Objective: The purpose of this study was to evaluate cardiac features associated with newly detected left bundle branch block (LBBB) in the outpatient department. Methods: A total of 57 patients with LBBB pattern were evaluated using electrocardiography (ECG). Patients were assessed based on their sex, age, detailed history, and cardiovascular symptoms. Cardiac investigations including ECG and echocardiography were performed. Results: The study included 30 (52.6%) males and 27 (47.5%) females, aged between 35 and 80 years. Dyspnoea (35.1%) and chest pain (22.8%) were the most common symptoms. 54.4% were hypertensive and 17.5% were diabetics. 28% had Left ventricular systolic dysfunction, and 24.5% had aortic valve disease. Left ventricular hypertrophy without any other structural heart disease was present in 28% of the patients. Only 24.5% patients presented with LBBB had a structurally normal heart in echocardiography. Myocardial performance index in echocardiography was abnormal in LBBB irrespective of the presence of structural heart disease. Conclusion: The prevalence of LBBB was found to increase with age and had slight male preponderance. Dyspnoea on effort was the most common presenting complaint, followed by chest pain and incidental detection of ECG abnormality. Most of the patients were hypertensive. Only 24.5% patients with LBBB had a structurally normal heart. MPI was abnormally high in the presence of LBBB despite having a normal left ventricular ejection fraction.
Diets rich in fruits and vegetables reduce blood pressure (BP) and the risk of adverse cardiovascular events. However, the mechanisms of this effect have not been elucidated. Many vegetables possess a high nitrate content and we hypothesized that this might represent a source of vasoprotective NO via bioactivation to nitrite. In 14 healthy volunteers, approximately 3h following ingestion of a dietary nitrate load (500ml beetroot juice), BP was substantially reduced (Δmax‐10.4/8 mmHg); this effect correlated with peak increases in plasma nitrite, but not nitrate, concentration. The dietary nitrate load also prevented endothelial dysfunction induced by an acute ischemic insult in the human forearm and significantly attenuated ex vivo platelet aggregation in response to collagen and ADP. Interruption of the enterosalivary conversion of nitrate to nitrite (facilitated by bacterial anaerobes situated on the surface of the tongue), prevented the rise in plasma nitrite, blocked the decrease in BP and abolished the inhibitory effects on platelet aggregation, confirming that these vasoprotective effects were due to the activity of nitrite converted from the ingested nitrate. These findings suggest that dietary nitrate underlies the beneficial effects of a vegetable‐rich diet and highlights the potential of a ‘natural’, low cost approach for the treatment of cardiovascular disease.
Background: Cardiovascular diseases (CVD) are the main cause of mortality and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVD. The present study was conducted to compare different cardiovascular calculators for CVD risk assessment models in young Indian patients presenting with myocardial infarction.Methods: This study included 85 patients with myocardial infarction (MI). Their predicted 10-year risk of CVD was calculated using three clinically most relevant risk assessment models viz. Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association (RiskACC/AHA) and the 3rd Joint British Societies risk calculator (RiskJBS).Results: RiskFRS recognized the highest number of patients (15.4%) at high CVD risk while RiskACC/AHA and RiskJBS calculators provided inferior risk assessment but statistically significant relationship. RiskFRS and RiskACC/AHA (Pearson's r 0.870, p<0.001).Conclusions: RiskFRS seems to be as most useful CVD risk assessment model in young Indian patients. RiskFRS is likely to identify the number of patients at ‘high-risk’ as compared to RiskJBS and RiskACC/AHA.
Background: In the diagnosis of patients with ST-elevation myocardial infarction (STEMI), prediction of left ventricular systolic function is one of the vital elements. Traditionally, assessment of left ventricular function is focused on measurement of left ventricular ejection fraction (LVEF). But it is load dependent and sensitive to the alterations in preload and after-load. However, myocardial performance index (MPI) demonstrates supremacy over older established indexes. Hence, the purpose of the study is to estimate the correlation between MPI and LVEF in patients with acute STEMI.Methods: A total of 105 consecutive patients underwent conventional estimation of ejection fraction and LV end-systolic volume by a Teichholz method. All patients received 325mg dispersible aspirin, 300mg clopidogrel at the time of admission and streptokinase. Doppler echocardiographic evaluations were performed at presentation, immediately after thrombolysis (90 minutes) and before discharge on 3rd to 5th days.Results: The mean patient age was 56.36years and 89 (84.76%) patients were male. A low LVEF of <40%, significantly correlated with higher (worse) MPI at the time of presentation (P= 0.04). LVEF showed improvement after thrombolysis, moreover it was significantly higher at 0' (P= <0.03) and 3rd day (P= 0.05) in patients with MPI <0.5.Conclusions: A significant correlation was found between left ventricular ejection fraction and myocardial performance index; lesser the left ventricular ejection fraction, higher the myocardial performance index. However, myocardial performance index could not predict adverse cardiac events during the hospital stay.
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