Primary varicose veins are a common affliction of the extremities, whereas the whole body including the genitals are very rarely affected, for reasons not clearly understood. The literature has little references in regards to the number of cases and management these type varicose veins. Treatment of the upper and lower extremities is the ligation and stripping of the varicose veins but what we can done for chest, abdomen, back, and genital varicose veins, is a query. Here we present a case of a 20-year-old male with this unusual condition of primary varicose veins of the whole body with genitals. Diagnosis in our case was made by means of physical examination and venography. The patient was treated surgically by ligation and stripping of the varicose vein from the upper and lower extremities with excellent functional and cosmetic outcome, but left the chest, abdomen, back, and genital veins for laser or other methods, and the patient was referred to higher center for that treatment.

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Objective : The objective of this study was to analyses the major risk factors for coronary artery disease (CAD) for patients with ischemic heart disease in Kerala. Design : A cross-sectional study among patients with established CAD admitted in the Department of Cardiology during the month of June-Dec 2012. Setting : Study was carried out in a tertiary cardiac center in Kerala. Participants: A total of 496 patients who were admitted in the Cardiology department between June 2012 and December 2012 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease. Risk factors studied were the conventional risk factors for coronary artery disease - hypertension, diabetes mellitus, dyslipidemia, body mass index (BMI), smoking, and family history of coronary artery disease. Data are collected from the patients, old medical records, Clinical Examination and Laboratory results of the patients were analyzed for the study. Results: From the study, it was seen that in Keralites-irrespective of gender, diabetes or impaired glucose tolerance (79%) and dyslipidemia (71%) are the major risk factor for Coronary artery disease. Hypertension (39%) and cigarette smoking (24%) were not seen to be a major risk factors for coronary artery disease as only a minority of the study population had hypertension or gives a history of cigarette smoking. 57% of the study population had a family history of coronary artery disease. Among the studied population, 55% of females are with increased BMI, whereas only 16% of males with CAD were with BMI above 30. Conclusion: Among South Indian population irrespective of gender, diabetes mellitus and dyslipidemia are the major Risk factor for Coronary artery disease. So early detection of diabetes mellitus and dyslipidemia and proper treatment of both, before developing the end organ damage, play a vital role for the prevention of coronary artery disease.

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Background: Various studies have shown that people of Indian origin have an increased risk of ischemic heart disease (IHD) compared with most other ethnic groups. This increased risk has been attributed to multiple risk factors related to lifestyle. Patients and Methods: A total of 100 cases and 100 age and sex-matched controls were taken into this prospective case-control study from Intensive Coronary Care Unit. Prevalence of the following risk factors for myocardial infarction: Age, sex, diet, smoking, alcohol consumption, history of hypertension, history of diabetes mellitus, and lipid profile were studied. Patient data were extracted from the medical records department and by interview. Results: The most important predictor of acute myocardial infarction (AMI) was high low-density lipoprotein (adjusted odds ratio [OR]: 4.124, confidence interval [CI]: 1.44-11.73, P = 0.008) history of hypertension and of overt diabetes mellitus were also independent risk factors (OR: 2, CI: 1.4-3 and OR: 2.29, CI: 1.5-3.5), respectively. Low high-density lipoprotein was found to have no significant association with AMI. Heavy drinkers were found to have a high-risk (OR: 68), while moderate drinkers were found to have protection (OR: 1). Conclusion: Smoking and heavy drinking cessation, treatment of hypertension and reduction in blood glucose, correction of abnormal lipid profile either through use of statins or by dietary modification may be important in preventing IHD in Asian Indians.

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Aortic aneurysm is a rare, but mostly fatal condition; the incidence is 5.9 new aneurysm/100,000 person-years with median age of 65 years for men and 77 years for women. It becomes still rarer when the cause is idiopathic and is associated with aortic regurgitation. Most of these patients present with aortic regurgitation and on investigation aneurysm is detected. Owing to its rarity and disguised presentation it is important to be aware of this entity. This case is being presented not only because of its rarity, but also because of its atypical presentation.

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Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5%) and rest were females. Most patients had ST elevation myocardial infarction (STEMI) 995 (63.7%) followed by unstable angina (UA) 390 (25%) and non-STEMI (NSTEMI) 177 (11.3%). Risk factors; smoking was present in 770 (49.3%), hypertension in 628 (40.2%), diabetes in 578 (37%), and obesity in (29.64%) patients. Angiography was done in 1443 (92.38%) patients. left anterior descending was most commonly involved, left main (LM) coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28%) UA, 94 (56.29%) NSTEMI and 468 (51.71%) STEMI patients. Double-vessel disease was present in 67 (18.08%) UA, 25 (14.97%) NSTEMI and 172 (19.01%) STEMI patients. Triple vessel disease was present in 28 (7.55%) UA, 16 (9.58%) NSTEMI, 72 (7.95%) STEMI patients. LM disease was present in 12 (3.23%) UA, 2 (1.19%) NSTEMI and 9 (0.99%) STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%), free wall rupture in 2 (0.1%), cardiogenic shock in 45 (2.9%), severe mitral regurgitation in 3 (0.2%), complete heart block in 11 (0.7%) patients. Total 124 (7.9%) patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent risk factor. Diabetic patients had more of multivessel disease. Complications and in hospital mortality was higher in females and elderly population.

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Background and Objectives: Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. There are fewer data regarding myocardial infarction in young adults, with varying risk factors and patterns of coronary involvement. This study was done to present the coronary angiographic characteristics of CAD in young patients aged <40 years. Materials and Methods: In this cross-sectional record-based study, patients aged <40 years who were evaluated angiographically for chronic stable angina or acute coronary syndrome were included. Single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD) were noted down. Onset of CAD before 40 years of age was considered as PCAD. Results: A total of 4526 cases underwent coronary angiogram between January 2008 and December 2014; 154 (3.40%) were <40 years of age with a mean (standard deviation) age of 36.51 (±3.654) years. In <40 years age group, nearly third-fourth of the cases (112, 72.73%) had critical CAD; among them, 98 (87.5%) were male and 14 (12.5%) were female. About two-third of the cases (74, 66.07%) had SVD, followed by DVD (25, 22.32%) and TVD (13, 11.61%). Conclusions: Incidence of critical CAD in young adults is quite high. Young patients with CAD are mainly males, and SVD is more common. Emphasis should be given on diagnosis and management of risk factors in this vulnerable group.

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Most common electrocardiogram (ECG) findings of myocardial ischemia are ST segment deviations & T wave (ST-T) alterations. However, multiple other conditions can cause ST-T changes mimicking ischemia including ventricular hypertrophy, bundle branch block, electrolyte imbalance, drugs, channelopathies, etc. Uncommonly, incorrect placement of limb leads can also produce ST-T changes leading to diagnostic dilemma. We report a case of erroneous limb-lead placement in a 45 years male mimicking ischemic ECG changes.

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Background: Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. Objective: To find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (J&K). Materials and Methods: A retrospective analysis of case-records data of 767,921 patients (0-18 years) over 3 years and 10 months period was conducted to ascertain the prevalence and spectrum of CHDs. Results: A total of 877 patients out of 767,921, were found having CHDs measuring a prevalence of 1.12/1000. About 777 (88.5%) were the acyanotics, and 100 (11.5%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 241 (31.2%), followed by patent ductus arteriosus in 184 (24.3%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 48 (48.0%) patients. Conclusion: Prevalence of 1.12/1000 among the hospital attending patients could be an underestimation of the actual disease burden in our community, and heightened awareness among the treating physicians about the cardiac diseases could actually reduce the mortality and morbidity associated with these ailments.

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Stable angina is managed primarily through lifestyle advice, medication therapy, and coronary revascularization procedures. Some patients with refractory angina exhibit symptoms that are not optimally controlled with the optimal medication and revascularization options available. Enhanced external counterpulsation (EECP) is a technique that can be used to improve symptoms in chronic stable angina. However, the role of EECP has also been investigated following positive outcomes in patients with both angina and heart failure in multicenter studies. We performed a systematic review of the evidence of the clinical effectiveness of EECP. EECP has been approved by the United States Food and Drug Administration (FDA) for the management of refractory angina (Class IIb). About 200 hospitals across India have adopted this technique. EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow, and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated through vascular endothelial growth factor, and nitric oxide-mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients. EECP is cost-effective if the observed quality of life benefits are assumed to continue throughout a patient's lifetime. However, there remain uncertainties around the long-term effects of the intervention.

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Two female patients presenting with shortness of breath on routine activity, were found to have severe iron deficiency anemia and moderate transudative pericardial effusion. With the correction of iron deficiency anemia, pericardial effusion disappeared in both patients. Moderate pericardial effusion occurring with severe anemia has not been described in the literature.

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Coronary angiography by right radial artery route using Optitorque Tiger catheter is on the rise given the low rate of local complications and feasibility to perform it as a day-care procedure. We report here a case of coronary angiography performed using Optitorque Tiger catheter (5-French) which resulted in a diagnostic error, missing the ostio-proximal left main coronary artery disease which was later detected using EBU 3.5 guide catheter (7-French) while performing angioplasty.

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A middle-aged female presented with recurrent flash pulmonary edema. On evaluation, the patient had apparently stable 2:1 atrioventricular block and a good left ventricular systolic function. Holter recordings revealed intermittent episodes of complete heart block (CHB) precipitating pulmonary edema. The patient underwent permanent pacemaker implantation with complete resolution of symptoms. Isolated recurrent pulmonary edema in CHB is a rare manifestation and has never been reported before.

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Overall prevalence of Thoraco abdominal aneurysm has increased due to widespread use of imaging techniques and aging population. Surgical aneurysm repair and endovascular stent graft repair have refined as successful treatment modalities in preventing aneurysm progression and rupture. Since spinal cord depends on branches of thoracoabdominal aorta for blood supply ,spinal cord ischaemia is a dreadful complication of these procedures. However recent animal experiments and surgical series thrown light in tackling this anatomical obstructions by physiologic means. The adoption of techniques for avoiding hypovolumea, hypotension, CSF pressure has reduced this complication rate from 23% to 2-6%.

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Introduction: Wide variations exist in the size, position, and shape of various body organs, finger prints, and proteins in different individuals. Some variations are of considerable clinical importance, such as the coronary arteries. Variations of coronary arteries can cause important clinical manifestation, including sudden death of the individual. Materials and Methods: Coronary arteries were dissected in 10% formalin-fixed cadaveric hearts. The normal and variant anatomy of coronary arteries was studied. Result: In 100% of cases, the right coronary artery (RCA) and main left coronary artery (LCA) were found to arise from anterior aortic sinus and left posterior aortic sinus, respectively. In 8% of cases, the conus was found to have independent origin from the anterior aortic sinus. The RCA was found to be dominant in 90% of cases. In 66.7% of cases, the length of RCA ranged from 4.5 cm to 7 cm. The average length of LCA was found to be 7 mm. In 10% of cases, the circumflex coronary artery was found to be dominant, where the length of the artery ranged 9-11 cm. In 10% of cases, LCA trifurcated, where the obtuse marginal branch was replaced by the ramus intermedius branch. Also, 43.3% of LAD showed myocardial bridging predominantly in the middle 1/3 ^rd segment, and 6.7% of cases of RCA showed myocardial looping. Discussion: Coronary arteries show immense variation in their origin, termination, branching pattern, myocardial bridging, looping, and dominance pattern. This knowledge is clinically and surgically important to manage coronary artery diseases.

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Background: Electrocardiography (ECG) is a simple, noninvasive, and relatively cheap investigative tool used for cardiac evaluation. However, there are limited electrocardiographic studies of Nigerian children. Adult studies of ECG have shown significant differences between Black and Caucasian populations. These differences may also be seen in children, hence, the need to develop local reference values. Materials and Methods: This was a cross-sectional study and multistage random sampling method was applied to select 650 subjects. The ECG machine was a portable heated stylus direct writing AT-2 Swiss made electrocardiograph (Schiller AG Cardiovit CH6341). Results: There were 350 males (53.3%) and 300 females (46.7 %), with a male:female ratio of 1.2:1. The mean heart rate decreased with increasing age. R-wave amplitudes were higher in the left precordial leads, in keeping with left ventricular dominance. Mean values were higher in boys than girls in the three age-groups in most of the precordial and limb leads. In V ₄ R, V ₂ , and V ₃ highest mean R wave voltages of 0.5 ± 0.1, 1.4 ± 0.3, and 1.4 ± 0.2 mV, respectively, were recorded in the 5-7-year-old. While in V ₅ and V ₆ , the mean R waves were higher in the 12-15-year-old age group (3.7± 0.5 and 2.5±0.4 mV, respectively). The S-waves showed progressive decrease in its amplitude on the left precordial leads with increasing age. Conclusion: The mean values in heart rate, QRS duration, PR interval, and P-wave amplitude showed higher amplitudes in boys. Similarly higher amplitudes of R-waves in boys were recorded in precordial leads V ₂ , V ₃ , V ₅ , and V ₆ in the three age groups.

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The mural endocarditis is a rare cause of intracardiac masses, which is difficult to diagnose and usually requires surgery to prevent embolization and intracardiac complications. We herein present an unusual case of right ventricular mural endocarditis in a patient with rheumatic heart disease, in which presence of multiple mural vegetations was visualized on two-dimensional transthoracic echocardiography and better delineated with three-dimensional echocardiography. There was complete resolution of vegetations with antibiotic therapy.

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Introduction: Hypertension is a major public health problem and an established major risk factor for developing myocardial infarction (MI). However, majority of the population with hypertension does not have sufficient knowledge regarding early sign and symptoms of MI as the sign and symptoms appear in a confusing way hence causes delay in seeking treatment. Aim of the Study: Assess the effectiveness of planned teaching program (PTP) on knowledge regarding early sign and symptoms of MI among hypertensive patients. Materials and Methods: A quasi-experimental research approach with nonrandomized control group design was used. Through purposive sampling, sixty patients were selected (thirty in each experimental and control groups). Data were collected with interview method by using self-structured knowledge questionnaire. Pretest was taken, and PTP was administered to experimental group only. After 7 days, posttest was taken from both groups. Collected data were analyzed using descriptive and inferential statistics. Results: In experimental group, mean pretest knowledge score was 13.87 and posttest mean knowledge score was 23.57. In control group, mean pretest knowledge score was 13.97 and posttest mean knowledge score 13.83. As per t-test, difference between mean posttest knowledge score (23.57, 13.83) of both groups was found statistically significant (t = 15.767 ***, P< 0.001). Conclusion: PTP significantly improved the knowledge of patients. This emphasized that providing education to patients at risk for MI can greatly reduce the morbidity and mortality associated with it.

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Complete heart block is a medical emergency managed by insertion of cardiac pacemakers. Most common reversible causes of AV (atrioventricular block) are drug induced, metabolic and endocrine causes. The metabolic causes of AV blocks are hyperkalemia and hypermagnesemia. Hyponatraemia is the commonest electrolyte disturbance seen in intensive care patients, but it causing cardiac conduction defects is very rare and here we present a 60 year old female with third degree (complete) AV block caused by hyponatraemia who reverted to sinus rythm after correction of hyponatraemia.

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Background and Objective: Hypertension is an important public health problem in both economically developing and developed countries. In India, recent community surveys have reported that the prevalence of hypertension has risen among urban and rural inhabitants. This study was conducted to find out the prevalence of hypertension and to identify the risk factors among adults residing in urban areas of Lucknow. Materials and Methods: The cross-sectional field study involved a survey of 300 respondents, aged 18 years and above using the stratified random sampling and probability proportionate to size technique. A study tool which contained risk factor questionnaire and physical measurements of height, weight, and blood pressure were used to collect the data. Data analysis was performed using the SPSS version 16. The Chi-squared test and logistic regression analysis were used to analyze the data. Results: The prevalence of hypertension was 14.67% among urban adults. Hypertension was significantly higher among individuals aged >40 years and those who consumed tobacco products. A higher proportion of the hypertensives belonged to the illiterate category. There was a significant difference in hypertension prevalence in different education classes. Respondents living in overcrowded houses had higher odds of having hypertension than those not experiencing overcrowding. Conclusion: Age, education, and overcrowding were independent risk factors of hypertension. Prevention measures targeting the modifiable risk factors associated with hypertension should be taken.

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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.

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A 40-year-old female presented with prolonged fever and new-onset seizures. On examination, she was found to have florid peripheral manifestations of infective endocarditis (IE), namely skin petechiae, subconjunctival hemorrhages, Janeway lesions, Osler nodes, and splinter hemorrhages. This helped in early, focused investigation and diagnosis of IE. Peripheral manifestations of subacute IE are rare in the current era of clinical practice owing to early diagnosis and treatment. We present a case where multiple peripheral signs were identified in the same patient.

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The steadily increasing use of contrast media in radiological and interventional cardiac procedures has led to more research and well designed studies of prophylactic strategies for its leading life threatening side effect of contrast induced nephropathy (CIN). CIN adversely affects the prognosis after interventional procedure and poses substantial extra burden on health care costs. The importance of understanding of CIN lies in the fact that no available treatment can reverse or ameliorate it once it develops, but prevention is possible. Herein, we discuss the detailed pathophysiological aspects, risk factors, proposed risk prediction algorithms and various prophylactic strategies for contrast induced nephropathy.

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Cardiac mass is always challenging, specially in the right side of the heart that should raise suspicion of a malignancy. A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. Transthoracic echocardiography revealed a large homogeneous mass in the RV apex which disappeared one week after intravenous heparin therapy. A trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility.

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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.

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