The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg.The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. The AAFP has decided to not endorse the recent hypertension guideline because it gave undue importance to the SPRINT trial and cardiovascular risk which was not validated and would lead to overtreatment. The guidelines are discussed in this article.

Risk stratification of patients before considering implantable cardioverter defibrillator (ICD) therapy is important for targeting therapy. Recommendations for selecting the optimal patients for ICD therapy are based on major trials. For patients with nonischemic dilated cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and associated heart failure (HF) with New York Heart Association (NYHA) functional Class II or III status, ICD therapy for primary prevention of sudden cardiac death (SCD) is recommended. ICDs are effective at reducing total mortality and mortality from SCD, although the benefits of an ICD on total mortality may be diminished in the setting of guideline-directed optimal medical therapy and cardiac resynchronization therapy. For patients with an LVEF ≤35%, HF with NYHA functional Class III or IV status, and a QRS duration ≥120 milliseconds, biventricular pacing combined with an ICD is recommended.

The microbiome comprises all of the genetic materials within a microbiota. This can also be referred to as the metagenome of the microbiota. Dysbiosis, a change in the composition of the gut microbiota, has been associated with pathology, including cardiovascular diseases (CVDs). The recently discovered contribution of gut microbiota-derived molecules in the development of heart disease and its risk factors has significantly increased attention toward the connection between our gut and heart. The gut microbiome is virtually an endocrine organ, capable of contributing to and reacting to circulating signaling molecules within the host. Gut microbiota-host interactions occur through many pathways, including trimethylamine-N-oxide and short-chain fatty acids. These molecules and others have been linked to chronic kidney disease, atherosclerosis, and hypertension. Dysbiosis has been implicated in CVD as well as many aspects of obesity, hypertension, chronic kidney disease, and diabetes.

Trials addressing the PCSK9 inhibitors, wearable cardioverter defibrillator, genotype-guided antiplatelet therapy, his bundle pacing, and therapies for HFpEF were discussed in American College of Cardiology 2018. TASMINH4 evaluated the need for self-monitoring and telemonitoring of blood pressure in the management of patients with poorly controlled blood pressure. In heart failure, issues regarding temporal trends and patterns of incidence, NT-proBNP, HeartMate pump, immunosuppression (sirolimus versus calcineurin) in heart transplant recipients, and aspirin use were evaluated in various trials. Drug-eluting balloon, MiStent, Resolute Onyx 2.0 drug-eluting stent, Omega-3 fatty acids, safety of drugs used in the treatment of gout (febuxostat versus allopurinol), and preventive strategies for those at risk for renal complications were tested in patients with coronary artery disease. Smokers were compared with nonsmokers presenting with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in terms of clinical, angiographic, and outcomes. Association of influenza infection with acute myocardial infarction was also tested. A good number of trials tested different antiplatelets in different manners.

Background: The burden of HF in India is high, with an estimated prevalence of about 5 million patients, an annual incidence of one million, an in hospital mortality as high as 30.8%, with postdischarge 6 month major adverse event and mortality rates at 39.5% and 26.3%. Acute decompensated HF is caused by a variety of precipitating factors and many are preventable. Methods: This 1 year study was a prospective study conducted on the patients admitted under a tertiary care unit in north India. Patients included in the study had chronic stable left ventricular systolic dysfunction and developed acute decompensated HF. Results: This study included 150 Patients with ADHF . Moderate to severe anemia was found to be the factor in 63.8% of the patients. New onset myocardial ischemia was the next most common factor leading to acute decompensated HF, Dietary indiscretion was seen in 45.3% of the patients. Noncompliance to drugs was also very common. The study revealed that higher rates of admissions with acute decompensated HF were seen in winters (October to December and January to March). Conclusion: Anemia and noncompliance with drugs were most common precipitating factors leading acute decompensated HF in North Indian population.Every patient needs a more intensive regular follow up and adequate diet pattern for prevention of acute decompensated HF. Systematic patient education and treatment can reduce the burden, risk of ADHF, and re hospitalization.

Background: Recent and emerging evidences show that glucose ingestion causes prolonged Q-T interval and can trigger arrhythmia. Objective: The objective of this study is to examine the effects of administration of glucose solutions on the heart rate, strength of myocardial contraction, and duration of the cardiac cycle in the frog's heart. Methods: Five pithed frogs with a mean weight of 119 g obtained from the research laboratory, Department of Human Physiology, Bayero University Kano, Nigeria, were dissected and their hearts were exposed; 2–3 drops of frog Ringer's solution were added regularly to keep the heart moist. A kymograph was used to record the frog's myocardial activity. This was also recorded after subsequent addition of 2 ml of 5%, 10%, and 50% dextrose solutions to the heart. Heart rate (b/min), strength of myocardial contraction (mm), and the duration of the cardiac cycle (seconds) were calculated. Data were analyzed using SPSS version 20.0 and the calculated parameters for each glucose solution were compared with that of frog's Ringer's solution using paired t-test. P < 0.05 is significant. Results: The result showed a significant decrease in the heart rate (b/min) from that obtained with Ringer's solution (54.40) after addition of 5%, 10%, and 50% dextrose solutions with mean heart rates of 50.40, 47.60, and 41.00, respectively. The height of myocardial contraction (mm) was found to be significantly decreased after addition of 50% dextrose solution only, with the mean heights for frog's Ringer's, 5%, 10%, and 50% dextrose solutions been 8.65, 8.90, 8.40, and 5.35, respectively. The duration of cardiac cycle in seconds was significantly increased after addition of 10% and 50% dextrose solutions, with the mean duration for the Ringer's, 5%, 10%, and 50% dextrose solutions been 1.11, 1.18, 1.26, and 1.47, respectively. Conclusion: Both 5%, 10%, and 50% dextrose solutions caused a significant decrease in frog's heart rate. Fifty percent dextrose solution caused a significant decrease in the strength of frog's myocardial contraction, and addition of both 10% and 50% dextrose solutions significantly increased the duration of cardiac cycle in frogs.

Linear regression is a statistical procedure for calculating the value of a dependent variable from an independent variable. Linear regression measures the association between two variables. It is a modeling technique where a dependent variable is predicted based on one or more independent variables. Linear regression analysis is the most widely used of all statistical techniques. This article explains the basic concepts and explains how we can do linear regression calculations in SPSS and excel.

A 24-year-old female with rheumatic heart disease presents with a 6 years history of symptoms, with an eventful pregnancy, medical management, and subsequent surgery. The history and management is discussed.

The introduction of β-adrenergic-blocking drugs in the early 1960s represented a major advance in therapeutics. Their use highlighted the importance of the sympathetic nervous system. This article briefly highlights some of the steps in their development.

Hamartoma of mature cardiac myocyte is a benign tumor of the heart. They are characterized by haphazardly arranged hypertrophic cardiac myocytes with variable amounts of intervening fibrosis, mature adipose tissue along with irregularly distributed variable-sized vascular channels. The case presented here had a hyperechoic mass in the left ventricle arising from the midinferior and posterior interventricular septum, infiltrating into the adjacent myocardium. The MRI , histopathology findings and the clinical outcome is presented.

Tricuspid valve replacement (TVR) is traditionally performed after giving cardioplegia and arresting the heart, but sometimes dense adhesions in redo cases can render looping superior and inferior vena cavae almost impossible. We had a case where the right atrium was hugely dilated and stuck and adhesions were dense, and the condition of the patient was too sick to tolerate myocardial ischemia. We did TVR on a beating heart with femoral and innominate vein cannulation without snugging vena cavae and carefully maintaining a blood level in the right atrium just below tricuspid valve and above the vena caval opening so as to avoid an air lock. It is an innovative technique in a difficult scenario.