No abstract

No abstract

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk

Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients

The incidence of Atrial Septal Defect (ASD) is approximately 3 per 10,000 live births. Ostium secundum ASD is most common type of ASD accounting for 75% of all ASD cases. Patients with irreversible Pulmonary Arterial Hypertension (PAH) are considered ineligible for shunt closure. It is important to ascertain the cause of PAH particularly to rule out pulmonary cause as in present case. A 56-yearold female patient, known case of Ostium secundum ASD presented with NYHA class IV dyspnea and chest infection. A transthoracic echocardiogram revealed 30 mm ASD with bidirectional shunt, dilated Right Atrium (RA), Right Ventricle (RV), severe Tricuspid Regurgitation (TR) (max PG 85 mmHg) and RV dysfunction. She was intubated and put on mechanical ventilator. CT chest showed right lower lobe bronchiectasis with infective changes. However repeated attempts to wean patient off Bipap support were unsuccessful. Subsequently cardiac catheterization and Balloon Occlusion of ASD revealed Qp/Qs ratio of 8:1 with step up in oxygen saturation of 19%. Mean pulmonary artery pressure was 35 mmHg. Later she underwent successful device closure for ASD with AMPLATZER septal occlude (36 mm) (AGA Medical Corp., Minneapolis, MN, USA). Her physical activity and symptoms were much improved. Follow up transthoracic echocardiography after 5 months revealed normal RV contractility and no PAH. While initially chest infection prevented ASD device closure, underlying bronchiectasis which got worsened by ASD shunt, prevented her from weaning off ventilator. ASD device closure thereby helped to reduce pulmonary blood flow and improvement in lung function enabling her to wean off ventilator support.