Gautam Sharma

• Doctor of Medicine
• Professor at All India Institute of Medical Sciences

Background: Ayurveda emphasizes a personalized medicine approach based on Prakriti (body constitution) assessment which involves morphological observation and detailed history of physiological, behavioural, and psychological attributes. In Ayurveda research, two commonly used prakriti questionnaires are developed by CSIR (Q1) and CCRAS (Q2). The...

Background and Objectives Rising hypertension from inadequate detection, noncompliance with treatment, and poor control presents a major public health challenge. Previously, adopting the strategy of self-monitoring of blood pressure (SMBP) showed better hypertension detection, control, and medication adherence. However, evidence from India is scarc...

Cardiac channelopathies are a group of heritable disorders that affect the heart’s electrical activity due to genetic variations present in genes coding for ion channels. With the advent of new sequencing technologies, molecular diagnosis of these disorders in patients has paved the way for early identification, therapeutic management and family sc...

Background Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders. Aims To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with...

Background Ayurveda, the Indian system of medicine, has been practised in India since ages. We evaluated the overall awareness regarding Ayurveda among patients attending two specialty clinics at a tertiary care institute. Methods We did a cross-sectional study on patients attending the cardiology and neurology clinics at a tertiary care hospital...

Background and objectives Persons with epilepsy are afflicted with co-morbidities such as stigma, anxiety and depression which have a significant impact on their quality of life. These co-morbidities remain largely unaddressed in resource limited countries. This randomized controlled trial (RCT) aimed to investigate if yoga and psychoeducation were...

Context: Frontline healthcare workers are at risk of developing psychological distress during a pandemic. Yoga, a form of mind-body medicine can reduce body stress and increases well-being. Aims: To assess the effect of yoga on the stress and well-being of healthcare workers during the COVID-19 pandemic. Settings and design: This single-arm pr...

Background: Objective of study was to evaluate the effect of prenatal yoga on maternal gestational weight gain (GWG) and psychological stress in pregnancy (PSS) and to evaluate the effect of prenatal yoga on labour outcomes. Methods: Prospective randomized controlled trial conducted at AIIMS, New Delhi between May 2020-December 2021. Sixty women ea...

Introduction Obstructive sleep apnea [OSA] is a risk factor for stroke and refractory hypertension [RH]. OSA causes disrupted sleep, intermittent hypoxia, and hypoxia-induced systemic inflammation and sympathetic activation are potential pathogenic mechanisms for the first ever stroke and refractory hypertension. The aim of the present study was to...

Background: Obesity is recognised as an important risk factor for obstructive sleep apnea (OSA), with obese individuals at a four times higher risk of being diagnosed with the syndrome. Treating obesity with lifestyle modification is associated with a reduction in the severity of obstructive sleep apnea. Yoga comprises lifestyle modification that...

An 88-year-old man underwent a dual chamber pacemaker implantation for complete heart block. Post procedure 12-lead electrocardiogram showed some abnormal findings. The reader is challenged to identify the abnormalities and then explain the mechanism of these findings. The discussion then guides the reader with the explanation.

Introduction: Mitral stenosis (MS) is associated with a high risk of cardio-embolic events. However, current recommendations for initiating anti-coagulant therapy in patients with MS is limited to patients with atrial fibrillation (AF),atrial thrombi or those with a prior stroke. In patients with moderate to severe MS who are in sinus rhythm there...

Chronic Insomnia is a highly prevalent sleep disorder, and often presenting challenges in treatment. We present a case of thirty-eight-year-old male diagnosed with chronic Insomnia who received treatment with Cognitive Behavioural Therapy for Insomnia (CBT-I) and multiple concurrent hypnotic and psychotropic drugs over a decade, without noticeable...

Background The prevalence and genetic spectrum of cardiac channelopathies exhibit population-specific differences. We aimed to understand the spectrum of cardiac channelopathy-associated variations in India, which is characterised by a genetically diverse population and is largely understudied in the context of these disorders. Results We utilised...

A middle-aged pre-menopausal female presented with shortness of breath and syncope. She had a past history of acute onset chest pain with elevated cardiac enzyme, regional wall motion abnormality on echocardiography, and a coronary anomaly in angiogram. She was being treated as a case of coronary artery disease. On current evaluation, she had right...

Objective Trikatu is an Indian polyherbal formulation comprising three herbs, i.e., Zingiber officinale, Piper longum, and Piper nigrum. It is traditionally used to treat metabolic disorders such as type 2 diabetes mellitus (T2DM), dyslipidemia, and obesity. However, its mechanism of action remains unknown. This study aims to explore the underlying...

Background The present study aimed to evaluate the safety and prophylactic efficacy of add-on Comprehensive Ayurveda and Mindfulness-based Yoga (CAY) regimen to standard care among Healthcare workers (HCWs) against COVID-19. Materials and methods This prospective single-blind (outcome assessor-blinded) RCT was conducted in tertiary care hospital i...

Aims: Sudden cardiac death (SCD) continues to be a devastating complication amongst survivors of myocardial infarction (MI). Mortality is high in the initial months after MI. The aims of the INSPIRE-ELR study were to assess the proportion of patients with significant arrhythmias early after MI and the association with mortality during 12 months of...

A 6‐year‐old girl presented with a difficult to control epilepsy syndrome. On evaluation, additional presyncope episodes associated with polymorphic ventricular tachycardia were also noted. A diagnosis of early repolarization syndrome was made with early repolarization pattern on ECG, documented VT episodes and clinical presyncope (Proposed Shangha...

Rheumatic heart disease (RHD) is often considered as a disease of developing countries and India is the home of about 40% of RHD patients. Environment seems to play a major role in its causation. Since gene environment interactions can lead to alterations of various metabolic pathways, identification of altered metabolites can help in understanding...

The COVID-19 pandemic has posed a significant threat to human health due to the lack of drugs that can potentially act against SARS-CoV-2. Also, even after the emergency approval of WHO, the vaccines’ efficacy is still a question, and people are getting reinfections. Previous studies have demonstrated the efficacy of traditional medicinal plants ag...

Background: Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India. Aims: The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational...

Background Nature and intensity of physical activity may influence cognition, coping mechanisms and overall personality of an individual. The objective of this cross-sectional study was to compare cognition, coping styles and vedic personality among individuals practicing different lifestyle. Methods Thirty-nine healthy young adults of both gender...

Background The use of complementary and alternative medicine, particularly yoga is increasing in non-communicable diseases (NCDs). We assessed the overall awareness regarding yoga among patients and their opinion about it as an adjunct therapy for NCDs. Methods We included 384 patients attending the cardiology and neurology clinics at a tertiary c...

We hereby present a case of congenitally corrected transposition of great arteries association of bicuspid aortic valve morphology and anomalous separate origin of the right ventricular branch of the right coronary artery. We aim to highlight the role of computed tomography angiography in identifying these rare associations.

Even after one and a half years since the outbreak of COVID-19, its complete and effective control is still far from being achieved despite vaccination drives, symptomatic management with available drugs, and wider lockdowns. This has inspired researchers to screen potential phytochemicals from medicinal plants against SARS-CoV-2, adopting a bio-in...

Context: In view of the rising burden of type 2 diabetes mellitus (DM) cases in India, there is an urgent need for an effective, low‑cost, sustainable intervention controlling diabetes thus preventing complications. Aims: This study aimed to assess the effect of structured yoga programs on diabetes. Subjects and Methods: This was a community‑based...

PurposeLate-onset atrial fibrillation (LOAF) after valve surgery for degenerative mitral valve disease often with underlying mitral valve prolapse is a known phenomenon. However, there is no similar data for postoperative rheumatic heart disease (RHD) patients. We sought to assess the incidence and predictors of LOAF during postoperative follow-up...

Classically described in tortuous coronaries, the concertina effect is a type of pseudostenosis induced by guidewire and is extremely rare in the left main coronary artery because of its short length. However, concertina effect in the left main coronary artery after percutaneous intervention should be considered in the appropriate setting to avoid...

Objectives This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS). Background There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been lar...

Background Epidemiological studies have shown an increased prevalence and incidence of hypertension as well as a higher incidence of stroke among patients suffering from RLS. The objective of this study was to estimate the prevalence of RLS among patients with resistant hypertension (RH) and compare the clinical characteristics of these patients wi...

Nisha Amalaki (NA), an Indian herbal formulation consisting of two herbs, Curcuma longa and Emblica officinalis , has been commonly used to treat Type 2 diabetes mellitus (T2DM). However, the pharmacological mechanism of NA remains unknown. In this study, a network pharmacology-based approach was used to explore its underlying mechanism. NA phytoch...

BACKGROUND: Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS + myocardial ATTR-CA) occurs in significant proportion of patients undergoing surgical aortic valve replacement (SAVR). OBJECTIVES: This study aimed to determine the prevalence of ATTR-CA in se...

With the current pandemic of the novel coronavirus disease 2019 (COVID-19) in hand, researchers around the globe are dexterously working to find the best suitable drug candidates and overcome vaccination-related challenges, to achieve efficient control over the second surge of COVID-19. The medical consultants time and again have been reiterating t...

Aortic involvement can be secondary to various pathologic disease processes. These may result in stenotic or aneurysmal aortic lesions with a varied spectrum of imaging findings including intra-luminal, mural, and periaortic changes along with associated loco-regional or distal changes, depending on the etiology. Multidetector computer tomography w...

Aim The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus. Methods Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with a...

The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left...

Background.: Nursing staff suffer from various level of stress and burnout. We aimed to assess the effect of 12 weeks of structured yoga on stress and the professional quality of life among nursing staff. Design and method.: An open-label, phase-II randomized clinical trial was undertaken considering a sample size of convenience was done. In ser...

Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of...

Background Inflammation has been implicated in the initiation and perpetuation of non‐valvular atrial fibrillation (AF). However, there is a lack of similar data on AF in rheumatic heart disease (RHD). The objective of this study was to analyze the association of inflammation as measured by serum inflammatory biomarkers with AF in rheumatic mitral...

Background: This study was designed to evaluate the effectiveness of a yoga-based exercise program (YBEP) in improving glycemic control in people with type 2 diabetes mellitus. Materials and methods: Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5%-10% were randomized in 1:1 ratio. The primary outcome measure...

Case presentation: A 32-year-old professional bodybuilder presented with acute decompensated heart failure. He gave a history of anabolic androgenic steroids (AAS) use for >2 years and mephentermine use for the preceding 3 months. Management: Transthoracic echocardiography showed severe left ventricular (LV) dysfunction with a large pedunculated, m...

Objective To evaluate the effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine. Methods CONTAIN was a prospective, randomized, open-label superiority trial with blinded endpoint assessment carried out at a single tertiary care academic hospital in New Delhi, India. Patients enrolled...

Objective: To evaluate effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine.Background: Standard therapy for prevention of migraine attacks entails use of pharmacological agents. However, not all patients are either compliant or respond optimally and many of them develop adverse effe...

A 50-year-old woman presented with complaints of palpitations and breathlessness of 6 months’ duration. She was being treated elsewhere as a case of dilated cardiomyopathy. On evaluation she had racoon eyes, poor progression of R wave on ECG and low-voltage complexes in the limb leads. Echocardiography revealed biventricular hypertrophy, diastolic...

Objectives: Bee-Humming Breathing (BHB) exercise is a simple yogic practice recommended for its favorable effect on cardiac physiology, including blood pressure (BP) and autonomic nervous system. However, strong evidence supporting its effectiveness is lacking. The present study was designed to evaluate the immediate effect of BHB exercise on bloo...

Introduction: This study was designed to investigate the effectiveness of a video-based lifestyle education program (VBLEP) in improving glycemic control in people with type 2 diabetes mellitus compared with usual care. Methods: Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5-10% were randomized in a 1:1 ratio...

Background Asynchronous activation of left ventricle (LV) due to chronic right ventricular (RV) pacing has been known to predispose to LV dysfunction. The predictors of LV dysfunction remain to be prospectively studied. This study was designed to follow up patients with RV pacing to look for development of pacing-induced cardiomyopathy (PiCMP), ide...

Background and objectives: Ischemic stroke (IS) and coronary artery disease (CAD) share common risk factors and one may be the harbinger of the other. We aimed to study prevalence of symptomatic and asymptomatic CAD in a cohort of consecutive patients with IS and assess its relationship with intracranial and extracranial large artery cerebrovascul...

Home to a culturally heterogeneous population, India is also a melting pot of genetic diversity. The population architecture characterized by multiple endogamous groups with specific marriage patterns, including the widely prevalent practice of consanguinity, not only makes the Indian population distinct from rest of the world but also provides a u...

A 40-year-old male, diagnosed to have WPW syndrome and symptomatic with recurrent palpitations, was taken up for radiofrequency ablation. There was difficulty in coronary sinus cannulation. Coronary venogram revealed coronary sinus atresia with persistent left superior vena cava, and collateral venous pathways draining into the right atrium. This c...

A 50-year-old woman presented to our hospital with Canadian Cardiovascular Society grade III angina of 4 months duration. Coronary angiography of the patient showed the absence of left main coronary artery from the left coronary sinus. There was a single right coronary artery (RCA) with a super dominant course from right coronary sinus. It also sho...

Won the first prize in "Clinical Case Award - unusual heart failure presentations: teach the teachers"

Background: Coronary artery disease (CAD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM) and may be asymptomatic. Objective: The objective of this study was to assess the prevalence of asymptomatic myocardial ischemia in patients with T2DM using stress myocardial perfusion imaging. Methods: We evaluated 97 conse...

Modified apical four chamber view showing ventricular lead insertion at right ventricular free wall.

Modified subcostal right ventricular outflow view showing ventricular lead at RVOT septal position.

Apical four chamber view showing ventricular lead at midseptal position.

Apical four chamber view showing ventricular lead at apical position.

Background: Pacing from RV mid septum and outflow tract septum has been proposed as a more physiological site of pacing and narrower paced QRS complex duration. The paced QRS morphology and duration in different RV pacing sites is under continued discussion. Hence, this study was designed to address the correlation of pacing sites in right ventric...

Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STE-MI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in pa...

Background and Objectives: Pain associated with injection is a root of great anxiety and distress and incite severe fear, which may lead to treatment noncompliance. The present study aimed to assess the effect of vibratory stimulation on pain perception after intramuscular (IM) injection of benzathine penicillin to patients having rheumatic heart d...

This study intended to find out the outcome (in terms of quality of life and activity levels) of coronary artery bypass graft surgery (CABG) in Indian population; and whether there are differences associated with gender of the patient. Standard SF 36 questionnaire was utilized to access patient's general health, emotional status, and social activit...

Long QT syndrome 10 is among the very rare forms of Long QT syndrome described sparingly. Phenotypically it is supposed to mimic LQTS 3 and is associated with sodium channel dysfunction due to defective Sodium Voltage-Gated Channel Beta Subunit 4 (SCN4B) gene. Here, we present a case of a boy from Punjabi family, presented with recurrent “seizures”...

Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Medication adherence ranges from 25% to 50%, and the tolerance of guideline-based medication is low for Indian patients. We took out guidelines on HF in 2015, and this update covers the changes which have occurred in HF management in the past 2 years. A...

Introduction Presence of chronic low grade inflammation has often been implicated in the etiology of atrial fibrillation (AF). Whether pre-existing inflammatory state promotes AF or initiation of AF activates inflammation is a dilemma among clinicians. This study investigates the role of high sensitive C reactive protein (hs-CRP) and interleukin 6...

Objective: Obstructive sleep apnea (OSA) is a prevalent condition that is increasingly recognized to be associated with cardiovascular disease. We aimed to investigate the subclinical systolic ventricular dysfunction of patients with OSA using novel speckle tracking echocardiographic (STE) techniques. Methods: This study included 31 patients of pol...

Purpose of the Study Normal values of cardiac mechanical synchrony parameters in gated myocardial perfusion single-photon emission computed tomography (GMPS) are well established in literature from the Western population. The aim of the study is to establish normal values of mechanical synchrony with GMPS in Indian population and to find out whethe...

Objective: The effect of cardiac resynchronization therapy (CRT) on right ventricular ejection fraction (RVEF) and intraright ventricular dyssynchrony (IRVD) is questionable. Furthermore, it is unclear whether baseline IRVD and RVEF influences response to CRT. The aim of this study is to evaluate the effects of CRT on RVEF and IRVD and to investig...

Background: Patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) are at risk for thromboembolism and restoration of sinus rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral valvotomy (PBMV) improves hemodynamics, but may not be enough to restore SR. Methods: Prospective randomized study aimed at evaluatin...

Objective: The aim of the study was to compare the myocardial perfusion defects in patients with right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on stress-rest Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography. Patients and methods: A total of 31 patients with permanent pacemakers (RVOT...

Background : Several studies have been conducted to assess the stroke awareness among the general population. Few studies conducted on stroke patients have revealed inadequate knowledge regarding various aspects of stroke. No comparative study of stroke awareness among patients with stroke and patients of cardiovascular disorders who are at high ri...

Background: Electrocardiographic (ECG) and fluoroscopic criteria, which are the only available guides to achieve a true septal position during right ventricular outflow tract (RVOT) pacing, have been infrequently validated. We sought to validate these using cardiac computed tomographic angiography (CTA) to confirm lead position within the RVOT sep...

Background: Studies on predictors of ischemic strokes caused by rheumatic heart disease (RHD) are sparse and extremely important for identifying high-risk cases to direct future therapeutic trials for prevention of ischemic stroke in this population. Objective: The aim of the present study was to study the predictors of ischemic stroke in patien...

Permanent pacing, being non physiological, often results in ventricular dysfunction over time. Narrower paced QRS duration from pacing the right ventricular outflow tract septum, might result in relatively preserved ventricular function over long term follow up.

The aim of this study was to evaluate equilibrium radionuclide angiography (ERNA) in prediction of response to cardiac resynchronization therapy (CRT) in non-ischaemic dilated cardiomyopathy (DCM) patients. Thirty-two patients (23 males, 57.5 ± 12.1 years) were prospectively included. Equilibrium radionuclide angiography and clinical evaluation wer...

The aim of the study was to evaluate gated myocardial perfusion SPECT (GMPS) in the prediction of response to cardiac resynchronization therapy (CRT) in nonischaemic dilated cardiomyopathy patients. Thirty-two patients (23 men, mean age 57.5±12.1 years) with severe heart failure, who were selected for CRT implantation, were prospectively included i...

Chronic ventricular pacing is known to adversely affect left ventricular (LV) function. Studies comparing right ventricular outflow tract (RVOT) pacing with RV apical (RVA) pacing have shown heterogeneous outcomes. Our aim was to objectively assess LV function and mechanical dyssynchrony in patients with RVOT and RVA pacing using equilibrium radion...