Indian Journal of Clinical Cardiology

In-stent restenosis (ISR) within bifurcation lesions of the left main (LM) coronary artery (LMCA) is challenging due to its complex anatomy and critical function. This case series highlights 3 patients with LM bifurcation ISR (Medina 1,1,1) post-index intervention using different stent strategies as follows:

Proton pump inhibitors (PPIs) have transformed the way acid-peptic diseases are treated, offering improved patient tolerance, safety, and treatment outcomes. This article explores the critical issue of co-administering PPIs with dual-antiplatelet therapy (DAPT) for cardiac patients, particularly those at risk of gastrointestinal bleeding due to DAPT. Understanding the pharmacokinetics of individual PPIs, including omeprazole, pantoprazole, lansoprazole, and rabeprazole, is essential. Variations in hepatic metabolism can impact clinical efficacy and contribute to drug interactions. Of particular concern is the potential for PPIs to counteract clopidogrel’s antiplatelet effects, thereby influencing major adverse cardiovascular events (MACE). This review sheds light on the intricate interplay between PPIs and antiplatelet agents. It emphasizes the necessity for cautious consideration when co-prescribing PPIs to cardiac patients on DAPT. This article advances our understanding of these interactions and their implications for cardiac safety, offering valuable insights for clinicians and researchers.

Carcinoma of lung (CoL) is the fourth most common cancer in India. It is classified as either small-cell or non-small-cell lung cancer, with adenocarcinoma being the most common variant. CoL can present either as paraneoplastic or non-paraneoplastic manifestation. We discuss a case of a patient who had an abrupt onset of sustained ventricular tachycardia and was subsequently diagnosed with metastatic non-small cell lung cancer with no cardiac infiltrates.

Cancer and coronary artery disease, both leading global causes of mortality, share common risk factors and are exacerbated by various cancer treatments. Coronary artery disease may delay cancer treatment initiation. Revascularization improves the safety of subsequent cancer treatment and long-term survival. Radiation commonly induces ostial coronary artery disease due to its proximity to the mediastinum, while ostial coronary artery disease related to chemotherapy is rarely reported. In this case, we explore an instance of Serous cystadenocarcinoma of the ovary, treated with Neo Adjuvant chemotherapy based on Paclitaxel, subsequently presented with ostial coronary artery disease, leading to cardiogenic shock and heart failure. The condition was successfully managed through bailed out angioplasty, followed by debulking oophorectomy surgery. The patient was under regular follow up for the past 3 years.

Pericardial disorders in connective tissue diseases (CTD) are common and may present as acute or chronic pericarditis. Their presentation as cardiac tamponade is rare. The availability of echocardiography has enhanced the ability to make a early diagnosis of pericardial effusion and tamponade. We report a case of mixed connective tissue disease (MCTD) manifesting as cardiac tamponade at presentation and review of the literature.

Hydatid disease is an indolent parasitic infection caused by Echinococcus. The disease is transmitted through the ingestion of uncooked, contaminated vegetables and can infect almost any human organ, commonly the liver, followed by the lung, and rarely the heart. A computed tomography scan is the modality of choice for identifying hydatid cysts, and magnetic resonance imaging is for identifying complications. The definitive treatment includes surgery, with the possible use of antihelmintics in inoperable cases. To avoid fatal complications, hydatid disease must be treated as soon as it is diagnosed. This case highlights a peasant farmer rearing livestock who presented with chest pain and was incidentally found to have a mass in the left ventricle by transthoracic echocardiography. Further imaging found a large hydatid cyst in the left ventricular wall that was causing chest pain, possibly from the mass effect or compression of the left anterior descending artery.

The diagnosis and therapy of heart failure with preserved ejection fraction (HFpEF) are complicated by the disease’s varied etiology. In the field of heart failure (HF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) has become an important biomarker, providing information on diagnosis, prognosis, and treatment monitoring. This in-depth investigation looks at the connection involving NT-proBNP levels and HFpEF, offering information on possible diagnostic applications as well as consequences for patient care. The study reviews the literature on the connection concerning NT-proBNP and HFpEF and emphasizes how NT-proBNP aids in the distinction of HFpEF from various cardiac and non-cardiac conditions. HF is known to be associated with elevated NT-proBNP levels, but the complex link with HFpEF necessitates careful examination. The abstract explores the difficulties in using NT-proBNP as a diagnostic tool for HFpEF, taking into account the potential influence of renal function, age, and comorbidities on NT-proBNP levels. Additionally, the predictive importance of NT-proBNP in HFpEF is explored, emphasizing its capacity to forecast death and severe cardiovascular events. The abstract emphasizes that diagnosing HFpEF requires a multimodal approach that includes clinical assessment, imaging modalities, and NT-proBNP measurement. In order to accurately manage patients with HF, particularly HFpEF, the abstract highlights the significance of integrating clinical judgment and other diagnostic measures, even though NT-proBNP is still a useful marker in this regard. Lastly, the study offers suggestions for future research trajectories that should further our knowledge of NT-proBNP’s function in HFpEF and improve its clinical applicability in this intricate and varied illness.

We present a case of refractory microangiopathic hemolytic anemia with pigment nephropathy in a case of paravalvular leak, emphasizing an early detailed evaluation of anemia in a patient with a prosthetic valve despite having an alternative etiology, which is completely reversible if treated adequately.

Truncus arteriosus is an exceedingly rare congenital heart disease involving the conotruncal septum of the developing heart. Clinical presentations vary depending on associated anomalies. Surgical management is extremely challenging and differs with anatomic subtypes. We present a case of truncus arteriosus––Vaan Praagh type A4, quadricuspid truncal valve with moderate truncal stenosis and regurgitation, type B interrupted aortic arch who underwent bilateral pulmonary artery banding.

Carotid sinus hypersensitivity is a rare cause of syncope. A 66 year old male patient, presented with an episode of syncope and after evaluation it was diagnosed as carotid sinus hypersensitivity and was treated with dual chamber pacemaker. In the presence of risk factors, carotid sinus hypersensitivity as a diagnosis is considered very rare.