Cardiac Outpatient Department Research Articles

A Case of Hip Chondrosarcoma Metastasis to the Right Ventricle

Background. While primary cardiac tumors occur rarely, it is observed that cardiac metastases are almost 20 times more common. These are, however, observed during autopsy and seldom missed in living patients. Patients with cardiac metastases present commonly with dyspnea on exertion or pleuritic chest pain. Most common site of intracardiac metastases is right atrium.
 Case presentation. Here we present a case of a 21-year-old male who presented for a routine check-up to the cardiac outpatient department for assessment of fitness for chemotherapy. He was a known case of right hip chondrosarcoma for 2 years, being treated with Ayurvedic medications. He had no symptoms related to the respiratory or cardiac system. He was afebrile during the examination, however, was restricted to a bed due to the pain in his right hip. On evaluation, the patient was diagnosed with a right ventricular thrombus extending to the pulmonary artery (PA) causing an impending pulmonary embolism. On opening the right atrium and PA, we found a loose, whitish-grey mass, adherent to the right ventricular papillary muscle, entangling the chordae. The tricuspid valve leaflets were also found to be tethered to this mass. The mass was found to extend to the PA beyond the leaflets, however, the leaflets were free of the tissue. The mass was extracted piece-meal through right atrium and PA approach. Histopathology revealed metastatic chondrosarcoma tissue.
 Conclusion. Cardiac metastases of chondrosarcoma are a rare condition, and can be often asymptomatic. Such patients often present with dyspnea, and imaging may not be able to rightly identify the cause. A high index of suspicion is necessary in patients with a known current or prior malignancy before committing to surgical intervention.

Non-Valvular Atrial Fibrillation in Young Adults in Eastern India: A Clinico-Aetiological Retrospective Analysis in a Tertiary Care Hospital.

The development of atrial fibrillation adds a lot to the morbidity and mortality of individual patients. The spectrum of non-valvular atrial fibrillation among young adults is less known. The present observational study aims to analyze the clinical-aetiological spectrum of non-valvular atrial fibrillation among young adults between 18 and 40 years of age. A retrospective observational study was carried out to analyze the clinical-aetiological spectrum of non-valvular atrial fibrillation among young adults less than 40 years of age attending the cardiac outpatient department in a tertiary care hospital in Eastern India over a period of two years. Patients with any form of organic valvular heart disease and patients more than 40 years of age were excluded from the study. One hundred and seventeen patients under 40 years of age were analysed with respect to demographic, aetiological, and clinical profiles. Most common aetiologies behind non-valvular atrial fibrillation in young adults (<40 years) were hypertension (40%) and the presence of left ventricular systolic dysfunction (31%). Thyrotoxicosis, obesity, obstructive sleep apnoea, the presence of congenital heart disease, coronary artery disease, myopericarditis, chronic kidney disease, dyselectronemia, diabetes mellitus, and the presence of chronic obstructive pulmonary disease contributed towards the development of non-valvular atrial fibrillation in the young population in less proportion of cases. Most of the cases were symptomatic with palpitation, shortness of breath, or diaphoresis. Less number of cases (17%) had left atrial thrombus which may be due to early clinical attention with the proper therapeutic anticoagulation regimen. Hypertension and the presence of left ventricular systolic dysfunction contribute to the majority towards the development of non-valvular atrial fibrillation among young adults. Accurate measurement and monitoring of blood pressure among young adults and careful assessment of left ventricular systolic dysfunction with subsequent appropriate management of hypertension and left ventricular systolic dysfunction in young can decrease the burden of non-valvular atrial fibrillation among the young population.

A COMPARATIVE STUDY OF EFFICACY AND SAFETY OF AZILSARTAN 40MG AND TELMISARTAN 40MG IN STAGE I HYPERTENSIVE PATIENTS ATTENDING CARDIAC OPD AT TERTIARY CARE HOSPITAL

Objective: To study the efficacy and safety profile of Telmisartan 40 mg and Azilsartan 40 mg in stage I systemic Hypertension among patients attending cardiac OPD in a tertiary care center. Methods: An open-labeled comparative study was conducted in the Department of Cardiology, Osmania General Hospital, Hyderabad, for 24 mo. All patients with stage I systemic hypertension of either sex, aged 18-65 y, with blood pressures of &gt;140/90 mmHg and/or diabetes mellitus attending the cardiac outpatient department at Osmania General Hospital. After initial screening, diagnosed cases of essential hypertension were randomly allocated to either group 1 (Tablet Azilsartan 40 mg or group 2 (Tablet Telmisartan 40 mg). The patients were advised to report for follow-up for review on the 4th, 8th, 12th, and 24th week. Results: The mean decrease in the systolic blood pressure in both groups was statistically significant with a P value of&lt;0.05 at the 8th week, 12th week, and the end of the 24th week. The mean decrease in diastolic blood pressure in both groups was statistically significant with a P value of 0.01 at the end of the 24th week. The difference between the SBP and DBP at various intervals is statistically significant with an Anova P value of&lt;0.0000001. Conclusion: Both drugs controlled blood pressure at similar proportions. However, the mean of SBP and DBP for the Azilsartan group was lower than the Telmisartan Group. Both drugs were tolerated well, and no significant adverse effects were noted during the study.

Impact of COVID-19 on cardiovascular clinics: Are we ready for telemedicine?

The need for telemedicine was felt more than ever during the COVID-19 pandemic, which impacted health care worldwide. Therefore, this study aimed to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19, along with assessing the awareness and acceptability of telemedicine. In this cross-sectional study, selected patients presenting to outpatient department of a tertiary care cardiac hospital were interviewed regarding the difficulties faced by patients in visiting the outpatient department during COVID-19 and their awareness and acceptability of telemedicine using a self-designed structured questionnaire. Of the 403 patients, 58.3% were male, the mean age was 53.04 ± 11.73 years, and most (77.7%) were urban residents. Ischemic heart disease was present in 69.5%, followed by hypertension (38.7%) and heart failure (29.3%). A total of 26.6% required emergency room visits. Limited appointments (55.6%) was the most common problem faced by patients during COVID-19, followed by financial issues (17.1%), fear of acquiring infection (13.4%), and limited mobility due to lockdown (22.6%). Only 12.2% were aware of telemedicine, 4.5% had previously used it, and 41.2% were willing to opt for telemedicine in the future. No internet access (39.2%) was the key barrier to the usage of telemedicine, followed by a lack of free medicine (39%) and a lack of a smart device (31.5%). Limited appointments due to COVID-19 restrictions has made it difficult for patients to visit the clinics, which has led to increased emergency room visits. Telemedicine awareness was found to be limited; however, many patients were willing to adopt it provided their limitations could be overcome.

An Assessment of Door to Consultation Time in Outpatient Department (OPD) of a Tertiary Care Cardiac Hospital: A Clinical Quality Improvement Project (QIP)

Objective: To assess door to consultation time in cardiac OPD of a tertiary care hospital and to recommend strategies to reduce patients waiting time.&#x0D; Study Design: Cross sectional study&#x0D; Place and Duration of Study: Surgical Out-Patient Department, Armed Force Institute of Cardiology, National Institute AFIC/NIHD, Rawalpindi Pakistan, from Aug 2020 to Sep 2020.&#x0D; Methodology: This quality improvement project (QIP) was conducted for a period of 4 weeks from 15th, Aug-15th, Sep 2020 in the surgical out-patient department of Armed Force Institute of Cardiology, National Institute/National Institute of Heart Disease (AFIC/NIHD). Time for registration, waiting time pre-consultation and consultation times were recorded on a patient survey proforma. A non-probability consecutive sampling technique was used to recruit study participants.&#x0D; Results: Data was collected from a total of 278 respondents. The results showed that 142(51%) participants had the total door to consultation time of 30 minutes and 86(31%) participants had the door to consultation time of 30-60 minutes 86(31%), respondents reported the actual consultation time to be 11-20 minutes and an equal percentage of participants 86(31%) responded that it was 6-10 minutes. Sixty-six percent 183(66%) participants reported that the doctors were aware of theirmedical history which helped in shorter consultation time.&#x0D; Conclusion: In this QIP we concluded that patients who had shorter waiting time lead to a significantly shorter door to consultation time. A few areas of concern identified in the QIP of note were; less number of registration counters and patients presenting on same day without appointments. Recommendations were made to reduce waiting times in outpatient department (OPD) which would in turn increase patient satisfaction.

IMPACT OF LOW-DOSE SACUBITRIL-VALSARTAN ON HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION

Objectives: The present study aimed to observe the beneficial effects of sacubitril-valsartan at a lower dose of 24/26mg BID in a third-world country (Pakistan).&#x0D; Methodology: This was a randomized, prospective, observational cohort study conducted at a tertiary care hospital in patients diagnosed, managed, and discharged as a case of heart failure with reduced ejection fraction and followed up in the cardiac outpatient department 6 weeks post-discharge. The required information was collected from the patients by means of a designed questionnaire containing minimal personal information, including age and gender. The questionnaire used was an FDA-approved KCCQ indicated for the use of assessing the quality-of-life change before and following the therapy indicated for HF with reduced ejection fraction. The data was analyzed using SPSS version 26.&#x0D; Results: This study included a total of 77 patients out of which 49 were male (63.6%) and 28 were female (36.4%). The mean age of the patients included was 60.05± 11.80 years. 68.8% of them were hypertensive and 51.9% were diabetic. All patients included were those with reduced Ejection Fraction out of which 29.9% had EF between 20-25%, 49.3 % had it between 30-35% whereas 20.8% of patients had an EF of 40%. In the case of NYHA class before starting Sacubitril/Valsartan approximately 84.4% of patients were in class 3 and 15.6% of them belonged to class 4. The functional class was improved 6 weeks post-treatment in which 79.2% of patients had functional class 2 and 20.8% of them had class 3. The comparison between KCCQ scores of heart failure patients before treatment and after treatment with sacubitril/valsartan at the dosage of 24/26mg BID were statistically significant.&#x0D; Conclusion: It was thus concluded from the study that even a low dose of sacubitril-valsartan results in improved quality of life as assessed by KCCQ scoring in patients with heart failure with reduced ejection fraction.

SELF-CARE MANAGEMENT AND ITS ASSOCIATED FACTORS AMONG PATIENT WITH HYPERTENSION IN NEPAL

Background: Hypertension is currently a common and serious health issue that leads to cardiovascular disease and premature death around the world. Self-care practice is essential for blood pressure control and reduction of hypertension complications of cardiovascular and renal diseases. The objective of this study is to assess the level of self-care management and its associated factors among patients with hypertension. Methods: The cross-sectional study was conducted at the Internal medicine and Cardiac outpatient department of Kathmandu University Hospital, Dhulikhel on 386 participants diagnosed with hypertension with six months of diagnosis and age of 30-80 years. The participants were recruited conveniently in the study. Face to face interviews with participants using Hypertension Self-Care Profile (HTN-SCP) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess self-care management and perceived social support. Descriptive and inferential statistics were performed using SPSS version 23. Results: The mean age of the participants was 57.39 years. Half of the participants (52.3 %) had poor self-care practice. There is significant association between level of self-care practice with religion (p= &lt;0.001), educational level (p= &lt;0.001), area of residence (p= 0.001), income (p=&lt;0.001) and perceived social support (p= 0.001). Conclusions: The present study revealed that half of the participants had poor self-care practice. Based on the results, the study concluded that good self-care practices and social support influence better self-care practice among hypertensive patients which may eventually help to prevent complications in the coming future.

Impact of Covid-19 on cardiovascular clinics: are we ready for tele-medicine?

Funding AcknowledgementsType of funding sources: None.BackgroundWorld is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future.MethodsThis cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables.ResultsA total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly.ConclusionIt was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. Figure. Difficulty faced during OPD visit Figure. Barriers to Tele-medicine

Drug utilization pattern at the cardiac surgical outpatient clinic in a tertiary care hospital at Goa

Background: Drug utilization research encourages rational drug prescribing practices and thus contributes to the contemporary use of drugs in the society. This study assesses the drug utilization pattern (DUP) at the cardiac surgical outpatient department of Goa Medical College hospital. We used the World Health Organization (WHO)-prescribing indicators to analyze the National List of Essential Medicines (NLEM) implementation as recommended in the National Drug Policy. Methods: We used a cross-sectional study design to analyze the DUP. We randomly selected 103 prescriptions dispensed to patients at the cardiac surgical outpatient during the study period. We critically examined these prescriptions for their consistency with WHO core drug use indicators. Results: The average number of drugs prescribed per person was 4.95. The most commonly prescribed top three drugs were antiplatelets (21.46%), beta-blockers (14.76%), and statins (13.78%). Most drugs were prescribed as single drugs (90.98%), whereas 9.02% were fixed-dose drug combinations (FDC). The combination of aspirin and clopidogrel was the most common prescribed FDC. The majority (72.44%) of the drugs prescribed were as per the NLEM 2015 list, whereas the generic name was low (2.8%). We measured Patient-Care Indicators and Facility-Specific Indicators also. The average consultation time and dispensing time were 7.76 and 3.23 min, respectively. The in-house pharmacy dispensed 82% of drugs. 93.75% of the key drugs were available in the facility. A copy of the essential drugs list was readily available in the facility. 96.67% of the patients knew the correct dosage of drugs. Conclusions: Anti-platelets and statins were the most commonly prescribed drugs. There was a high prescribing trend from the NLEM; however, the inclination to prescribe generic names was less. Patient-care and facility-specific indicators were also far from the optimal values except that of the average dispensing time.

Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected.Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.

Impact of Focussed Care in Heart Failure Patients on Hospital Readmission and Mortality

: Objectives: To compare patient health outcomes like mortality and rehospitalisation among heart failure patients receiving focussed care under HF clinics and those receiving usual care under regular cardiac outpatient department. Methods: A total of 200 heart failure patients who consulted in Heart Failure clinic and general cardiology outpatient department during the year of 2017 who satisfied the inclusion and exclusion criteria were selected for the study. The study was carried out in a tertiary care Interventional Cardiology and Cardiac Surgery hospital with a dedicated well established heart failure clinic in Kerala, for a period of 1 year. Patients were followed retrospectively for a period of one year and relevant patient data were obtained from the electronic medical record. The data collected were then evaluated for health outcomes like rehospitalisation and mortality among the two groups. Results: Among the total number of rehospitalisation’s reported, only 32.8% of them were from Heart Failure clinic while 67.2% of reported rehospitalisation’s were from general cardiology outpatient department. Chi square test was applied and statistically significant difference was obtained when mortality rate was compared between the two study groups. 80% of reported cases of death was among patients who consulted in general cardiology outpatient department while only 20% was from Heart Failure clinic. Conclusion: Management of heart failure patients in heart failure clinic was associated with significant reduction in one year mortality and rehospitalisation.Key words: Heart Failure, Heart failure clinics, Rehospitalisation, Mortality, Cardiology, Cardiac care.

Effect of COVID-19 Pandemic on the Cardiac Outpatients' Perception of Seeking Medical Advice.

ObjectivesDuring this unprecedented time of COVID-19 pandemic, it was noticed a decline in cardiovascular cases presentation to the Emergency rooms in many countries, raising many speculations about the reasons and its ramifications. 1 - Identify the reasons during this pandemic that refrain patients from seeking medical care and its impact on stress level and medication adherence. 2 - Emphasize the new role of virtual medicine.MethodsA quantitative descriptive cross-section survey study of 388 patients. It has been done in the cardiac outpatient department and conducted virtually through telemedicine.ResultsDespite this pandemic and its consensuses, the majority of cardiac outpatients will still seek medical advice in case of experiencing symptoms. Nevertheless, the fear of contracting COVID-19 infection, which can alter patient’s decisions from visiting the emergency room and the increase in stress level during these challenging times, is genuine and no more an element of guessing.ConclusionThe majority of cardiac outpatients will wisely seek medical advice in case of serious cardiac symptoms and are adherent to their medications during this pandemic. Nevertheless, they face many concerns which need to implement a preventive and helping measures to fight the consensuses of COVID-19 such as, patient educations, establishing a hotline to all patients, telemedicine, new phone applications, and delivering medications to patients are essential in such circumstances to ensure continuity of care.

Effectiveness of Life Style Modification on Lipid Profile for Patients with Hyperlipidemia

Background: Major predisposing factors of Coronary artery diseases were urbanized lifestyles and growth of ageing populations in developing country like Egypt. The modifiable risk factors for cardiovascular disease (CVD) such as hyperlipidemia, diabetes mellitus, and obesity are likely to increase in the future, but they can be controlled through lifestyle modification. Aim of the study: This study was carried out to examine the effect of life style modification for patients with hyperlipidemia on their lipids profile. Design: Quasi experimental design was utilized. Setting This study was conducted among the patients attending at cardiac outpatient department, Menoufia University Hospital, Menoufia Governorate, Egypt. Subject: A purposive sample of 100 men and women attending cardiac outpatient clinic were selected. The subjects were divided equally into study and control groups. Instrumentations: a. Structured interview questionnaire: it consists of sociodemographic and medical data b. Bio-physiological measurement: Fasting venous blood samples for Glycosylated hemoglobin level, Lipid profile were obtained from all participants, and sent to biochemistry laboratories. Blood pressure assessment and BMI for all patients were compiled. Results: Statistical analysis showed that there were statistical differences among study and control group regard to total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol and their arterial blood pressure level. Conclusion: The need for tailoring and following up of intervention for coronary artery diseases is an essential maneuver to reduce their risk factors occurrence. Recommendations: Implementation of lifestyle modification for at risk patient for coronary artery diseases by modifying their lifestyle. Routine screening for all subjects above the age of forty to detect abnormal lipid profile early and to increase their awareness to prevent and control of cardiovascular disease (CVD) is recommended.

Prevalence of Anxiety Disorders in Patient Presenting to Cardiology Outpatient Department

Psychiatric comorbidities in a cardiovascular condition has been in an increasing ratio. Psychiatric disorders such as depression and anxiety, represent an additional risk for Coronary Artery Disease. As a consequence, the co-existence of physical and psychiatric morbidity negatively affects the course and outcome of both the conditions resulting in increased overall burden of disease. One study conducted in 2001 in Bikaner, India found high prevalence (75%) of Diagnosable psychiatric morbidity among patients attending Cardiac OPD. Most commonly (38.67%) diagnosed disorder was Depressive disorder followed by panic disorder as the diagnosis (38.10%). Psychiatric morbidity among patients attending cardiac outpatient department has been revealed as a significant problem in many studies. The objective of this study was to determine the proportion of psychiatric morbidity among patients attending the cardiology outpatient department in a tertiary care centre. This is a cross-sectional study Convenient sampling technique was used. The aim of this study is to find out the prevalence of psychiatric morbidity in patients attending the cardiology OPD. This will help in planning proper diagnosis and treatment in time of these non-cardiac psychiatric disorders and may reduce mortality, improve quality of life and speed the recovery of patients with cardiac diseases.

Quality of Life of Adult Patients Who Have Undergone Cardiac Surgery at No. (1) Defence Services General Hospital (1000 Bedded)

A hospital-based, cross-sectional descriptive study design was conducted to study the quality of life of adult patients who have undergone cardiac surgery at cardiac Out-Patient Department, No. (1) Defence Services General Hospital (1000 Bedded), Mingaladon using combination of qualitative and quantitative methods in 2012. For quantitative data, a total of 55 respondents were interviewed using WHOQOL-BREF (World Health Organization, Quality of life) questionnaire. Six out of them selected through purposive sampling method were semi-structure interviewed to support the quantitative findings. The Kruskal-Wallis H and Mann-Whitney U test were used for statistical analysis of relationship between study variables. Postoperative median scores of Quality of Life (QOL) scale revealed an improvement in all dimensions except psychological with average of 50% of the respondents. Consistently, most respondents expressed their quite often negative feelings such as anxiety and worry after surgery. However, responses on QOL to their lives were mostly satis-fied. Psychological QOL scores were affected by their education (p=0.022). There were strong relationship between marital status, occu-pation, family income, family member and environmental domain scores at p&lt;0.05. However, there was no significant relationship between socio-demographic and QOL regarding physical and social domain. Findings of this study highlighted that psychological support is an essential part of care programs following surgery and consideration should be put on the patients with low socio-demographic status. Provision of complete health information and comprehensive services for cardiac patients were recommended so as to increase QOL among them.

Quality of life after myocardial infarction in women from rural India

Introduction: Health expenditures in survivors of myocardial infarction (MI) causes increased financial burden. Secondary prevention strategy can be planned with knowledge of health-related quality of life (HRQoL) in survivors of MI. Aim: To study HRQOL using Mac New Heart questionnaire. Objective: Female survivors of MI will undergo the questionnaire and the scores across physical, social and emotional domains will be noted. Material and Methods: Observational study. Female survivors of MI attending follow up in cardiac outpatient department between January 2017 and January 2018 were subjected to MacNew Heart Disease HRQoL questionnaire. Statistical Analysis Used: Pearson's correlation coefficient; software used was SPSS 22.0 version. Results: Mean age 60 years; mean duration since MI – 7.88 months; 74% were married and 88% on vegetarian diet. Those women with mean age of 40 years, vegetarian and married had better mean scores. The emotional score improved over a period of time whereas the physical and social score remained the same. Conclusion: Female survivors above 40 years showed poor scores across all three domains and therefore need early cardiac rehabilitation as also long-term follow up.

Adverse cardiovascular effects of betel nut

Background: Areca nut (Areca Catechu) is considered to be the fourth extremely prevalent addictive psychoactive substance consumed widely by about 10%–20% of the world population. Due to its theological and cultural acceptance, areca nut is chewed in different forms and formulations. It has been observed that people who chew supari (areca nut) exclusively for many years suffer from diabetes mellitus, coronary artery disease (CAD), oral submucous fibrosis, and oral cancer. We, therefore, planned to see its association with various cardiovascular ailments at our center. Materials and Methods: This was a single-center observational study carried out on people chewing areca nut exclusively (no other toxic or addicting substance) attending cardiac outpatient department (OPD) in National Heart Institute and Research Centre, Delhi, India. The subjects data were collected regarding the history of the disease, consumption of areca nut, and socioeconomic status with relevant work up. Results: There were 17 subjects who primarily chewed areca nut; 11 of them had CAD, diabetes, oral submucous fibrosis, and aplastic anemia. Further, one particular case not only suffered oral cancer but also had two episodes of myocardial infarction, but continued to chew areca nut. The second episode of myocardial infarction was fatal. Conclusion: Areca nut chewing is also associated with significant cardiovascular morbidities besides oral cancer. In such preparations, the risk of some other toxic substances together with areca nut cannot be eliminated as no empirical analysis has been carried out to the best of our knowledge and belief. In order to clarify its effect on other vascular diseases, further work with a larger sample size is required.

Role of Platelets in Rheumatic Mitral Stenosis: An Observational Study

Abstract Background As previous studies demonstrated, the mean platelet volume (MPV) is one of the determinant factors for the development of left atrial appendage (LAA) clot. The authors wanted to see other parameters such as platelet distribution width (PDW) along with MPV in patients with chronic rheumatic heart disease (CHRD) in whom transesophageal echocardiogram (TEE) was done. Methods Total 50 consecutive CRHD patients with predominantly mitral stenosis (MS) came for cardiac outpatient department (OPD) for balloon valvuloplasty and were enrolled. Transthoracic echocardiography (TTE) and TEE were performed for each patient. Laboratory investigations included all biochemical parameters. In addition MPV and PDW were noted. Results Most of the 50 patients enrolled in this study were middle-aged women (n = 37), with mean age of 40.18 ± 9.50 years. Patients were divided into two groups: with left atrial (LA) clot (n = 24, group 1) and without LA clot (n = 26, group 2). Out of them, male population with severe MS was more prone for LA clot formation (p = 0.031). When comparing severity of MS with electrocardiographic (ECG) rhythm (normal vs. atrial fibrillation), no statistically significant difference was observed with clot formation (p = −0.44). In this study, presence of clot is more when the patient has larger-size platelets, that is, higher MPV, which is statistically significant (9.823 ± 0.759 vs. 10.996 ± 0.534; p = 0.000). Severe MS is associated with high normal PDW whether the clot is present or not but statistically not significant (p = −0.926). Conclusion Severity of MS in CRHD patients is an independent determinant of LA clot formation irrespective of rhythm abnormalities and higher MPV value. Male patients with severe MS are more prone to LA clot formation.

Anxiety and Depression among Patients with Coronary Artery Disease Attending at a Cardiac Center, Kathmandu, Nepal.

Psychiatric morbidity such as anxiety and depression is common among patients with coronary artery disease (CAD). The coexistence of psychiatric morbidity negatively affects the outcome of treatment and increases the overall burden of disease in CAD patients. The objective of the study was to identify the level of anxiety and depression among patients with CAD. Descriptive, cross-sectional research design and purposive sampling were used and a total of 168 patients having coronary artery disease were selected purposively for the study from the patients attending cardiac outpatient department of Sahid Gangalaal National Heart Center, Kathmandu, Nepal. Data was collected on 2017 by using pretested semistructured interview schedule, Hospital Anxiety and Depression Scale. The findings showed that 27.4% of the respondents had anxiety caseness and 23.8% of the respondents had depression caseness. Bivariate analysis showed that patient's level of anxiety was significantly associated with sex, family income, occupation status, and self-esteem. Higher level of anxiety (42.4%) was found in female than male patients. Likewise, level of depression was significantly associated with education status, occupation status, presence of comorbidities, physical exercise, and self-esteem of the patients. There was significant positive relationship between anxiety and depression score. Thus anxiety and depression were common among patients with CAD. Hence, anxiety and depression in CAD patients need be monitored regularly, provide regular counseling services, and refer the patients for the treatment when needed.

Psychometric Testing of the Indonesian Version of Dietary Sodium Restriction Questionnaire Among Patients with Hypertension

PurposeThe purpose of this research was to test the validity and reliability of the Indonesian version of the Dietary Sodium Restriction Questionnaire (DSRQ-I) among patients with hypertension. MethodsThe cross-sectional study enrolled hypertensive patients from a cardiac outpatient department in Indonesia using convenience sampling. Eligible patients received a demographic questionnaire and DSRQ-I during a one-month period of data collection. Content and construct analysis examined the validity, whereas internal consistency assessment checked reliability. Participation required 10–15 minutes on average. ResultsOne hundred thirty-five patients participated: mostly females (54.1%) and married (82.9%) with mean age of 58.18 ± 10.44 years. The item of content validity index was .97, and subscale content validity index was .81 for DSRQ-I. The Kaiser–Meyer–Olkin test gave a value of .83, indicating adequate sampling, and the Bartlett's test of sphericity reached significant result (p < .001). The principal component analysis indicated three components, with 64.2% explaining variance, including perceived behavioral control (35.5%), attitude (19.3%), and subjective norm (9.4%). Confirmatory factor analysis produced a parsimonious model on the three-factor outcome by removing a single item. The indices of good fit model was achieved at χ2/df = 2.17, goodness fit index = .85, root mean square error of approximation = .09, standardized root mean square means = .07, and Bentler comparative fit index = .90 (p < .001). Cronbach's alpha coefficients for attitude, subjective norm, and perceived behavioral control were .85, .87, and .85, respectively. All interitem and item-total correlations indicated adequate outcome and acceptable result. Consequently, 15 items were determined reliable measurement and included in the final version of DSRQ-I. ConclusionThe DSRQ-I is a valid and reliable instrument to measure facilitators and barrier of sodium restriction among hypertensive patients in Indonesia.