Cardiovascular disease is still on the increase in India owing to changing socioeconomic factors and unhealthy lifestyles. Better understanding of the role of hypertension (HTN) has led to new Joint National Committee (JNC-7) guidelines for its diagnosis and management. The authors aimed to evaluate the predictors and correlates of prehypertension (PreHTN) among adults in urban India. Study design is a cross-sectional survey among 2,007 adults in Chennai in July 2003; 1,505 men and 502 women over the age of 18 years were studied. Demographic data collected by direct interview were the following: age, smoking, alcohol intake, type of work, exercise patterns, and monthly income. Anthropometric data of height, weight, and waist and hip dimensions were measured. Blood pressure (BP) was recorded thrice, with at least 15 minutes between readings 2 and 3. The mean of readings 2 and 3 was taken for the study. Of the 2,007 people studied, 951 (47.4%) had PreHTN and 696 (34.7%) had HTN. PreHTN was found in 46.6% of the men and 49.8% of the women. PreHTN was prevalent in 47.4% of adults, and another 34.7% had hypertension (Stage I, 20%, and Stage II, 14.7%). In urban India less than 18% of adults have normal BP of less than 120/80. Multiple logistic regression analysis after age and sex correction identified obesity, diet, family history and middle-income group as correlating with PreHTN. The factors that predict HTN were age, sex, smoking, alcohol intake, sedentary lifestyle, and type of work.
Primary Intracardiac thrombosis in the absence of indwelling catheters or pacemaker etc. is an uncommon complication.Although cases of primary coronary sinus thrombosis are reported, most cases occur due to endothelial damage following invasive cardiac procedures involving the right atrium, such as Central Venous Pressure (CVP) placement, Right Ventricle (RV) pacing, cardiac resynchornising therapy and cardiac transplant.We report the case of a 31 yr -old woman, who was admitted with chest discomfort and exertional dyspnea and was found by investigation to have Systemic Lupus Erythematosus (SLE) with secondary antiPhospholipid antibody syndrome. Subsequent 64 slice spiral computerised tomography showed pulmonary embolism. In addition, Trans-Thoracic Echocardiography (TTE) and Trans-Esophageal Echocardiography (TEE) revealed an hyperechoic signal highly suggestive of tumor/thrombus at an unusual site, namely the coronary sinus. The patient underwent surgery under cardiopulmonary bypass and moderate hypothermia. The organized calcified tumor/thrombus was removed through trans-atrial approach and an 8mm Polytetrafluoroethylene (PTFE) graft was placed at the coronary sinus opening. Histological examination of the specimen obtained from the coronary sinus showed an organised, partiallycalcified thrombus. In our patient, pre-operative investigations could not differentiate a thrombus from a mass and the definitive diagnosis was made post-operatively.Keywords Thrombosis . Cardiac . Cardiopulmonary bypass
Case reportIn May 2009, a 31 year-old woman presented at the emergency room of our hospital with sudden-onset chest discomfort and exertional dyspnoea of class III severity (New York Heart Association criteria). The patient was a known hypothyroid for last 2 years, for which she had been on supplementary dose of thyroxine (100 μg/day). She was recently diagnosed to have hypertension and was on medical treatment.At the time of presentation in May 2009, physical examination revealed a blood pressure of 160/100 mm Hg, heart rate of 100/min and respiratory rate of 24/min. The jugular venous pressure was not elevated. First and second heart sounds were regular, but the pulmonic component of 2nd heart sound (P2) was accentuated. The lungs were clear and the abdomen was soft; no peripheral oedema was found. Acanthosis nigricans and livedo reticularis, markers of autoimmunity, were noted. A chest radiograph showed a normal-sized heart with a relative decrease in right-sided bronchovascular markings, a finding suggestive of segmental pulmonary artery occlusion. Electrocardiogram (ECG) showed sinus tachycardia with right-axis deviation (mean frontal plane QRS axis of 105 degrees) and symmetrical 'T' inversion in right sided precordial leads (V1, V2, and V3). Colour Doppler and duplex scan ultrasonogram of the lower limbs excluded deep vein thrombosis.Two dimensional Echocardiography (Philips HD7 ultrasound system, 2-5 MHz transducer) revealed normal left ventricular and left atrial dimensions. Aortic and mitral
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