Sinus Node Dysfunction and Pulmonary Hypertension-"Double Trouble" with Lithium Therapy.

Lithium is considered a gold standard drug for the management of bipolar disorder and is a widely used mood-stabilizing drug in psychiatry practice. However, its side effects are of important concern. The narrow therapeutic index of lithium predispose to its toxicity/side effects, but various case reports and research has shown that adverse drug reactions can occur even in the therapeutic range. We present the case of a 56-year-old woman with no history of cardiac illness presenting with tachycardia-bradycardia syndrome along with moderate pulmonary hypertension. Patients recovered to sinus rhythm after withholding lithium therapy for 1 week while her mean pulmonary artery pressure remained the same at day 10 of drug withdrawal.

Snake in right coronary artery-Extensive spontaneous coronary artery dissection in a young male.

We report an interesting case of a young man who revealed extensive spontaneous dissection of the RCA in diagnostic angiography. It was surprising that despite an extensive dissection, the patient remained hemodynamically stable on medical management throughout the procedure and during the post-procedure hospital stay.

Silent giant left atrium: A case report.

A 30-year-old woman presented with low-grade dyspnea on exertion. Chest X-ray demonstrated enlarged cardiac silhouette but was insufficient to delineate the cause. Echocardiogram revealed the cause to be the giant left atrium from mitral stenosis.

Recurrent ST-Elevation Myocardial Infarction in a Single Coronary Artery: A Rare Anomaly.

Single coronary artery anomalies are those where the entire myocardium is supplied by an artery arising from one ostium. It is a rare coronary anomaly and has been there in literature ever since 1867. Over the years, this has intrigued anatomists and physicians whether its presence has life-threatening consequences or is mere a benign entity. Most of the cases are generally silent except for the interarterial course variants which are associated with sudden deaths. We report the case of a patient presenting with recurrent inferior wall ST-elevation myocardial infarction who was found to have a single coronary artery on angiography. The patient underwent primary percutaneous coronary intervention and uneventful further course.

Medical Therapy for Eisenmenger Syndrome: A Case Report and Review of Literature.

Eisenmenger syndrome (ES) is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect is eventually reversed into a cyanotic right-to-left shunt. It is crucial to recognize this grave pathology at the earliest because once it develops, treatment by medical or surgical means becomes even more challenging. In past decades, various therapeutic options have been developed that address the specific pathophysiological aspects of the disease and have shown to improve functional capacity and quality of life. There are three major therapeutic pathways in pulmonary hypertension treatment - endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, and prostacyclin derivatives. These therapies not only improve hemodynamic parameters and exercise capacity but they also improve prognosis with various form of Pulmonary hypertension including ES. We report a case of a 35-year-old female of ostium secundum atrial septal defect with ES, started on upfront combination therapy of ambrisentan and tadalafil who demonstrated marked improvement after 3 months of medical therapy.

A "20/20" Match: ACC/AHA 2017 versus ESC/ESH 2018 Guidelines for Management of Hypertension.

Hypertension, the commonest noncommunicable disease globally, is an important risk factor for cardiovascular disease and renal failure. Theoretically, while it is easy to diagnose and manage by simple measures, practically it has been observed that not only treatment but also diagnosis and its preventive measures are inadequate in developing as well as developed nations. Several guidelines by various international organizations are available to guide clinicians for hypertension management. Though the basic principles of hypertension management are similar in all the guidelines, subtle differences are there. In this article, we compare the two most widely accepted guidelines for hypertension, that is, American College of Cardiology/American Heart Association 2017 Hypertension Guidelines and 2018 European Society of Cardiology and European Society of Hypertension Guidelines on Hypertension. Both the differences and similarities between these two widely followed guidelines are presented.

Hydropneumopericardium: A rare complication of pericardiocentesis.

Hydropneumopericardium is defined as the presence of air and water in the pericardial cavity. Several causes have been postulated which can lead to hydropneumopericardium including trauma, infections secondary to gas-producing bacilli, fistula formation, positive pressure ventilation or even spontaneously without an underlying cause in healthy adults and rarely after pericardiocentesis. We report an uncommon instance of hydropneumopericardium after pericardiocentesis in a 35-year-old man, which developed due to a leaky drainage system. It was immediately drained through the subxiphoid approach under echocardiographic guidance, and the patient was relieved. Hydropneumopericardium is an uncommon but easily diagnosable and avoidable complication of pericardiocentesis. It should be suspected whenever the patient develops increasing dyspnoea following a temporary relief by pericardiocentesis.

COVID-19 and Cardiovascular Diseases: Challenges and Solutions.

Rampantly spreading around the globe and taking thousands of lives each day, coronavirus disease 2019 (COVID-19) may present with varied cardiovascular manifestations. Those with evidence of myocardial injury have a worse prognosis too. Patients with pre-existing cardiovascular diseases or risk factors are at greater risk of adverse outcomes and mortality by this infection. Being highly contagious, measures to prevent cross-infection are of paramount importance. In this article, the authors summarize the various cardiovascular manifestations of COVID-19 and precautions needed while handling them and the long-term consequences of COVID-19 infection.

Review on sodium-glucose cotransporter 2 inhibitor (SGLT2i) in diabetes mellitus and heart failure.

SGLT-2 inhibitors are a novel class of anti-diabetic agents which act by inhibiting glucose reabsorption in proximal convoluted tubules of kidney. Apart from maintaining glucose homeostasis they exert a number of positive effects on the cardiovascular system like weight loss, decreasing blood pressure, preserving renal function, reducing triglycerides, natriuresis and improving endothelial dysfunction. In large clinical trials, all the three prototype agents - Empaglifozin, Canaglifozin and dapaglifozin have shown reductions in major adverse cardiovascular events including cardiovascular deaths, non fatal MI, stroke and heart failure (HF) hospitalizations. The reduction in heart failure hospitalization is a surprising finding and trials of these drug are now underway for HF also. More surprising is the fact that the benefits are comparable or even better that achieved by recently approved novel drugs for HF. In this review, we briefly discuss the pathophysiology of HF in diabetes, describe the prototype SGLT-2 molecules available, their data from large cardiovascular outcome trials till date and their role in current practice of diabetes management.