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   2014| January-March  | Volume 15 | Issue 1  
    Online since May 9, 2014

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Rationale, design, methodology and hospital characteristics of the first gulf acute heart failure registry (gulf care)
Kadhim J Sulaiman, Prashanth Panduranga, Ibrahim Al-Zakwani, Alawi Alsheikh-Ali, Khalid Al-Habib, Jassim Al-Suwaidi, Wael Al-Mahmeed, Husam Al-Faleh, Abdelfatah El-Asfar, Ahmed Al-Motarreb, Mustafa Ridha, Bassam Bulbanat, Mohammed Al-Jarallah, Nooshin Bazargani, Nidal Asaad, Haitham Amin
January-March 2014, 15(1):6-12
DOI:10.4103/1995-705X.132137  PMID:24949181
Background: There is paucity of data on heart failure (HF) in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry (Gulf CARE). Materials and Methods: Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF (AHF). The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. Results: A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States (Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain) participated in the project. The majority of hospitals were community hospitals (46%; 22/47) followed by non-University teaching (32%; 15/47 and University hospitals (17%). Most of the hospitals had intensive or coronary care unit facilities (93%; 44/47) with 59% (28/47) having catheterization laboratory facilities. However, only 29% (14/47) had a dedicated HF clinic facility. Most patients (71%) were cared for by a cardiologist. Conclusions: Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region.
  9,379 189 22
Recurrent myocardial infarction in a case of congenital Afibrinogenemia
Soumya Patra, Babu Reddy, CM Nagesh, BC Srinivas, CN Manjunath
January-March 2014, 15(1):16-18
DOI:10.4103/1995-705X.132141  PMID:24949183
Afibrinogenemia is a rare autosomal recessive bleeding disorder with an estimated prevalence of 1:1,000,000. Usual presentation of this disorder is spontaneous bleeding, bleeding after minor trauma and excessive bleeding during interventional procedures. Paradoxically, few patients with afibrinogenemia may also suffer from severe thromboembolic complications. The management of these patients is particularly challenging because they are not only at risk of thrombosis but also of bleeding. We are presenting a case of 33-year-old male patient of congenital afibrinogenemia who had two episodes myocardial infarction in a span of two years. The patient was managed conservatively with antiplatelet therapy and thrombolytic therapy was not given due to high risk for bleeding.
  8,919 122 5
Short term efficacy and safety of low dose tolvaptan in patients with acute decompensated heart failure with hyponatremia: a prospective observational pilot study from a single center in South India
Soumya Patra, Basant Kumar, Kaushal K Harlalka, Apoorva Jain, HM Bhanuprakash, KS Sadananda, Harsha Basappa, K Santhosh, KS Rajith, KS Bharathi, CN Manjunath
January-March 2014, 15(1):1-5
DOI:10.4103/1995-705X.132136  PMID:24949180
Background: In acute decompensated heart failure (ADHF), diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. Vasopressin mediates fluid retention in heart failure. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Hyponatremia (serum sodium concentration, <135 mEq/L) is a predictor of death among patients with heart failure. Objective: We prospectively observed the short term efficacy and safety of low dose (15 mg) tolvaptan in admitted patients with hyponatremia and ADHF in Indian population. Methodology: A total of 40 patients with ADHF along with hyponatremia (<125 mEq/L) on standard therapy were treated with 15 mg of tolvaptan at a single oral dose for 7 days. Results: Serum sodium concentrations increased significantly after treatment with tolvaptan from baseline (P < 0.02). There was a significant improvement in symptoms and New York Heart Association (NYHA) class after starting tolvaptan (P ≤ 0.05). Total diuretic dose and mean body weight was reduced non-significantly at 7 th day from the baseline. Side-effects associated with tolvaptan included increased thirst, dry mouth and increased urination. Few patients had worsening renal function. However, several patients developed hypernatremia. Conclusion: In this small observational study, tolvaptan initiation in patients with ADHF with hyponatremia in addition to standard therapy may hold promise in improvement in NYHA class and serum sodium. At the same time, we observed that serious adverse events such as renal function deterioration and hypernatremia developed after tolvaptan treatment, which needs to be addressed in future by randomized study with larger sample size.
  6,502 196 5
Two cases of acute myocarditis with multiple intracardiac thrombi: The role of hypercoagulable states
Halil Atas, Fuad Samadov, Murat Sunbul, Altug Cincin, Kenan Delil, Bulent Mutlu
January-March 2014, 15(1):22-25
DOI:10.4103/1995-705X.132143  PMID:24949185
In acute myocarditis, thrombus formation is an important prognostic factor. Early diagnosis and treatment of intracardiac thrombus is critical, especially when there are multiple thrombi. When a patient presents with multiple cardiac thrombi not only cardiac disorders, but other diseases such as malignancies, rheumatologic disorders and thrombophilia must be considered in the differential diagnosis. Although the presence of hypercoagulable states does not generally affect the treatment choice, it may have an impact on continuation and duration of the anticoagulant therapy. In this paper, we present two cases of acute myocarditis with multiple intracardiac thrombi. Additionally, these cases had hypercoagulable states which might have contributed to the thrombus formation.
  6,264 133 5
Successful accessory renal artery denervation in a patient with resistant hypertension
Halil Atas, Erdal Durmus, Murat Sunbul, Bulent Mutlu
January-March 2014, 15(1):19-21
DOI:10.4103/1995-705X.132142  PMID:24949184
Renal sympathetic denervation is safe and effective in patients with resistant hypertension. In all of the studies of renal artery denervation, patients with accessory renal arteries are excluded. So there is not any data regarding renal sympathetic denervation applied to the accessory renal arteries. We present a young female patient with resistant hypertension despite use of five different antihypertensive drugs. The patient had a well developed (diameter >4 mm) left renal accessory. We believe that if we omitted the well developed accessory renal artery, we would not have maintained adequate blood pressure control. Thus, we applied radiofrequency ablation to both renal arteries and left accessory artery. Immediately after the procedure, the patient's blood pressure was reduced to 110/60 mmHg and this effect was continued during the first month of follow-up.
  5,401 95 6
Expanding giant right coronary artery aneurysm: An acute need for new management strategies
Anurag Bajaj, Vishal Sehgal, Sukhminder Jit Singh Bajwa, Ankur Sethi, Samir B Pancholy
January-March 2014, 15(1):13-15
DOI:10.4103/1995-705X.132139  PMID:24949182
Angiography use has become increasingly common worldwide. Coronary artery aneurysm may be an incidental finding during angiography. Occasionally it might be symptomatic or may become symptomatic over the course of time. Rupture of aneurysm may lead to disastrous complications. Here we present a case in which aneurysm was asymptomatic but surgical intervention was done because of rapid increase in the size of aneurysm. This is to drive home the point that timely surgical intervention is instrumental in preventing complications associated with possible rupture of the aneurysm.
  4,170 121 2
Aortic debranching and endovascular treatment of aortic arch aneurysm
Murat Ugurlucan, Ahmet Hulisi Arslan, Kutlay Karaman, Sertac Cicek
January-March 2014, 15(1):29-29
DOI:10.4103/1995-705X.132145  PMID:24949187
  3,284 89 2
Mechanical heart pump in the thorax

January-March 2014, 15(1):30-30
  2,403 53 -
Early extracorporeal membrane oxygenation support for 5-fluorouracil-induced acute heart failure with cardiogenic shock
Robert Höllriegel, Julia Fischer, Gerhard Schuler
January-March 2014, 15(1):26-28
DOI:10.4103/1995-705X.132144  PMID:24949186
A 50-year-old man with no previous history of cardiovascular disease or risk factors was admitted for syncope and orthopnea. Importantly, he underwent recent chemotherapy with 5-fluorouracil (5-FU) until 1 day before his acute presentation. In the emergency room, patient developed asystole and was successfully resuscitated for 2 min. At coronary angiography, no signs of coronary artery disease were detectable, but transthoracic echocardiography showed a severely decreased left-ventricular systolic function. Due to the progressive cardiogenic shock, an extracorporeal membrane oxygenation (ECMO) support was used as bridge-to-recovery and to avoid the use of sympathomimetics with their known disadvantages. On ECMO support, hemodynamic stabilization was evident and medical heart failure treatment was commenced. Left-ventricular function recovered to normal values within a short period of time. Cardiac complications after chemotherapy with 5-FU are not rare and should be taken into consideration even in acute heart failure with cardiogenic shock. ECMO as the most potent form of acute cardiorespiratory support enables complete relief of cardiac workload and therefore recovery of cardiac function.
  959 47 2