Prediabetes and hypertension.

Prediabetes occurs due to two basic defects--insulin resistance and/or beta-cell failure. An observation suggested that insulin resistance may be associated with essential hypertension. There are some thoughts to favour the argument that insulin resistant Individuals are at a higher risk to develop hypertension as compared to insulin sensitive individuals. Some pathophysiological causes which have been commonly observed and hypothesised are narrated in this article. Management of hypertension in prediabetes should include antihypertensives and therapeutic lifestyle modification. To manage hypertension in prediabetes one should think for dietary modification, reduced salt intake, physical activity, smoking cessation, use of statins and antihypertensives.

Prevalence of renovascular abnormality in patients undergoing cardiac catheterization.

OBJECTIVE: To determine the prevalence of renal artery disease and to correlate the underlying risk factors like age, sex, diabetes, hypertension, urea and creatinine in patients who have undergone angiogram for cardiovascular diseases. METHODS: Retrospective analysis of the reports of angiogram of patients who have undergone cardiac catheterization in Vijaya Heart Foundation for cardiovascular diseases. RESULTS: The prevalence of renovascular stenosis is 12.4%. Prevalence of hypertension and diabetes in the group of patients with renovascular stenosis compared with group having coronary artery disease is not statistically significant (p > 0.8). Univariate and multivariate logistic identified age, diabetes, hypertension and urea as independent predicators of renal artery stenosis; while variables like sex and serum creatinine were not associated. CONCLUSION: High prevalence of unsuspected renovascular abnormalities is found in patients who undergo angiography for cardiovascular disease. Factors like age, diabetes, hypertension and urea could be clinical predicators of renal artery stenosis. Hence renal arteries should be visualized routinely in patients undergoing coronary angiogram for cardiovascular disease.

Fatty acid profile and the atherogenic risk in fish consuming and non fish consuming people.

Epidemiological studies have indicated a lower incidence of cardiovascular disease in populations with a high habitual intake of marine fish and fish oils, and this apparent protection may be due to the presence of n-3 fatty acids in the dietary fish. Two populations, a rish consuming one from coastal area and an inland one with non fish consuming from Nellore district or South India were selected for the present study. A total of one thousand healthy subjects were randomly chosen (500 in each population) from both sexes, aged from 20 to 70 years. The concentration of serum cholesterol, triacylglycerol and LDL-cholesterol were significantly lower in fish consumers, whereas HDL-cholesterol was higher in fish consumers than in non fish consumers. The difference between the percent quantities of the three n-3 fatty acids (eicosapentaenoic, docosapentaenoic and docosahexaenoic acids) was highly significant (p < 0.001) with a greater value in fish consumers.

Ventricular septal defect with aortic regurgitation: a hemodynamic and angiographic profile in Indian subjects.

The records of 362 patients of Ventricular Septal Defect (VSD) were analysed to find out the incidence of aortic regurgitation (AR) and their hemodynamic and angiographic features. Thirty-seven patients (10.2%) were found to have AR, whose mean age was 13.4 years (range: 2-45) and male to female ratio was 5:1. Of the 37 cases 31 (84%) had infracristal and 6 (16%) had supracristal VSD. In 31 patients with infracristal VSD the prolapsing cusp was Right Coronary Cusp (RCC) in 14 (48%), Noncoronary Cusp (NCC) in 12 (41%) and both RCC and NCC in 3 (11%). Of the 6 patients with supracristal VSD the prolapsing cusp was RCC in 5 (83%) and NCC in 1 (17%). In two patients the AR was due to bicuspid aortic valve. The pulmonary artery pressure was normal in 26 of 37 (70.2%) patients and the left to right shunt was 1.5:1 or less in 23 of 37 (62%) patients. Nineteen of the 37 patients (51.3%) had grade I or II AR and the remaining 18 (48.7%) had grade III or IV AR. There was no relationship between the severity of AR and the location of the VSD. In conclusion, in this series, the incidence of VSD+AR is relatively higher and that of supracristal VSD is lower. In majority of patients the left to right shunt is small and pulmonary artery pressure within normal limits. The prolapse of RCC is more common in supracristal VSD and there is no relation between the severity of AR and the location of the VSD.

Correlation of 12 lead ECG QRS score with severity of aortic stenosis.

The hemodynamic data and electrocardiograms of thirty-three patients of moderate to severe aortic stenosis were analysed retrospectively to find out if there was any correlation between 12 lead ECG-QRS score and left ventricular peak systolic pressure (LVPSP) and/or peak systolic gradient (PSG) across the aortic valve. The mean age of the study population was 33.33 (+/- 15.02SD) years, with the male to female ratio being 9:2. The mean 12 lead ECG-QRS score in these 33 patients was 281 mm (+/- 46.02SD), the mean LVPSP 203.52 mmHg (+/- 46.62SD) and the mean PSG across the aortic valve was 81.0 mmHg (+/- 41.62SD). There was good correlation of 12 lead ECG-QRS score with LVPSP (r = 0.47, P less than 0.001) and with PSG across the aortic valve (r = 0.58, P less than 0.001), latter being more significant. The best correlation was however found between 12 lead ECG-QRS score and PSG across the aortic valve in patients over 35 years of age (r = 0.88). In conclusion there is a direct relationship between 12 lead ECG-QRS score and peak systolic gradient across the aortic valve and the latter can be approximately calculated non-invasively with the help of regression equation- Peak systolic gradient (in mmHg) = 12 lead ECG-QRS score/3 - 10.6

Tetralogy of Fallot with hypertrophic cardiomyopathy--an unknown combination.

A hitherto unknown association of Tetralogy of Fallot (TF) and Hypertrophic Cardiomyopathy (HCM) diagnosed by two dimensional echocardiography, cardiac catheterization and angiocardiography is reported. Patient underwent emergency aortopulmonary shunt successfully. The literature is reviewed in brief.

Myocardial bridge (MB): an angiographic curiosity?

The coronary angiograms of 1,500 cases performed between 1981 and 1989 were analysed to find out the incidence of Myocardial Bridge (MB) and its significance as regards myocardial ischemia. Sixteen of these (1.06%) were found to have MB. Their ages ranged from 27-70 years (m = 49.2) and male:female ratio was 13:3. Out of 16 patients, 7 (group A) had associated coronary artery disease (CAD) (7 of 1421; 0.49%) and remaining 9 (group B) had no associated CAD (9 of 79; 11.39%). All the MB were found on left anterior descending artery (LAD) (3 on proximal LAD and 13 on mid LAD). No MB was found on right coronary artery (RCA) or circumflex arteries. The location of the MB did not affect the pattern of CAD. Chronic stable angina was the commonest presenting symptom in group A patients (5 out of 7) and atypical angina in group B patients (5 out of 9). Majority of group B patients had either normal or nonspecific ST-T changes in ECG (7 out of 9). However, the presence of previous myocardial infarction or ECG evidence of 'Q' wave infarction (2 out of 2) was always associated with significant CAD. Similarly, regional wall motion abnormalities on echocardiogram were always found in patients with significant CAD and old myocardial infarction. All 9 patients with MB and normal coronary arteries were managed conservatively with good relief of symptoms, whereas other seven patients were managed on the merits of the underlying CAD. In conclusion, the MB is a normal variant found incidentally on coronary angiography, and does not have any definite clinical correlations or pathological significance.

Mean frontal QRS axis and pulmonary artery pressures in rheumatic mitral stenosis.

The relationship between the mean frontal QRS axis calculated from the scalar 12 lead ECG, and the pulmonary artery (PA) pressures obtained by cardiac catheterisation in 64 cases of isolated rheumatic mitral stenosis (MS), was analysed. An overall trend of rightward axis shift with increasing PA pressures was observed; the best correlation was seen with systolic PA pressures (r = 0.51). It was possible to recognise 3 categories of patients: (1) With an axis of 70 degrees and below, systolic PA pressures were below 70 mm Hg in 82.4% of cases and below 80 mm Hg in 94% of cases; diastolic pressures were below 40 mm Hg in 88.2%; mean PA pressures were below 50 mm Hg in 88.2% cases. (2) With an axis of 71 degrees to 100 degrees, systolic PA pressures ranged from 30 to 120 mm Hg, diastolic PA pressures from 12 to 60 mm Hg and mean PA pressures from 19 to 80 mm Hg. (3) With an axis of above 100 degrees, systolic PA pressures were over 70 mm Hg in 95.5% of cases, diastolic PA pressures more than 30 mm Hg in 90.9%, and mean PA pressures more than 45 mm Hg in 90.9% cases. It was therefore possible to predict, with reasonable accuracy, the range of PA pressures in patients with isolated MS, except in those cases with an axis between 71 and 100 degrees.

Detection of silent myocardial ischemia by Holter monitoring and its relation to severity of coronary artery disease.

Thirty-five patients of chronic stable angina, unstable angina and post MI angina, who were on medical treatment, underwent 24 hours Holter monitoring and coronary angiography to find out the incidence of Silent Myocardial Ischemia (SMI) and its relation to anatomic severity of coronary artery disease. Total duration of Holter monitoring was 835.32 hours (average 23.40 hours per patient) with 48 ischemic episodes out of which 16 were painful and 32 painless. Total duration of painful episodes was 189 minutes and that of painless episodes was 428 minutes (70% was constituted by SMI). Out of 35 patients, 6 (17.14%) had SMI; 2 of 17 (11.7%) of chronic stable angina, 2 of 8 (25%) of unstable angina, and 2 of 10 (20%) of post-infarction angina patients. On analysis of coronary angiogram, all 6 (100%) patients with SMI, and only 22 out of 29 (76%) without SMI, had severe multiple coronary artery disease. Thus, although the overall incidence of SMI in this series is low, its presence invariably indicates a severe degree of coronary artery disease.

Subaortic stenosis associated with anomalous right ventricular muscle bundle and ventricular septal defect.

A rare case of biventricular outflow tract obstruction in the form of discrete subaortic membrane and hypertrophic anomalous right ventricular muscle bundle associated with ventricular septal defect is presented.

Severe syphilitic aortic regurgitation with bilateral critical coronary ostial stenosis.

A forty-year-old male with syphilitic severe aortic regurgitation and critical bilateral coronary ostial stenosis, proved by cardiac catheterization and angiocardiography, is presented. He underwent successful aortic valve replacement and coronary artery bypass grafting with gratifying results.

Results of 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in single and multiple vessel coronary artery disease (CAD).

Over the last 1-year period, we performed 130 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures in 108 patients, 103 of them were males and 5 females. Their mean age was 50.9 +/- 6.83 years (range 33-70). All of them were symptomatic, manifested by acute infarction in 18 (17%), chronic stable angina in 30 (28%), unstable angina in 5 (5%) and post-myocardial infarction angina in 55 (51%) cases. Among these patients, single-vessel CAD was present in 42 (39%), double-vessel in 37 (34%) and triple-vessel CAD in 11 (10%) patients. Nine patients (8.3%) had total occlusion, and 18 (16.6%) had tandem or bifurcation lesions of target artery. Of the 112 PTCA procedures (excluding those in acute infarction), 53 (47%) were performed on LAD, 29 (26%) on RCA, and 30 (27%) on circumflex artery, with success rates of 86.7%, 83.3% and 82.7% respectively. The overall success rate was 85% (95 of 112). The PTCA was successful in 36 of 42 (85.7%), 32 of 37 (86.5%) and 9 on 11 (82%) patients with single, double and triple-vessel CAD respectively. The mean diameter stenosis reduced from 67.1 +/- 16.54% to 19.9% +/- 10.9%. PTCA was unsuccessful in 17 (15%) due to failure to cross the lesion in 11 (9.7%), failure to dilate in 1 (0.9%) and abrupt reclosure of dilated segment in 5 (4.4%). Four (3.5%) patients underwent CABG. Two patients had redo PTCA owing to restenosis at about 6 months of first PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)