Heart failure (HF) imposes huge morbidity and mortality on society. In recent times, HF with preserved ejection fraction (EF) has emerged as the predominant form of HF syndromes. Natriuretic peptides (B-type natriuretic peptide [BNP] and N-terminal [NT] pro BNP) have now emerged as preferred biomarkers for diagnosis and guiding further therapy in HF. Ivabradine and Eplerenone are now approved for HF patients who are symptomatic despite optimal therapy. Tolvaptan has been shown to improve hyopnatremia as well as dyspnea in patients of HF. Coronary bypass grafting has demonstrated a decrease in cardiovascular death and HF hospitalization in patients with of HF with angina. Cardiac resynchronization therapy has now consistently shown to decrease mortality in Mild HF.

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Scrub typhus, caused by Orientia tsutsugamushi, is endemic in the so-called "tsutsugamushi triangle". There is a wide spectrum of presentation of the disease ranging from uncomplicated febrile illness to life-threatening sepsis with multiorgan dysfunction. We are presenting a case of scrub typhus causing myocarditis and acute respiratory distress syndrome (ARDS) in an adult female with no previous comorbid illness who recovered fully with prompt treatment in spite of prolonged ventilator support, emphasizng the need for early diagnosis and prompt treatment with antirickettsial antibiotics in a patient presenting with features of scrub typhus.

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Introduction: Coronary heart Disease (CHD) though primarily considered to be man's disease, it is also a leading cause of mortality and morbidity in middle aged women throughout world. Coronary manifestations occurs approximately 20 years later in women as compared to men and may have atypical presentations. The poor prognosis in women due CHD has been attributed to advanced age , concomitant medical illnesses, late presentation because of atypical presentations, ignorance of seriousness of the disease and delayed treatment. Materials and Methods: 80 consecutive female patients admitted in the department of Medicine and cardiology of Indira Gandhi Medical college Shimla from 1 ^st June 2008 to 31 ^st May 2009 were included in the study informed consent , demographic profile and risk factors were recorded. After focused clinical examination biochemical investigations such as RBS, Hb A1C, Lipid profile, 12 lead electrocardiogram and echocardiography etc. was done. Results: total 80 patients included in the study had mean age of 62.7 ± 13.6 years. The majority of females between the of age 61-70 years constituted 50% 0f study population. Dyslipidemia was the commonest risk factor followed by obesity, smoking ,hypertension and diabetes. Chest pain was the common presenting feature with atypical pain chest in 25% of females. Conclusion: CHD is a under diagnosed undertreated and under researched disease in women for various reasons and it is more age dependent in women than in men. The primary care physicians, paramedics posted in peripheral institutes' should be appraised about the clinical profile ,risk factors of CHD in females so that effective therapy can be instituted in time to decrease subsequent morbidity and mortality.

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We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple 'a' waves corresponding to atrial tachycardia rate.

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Background: Caregivers of chronically bedridden patients are likely to suffer from mental and physical exhaustion leading to stress. This is important in view of the prevailing socioeconomic as well as the healthcare system available in a developing country like India. Therefore, the present study is designed to measure heart rate variability (HRV) among this special group of population who give care to long-term bedridden patients. Materials and Methods: Fifteen female subjects were enrolled from among attendants of patients admitted with an immediate history of a cerebrovascular accident with locomotor deficits, who required constant care. They were free from any type of physical and mental health issues, nonsmokers and nonaddicts. Each care giver was subjected to HRV analysis on three occasions: The first record was performed in the 1 ^st week of their arrival in the hospital as caregivers. The second observation was recorded after 3 months of caregiving. The final HRV analysis was done after 6 months of care giving. Two types of parameters were analyzed: Time domain and frequency domain. Statistical analysis was done using paired t-test. Results: Both the HRV parameters: Time and frequency domain, showed decreased values during the 3 ^rd and 6 ^th month recording as compared to the 1 ^st week recording. The decrease is much more during the 6 ^th month recording as compared to the 3 ^rd month recording. Statistically significant decrease is observed in mean RR interval, heart rate, very low frequency (VLF), and LF only when the 1 ^st week recording is compared with the 3 ^rd month recording, but when the 1 ^st week recording was compared with the 6 ^th month recording significant decrease was found in mean RR interval and heart rate. Conclusion: Subjects involved in taking care of chronically ill bedridden patients are likely to undergo a lot of physical and mental stress, thus affecting their autonomic status. HRV analysis using short term electrocardiogram (ECG) recording was used to detect changes consequent to this stress. It was found that almost all HRV parameters measuring heart rate complexity were decreased in the period of caregiving.

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A 68-year-old male presented with Group B Streptococcus aortic valve (AV) endocarditis with aortic root abscess and refractory sepsis. An emergency cardiac surgery was performed with root abscess drainage, excision and debridement of necrotic tissue, reconstruction of annulus, and AV replacement. Fifteen months later he presented with a huge aortic root pseudoaneurysm (PA). This case illustrates late occurrence of aortic root PA following AV surgery for endocarditis.

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