心血管疾患と診断

Cardiovascular diseases (CVD) are one of the major causes of death all around the world. In India, death rate from heart diseases has increased in parallel with the tremendous increase in population which is a major reason why clinical research in this field is extremely important. The present study was undertaken to assess the nutritional status and the risk factors for prediction of CVD in forty middle aged Indian subjects to enable them to take early preventive measures. The study revealed that genetic factors, high Body Mass Index (BMI), high fat and low fibre diets, serum Lipoprotein (a) and Homocystiene were largely responsible for the subjects to be in high risk category. The serum Lipoprotein (a) levels (47.7 ± 2.5 mg/dl) and Homocystiene levels (19.0 ± 7.8 mg/dl) were significantly high (p ≤ 0.01) as compared to normal. A strong two tailed correlation was seen at 0.01 and 0.05 levels between the serum cholesterol and LDL levels of diabetic subjects. Similarly correlation was seen between high fat intake and high BMI of all the forty subjects studied. The results indicate that Indians need to control their saturated fat intakes, take a high fibre and folic acid rich diet, exercise and reduce stress to bring a halt to the rapidly rising incidence of this chronic and serious problem of CVD in India.

Background: Coronary pulmonary fistula is a rare clinical entity. Majority of them are clinically silent. But rarely chest pain, myocardial ischaemia and heart failure may be the presenting features. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases.

Case Presentation: Here we present a case of 41 years male presenting with recurrent chest pain for the last 2 years which had increased in frequency for last couple of days. Repeated Chest x rays, electrocardiograms and echocardiography being normal. Lastly this case was diagnosed by CT coronary angiography which revealed normal caliber left and right coronary arteries but abnormal torturous plexus of vessels seen to arise from proximal part of left anterior descending artery finally communicating with pulmonary trunk suggestive of coronary pulmonary fistula.

Learning objective: Above case depicts an anomaly of coronary artery underdiagnosed since long time in many clinical scenarios in which patient might have repeated episodes of angina and this should be kept mind as a possible differential and CT angiography proves to be diagnostic in identifying the anomalous vessel with its origin and communications.

Introduction: Our aim was to assess by Tissue Doppler Imaging (TDI) the early left ventricular (LV) myocardial function abnormalities in obstructive sleep apnea (OSA).

Methods: Thirty four patients (11 females, 23 males, aged 25-51) with newly diagnosed, nontreated OSA and normal echocardiographic parameters of LV diastolic and systolic function were investigated. The patients with known cardiovascular or respiratory disease were excluded. The LV end-systolic longitudinal strain (LS), peaksystolic longitudinal strain rate (LSR) and isovolumetric acceleration (IVA) of the septal and lateral mitral annulus was evaluated by TDI. Twenty two healthy persons (9 women, 13 men, and aged 23-48) were assessed as controls.

Results: All OSA patients demonstrated significant decrease of the LV end-systolic LS: -15.7 ± 0.42% vs controls: -18.9 ± 0.56% (p<0.01) and LV peak-systolic LSR: 1.72 ± 0.63 s-1 vs 3.19 ± 0.68 s-1, respectively (p<0.001). The IVA was also reduced: the septal mitral annulus: -2.82 ± 0.45 cm/sec in OSA vs -4.03 ± 0.6 cm/sec in healthy subjects (p<0.01) and the lateral mitral annulus: -3.37 ± 0.54 cm/sec in gr. I vs -4.29 ± 0.42 cm/sec in gr. II (p<0.01).

Conclusions: Tissue Doppler Imaging might be a reliable method for detection of early abnormalities in LV function in patients with OSA. Reduction of longitudinal strain, strain rate and isovolumetric acceleration might be present in patients with OSA, even without overt diastolic or systolic LV dysfunction. Further studies with larger sample size are needed.

Objective: To evaluate and analyze the echocardiographic changes in end stage renal disease patients on maintenance hemodialysis.

Material and methods: End stage renal disease (ESRD) patients on maintenance hemodialysis for at least 3 months were included in the study. We performed M-mode echocardiography in 35 ESRD patients during interdialytic period usually after 18 hours, without obvious clinical evidence of coronary artery disease, valvular heart disease, congenital heart disease and pericardial effusion.

Results: Echocardiography revealed LV dilation and diastolic dysfunction in 18 (51.2%), left ventricular hypertrophy (LVH) in 17 (48%), systolic dysfunction and pericardial effusion in 10 (28.57%) and 6 (17.14%) patients respectively. RWMA was present in 8.5% and valvular calcification was not seen in our patient group. In sub-group of patients with Hb<10 gm%, LVH was present in 71.42% (15) vs 14.28% (2) in patient group with Hb ≥ 10 gm% (p=0.002). Hypertensive patient population also had higher prevalence of LVH (51.85%)] and systolic dysfunction and RWMA was absent in normotensive group.

Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH.

Background: Statins are a class of drugs for treatment of dyslipidemias, but they are also known to significantly reduce the cardiovascular morbidity and mortality in patients at high cardiovascular risk. The objective of our study was to assess the lipid-lowering potency and tolerability of generic rosuvastatin ROSWERA®, prescribed to patients at high and very high cardiovascular risk, with or without hypercholesterolemia.

Methods: Forty-five consecutive patients (24 females, 53.3%), mean age 62 years were included in this prospective study. ROSWERA® was prescribed 10 to 20 mg once in the evening for primary prevention of high-risk patients or secondary prevention of patients with an overt cardiovascular disease. Levels of total cholesterol, LDLcholesterol, HDL-cholesterol, triglycerides, transaminases and creatine kinase were examined at baseline and at months 3, 6, 12.

Results: total cholesterol and LDL-cholesterol levels decreased from 6.84 ± 0.89 and 4.44 ± 1.01 mmol/l (baseline) to 5.05 ± 0.37 and 2.77 ± 0.61 mmol/l (month 12) in patients, treated with ROSWERA® 10 mg. The levels of total cholesterol and LDL-cholesterol diminished to 5.30 ± 0.43 and 2.84 ± 0.45 mmol/l at month 12 in patients, receiving ROSWERA® 20 mg. The transaminase and creatine kinase values did not change significantly and no adverse events were reported.

Conclusion: The generic rosuvastatin ROSWERA® at dosage 10 mg and 20 mg daily demonstrated high lipidlowering efficacy and good safety profile in patients at high and very high cardiovascular risk.

Psychosocial factors play an undoubtedly important role in the development of cardiovascular diseases and can also highly affect efficacy and outcome of cardiac treatment or the success of rehabilitation. These factors are proven to have a major role in patient evaluation in two ways: (1) risk factors are important in establishing prognosis and/or as (2) indicators of need for further specific psychological interventions.

According to the literature available: depression, severe anxiety and other psychosocial characteristics are considered to be risk factors. These factors include low socio-economic status, chronic family or work related stress, social isolation or lack of support, negative emotions, affective dysregulation and also negative personality patterns or hostility. Identifying and examining these factors have great importance in multidisciplinary patient care. It is important to highlight the chances of adverse outcome and provide clinical solutions since many of the risk factors are treatable psychological conditions.