Risk Factors of Cardiovascular Disease (CVD) - A Critical Scientific Review

Cardiovascular Diseases (CVDs) are taking the biggest toll on human health since the last few decades. Around the middle of the 20th century, morbidity and mortality due to CVDs began to increase exponentially due to drastic change in lifestyle and rapid urbanization. At that point of time a very little was known about its causes or risk factors. Identification of risk factors is crucial in planning the treatment and prevention strategies for any disease. Profound research works have been conducted worldwide to identify risk factors of CVDs. Conventional risk factors like obesity, smoking, hypertension, diabetes, dyslipidemia, physical inactivity etc are already given due importance in risk prediction, prevention and management of CVDs. The risk assessment tools available at present are mainly based on these conventional risk factors. Even after adjusting the conventional risk factors, CVD related morbidity and mortality are still growing. Moreover CVDs are now reported at an early age. Hence there is also a need to identify novel risk factors which can be helpful in predicting and identifying CVDs earlier. The future of CVD risk assessment is an integration of both traditional as well as emerging risk factors for better prediction, diagnosis and planning therapeutic and preventive interventions of CVDs.

Myocardial Performance Index in Patients of Acute Coronary Syndrome.

Evaluation of ventricular systolic and diastolic functions is an essential part of echocardiographic evaluation in a patient of acute coronary syndrome (ACS). Both systolic and diastolic functions change as disease progresses. There are many limitations of the echocardiographic indices of LV functions used routinely in patients of acute coronary syndrome. Tei Chuwa devised a reliable index of myocardial performance (The Tei Index/ Myocardial Perfomance Index). It is a reliable index for evaluation of LV systolic and diastolic performance in acute coronary syndrome. Materials and Methods: 75 patients of acute coronary syndrome and 25 controls were studied. All patients admitted with the complaints of ischemic chest pain were included in the study. An informed consent was taken from all patients. Detailed history and physical examination were carried out and baseline investigations were done. Tei index was calculated from the ratio of time intervals: a-b/b, derived with the aid of pulse doppler echocardiography. Its relationship was studied with acute coronary syndrome and complications after ACS. Results: The Cardiac Output was not significantly different from controls in UA; but it was significantly deranged in STEMI (p<0.001) and NSTEMI (p <0.001). MPI was significantly different in all the three groups from controls. The t and p values of MPI of various groups on comparison with controls were t=9.0, p<0.001; t=12.5, p<0.001; t=18, p< 0.001 for UA, STEMI and NSTEMI respectively. The MPI of STEMI patients was 0.64±0.08 that of NSTEMI patients was 0.57±0.059, that of UA was 0.48±0.06 and that of controls was 0.39±0.04. The correlation showed that MPI was more strongly related to complications as compared to other echocardiographic parameters. Conclusion: MPI is a non-geometric doppler index, that combines systolic and diastolic performance of left ventricle. As compared to controls, MPI was found to be deranged in patients of acute coronary syndrome. when recorded within 24 hours of admission, myocardial performance index was a sensitive and independent predictor of in-hospital events.

Trauma: an unusual aetiology of pulmonary pseudocyst.

Traumatic pulmonary pseudocyst due to blunt chest trauma is rare. It is a clinical entity that manifests itself with minor clinical and major radiological signs. We report a case of a 16-year-old girl, who during an attack by a violent cow sustained a chest impact that resulted in a traumatic pulmonary pseudocyst, confirmed with a computed tomographic (CT) scan of the chest. The patient recovered with conservative management.