Indian Journal of Clinical Cardiology

Beta blockers (BBs) are widely acknowledged as a standard care for numerous cardiovascular conditions. They have a long-established history in treating angina, regulating heart rate in atrial fibrillation and ventricular tachycardia, and managing heart failure with reduced ejection fraction (HFREF). The effectiveness of BBs in treating acute coronary syndrome was established during a time when reperfusion therapies were not readily available. However, with the recent advancements in coronary revascularization techniques, the role of BB therapy in managing patients after a myocardial infarction and in those with stable angina has become a subject of debate. Likewise, there are uncertainties about the efficacy of BBs in individuals with HFREF who also suffer from atrial fibrillation, as well as in patients with heart failure with preserved ejection fraction (HFPEF). Furthermore, there are numerous concerns about using BBs as the initial therapy, as was customary in hypertension management in the past, and safety concerns regarding their use in patients undergoing non-cardiac surgery. This comprehensive review aims to thoroughly examine all existing recent evidence concerning BB therapy in various cardiovascular scenarios and to provide a valuable guidance to the clinicians in the field of cardiology.

Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) used to examine the coronary arteries with a higher resolution. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify vulnerable plaque. Because of the strong attenuation of light by blood, OCT requires a field of view that is free of blood. OCT can provide detailed information on coronary intervention such as dissection, tissue prolapse, thrombus stent malapposition, and under expansion. Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited for various reasons. Herein, we provide a comprehensive up-to-date overview on the utility of OCT in coronary artery disease, specifically acute coronary syndromes along with a summary of the evidence, work in progress, and future directions.

For more than six decades, ischemic heart disease has sustained as the world’s leading cause of death. Growing evidence suggests chronic inflammation as the underlying pathophysiology of this illness. Due to this, inflammatory markers have become a mainstay of diagnosing, prognosticating, and following up the effectiveness of therapy. Colchicine remains a contentious treatment option for coronary heart disease, despite mounting evidence to the contrary from recent studies. This article discusses the basics of inflammation, the role of colchicine, various clinical studies, and the latest guidelines on colchicine. Colchicine has the potential to develop into a cheap, novel, and effective therapy for coronary artery disease.

Transcatheter aortic valve replacement (TAVR) has become the mainstream option for patients with symptomatic severe aortic valve stenosis and is preferably performed by the transfemoral route. However, a subset of patients requires alternative access with comorbidities associated with femoral access routes, and alternative access such as transapical, transaxillary, transcarotid, subclavian, and transcaval can be considered. However, access options are further limited by the presence of severe comorbidities. This case reports TAVR performed through a transfemoral approach in a patient with previous aorto bi-iliac bypass graft surgery.

“Coronary cascades” or “coronary arcades” are congenital inter-coronary communications allowing uni- or bi-directional blood flow seen in the absence of obstructive coronary lesions. Coronary cascades take up the role of collaterals if atherosclerotic lesions develop. We present the angiogram images of a coronary cascade connecting left anterior and right posterior descending arteries (LAD and RPDA) in the distal interventricular groove in a patient with spontaneous coronary artery dissection and near total occlusion of LAD who presented with inferior wall myocardial infarction secondary to acute thrombotic occlusion of the right coronary artery. The presence of the arcade prevented a massive inferior or anterior wall myocardial infarction in our patient.

Acute promyelocytic leukemia (APML) is a myeloid leukemia classified as M3-AML. It is known for its bleeding diathesis, which is predominantly driven by disseminated intravascular coagulation and primary hyperfibrinolysis. However, thrombotic events are relatively less common. A combination of bleeding and thrombotic events is rare and poses a challenge in management. We present a case of acute promyelocytic leukemia complicated by deep venous thrombosis, pulmonary thromboembolism, and hematemesis.

For mitral valve pathologies like mitral stenosis and mitral regurgitation various treatment options are currently available. However, in patients who have previously operated on mitral valves only a few options are applicable. In this case report, we provide detailed insight into transcatheter mitral valve-in-valve implant in a patient with a degenerated surgically implanted mitral bioprosthetic valve.

Coronary artery anomalies are a rare group of congenital cardiac disorders with an incidence of less than 1% in general population. Coronary cameral fistula (CCF) are abnormal vascular communications between coronary artery and a cardiac chamber. These fistulae result from congenital abnormalities or are acquired as a result of trauma or cardiac surgery. We present the transcatheter closure of a large CCF from right coronary artery (RCA) to right atrium in an eight-year-old girl.

We present a bizarre electrocardiogram that needs critical evaluation to avoid unnecessary investigations.

Pacemaker bigeminy is not an uncommon electrocardiographic finding in device clinics. However, such a pattern mandates the differentiation of important possible diagnostic considerations such as premature atrial contractions, oversensing the T wave or the QRS complex, dual AV nodal physiology, and retrograde atrial depolarization. We present a case of pacemaker bigeminy where ventricular pacing was used to exclude the truncated form of pacemaker-mediated tachycardia and reach a diagnosis of atrial bigeminy, which was crucial from the management’s perspective.

The population with chronic kidney disease (CKD) is unique in the sense that they are more prone to heart failure and ischemic heart disease. This is mainly due to the presence of hypertension, anemia, and associated fluid overload, which is common to them. Managing heart failure in this cohort of patients is challenging as treatment of heart failure leads to worsening of kidney parameters.