Article: An Unusual Complication during Bronchoscopy: Hypotension, Global ST Segment Elevation and Acute Severe Left Ventricular Systolic Dysfunction.[show abstract] [hide abstract]
ABSTRACT: Bronchoscopy is a procedure that is widely performed and is generally considered to be safe. Cardiac complications occurring during bronchoscopy are uncommon, and usually occur in elderly patients with co-existent coronary artery disease, hypertension or severely impaired pulmonary function with resting hypoxemia. We report an unusual patient who developed sudden onset restlessness, chest discomfort, hypotension, global ST elevation in multiple ECG leads with acute severe left ventricular (LV) systolic dysfunction, during a bronchoscopic transbronchial lymph node biopsy procedure. Differential diagnosis included a massive myocardial infarction, apical ballooning (Tako-tsubo syndrome) or coronary vasospasm. The ECG changes resolved spontaneously and a coronary angiogram done later, revealed normal coronary artery anatomy and normal LV function. The patient made an uneventful recovery. It is important for physicians to be aware of such unusual complications to be able to appropriately manage these patients in clinical practice.Respiratory care 02/2013; · 2.01 Impact Factor
Article: Metabolic syndrome & Framingham Risk Score: Observations from a coronary angiographic study in Indian patients.[show abstract] [hide abstract]
ABSTRACT: Background & objectives: Metabolic syndrome (MS) is an important determinant of cardiovascular (CV) risk. Framingham Risk Scores (FRS) often underestimate the CV risk in Asians, younger patients and those with MS. Asians often develop coronary artery disease (CAD) at a younger age and also have a high prevalence of MS. Only limited data are available on the relationship between MS and FRS in such patients and the present study was undertaken to report on this aspect in an Indian patient population with angiographically documented CAD. Methods: Two hundred patients undergoing coronary angiography during a three months study period were included. Diagnosis of MS was based on modified south Asian guidelines. Results: Of the 200 patients (age 56.5 ± 8.6 yr) undergoing coronary angiography, MS was diagnosed in 77 per cent n=154; abdominal obesity, low HDL and hypertension were the commonest of the diagnostic criteria of MS, being present in >70 per cent cases. Patients with MS had significantly higher mean FRS than those without MS (15.1 vs 8.65, P<0.0001). Most patients with MS (74%, n=148) had an intermediate to high 10-year CV risk (>10%) as estimated by FRS. The proportion of patients with MS progressively increased in those with low, intermediate and high FRS (61, 87 and 92%, respectively). Though the prevalence of MS was uniformly similar (74-84%) in all age groups (<45, 45-55, 55-65 and > 65 yr, respectively), amongst those <45 yr, none of the patients could be categorized as having high CV risk as estimated by FRS despite having angiographic CAD, highlighting the limitation of age dependence of FRS. Interpretation & conclusions: MS is common in Indian patients with angiographically documented CAD; most patients with MS have 10-year risk of >10 per cent as estimated by FRS. Though MS is uniformly prevalent across all age groups, using the FRS may underestimate the CV risk in Indian patients despite documented CAD. These findings have significant implications for Asian patients with CAD in whom onset of CAD is often at a younger age than their Western counterparts. There should be continued health care emphasis on detection of MS and intensification of targeted preventive strategies.The Indian journal of medical research 02/2013; 137(2):295-301. · 1.84 Impact Factor
Article: Erectile Dysfunction Precedes and Is Associated with Severity of Coronary Artery Disease among Asian Indians.Jatinder Kumar, Tanuj Bhatia, Aditya Kapoor, Priyadarshi Ranjan, Aneesh Srivastava, Archana Sinha, Sudeep Kumar, Naveen Garg, Satyendra Tewari, Rakesh Kapoor, Pravin K Goel[show abstract] [hide abstract]
ABSTRACT: INTRODUCTION: Erectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients. AIM: To study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD. METHODS: In all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function-5 questionnaire. MAIN OUTCOME MEASURES AND RESULTS: Among 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21-fold higher risk of having triple-vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41-141.09, P = 0.001) and an 18-fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11-111.09, P = 0.001). CONCLUSION: Asian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.Journal of Sexual Medicine 01/2013; · 3.55 Impact Factor
Heart Views 01/2013; 14(1):36-7.
Article: Kocher-Debre-Semelaigne syndrome with arrhythmogenic right ventricular cardiomyopathy: A hitherto unrecognized association[show abstract] [hide abstract]
ABSTRACT: Kocher-Debre-Semelaigne (KDS) syndrome is a rare form of hypothyroid myopathy, with associated hypertrophy of muscles. Although cardiac manifestations of hypothyroidism are well known, reports of cardiac involvement in KDS have only described the occurrence of pericardial effusion as an association. This report describes an adolescent male presenting with typical features of this rare syndrome along with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), an association not yet described in the literature.Indian Journal of Endocrinology and Metabolism. 12/2012; 16(6):1032–1034..