Seshasayee Narasimhan

Hunter New England Health | HNEPH · Department of Medicine

Keywords: Diabetes Mellitus; Revascularization; AKI Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD) and is associated with a higher incidence of myo-cardial infarction (MI) and sudden cardiac death (SCD). Patients with DM have higher mortality during the acute period of acute coronary syndrome (ACS), greater morbidit...

Keywords: Fibroelastoma Recurrence; Left Ventricular Cardiac Tumor; Transthoracic Echocardiography Papillary fibroelastomas are an uncommon cardiac anomaly which may present with cardiac or neurological symptoms or be found incidentally on echocardiography [1]. We report a patient who presented as a 74-year-old in 2007 following a cerebrovascular a...

Coronary artery bypass grafting represents one of the most commonly performed cardiac surgeries worldwide. Recently, interest has increased in providing patients with a less invasive approach to cardiac surgery, such as thoracotomy and endoscopic techniques using robotic technology as an alternative to traditional sternotomy. As the population gets...

We present an interesting case of an atypical presentation in a 63-year-old male with sudden onset chest and jaw pain, and electrocardiographic findings suggestive of pericarditis. Following a positive exercise stress test, and ongoing intermittent symptoms not relieved by nitrate administration, he unfortunately succumbed to cardiac arrest with pu...

Transcatheter aortic valve replacement has transitioned from an experimental procedure to an important alternative therapy for patients with symptomatic aortic stenosis and high surgical risk. We present a case outlining an approach to deal with the issue of "failure to cross" the aortic valve in transcatheter aortic valve replacement from the tran...

Antinuclear antibodies (ANA) are autoantibodies produced against nuclear antigens which is an indispensable tool that improves diagnostic efficiency of systemic rheumatological conditions and possible identification of neoplasia in certain patient populations with unexplained diagnosis. The staining pattern may be beneficial in assisting the clinic...

Cold agglutinin (CA) disease is an autoimmune disease characterized by the presence of high concentrations of circulating antibodies, usually IgM, directed against red blood cells, causing them to agglutinate and undergo lysis. It is a form of autoimmune haemolytic anaemia, specifically one in which antibodies bind red blood cells only at low body...

Suppurative pericardial effusion (SPE) is characterized by infection of the pericardium that produces a purulent effusion that is either seen macroscopically or on tissue microscopy. Bacterial pericardial infections are rare but typically manifest as a serious febrile disease with tachycardia, hypotension and altered mental state. Prompt diagnosis...

Keywords: Aortic Stenosis; Transcatheter Aortic Valve; Transseptal Puncture Transcatheter aortic valve implantation (TAVI) has transitioned from an experimental procedure to an important alternative therapy for patient with symptomatic aortic stenosis and high surgical risk. We present an approach to deal with the issue of 'failure to cross' the ao...

We present an intriguing case of delayed diagnosis in a 67-year-old male with exertional dyspnoea and chest pain. Following a positive exercise stress test, a coronary angiogram was performed showing a 90% stenosis in the mid third of the posterolateral ven-tricular branch of the right coronary artery. Despite successful revascularization of the ve...

Introduction Background: Chronic heart failure (CHF) affects two percent of Australians, with a disproportionate larger prevalence in regionalrural centres. Heart failure with reduced ejection fraction (HFrEF) accounts for over three-quarters of CHF cases. The aim of this study was to characterize the HFrEF population in regional NSW and its manage...

Background: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. Methods: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community pract...

Background: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stab...

Dual antiplatelet therapy (DAPT) has become a mainstay of treatment for coronary artery disease. The recently updated 2016 American College of Cardiology/American Heart Association (ACC/AHA) guidelines have challenged the optimal duration of DAPT therapy. We discuss the currently available antiplatelet agents and the evidence in support of their co...

We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From computed tomography coronary angiography, a left anterior descending artery lesion was identified and successfully revascularized with a drug-eluting stent. Due to persistent chest pain, further investigation re...

Introduction: The direct oral anticoagulants (DOACs) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter (AFL). The adoption and application of these drugs was analysed in a regional hospital inpatient cohort and compared to national prescribing data. Method: Digital medical records identified pre...

Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist early exclusion of acute coronary syndrome in Australian emergency departments. The utility and limitations of this approach are discussed.

This is a case report of a 61-year-old female presenting with ongoing chest pain in the setting of an NSTEMI with lateral ST-T changes. On attempting to open the left circumflex (LCX), it resulted in a proximal LCX dissection. The patient remained stable with no further chest pain. She was treated with IV Eptifibatide for 48 hours and restudied in...

Nursing, throughout the ages, has crawled out of the metaphorical gutter and into the professional arena. This occurred through various efforts, including the introduction of nursing education, to professionalise nursing. The role of doctors and nurses are inherently different, which transfers to their education and professional responsibilities, r...

A 60-year-old woman was brought to the emergency room after acute onset chest pain and shortness of breath developed while she was shopping. Her medical history was significant for migraine headaches. Her home medications were sumatriptan and ibu-profen. A 12-lead electrocardiogram showed ST-segment elevation in leads II, III, aVF, and V 2 through...

We report 2 noteworthy cases of very late stent thrombosis presenting as ST-segment-elevation myocardial infarction, with vastly different manifestations. Both patients were women who had histories of multivessel percutaneous coronary intervention with first-generation sirolimus-eluting stents, in 2005 and 2006. On the more recent occasions reporte...

A 56-year-old man presented with anasarca and a 40-lb weight gain that had occurred over the course of 3 to 4 weeks. He had a history of permanent atrial fibrillation and a congenital anomaly of the right ventricular inflow tract. This defect consisted of a muscular shelf in the right ventricular inflow tract, which encased the tricuspid subvalvula...

It is well established that South Asians living in the western world have a higher burden of cardiovascular disease than other ethnicities. Additionally, South Asians develop cardiovascular disease at a younger age, have a more aggressive form of coronary artery disease, and a higher overall mortality. This predilection seems to be multifactorial a...

The long-term benefits of a left internal mammary artery bypass graft compared to the left anterior descending artery have been well described. The use of drug-eluting stents has minimized the morbidity of revascularization. Hybrid coronary revascularization is the planned use of minimally invasive surgical techniques for left internal mammary arte...

over medical therapy (HR 0.43, 95% CI 0.32 to 0.58) and PCI (HR 0.53, 95% CI 0.39 to 0.72) after adjustment for age, sex, smoking status, hypertension, diabetes, previous MI, cholesterol, angina status, number of diseased vessels and treatment allocation. When comparing individual outcomes among the three strategies of medicine, PCI or CABG at 10 y...

Percutaneous coronary intervention (PCI) provides advantages compared to thrombolytic therapy in the treatment of ST-elevation myocardial infarction (STEMI). Elderly patients have increased in-hospital mortality; the predictors of adverse outcomes are not well established, with limited data available regarding late follow up of these patients. We e...

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay u...

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay uni...

To compare results of statistical process-control analyses of in-hospital deaths of patients with acute myocardial infarction by using either administrative or clinical data sources and prediction models, and to assess variation in results according to selected patient characteristics. Retrospective, cross-sectional study comparing variable life-ad...

Screening of target populations for hemochromatosis (HFE) gene allele status has been recommended. Alcoholic liver disease may be associated with iron overload and there is evidence of excessive alcohol consumption among patients with hereditary hemochromatosis. This study determined the HFE gene allele status in alcohol-dependent patients and expl...

Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at our hospitals with the current international guidelines for the use of this drug. A retrospective audit was carried out on all patients aged 15 years or older, with a primary di...

To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. A postal questionnaire sent to hospital doctors and nurses. All doctors working at Wellington, Kenepuru, and Hutt Hospitals in the greater Wellington region, and nurses working in acute medica...

Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in alcohol-dependent male subjects. In this study, we measured plasma homocysteine levels in 20 female and 31 male alcoholic subjects admitted to hospital for detoxification. Nutritional...

re-thrombolysis with t-PA. Her ST segments settled butshe developed post infarction angina and LVF, whichrequired IV morphine and nitrates. An echocardiogramdone on day 1-post infarction showed a LVEF of 20%and global LV dysfunction. Additionally, she developedacute renal failure with a creatinine of 112mmol/L.Dopamine was commenced at 2.5mcg/kg an...