Left main coronary artery (LMCA) dissections may be iatrogenic or spontaneous. Spontaneous coronary artery dissections (SCADs) are common in pregnant women, with predominantly left anterior descending artery (LAD) involvement. In males, coronary artery dissections may happen in alcoholics. Spontaneous LMCA dissection as the cause of myocardial infarction is very rare. We are reporting a case of spontaneous LMCA dissection in a 45-year-old male alcoholic with the involvement of LAD ostium, which resolved spontaneously with conservative management.
Background The aim of this study was to study the prognostic implications of minimal coronary artery disease (CAD) in patients with dilated cardiomyopathy (DCMP) in terms of mortality and hospitalization due to heart failure. Methods One-hundred sixty-three patients with DCMP were recruited for this study. Out of these, 61.9% (n = 101; 62.4% men) patients were without associated minimal CAD and 38% (n = 62; 66.1% men) with associated minimal CAD (stenosis < 50%), and their risk factor profile was noted. These patients were followed for 30 months, with mortality being the primary endpoint, and hospitalization secondary to cardiac decompensation in the form of heart failure was denoted as the secondary endpoint. Results In our study, independent significant predictors of CAD were age (p = 0.002), hypertension (p = 0.001), diabetes (p < 0.001), and smoking (p = 0.023). The presence of minimal CAD in DCMP patients as a predictor of mortality was not significant (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 0.62–4.62, p = 0.303); however, it was a significant predictor of hospitalization secondary to cardiac decompensation (OR: 6.78, 95% CI: 2.28–20.13, p = 0.001). Conclusions Minimal CAD was observed in 38% of DCMP patients. The risk factor profile predicting CAD in DCMP patients was the same as that of the general population. The presence of minimal CAD in DCMP patients was not associated with mortality. However, it was associated with hospitalization secondary to cardiac decompensation in the form of heart failure.
Background : Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, and extra-articular features are also very common . RA is associated with an increased mortality , the majority of which is originating from cardiovascular diseases . The most common cardiac involvement in RA is pericarditis . Varying the method of assessment pericarditis occurs in 30–50% of the patients. Objective : To study prevalence of pericarditis in Rheumatoid arthritis patients , by echocardiography Methods: A Prospective observational study , conducted in department of general medicine GMC Srinagar , from 2016 to 2018. 110 patients of rheumatoid arthritis were enrolled in this study. Results : Out of 110 patients , 49 % had some form of heart involvement , pericardial effusion was present in 9.1 % of patients. Female to male ratio was 3.6:1 , there were 24 (22%) males and 86 (78%) females, there was no significant relationship between gender and abnormal echocardiography findings in RA patients (p > 0.05) Conclusion : Prevalence of pericarditis was present in only 9.1% patients in our study , which is less compared to the previous studies. It is most likely because our patients were on DMARD and their disease was well controlled .Most of the previous studies date back to 70 and 80s , when DMARDS were not available and likely because of that pericarditis was very common.
Background: Contrast-induced nephropathy (CIN) is a grave but underdiagnosed complication of percutaneous coronary intervention (PCI) that is associated with increased in-hospital morbidity and mortality. Our aim was to study the incidence, risk factors of CIN, and applicability of Mehran risk score (MRS) in Indian population. Materials and Methods: A total number of 432 patients were enrolled in the study. Inclusion criteria were patients with acute coronary syndrome or chronic stable angina who underwent PCI. Baseline parameters of patients were noted and patients were followed for development of CIN. Results: The mean age of the study population was 57.2 + 10.43 years; males were 348 (80.6%) and females 84 (19.4%). Hypertension was present in 257 patients (59.5%), diabetes in 208 (48.1%), smoking in 208 (48.1%), anemia in 104 (24.1%), and heart failure in 95 (22%); the mean estimated glomerular filtration rate (eGFR) was 88.4 + 30.65 ml/min/1.73 m2 and the mean contrast volume usage was 122.8 + 41.9 ml. 64 patients (14.8%) developed CIN. On univariate analysis, age (P = 0.435), gender (0.125), hypertension (0.679), diabetes (0.177), and contrast volume (0.155) were not associated with the development of CIN, whereas smoking (0.021), hypotension (<0.001), heart failure (<0.001), anemia (0.001), and median eGFR (P < 0.001) were significantly associated with the development of CIN. However, on multivariate regression analysis, smoking was not associated with the development of CIN (P = 0.104). The incidence of CIN was 2.7-fold higher (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.299–5.540, P= 0.008) in the intermediate group (MRS 6-10), 5.4-fold higher (OR: 5.403, 95% CI: 2.249–12.978, P < 0.001) in the high-risk group (MRS 11–15), and 51-fold higher (OR: 51.059, 95% CI: 18.195–143.278,P< 0.001) in the very high-risk groups (MRS >16) when compared to the low-risk group (MRS < 5). Dialysis was required only in 2 (3.1%) patients (P < 0.022). Conclusions: The overall incidence of CIN was 14.8%. The incidence of CIN in the very high-risk group (MRS >16) was substantially higher in our study (77.8%) as compared to the same group in Mehran study (57.3%).
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