The EMPULSE trial was a randomized, double-blind, intention-to-treat trial that screened 566 patients, hospitalized for acute heart failure (HF). It showed that empagliflozin is effective and safe in patients admitted as decompensated chronic HF or de novo HF irrespective of baseline ejection fraction (EF).

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A 44-year-old male with no prior cardiovascular risk factors presented with exertional dyspnea and dry cough followed by features of the right heart failure including early satiety and pedal edema. He had congestive heart failure at presentation with cardiac auscultation revealing murmurs of mitral regurgitation at the apex and tricuspid regurgitation at the lower left sternal border and aortic stenosis at the right second intercostal space. He was diagnosed as case of rheumatic heart disease based on clinical and echocardiographic assessment. The following clinical case discussion highlights some common questions that come to mind during evaluation of such patients. Physical examination findings in a patient presenting with heart failure syndrome are highlighted in particular.

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Background: Two-dimensional speckle-tracking echocardiography (2D STE) has been used by many cardiologists globally for assessing the left ventricle (LV) function by having global longitudinal strain (GLS) as an important parameter; however, it is not incorporated into daily practice and some studies have proved to be a better diagnostic value for evaluation of detecting significant coronary artery disease (CAD) and also in predicting the culprit coronary artery. Methods: We enrolled 100 consecutive symptomatic patients with suspected CAD who have undergone angiogram in our institute. Out of these, 21 patients had poor echo window and were excluded. The patients were divided into two groups those presenting with acute coronary syndrome ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and others with stable angina. All patients underwent a 2D echocardiogram, 2D strain imaging, and coronary angiogram. Results: GLS correlated well with ejection fraction in our study. GLS was more impaired in patients with double- and triple-vessel disease than in patients with single-vessel disease. The number of patients presented with STEMI is 26 (anterior wall myocardial infarction – 20 and inferior wall myocardial infarction – 6), 23 had NSTEMI, and 30 had stable angina. The results of regional peak systolic strain had a stronger correlation with coronary angiogram in stable angina (P = 0.03), but in ACS patients, it was not significant (P = 0.136). This correlation was better in patients with adequate LV systolic function (P < 0.05) than patients with left ventricular systolic dysfunction (P = 1.0). Conclusion: 2D STE is a simple, noninvasive, and reproducible diagnostic tool in the evaluation of CAD and is immensely helpful in the localization of culprit vessel in chronic coronary syndrome.

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Introduction: Left ventricular (LV) systolic function evaluation is based on ejection fraction assessment. Due to the great sensitivity of the examination and the ease of measurement, systolic time intervals (STIs) are ideally appropriate for studying the effects of pharmacologic agents upon the heart. In this context, the present study aimed to estimate and compare STI in patients with ischemic heart disease (IHD) with clinical heart failure and among control subjects without clinically established LV dysfunction based on their LV ejection fraction (LVEF). Materials and Methods: This case–control study included 33 IHD patients as cases and 32 healthy subjects as controls. All subjects underwent pulsed-Doppler echocardiogram to estimate STIs: total electromechanical systole (QS₂), preejection period (PEP), and LV ejection time (LVET). Results: A significant difference between PEP (145.23 ± 23.20 vs. 82.99 ± 8.63, P < 0.00001), LVET (231.34 ± 40.89 vs. 265.39 ± 31.98, P = 0.000947), and PEP/LVET ratio (0.63 ± 0.15 vs. 0.31 ± 0.08, P < 0.00001) between cases and controls was found. On subgroup analysis, a weak correlation was found in patients with LVEF ≤40% and PEP/LVET (r = −0.3677, P = 0.1958). In addition, a relatively strong correlation between LVET and heart rate (r = −0.432, P = 0.012) was found among the cases. Conclusion: The current study results showed that the differences in the values of STI among cases than in controls could be an indicator of LV systolic dysfunction. In addition, this method may have impending applications in the management of IHD.

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Introduction: The most plausible factor for coronary artery ectasia (CAE), a subset of coronary artery disease (CAD), is extensive inflammation. High-sensitivity C-reactive protein (hs-CRP) and serum uric acid (sUA) are well known markers of inflammation. Most of the previous studies (done in the Western population and of Middle East Asia) evaluated their role individually as a marker of inflammation in CAD. We aimed to investigate the possible association of isolated CAE with inflammation as assessed by the hs-CRP and sUA levels and check whether the inflammatory hypothesis holds good in the south Asian population. Materials and Methods: Patients admitted for coronary angiography with age ≥30 years were evaluated. Patients with both CAE and CAD were excluded. A total of 60 patients were studied. Patients with isolated CAE (30) were compared with an equal number of patients with obstructive CAD (30) and their clinical profile was studied. The hs-CRP, sUA, and novel inflammatory markers such as neutrophil–lymphocyte ratio (NLR), mean platelet volume (MPV), and red cell distribution width (RDW) were compared between the groups. Results: Of the 60 patients studied, males were 56% in the isolated CAE group and 50% in the obstructive CAD group. The hs-CRP (2.39 ± 0.41 vs. 1.41 ± 0.29, P < 0.001) and sUA levels (6.46 ± 0.58 vs. 5.36 ± 0.40, P < 0.001) were significantly elevated in the isolated CAE group compared to the obstructive CAD group. Among the novel inflammatory markers, the NLR (3.98 ± 0.42 vs. 2.91 ± 0.30, P < 0.001) and RDW (12.69 ± 0.27 vs. 12.13 ± 0.48, P < 0.001) were significantly higher in the CAE group compared to obstructive CAD group, whereas the MPV did not have a statistically significant difference (9.5 ± 0.98 vs. 9.6 ± 1.08, P = 0.525). Conclusion: The inflammatory etiology of CAE was supported by an elevated hs-CRP, sUA, and other novel inflammatory markers compared to the atherosclerotic obstructive CAD group.

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Background: Sleep plays a vital role in disease prevention and rejuvenation. Diet and exercise are emphasized in the prevention of diseases, whereas sleep is often overlooked. The consequences of poor sleep often go unnoticed. Insufficient and poor sleep has been associated with various health problems and is considered an important risk factor. The objective of this study was to explore the association between perceived sleep quality and quantity before acute myocardial infarction (MI). Materials and Methods: It was a prospective observational study. Thirty hospitalized patients of acute coronary syndrome with an index event of first-time MI satisfying the inclusion and exclusion criteria were enrolled. The Pittsburgh Sleep Quality Index (PSQI) was administered to the patients. Other basic investigations done for the diagnosis and work-up of the cases by the treating doctors were noted and data were analyzed. Results: In our study, the mean Global PSQI score was 7.16 (standard deviation = 3.79). In our study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients with acute MI which was statistically significant (Spearman's Rho: r = 1) and “Good” (Global PSQI score <5) in 7 (23.3%) patients. All the patients >60 years of age had poor sleep quality. The average duration of sleep was 5 h 30 min. The majority of the patients (71%) with acute MI slept for <6 h which was statistically significant (Spearman's Rho: r = –1). Conclusion: This pilot study, based on PSQI, establishes the association between perceived sleep quality and quantity and acute MI.

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Ebstein anomaly (EA) is a congenital malformation with an incidence of 0.72/10,000 populations. It is characterized by abnormal displacement of tricuspid valve, atrialization of proximal portion of the right ventricle, right atrial enlargement, and tricuspid valve regurgitation. Twenty percent of patients with EA are associated with Wolff–Parkinson–White syndrome (WPW syndrome). WPW syndrome is a preexcitation syndrome characterized by abnormal accessory pathway between atria and ventricles which can cause perioperative life-threatening arrhythmias such as atrial fibrillation and paroxysmal supraventricular tachycardia. Here, we describe the successful anesthesia management of electrophysiological study with three-dimensional mapping and radiofrequency ablation procedure in an 8-year-old child of EA with WPW syndrome under general anesthesia.

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Coronary artery aneurysms are extremely rare, major causative factors associated with this condition are atherosclerosis, trauma, connective tissue disorders, vasculitis, idiopathic, mycotic, and congenital. We present a case of a 49-year-old male who underwent primary angioplasty for acute ST-elevation myocardial infarction and presented with chest pain, fresh ST elevation, and fever after 10 days of the index procedure. The patient was suspected to have subacute stent thrombosis along with some infective pathology. However, work up did not reveal any systemic localization, and blood cultures were negative. Coronary angiogram showed aneurysm of the left anterior descending artery (LAD) with Grade 3 thrombus in the proximal part of stent with thrombolysis in myocardial infarction (TIMI) II antegrade flow. A two-dimensional echo revealed mild left ventricular dysfunction with moderate pericardial effusion. Cardiac positron emission tomography scan confirmed the suspicion of a stent-related mycotic aneurysm. Therefore, the patient was managed with intravenous antibiotics, antiplatelets, and low-molecular-weight heparin, followed by newer oral anticoagulants.

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Hyperkalemia-induced Brugada ECG pattern is rare. Although the association of hyperkalemia with Brugada pattern is a known entity, it is also very important to be aware of this presentation as the treatment of this Brugada Phenocopy is different from Brugada syndrome . This case presented with a Brugada like ECG but had hyperkalemia. On correcting the hyperkalemia, the ECG settled to normal.

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