Hypertrophic cardiomyopathy is an autosomal dominant disease of cardiac sarcomere with the varied clinical presentation. The common manifestations are heart failure (dyspnea), palpitations, chest pain, stroke and even sudden death. Majority of patients are not recognized because of being asymptomatic. Stroke is one of the complications of hypertrophic cardiomyopathy and usually occurs in the setting of atrial fibrillation, advanced age and congestive cardiac failure. Although infective endocarditis is known, but relatively uncommon, complication of hypertrophic cardiomyopathy, it is not reported from Nepal. We report here a case of 42-year male patient with hypertrophic cardiomyopathy in normal sinus rhythm with infective endocarditis who developed malignant cardioembolic stroke involving left middle cerebral artery territory.
Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia.
Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition.
Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency.
Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.
BACKGROUND: There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient.
METHODS: This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021.
RESULTS: The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age ≤35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36-54 years was 13(68.4%) and 16(51.6%) and elderly ≥55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36-54 years’ age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant.
CONCLUSION: The study showed that White-coat hypertension was more common in male patients and in middle age group 36-54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.
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