Background: Chronic liver disease is an important cause of mortality as well as morbidity all over the world. Cirrhosis causes clinical manifestations extending beyond the liver. In patients with chronic liver disease, the cause of mortality is usually related to the liver pathology, but extrahepatic manifestations of chronic liver damage contribute significantly to the morbidity. With regards to the cardiovascular system, the manifestations are due to circulatory disturbances and cardiac dysfunction. Among all etiologies, cirrhotic cardiomyopathy is the cardiac dysfunction secondary to chronic liver disease. Objective: To study the echocardiographic abnormalities in patients with chronic liver disease. Materials and Methods: This was a cross-sectional study that was conducted on 80 patients in a tertiary care center. All etiologies for chronic liver disease were included. The diagnosis was confirmed by clinical features, laboratory and imaging criteria, and endoscopic evidence, and the duration of the abnormalities was to be persistent for more than six months. Echocardiography was done within one week of conducting the investigations. Echocardiography was done by the same cardiologist, who was a part of the study group, for all the patients. Results: The study cohort included 69 males and 11 females. The age ranged from 36 years to 76 years. The most common abnormality noted was left ventricular hypertrophy 48 (60%). Diastolic dysfunction was observed in 33 (41.5%). The other abnormalities noted include: left ventricular dilatation 5 (6.25%), dilated left atrium 13 (16.25%), increase in pulmonary artery pressure 15 (18.75%), and right ventricular dysfunction 10 (12.5%). Conclusion: Cirrhotic cardiomyopathy is a common but silent entity. A high index of suspicion is to be kept for this entity while managing patients with cirrhosis. The existence of this entity, if known, will be helpful in the management of patients during procedures or diseases that place stress on the heart. The use of newer modalities of imaging such as tissue Doppler imaging and two-dimensional speckle tracking echocardiography is more sensitive than conventional echocardiography for identifying cardiac dysfunction.

BACKGROUND Chronic obstructive pulmonary disease is a leading cause of mortality and morbidity. Its effects extend beyond the respiratory system, to involve other organs like the heart and the brain. This study aimed to find out the relation between the severity of COPD as assessed by the CAT score and the echocardiographic abnormalities in subjects who did not have other comorbid conditions to influence the echocardiographic findings. METHODS The study population included 33 patients with a confirmed diagnosis of COPD based on pulmonary function tests. The study was done in Government Medical College, Thrissur, which is a tertiary care centre. RESULTS The study established that left ventricular diastolic dysfunction is a close accompaniment of COPD, more so as the severity of COPD increases. Another interesting observation is that it is the left ventricle which is more commonly affected in subjects with COPD, than the right ventricle even in subjects with pulmonary artery hypertension. CONCLUSIONS Left ventricular diastolic dysfunction is a well-established accompaniment of COPD, the severity of which has a linear relationship with the severity of COPD. Thus it becomes important to rule out decompensated heart failure during exacerbations of COPD.

Background: Elderly patients constitute a majority subset of population developing acute coronary syndrome. But specific risk factors and in-hospital outcome have not been well-studied. Objectives: To study the risk factors and inhospital outcome of people aged >60 years with acute coronary syndrome. Materials and Methods: 220 patients aged >60 years admitted with acute coronary syndrome under Department of General Medicine (during a time period from 1 st January 2015 to 31 st December 2015) were studied between admission and death/discharge. All patients who opted for primary PCI and who left treatment before completion were excluded. Patients were grouped into STEMI, NSTEMI and unstable angina. Various factors affecting mortality were studied. Results: After exclusion, 212 patients were included in the study. The mean age of men was 68±6 years while that of women was 71±7 years) (p=0.01). Modifiable risk factors were present in 84.9% (n=180), most common risk factor observed was past history of systemic hypertension. (52.36%) (n=111). Hypertension was found to have significant association with mortality. (p value=0.05). Chest pain was the most common symptom. Atypical features were found to be higher in those aged above 80 years. (p value = 0.04). Thrombolysis was not done in 15.7% (16) patients with STEMI, reason being they were out of window period for thrombolysis Women were found to have more pre-hospital delay (p value= 0.026) High Killip class and also hypotension during admission was found to be associated with increased mortality (p value<0.001). Conclusion: Hypertension still remains as an important modifiable risk factor for coronary artery disease in the elderly population. Hence regular monitoring of blood pressure and proper management has to be followed in this age group also. The delay to reach the hospital should be avoided, because thrombolytic therapy is very effective in elderly patients.