Introduction: Heart Failure is a leading cause of mortality worldwide including India. Most cross sectional studies have demonstrated heart failure is associated with deficiency of essential micronutrients including Vitamin D which may play a important role in pathogenesis of ventricular remodelling in heart failure. Aim: Our study performed aimed to determine the effect of supplementation in patients of Heart Failure presenting with Vitamin D deficiency to our institute on severity of Heart Failure. Design and Method: 97 patients of Heart failure coming to our institute were given conventional therapies for Heart Failure along with Vitamin supplementation based on serum Vitamin D levels and followed up for 3 months. Results: Patient of Heart failure having Vitamin D deficiency had significant reduction in cardiac biomarkers (NT-pro BNP levels), improvement in Left ventricular ejection fraction (LVEF) and more favourable reverse remodelling determined by Left ventricular end diastolic and systolic diameter (LVEDD & LVESD) though quality of life determined by WHODAS 2.0 score did not changed following 12 weeks supplementation of High Dose Vitamin D. Conclusion: Recognising and treatment of Vitamin D deficiency may determine long term prognosis in patients of Heart Failure.

Platypnoea-orthodeoxia syndrome (POS) is a rare clinical entity with very few cases reported worldwide. We report a case of a 27-year-old male with a seven-day history of fever, dry cough, and breathlessness; later on, diagnosed to have H1N1 (Swine flu) and acute respiratory distress syndrome. He was put on mechanical ventilation and weaned off in due course. However, he had persistent dyspnoea and desaturation in sitting position that relieved on lying down (platypnoea/ orthodeoxia). He was again mechanically ventilated. High resolution computed tomography of chest revealed tension pneumomediastinum and pneumothorax. Computed tomography-guided pigtail drainage of mediastinal air and bilateral intercostal drainage tubes were performed. His symptoms improved immediately. He had no underlying demonstrable cardiac disease. The diagnosis of POS was made due to a high index of clinical suspicion and helped in establishing POS as a presentation of concomitant pneumomediastinum-pneumothorax in this patient. To the best of our knowledge, acute respiratory distress syndrome complicated by concomitant pneumomediastinum-pneumothorax as an extra-cardiac cause of POS has not been reported.

Background: The association between vitamin D and heart failure, especially left ventricular (LV) function, is still not clear. Objectives: We aimed to study the correlation between 25-hydroxy vitamin D levels and parameters of cardiac systolic and diastolic functions in patients with LV systolic heart failure. Materials and Methods: Ninety patients of heart failure coming to our hospital with systolic heart failure (LV ejection fraction <40%) were included. Venous sample were taken for measurement of 25-hyrdoxy vitamin D levels. Transthoracic echocardiography was done for all patients, and parameters of LV systolic and diastolic functions were taken. Results: Compared to patients having vitamin D <20 ng/ml, patients having vitamin D levels ≥20 ng/ml had higher early diastolic mitral annular velocity (e'), significantly lower ratio of early diastolic mitral inflow velocity (E) to e' (E/e'), significantly shorter isovolumetric relaxation time (IVRT) suggestive of better diastolic function. Furthermore, patients having vitamin D <20 ng/ml had higher LV end-systolic volume, LV end-systolic diameter, larger LV end-diastolic diameter, higher interventricular septum thickness, higher LV wall thickness, and higher LV mass. Conclusion: Reduced vitamin D (<20 ng/ml) was associated with worse systolic function in terms of systolic volume and diameter, diastolic function in terms of lower e′, higher E/e′, and longer IVRT.

Idiopathic isolated right ventricular cardiomyopathy is an extremely rare cause of right ventricular failure. Here, we report a case of 65-year-old male presented with chief complaints of dyspnea, fatigue, and bilateral pedal edema for the last 6 months. On clinical evaluation, grade II/III pansystolic murmur was present in left parasternal area. Investigations and imaging revealed dilated right atrium and ventricle with normal pulmonary artery pressure without any etiology. Magnetic resonance imaging ruled out other common causes of right ventricular cardiomyopathy; thus, the patient was diagnosed as a case of idiopathic isolated right ventricular cardiomyopathy that is a diagnosis of exclusion.