Prevalence and trends of occult coronary artery disease in patients with dilated cardiomyopathy.

BACKGROUND: Many patients with dilated cardiomyopathy (DCMP), presenting with only dyspnea, have hidden ischemic etiology. In low-income countries, logistic and financial restraints lead to reduced identification of this ischemic burden. We aimed to assess the role of coronary angiography in patients with cardiomyopathy presenting predominantly dyspnea. METHODS: This was a single-center, prospective, observational study conducted at a tertiary-care center in North India over the period of one year. The study population consisted of patients with dyspnea (NYHA II and III) and left ventricular dysfunction [i.e., left ventricular ejection fraction (< 40%)] without a prior documented coronary artery disease (CAD). All patients underwent invasive coronary angiography to detect underlying occult CAD. RESULTS: A total of 209 patients with global left ventricular hypokinesia (LVEF) were enrolled. Almost half of the study population belonged to the 51-60-year-old group. Diabetes mellitus and smoking were most prevalent risk factors observed in 93 (44.5%) and 92 (44.1%) patients, respectively. Abnormal coronaries were detected in 75 (35.9%) patients; 44 (58.7%) and 29 (38.7%) patients had significant and insignificant CAD, respectively. Single-, double-, and triple-vessel disease was observed in 18 (40.9%), 14 (31.8%), and 12 (27.3%) patients, respectively. The mean age (54.08 ± 6.02 years), LVEF (39.83 ± 3.27%), SYNTAX score (17.14 ± 2.21), and left ventricular internal dimensions (4.93 ± 0.44 cm) were all statistically insignificant. CONCLUSION: Patients with DCMP presenting predominantly with dyspnea and having silent underlying significant CAD may benefit from revascularization if CAD is detected by angiography on time.

Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole.

Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion.

Relation of glycated hemoglobin with carotid atherosclerosis in ischemic stroke patients: An observational study in Indian population.

CONTEXT: Glycated hemoglobin A1c(HbA1c) indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. AIMS: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA1c and marker of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque) in ischemic stroke patients. SUBJECTS AND METHODS: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006). Levels of HbA1c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA1c levels with CIMT and plaque. RESULTS: The average value of HbA1c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%). The patients with high CIMT (>0.8 mm) had higher values of HbA1c then that of normal CIMT patients and this was nearly significantly (P = 0.06). However, HbA1c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008). CONCLUSIONS: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA1c levels in both diabetic and non-diabetic population.

Takayasu's arteritis presenting as digital gangrene of right hand.

Takayasu's arteritis (TA) is a chronic inflammatory disease of medium and large vessels, mainly involving the aorta and its major branches. TA may have diverse clinical presentation including claudication, stroke, asymmetric pulse or blood pressure. However, the association of TA with digital gangrene is a rare entity. Here, we report a case of a 40-year-old woman who presented with digital gangrene of the right hand, which on workup was diagnosed as a case of TA.

Asymmetric graves ophthalmopathy as a sole manifestation of autoimmune hypothyroidism.

Graves ophthalmopathy (GO) is commonly associated with hyperthyroidism, however its coexistence with hypothyroidism is seen uncommonly in 5% of cases. The ophthalmic signs in GO are usually bilaterally symmetrical, however in 10-15% of cases patients may present asymmetrically. The ophthalmic signs in GO are commonly seen with other systemic features of thyroid disease, however when a patient present with asymmetric ophthalmic signs in the absence of other thyroid manifestations, it is difficult to consider the possibility of thyroid disorder, which may result in delayed diagnosis and further progression of disease. Here, we report a case of 22-year-old man who presented with progressive painless bulging of right eye without other features of thyroid disease which on workup was diagnosed as a case of autoimmune hypothyroidism.