Relation between central aortic pulse pressure and coronary artery disease: a coronary angiographic study in a tertiary care center

Background: Aortic pulse pressure is a significant marker of cardiovascular morbidity independently of mean blood pressure and pulse pressure of 60 mm Hg should be considered as the threshold at risk both in normotensives and hypertensives. Coronary perfusion is dependent on diastolic blood pressure and patients with CAD may be susceptible to the adverse effects of low diastolic blood pressure. This study conducted to examine the relation between central aortic pulse pressure and the prevalence and extent of CAD.Methods: A cross sectional, hospital-based study conducted in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, among patients undergoing diagnostic coronary angiography.Results: Risk factors like Diabetes, Hypertension, Dyslipidemia and smoking rates were significantly higher in patients with PP of >60 mmHg (p<0.01). In the first group, the ratio of having normal coronaries is higher 61.9% vs 38% and diseased coronaries was lower when compared to the other group 38% vs 98%. In patients with aortic pulse pressure >60 mmHg, 4 patients had left main coronary artery (LMCA) disease, 20 patients had single vessel disease, 11 patients had two vessel disease and 20 patients had triple vessel disease.Conclusions: In this study it was demonstrated aortic pulse pressure of more than 60 mm Hg is associated with significant CAD.

Nstemi “But” Stemi-De Winters Sign.

Anterior ST elevation myocardial infarction can present with a specific electrocardiographic (ECG) pattern without ST segment elevations, known as De Winter sign. Recognizing this ECG pattern is important since it is considered an equivalent to ST elevation myocardial infarction (STEMI), hence may require thrombolysis when primary PCI facilities are not available or delayed. We report a28 year old male who presented to us with de winters ecg pattern. Subsequent coronary angiogram showed Proxmial left anterior descending (LAD) artery occlusion.

Thoracic Aorta Aneurysm-Endovascular Aortic Repair.

Endovascular aortic repair (EVAR) is the treatment of choice for patients with descending thoracic aortic aneurysm who are unfit for open surgery. We report a 50-year-old Asian woman who presented with a saccular symptomatic thoracic aortic aneurysm and underwent EVAR with a covered stent with prompt relief of symptoms and no residual complications at 1 year of follow up.

Patients' preferences towards antiepileptic drug therapy following first attack of seizure.

BACKGROUND: Antiepileptic drug (AED) therapy following first unprovoked seizure is controversial. AIM: To study the patients' preferences towards AED therapy following first unprovoked generalized tonic clonic seizure (GTCS). DESIGN: Prospective cohorts with one year follow-up study. SETTING: Government teaching hospital, a tertiary care center. MATERIALS AND METHODS: Patient cohort included patients with first attack of unprovoked GTCS within 30 days of onset, aged between 18-60 years and with normal brain CT scan. Counseling was done for all the patients and the relatives regarding seizure recurrence, duration and adverse effects of AED therapy if preferred. Patients were encouraged to make their own decision in preferring or deferring AED with reasons. They were followed up for one year. RESULTS: Of the 73 enrolled (54 males and 19 females) 39 (53%) preferred to go on AED therapy. The reasons for preferring AED therapy were; (a) fear of seizure recurrence, 21 (54%); (b) risky occupation, 14 (36%); and (c) fear of injury, 4 (10%). The reasons for deferring were: (a) fear of adverse effects of long-term AED therapy, 19 (56%) and (b) preferring to wait for the second attack, 15 (44%). All the patients were happy about being involved in the decision-making. CONCLUSION: Following first attack of unprovoked GTCS the decision regarding AED therapy may be taken by the patients and their family members after adequate counseling and such decisions have more relevance from their perspective.

Physical growth and psychomotor development of infants exposed to antiepileptic drugs in utero.

OBJECTIVE: To evaluates the physical growth and psychomotor development of infants born to women with epilepsy on regular Anti Epileptic Drugs (AEDs). SETTING: Govt. Stanley Medical College and Hospital, Tertiary care referral centre, Chennai. DESIGN: Open prospective cohort study with a control group. MATERIALS AND METHODS: Consecutive women with epilepsy who were on regular anticonvulsants were followed up from their first trimester. Their babies were examined at birth and anthropometric measurements including anterior fontanelle size were noted. They were followed up till one year and periodically evaluated at 1st, 6th and 12th month of age. Development testing using Griffith scale was done at 2nd, 6th and 12th month. An equal number of control babies were also studied using the same scale for one year at the specified intervals. The results in both the groups were compared. RESULTS: 30 babies were enrolled in the case and control group. The AEDs received by the mothers with epilepsy were Phenytoin, Carbamazepine, and Sodium valproate. At birth and 1st month the weight, head circumference and length of case and control babies were equal. At 6th and 12th month reduction in the above 3 parameters were noted in the case babies ( P < 0.01). Area of anterior fontanelle (AF) was larger in the study group particularly in those exposed to phenytoin in utero (P < 0.001). In the case babies reduction in the sitting, prone and erect progression of the locomotor scores was observed at 2nd month (P < 0.001). Prone progression alone improved by 12th month and other two remained less than the control (P < 0.001). No difference was observed in reaching behaviour and personal/social scores in both groups. Infants exposed to Phenytoin monotherapy had a negative impact on sitting progression. CONCLUSION: Among infants exposed to AEDs in utero physical growth was equal to that of control at birth but reduced at 6th and 12th month probably due to extraneous factors. The Locomotor scores showed reduction in all areas in 2nd, 6th and 12th month except prone progression which alone improved by 12th month. Phenytoin exposure in utero resulted in large AF and it had a negative impact on sitting progression in comparison with Carbamazepine and Sodium valproate.

Nonepileptic attack disorder among married women.

AIM: To study the clinical features, precipitating stressful life events and prognosis of nonepileptic attack disorder (NEAD) among married women. DESIGN: Prospective cohort study with 1-year follow-up. SETTING: A tertiary care teaching hospital. SUBJECTS: Of the 1020 patients with epilepsy referred to the epilepsy clinic during 2002-2003, 30 were married women with NEAD. MATERIALS AND METHODS: The diagnostic criteria for NEAD included normal EEG during ictal and post-ictal phase of the generalized 'attack.' The data collected included clinical characteristics, semiology of the attacks, precipitating stressful events, and co-morbid psychiatric disorders. The control group included 30 age-matched married women with generalized tonic-clonic seizures. The long-term outcome and factors influencing the outcomes were analyzed. RESULTS: The mean duration of illness was 18 months, and the pattern of the attack was 'fall and lying still' in 53% and 'fall with generalized motor movements' in 47%. The frequency was one or more per week in 57% and occasionally in 43%. The important stressful events were matrimonial discord following illegal relationship of the husband with another woman (chi2 = 9.02, P = 0.003) and constant quarrel with other family members (chi2 = 5.19, P = 0.02). The prevalence of sexual abuse was low (7%). Co-morbid psychiatric disorder was observed in 70%. At the end of 1 year, 39% were free from the attack. Resolution of the stressful life events (chi2 = 4.52, P = 0.03) and lower frequency of attack at the time of reporting (chi2 = 3.88, P = 0.05) correlated with good outcomes. CONCLUSION: Among patients with NEAD in India, the major precipitating factors were matrimonial discord following illegal relationship of the husband with another woman and constant quarrel with other family members and not sexual abuse. Women with low frequency of attack at the time of reporting and the remission of the stressful events had better outcomes.