Risk factors for coronary heart disease in Asian Indians: clinical implications for prevention of coronary heart disease.

Contrary to popular belief that coronary heart disease (CHD) is uncommon in developing countries, Asian Indians have among the highest prevalence of CHD. Analysis of numerous studies have now revealed that the usual risk factors i.e. hypertension, hypercholesterolemia, obesity, smoking and a family history of CHD, are not common among South Asians. Rather, they possess a different risk factor profile characterized by high triglycerides, low HDL, glucose intolerance, insulin resistance, abdominal obesity and increased lipoprotein(a) levels. On account of this difference and the alarming explosion of CHD in India, guidelines for prevention of CHD as laid down by the American Heart Association may not be applicable in our population. A judicious diet incorporating commonly used Indian food items and regular exercise will go a long way in effective primary prevention.

Alteration in pulmonary mechanics after coronary artery bypass surgery: comparison using internal mammary artery and saphenous vein grafts.

Pulmonary function tests, arterial blood gas tensions and morbidity were compared in 50 patients undergoing coronary artery bypass graft surgery. Thirty patients had bilateral internal mammary grafts (Group 1), 5 patients had only saphenous vein grafts (Group 2) and 15 patients had a single arterial graft in addition to vein grafts (Group 3). Pleural effusion and wound infection were more common in patients with internal mammary artery grafts (p < 0.05). Patients in Group 2 required prolonged ventilation but this could be related to their underlying left ventricular dysfunction. Patients in all the three groups developed a severe restrictive ventilatory defect in the postoperative period and the degree of impairment was maximum in Group 1 patients (p < 0.01). These patients also had evidence of small airway obstruction. Thus an overall decrease in pulmonary function occurs in the postoperative period by 30 to 40% (p < 0.001). The derangement is greater in patients with arterial grafts, as a result of impaired blood supply, increase in pleural drains and additional surgical trauma secondary to mobilization of internal mammary arteries leading to delayed recovery. The awareness of these findings can be of great value in postoperative management of these patients. In addition, these observations should also be kept in mind while planning the choice of grafts in a patient undergoing coronary artery bypass graft surgery.

Percutaneous mitral valvotomy in 200 patients using Inoue balloon-immediate and early haemodynamic results.

We report our experience with percutaneous balloon valvotomy using the Inoue technique in 200 cases with rheumatic mitral stenosis. The procedure was successful in 195 (97.5%) cases with a fluoroscopy time of 9 +/- 2.7 and procedure time of 60 +/- 19 minutes. Mitral valve area as estimated by Gorlin's equation and pressure half time increased from 0.86 +/- 0.17 to 2.21 +/- 0.41 and from 0.94 +/- 0.14 to 1.90 +/- 0.26 (p < 0.001) respectively. Other hemodynamic variables including mitral valve gradient, cardiac output, left atrial mean and pulmonary artery pressure improved significantly. There were no deaths and the incidence of major complications was small. Increase in mitral regurgitation was observed in 35 (17.9%) with grade 2+ increase in 7 (3.6%). Inoue balloon technique is safe, easy to perform and provides excellent clinical and hemodynamic benefits in majority of cases.

Coronary artery disease in premenopausal Indian women: risk factors and angiographic profile.

Coronary angiographic and clinical profile of 47 premenopausal women presenting with myocardial infarction (MI) or angina is presented. Seventeen patients (36%) had significant obstructive coronary artery disease (CAD) (Group I), while 30 (64%) had normal coronaries (Group II). The latter group included 4 who had MI and 26 who presented with angina. Risk factors in Group I included hypertension (53%), diabetes mellitus (24%), hypercholesterolemia (29%), oral contraceptives and a positive family history (11.8%). Frequency of one, two and three vessel disease was 47%, 18% and 35% respectively. The left anterior descending artery was most commonly affected (82%). In Group II the risk factors included hypertension (17%) and diabetes (7%). No patient in either group was a smoker. This analysis shows that significant obstructive CAD in premenopausal Indian females is more commonly associated with hypertension, diabetes and hypercholesterolemia. Smoking was not encountered and ingestion of contraceptive pills is uncommon.

Incidencia de ictericia em recem-nascidos de alto risco. / Occurrence of jaundice in high risk newborn infants

O estudo de 4.703 recem-nascidos da Unidade Neonatal do Hospital Israelita Albert Einstein, Sao Paulo, no periodo de julho de 1979 a dezembro de 1980, revelou uma maior incidencia de ictericia nos nascimentos por cesarea, nao havendo diferenca estatisticamente significativa na incidencia de ictericia entre os recem-nascidos a termo, prematuros e com desnutricao intra-uterina. Nao se evidenciou a importancia de processos patologicos neonatais (disturbios respiratorios, metabolicos e infecciosos) como fatores responsaveis por uma maior incidencia de ictericia nesse periodo de vida