Despite rapid strides in pharmacotherapy for hypertension over last few decades, resistant hypertension continues to be prevalent. Activation of the sympathetic nervous system is an important etiological factor in the pathogenesis of hypertension and renal sympathetic nervous system is one of its pivotal arm. Thus, renal sympathetic system was the target of therapy for hypertension in the initial period, in the form of sympathectomy. The major adverse events associated with this procedure and the emergence of potent blood pressure (BP) lowering medications led to disrepute of this procedure. Of late, novel techniques targeting the sympathetic nervous system have emerged. Among them and the most promising one is catheter-based radiofrequency ablation of renal nerves-Renal sympathetic denervation (RSD). Clinical trials of renal denervation therapy have shown consistent and durable reduction of systolic as well as diastolic BP persisting up to 3 years. Beyond BP control, renal denervation also exerts favorable effects on glucose metabolism, heart failure, and sleep apnea. As many as five different catheter-based renal denervation systems are now approved for treating resistant hypertension, the maximum clinical experience being with Medtronic's symplicity system. The European Society of Cardiology guidelines for hypertension 2013 now recommend catheter-based renal denervation for management of drug-resistant hypertension. In this review, we briefly discuss the role of sympathetic nervous system in the pathogenesis of hypertension, the present status, and future perspectives of RSD in the treatment of resistant hypertension.

Background: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. The aim of this study was to determine the conventional risk factors of CAD in young and elderly aged patients in Andhra Pradesh. Materials and Methods: Total of 190 CAD patients admitted in ICCU at Santhiram Medical College General Hospital, Nandyal, Andhra pradesh were selected for the study. In this, 90 patients were aged between 18-45 years, and 100 were more than 45 years of age. These patients were evaluated for risk factor contributing to occurrence of CAD. Results: The hypertension (20%), smoking (22%), diabetes mellitus (11%) and dyslipidemia (8%) were the most common risk factors in young patients. Overall risk factors were more likely in males compared to females (18 to <45 years, 79%; ≥65 years, 69.1%). With reference to elderly patients, the diabetes mellitus (21%), hypertension (14%), smoker (17%), kidney disease (11%) and dyslipidemia (9%) were the most common risk factors. Conclusion: Young patients had a different risk-factor profile when compared with older patients. Hypertension and smoking were the most common risk factors in young patients of CAD, whereas diabetes mellitus, kidney disease, and smoking were found in elderly patients.

Background: The yogic visual concentration technique, trataka is similar to meditation. Research studies have shown a shift toward the vagal tone during meditation. However, autonomic changes in trataka were not studied. Objectives: The present study was planned to assess the changes in heart rate variability (HRV) following trataka. Materials and Methods: HRV and breath rate were assessed in thirty healthy male volunteers with ages ranging from 20 to 33 years (group mean age ± SD, 23.8 ± 3.5) before and after yogic visual concentration (trataka) and control session on 2 separate days. Repeated measures analysis of variance (ANOVA) were performed with two "within subjects" factors, i.e., Factor 1: Sessions; trataka and control and Factor 2: States; "Pre", and "Post". This was followed by post-hoc analyses with Bonferroni adjustment comparing "Post" with "Pre" values. Results: There was a significant decrease in LF (RM ANOVA with Bonferroni adjustment P < 0.01) and increase in high frequency (P < 0.01) after trataka. Breath rate (P < 0.001) and heart rate (P < 0.01) were significantly reduced after trataka compared to before. Control session showed no change. Conclusions: The practice of trataka leads to increased vagal tone and reduced sympathetic arousal. Though trataka is known as cleansing technique, it could induce calm state of mind which is similar to a mental state reached by the practice of meditation.

Cor triloculares biatritum is a rare congenital heart disease characterized by a three-chambered heart consisting of two atria and a single ventricle; however the case of a 5-month-old African boy who in addition to this defect had an associated tricuspid atresia and an atrial septal defect is reported.

Rasopathy syndromes are a class of phenotypically similar, but genetically distinct multiple anomaly syndromes caused by germ line mutations in genes that encode protein components of the Ras/mitogen activated protein kinase (MAPK) pathway. Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome are part of this group of developmental syndromes and have similar cardiac abnormalities. A 19-year-old male presented with complaints of exertional breathlessness class I for 6 months. Clinical examination revealed characteristic facial features, skeletal abnormalities, growth and neurocognitive problems reported in patients with Noonan syndrome. There was evidence of severe pulmonary hypertension. Trans-thoracic echocardiography revealed right atrial and right ventricular enlargement, severe pulmonary hypertension, no intra cardiac shunt, prolapse of anterior mitral leaflet with mild mitral regurgitation. CT pulmonary angiogram revealed bilateral branch pulmonary artery stenosis. A final diagnosis of Noonan syndrome was made.

Dilated cardiomyopathy (DCM) commonly presents with exertional dyspnea, fatigue, dependent edema and ascites. Jugular venous distension with prominent positive waves, S3 gallop, and regurgitant murmur are usual signs of DCM. There is one reported case of DCM presented with superior vena cava (SVC) thrombosis. Our patient presented with classical clinical features of SVC syndrome, later on confirmed as having DCM and there was no evidence of structural SVC obstruction.