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Drug-drug interactions (DDIs) represent a special category of adverse drug reactions in which the effects of one drug influence the effects of the other, thus either limiting effectiveness or inducing toxicity. Overall, 1% of hospital admissions and 16% of admissions due to ADRs can be attributed to DDIs. A higher number of DDIs is also significantly associated with longer hospitalization and higher treatment costs. 1,2 Approximately 37-60% of patients admitted to hospital may have one or more potentially interacting drug combinations at admission. In inpatients, the risk of having potentially interacting drug combinations can additionally increase because new drugs are often added to the existing drug therapy. DDIs are a concern for patients and providers, as polypharmacy is becoming more common in managing complex diseases or comorbidities and the consequences can range from untoward effects to drug-related morbidity and mortality. Healthcare professionals' ability to recognize potential DDIs is important in reducing their potential risks and adverse consequences. 3 Studies have revealed that DDIs are a major clinical problem along with other adverse drug reactions especially in the hospitalized cardiac patients. Cardiovascular patients are more often reported with potential drug-drug interactions (pDDIs) as compared to patients with other diseases. The possible reason behind higher pDDI rate in cardiovascular diseases may include ABSTRACT Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions. Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student 't' test, ANOVA and Pearson correlation coefficient were used to analyse the results. Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated...

‘Takotsubo cardiomyopathy (TCM)’ or ‘stress cardiomyopathy’ is a reversible cardiomyopathy that is precipitated by intense emotional or physical stress. This syndrome is characterised by symptoms mimicking acute coronary syndrome with transient systolic dysfunction associated with regional wall motion abnormalities, which extend beyond a single coronary vascular bed in the absence of obstructive coronary vascular disease. The presentation of TCM and myocardial infarction is similar with sudden onset of chest pain, breathlessness as well as abnormalities in both the electrocardiogram and cardiac enzymes. It is difficult to differentiate between the two until cardiac catheterisation establishes the diagnosis. We report a case of TCM in a post-menopausal female, precipitated by negative pressure pulmonary oedema following total thyroidectomy in whom timely cardiac catheterisation established the diagnosis and influenced the management. Heightened awareness of this unique cardiomyopathy is essential to have a high index of suspicion in at-risk population for the prompt diagnosis of stress-related cardiomyopathy syndromes occurring in the perioperative period.