severe complication as soon as possible.
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Platypnea-orthodeoxia syndrome years after acute pulmonary embolism: Two consecutive cases p. 85
Luca Allievi, Amedeo Bongarzoni, Barbara Conconi, Gabriele Tumminello, Lucia Barbieri, Stefano Carugo
DOI:10.4103/ACCJ.ACCJ_15_21  
Platypnea-Orthodeoxia syndrome (POS) is a rare condition in which dyspnoea and arterial oxygen desaturation are present in the upright position, while in the supine position, they are alleviated. It is observed in the presence of an anatomical (intra- or extracardiac) communication between the right and left heart causing a right-to-left shunt. POS is most frequently caused by a patent foramen ovale (PFO) and usually, the clinical assessment and a transthoracic echocardiograms with bubble study are enough to reach the diagnosis. The only possible treatment of POS is the percutaneous closure of the defect. We describe two cases of POS due to a PFO which manifested itself years after an episode of acute pulmonary embolism (PE), a finding never reported to date in the literature. Few cases describe the relationship between PE and POS, but these conditions may be more closely related than we currently think.
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