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changes were minimal. The LV strain also changed from 1 month with the
change in absolute value being less than 1 point. The RV strain had a sig-
nificant change from the first week and the change in absolute was more
than 5 points at six months. These changes were seen independent of the
cause of the pacemaker. The patients of acute myocardial infarction and in
patients of symptomatic sick sinus syndrome had similar findings. In our
study, we also observed that the biggest change in RV strain were seen in
patients in whom the percentage of paced beats were high, 1 point in less
than 20 percent paced versus more than 7 points in patient in more than
80 percent.
Conclusion: Right ventricle dysfunction precedes left ventricle dysfunction
in patients who have undergone permanent pacemaker implantation.
Right ventricle strain can predict right ventricular dysfunction as early as 6
months. The patients with a higher percentage of paced beats tend to
develop dysfunction earlier than the patients with lesser percentage of
paced beats.
ABN10090
TO DETERMINE THE RELATION BETWEEN ANKLES BRACHIAL INDEX
WITH ANGIOGRAPHIC STENOSIS AND MAJOR CARDIOVASCULAR RISK
FACTORS IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE
S.R. Mutha, D. Choudhary, Sn Gurmukhani, S. Shah, T. Patel. SMT NHL
Muncipal Medical College, Ahmedabad, India
Introduction: The Ankle Brachial Index(ABI) is an efficient toolfor objectively
documenting the presence of lower-extremity Peripheral Arterial Disease
(PAD).An ABI less than 0.90 have been shown to have a sensitivity of 69-73%
and a specificity of 83-99% fordetecting a lower-extremity stenosisof greater
than 50%. A low ABI has been related to generalized atherosclerosis and an
increased incidence of Cardiovascular (CV) mortality and is independent of
baseline CV disease and risk factors, suggesting that the ABI might have an
independent role in predicting CV events Aims and Objectives Prevalence of
low ABI in patients of ischemic heart disease (IHD). To compare the rela-
tionship between various physiological parameters like age, sex and body
mass index (BMI) with ABI. To compare the relationship betweenprevalence
of low ABI and number of coronaries involved.
Methodology Inclusion Criteria: All the 1423 patients aged 23-90 years
including 1047 male and 376 female undergoing coronary angiography in
tertiary care hospital Exclusion Criteria : Critically ill or who had severe
limb ischemia or patients with amputation were excluded. Statistical
analysis was done by using SPSS 20.0 version. Univariate analysis was
performed by applying the Pearson chi-squared test. Results In this study,
1423 patients were evaluated out of which 66 (4.6%) patients had ABI<0.9.
Out of 66 patients with low ABI, 60(91%) were male and 6(9%) were female,
showing high prevalence in male. In patients having low ABI shows
12(18.2%) had SVD,11(16.7%) had DVD, 26(39.4%) had TVD, comparing this
with patients having normal ABI, shows P value of 0.035 which is signifi-
cant. 411 patients were diabetic including 40(60.6%) patients having low
ABI and 371(27.3%) patients having normal ABI, shows P value of 0.005
which is highly significant.
Conclusion: ABI is helpful in identifying individuals at high risk of coronary
involvement. Although prevalence of low ABI in patients of IHD is 4.6% that
is very low but is highly specific (91%). In patients with ischemic heart
disease low ABI suggests involvement of multivessel disease. Direct asso-
ciation between ABI and significant CAD noted.
ABN110015
NOT SO INNOCENT HEART: ECHO ASSESSMENT OF OBSTRUCTIVE COR
TRIATRIATUM WITH CLEFT MITRAL VALVE
S. Srinivas, N. Swaminathan, G. Ravishankar, G. Justin Paul, S.
Venkatesan. Madras Medical College, Chennai, India
A 29 year old male presented to the outpatient department with evidence
of alcohol intoxication. He had previous history of congenital heart disease
and had lost to follow up for years. He had no symptoms of shortness of
breath, palpitations, chest pain or swelling of feet. There was no h/o bluish
discolouration of skin/mucous membrane or recurrent respiratory tract
infections in childhood. He had stable vitals with normal saturation
measured in all four limbs. General physical examination was unremark-
able with no evidence of cyanosis. Systemic examination revealed a pan-
systolic murmur of grade 3/6 in mitral area. Blood investigations were
normal and 2D transthoracic echocardiography revealed features of
ostium primum atrial septal defect with left to right shunt with partial
atrioventricular septal defect with cleft mitral leaflet with moderate mitral
regurgitation and obstructive cor triatriatum with a peak gradient of 27.5
mmHg. But, as the patient was asymptomatic despite observation of
obstructive cor triatriatum, transesophageal echo was planned which
revealed partial pulmonary venous drainage into low pressure LA cham-
ber. We proceeded with Cath study which proved our findings. Teaching
lesson: Sequential assessment of congenital left atrial flow lesions will be
discussed with an exploration of hemodynamic interaction between cor-
triatriatum and mitral regurgitation.
ABN100010
ALCOHOLIC CARDIOMYOPATHY MIMICKING AS LMCA DISEASE - A RARE
CASE REPORT
S. Srinivas, N. Swaminathan, G. Ravishankar, G. Justin Paul, S.
Venkatesan. Madras Medical College, Chennai, India
A 36 year old male was referred to cardiac ICU with complaints of typical
chest pain and shortness of breath eclass IV NYHA since 2 days. Patient
was a smoker and an alcoholic and had an alcohol binge 2 days ago. There
was no h/o fever, joint pain, rash, and drug or toxin ingestion. Atadmission
patient was drowsy with tachycardia (seen on monitor) with hypotension
on dual inotropes. ECG revealed sinus tachycardia with normal axis with
classical findings of LMCA occlusion- global horizontal ST depression with
ST elevation in lead avR. ECHO done at that time revealed global LV
hypokinesia with a non dilated LV with grade 2 LVDD with normal RV
function. Troponin I was positive. The patient regained full consciousness
in a span of two days as he became hemodynamically stable. Subsequent
ECG revealed normal sinus rhythm with poor progression of R wave and T
wave inversion in L3. Blood investigations revealed deranged renal and
liver parameters. Viral markers were negative. Chest X ray was normal.
After the patient was stabilized, repeat ECHO revealed improved LV
function (EF -45%) with global LV hypokinesia. Patient was planned for
coronary angiogram which revealed normal coronaries. At discharge pa-
tient was hemodynamically stable, ECG showed normal sinus rhythm with
normal axis with poor progression of R wave. Discharge ECHO revealed
improved LV function with EF of 57%, with patchy areas of complete re-
covery. The case highlights the possible alternate diagnosis in patients
with ECG suggestive of LMCA disease.
ABN150023
PERSISTENT LV DYSFUNCTION IN RAT KILLER PASTE POISONING eA
RARE CASE REPORT
S. Srinivas, N. Swaminathan, G. Ravishankar, G. Justin Paul, S.
Venkatesan. Madras Medical College, Chennai, India
A 31 year old female presented with alleged h/o consumption of rat killer
paste (ratol ehalf tube) poisoning to emergency on 04.08.15.Patient was
initially treated in a private hospital for 10 days and referred to our hospital
for further management. At admission patient was in altered sensorium
with tachycardia and hypotension. Cardiorespiratory examination was
unremarkable. There was significant derangement of hepatic parameters
(elevated bilirubin and enzymes with deranged coagulation profile). Renal
parameters and electrolytes were normal. Viral markers were negative.
USG abdomen and KUB was normal. ECG revealed sinus tachycardia and
poor progression of R wave at that time. Echo revealed global hypokinesia
with normal LV dimensions and severe LVSD with EF of 35% with grade 2
LVDD. RV dysfunction was also present. Patient was treated with sup-
portive measures and recovered gradually from toxic hepatitis and toxic
myocarditis. Her discharge echo revealed mild LVSD (EF-50%) and grade I
LVDD with complete recovery of deranged blood parameters. She was
Abstracts / Indian Heart Journal 71 (2019) S30eS97 S69