ObjectiveTo report the prevalence, risk factors and consequences of atrial fibrillation (AF) in patients of rheumatic heart disease (RHD).MethodsThe Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry database of 1918 patients was analyzed. AF was diagnosed with 12-lead ECG recording at entry in to the registry. The association of AF with nature and severity of valvular dysfunction was analyzed, adjusted for age, left atrial (LA) dimension and pulmonary arterial hypertension using multivariable logistic regression model and strength of association was reported as odds ratio (OR) with 95% confidence intervals (C. I.).ResultsThe study population consisted of young (40.2 ± 14.3 years), predominantly females (72.3%) from rural area (94.1%). Prevalence of AF was 23.9% (95% C. I. 22.1%–25.8%). The independent determinants AF were age (OR 1.04, 95% C.I. 1.03–1.06), LA size (OR 1.10, 95% C.I. 1.08–1.11). The association of AF with age, New York Heart Association functional class, mitral stenosis severity and tricuspid regurgitation was statistically significant and graded. Mitral regurgitation and aortic valve disease had no significant independent association with AF. The prevalence of heart failure, stroke, peripheral embolism and mortality was significantly higher among patients with AF (p < .01).ConclusionAF is common in RHD patients and is significantly associated with heart failure and systemic thromboembolism. Age, mitral stenosis severity, tricuspid regurgitation and LA size were independently associated with AF.
BackgroundThe study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF).MethodsSerum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables.ResultsIron deficiency and anemia were prevalent in 58.8% (52.2%–65.1%) and 35.8% (29.8%–42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9–6.5)], history of bleeding [OR 11.7 (95% CI 1.4–101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4–4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40–6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97–0.99)], history of bleeding [OR 13.0 (95% CI 2.3–70.9)], and female gender [OR 2.9 (95% CI 1.5–5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70–0.96) and transferrin saturation (OR 0.98 (95% CI 0.96–0.99)] had a significant inverse association with symptoms of advanced heart failure.ConclusionIron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure.
Lymphatic filariasis is one of the major public health problems across the globe. Clinical manifestations usually depend on the site of lymphatic involvement. A 21-year-old female resident of a non-endemic filarial region presented with axillary lymphadenopathy, bilateral pleural effusion, ascites and pedal oedema. Fine-needle aspiration cytology (FNAC) of axillary lymph nodes revealed microfilariae. On the administration of diethyl carbamazine, lymph nodes gradually disappeared, the patient improved symptomatically and the filarial antigen test after treatment was negative. We report this case of bilateral axillary lymphadenopathy with pleural effusion and ascites as a rare manifestation of filariasis.
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