Aspirin has been a widely used antiplatelet drug for management of cardiovascular disease for last five decades. Multiple studies have established its role in secondary prevention of cardiovascular diseases. For primary prevention, the situation is not so simple. Initial studies (though large and with long follow up) performed two decades ago suggested an impressive positive risk -benefit profile. But such benefits could not be replicated in subsequent studies performed in the new millennium. Recently, three back to back studies of aspirin in primary prevention in contemporary era failed to demonstrate any benefits or the benefits were counterbalanced by bleeding events. Hence, the role of aspirin for primary prevention of cardiovascular disease is under intense scrutiny.

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Background: Heart failure with reduced ejection fraction (HFrEF) has growing prevalence, especially in postmenopausal females. Heart failure reversal therapy (HFRT) is a combination of Panchakarma and allied therapies used by Ayurveda physicians for chronic heart failure patients. This observational study was done to evaluate HFRT in HFrEF-affected postmenopausal females. Materials and Methods: The study was conducted between January 2015 and December 2017 at a Madhavbaug Hospital in Khopoli, India. The data of HFrEF patients who were administered HFRT twice over 7 days in hospital were considered. VO₂ max, distance covered on 6-min walk test (6MWT), weight, body mass index (BMI), abdominal girth, heart rate (HR), and blood pressure (BP) were compared to day 1 and 90 of HFRT. Results: Twenty females were enrolled with a mean age of 64.2 ± 4.38 years. There was a significant improvement in mean VO₂ max (12.30 ± 2.12 vs. 13.45 ± 2.10, P < 0.05) and mean distance covered after 6MWT (319.5 ± 92.1 vs. 369.5 ± 91.39 m, P < 0.05) of patients on day 90, when compared to day 1 of HFRT. Mean weight (55.20 ± 7.23 vs. 51.48 ± 6.70 kg, P < 0.05), mean BMI (22.51 ± 3.10 vs. 21.45 ± 2.47 kg/m², P < 0.05), and mean abdominal girth (86.05 ± 8.57 vs. 81 ± 8.65 cm, P < 0.05) were decreased at 90 days after HFRT therapy initiation. BP and HR were reduced but not significantly (P > 0.05). Conclusion: HFRT effectively increases the VO₂ max, distance walked on 6MWT and decreases metabolic parameters in postmenopausal HFrEF patients.

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Context: Cirrhosis is the leading cause for hepatic transplantation worldwide. Heart is one of the most adversely affected organs in cirrhosis and it increases morbidity and mortality in these patients. Aims: The objective of this study is to identify the echocardiographic abnormalities in patients with cirrhosis and their relation to severity of cirrhosis. Subjects and Methods: An observational study was done on patients with cirrhosis (n = 55) and age- and sex-matched controls (n = 30). Detailed echocardiographic examination including 2D, M-mode, pulsed-wave Doppler, tissue Doppler, and 2D speckle-tracking imaging was performed. Severity of cirrhosis was defined by model for end-stage liver disease (MELD) score. Comparison of various echo parameters among cases and controls and among the two groups with MELD score >12 and <12 was made. Results: The major echocardiographic abnormalities noticed were left ventricular hypertrophy in 47.3%, diastolic dysfunction in 40%, pulmonary artery hypertension in 32.7%, and pericardial effusion in 3.6% of patients. Among the various echocardiographic parameters, mitral annular velocity, deceleration time, isovolumetric relaxation time (IVRT), Sm velocity, e' velocity, E/e' ratio, and average global longitudinal strain (GLS) were significantly different in cirrhosis patients compared to the control population. Mitral annular a velocity and IVRT were significantly more in cirrhotic patients with MELD score >12. Conclusions: Cirrhosis is associated with increased LV mass and cardiac output. Diastolic dysfunction was present in 40% of patients. Although systolic function by ejection fraction was normal in cirrhotic patients, GLS was less compared to controls.

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Introduction: Hypertension is a chronic disease which necessitates daily medication intake and changes in the lifestyles. This may influence the quality of life. Aims and Objective: The aim of the study was to compare the health-related quality life of hypertensive individuals and age- and gender-matched nonhypertensive individuals in an urban area of Puducherry. Setting and Design: The cross-sectional analytical study was conducted as facility as well as community-based study. Methodology: The study involved 101 hypertensive patients attending the outpatient department of an Urban Health Training Center and 101 age- and gender-matched nonhypertensive individuals recruited from the community. The health-related quality of life (HRQoL) was measured using Short Form-12 (SF-12) questionnaire. The HRQoL was expressed in eight domains: physical functioning, physical role play, bodily pain, general health, vitality, emotional role play, social functioning, and mental health. The data were entered in Epidata software, and analysis with unpaired t-test was done using SPSS software for comparison of scores between the two groups. Results: The hypertensive individuals were found to have lower quality of life in both physical and mental domains compared to nonhypertensive individuals. The physical functioning, bodily pain, and general health domains of physical component recorded statistically significant difference. Conclusion: Hypertensive individuals have poor quality of life, especially in physical component domain in our study population. Hypertensive individuals merit a vulnerable population and need special focus by health-care providers in the context of achieving universal health coverage and sustainable goals.

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Aim: Incidence, diagnosis, and management of spontaneous coronary artery dissection (SCAD) in the Indian subcontinent are less well understood. The present study is to find the incidence and clinical features of SCAD in acute coronary syndrome (ACS) patients undergoing coronary angiography in acute coronary settings. Subjects and Methods: This is a prospective and retrospective analysis conducted on ACS patients who underwent emergency angiogram in the Department of Cardiology, Government Medical College, Kottayam, India, from February 19, 2008, to December 31, 2017. Those without SCAD were kept as control. Results: Out of 3708 patients studied, SCAD was seen in 5.9% patients with 78.8% females and was responsible for 31.4% and 6% of ACS in females aged <50 and >50 years, respectively. The mean age of presentation was 47.2 years. Age <50 years, female sex, emotional and physical stress, and fibromuscular dysplasia (FMD) were the risk factors identified. In-hospital and 6-month mortality rate was 3.1% and 6.3%. 31.9% of SCAD patients were diagnosed to have FMD on follow-up. Only 4.1% of patients belonged to peripartum period. Medical management is superior in hemodynamically stable SCAD patients compared to invasive strategies. Conclusions: SCAD is far more common than expected in this part of the world, and the awareness regarding the diagnosis, treatment, and follow-up has to be improved.

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Bifurcation lesions are synonymous with unfavorable angiographic and clinical outcomes. We present a case of a bifurcated lesion in the left anterior descending artery diagonal. She was managed by implanting a single stent using the proximal optimizing technique (POT), side branch inflation, and final POT (POT-side-POT technique), without final kissing balloon.

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