We describe a case of ruptured aneurysm of the left coronary sinus of Valsalva diagnosed by transthoracic two-dimensional echocardiography. A very few cases with ruptured left sinus of Valsalva have been reported. We are reporting a rupture of the left sinus of Valsalva into the main pulmonary artery in a 40-year-old male diagnosed by transthoracic echocardiography.

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Background: No study has been undertaken on people of Asian Indian origin to investigate the age and sex variation in the prevalence of cardiovascular disease (CVD) risk factors. Objectives: To investigate the age and sex variation in the prevalence of CVD risk factors among the people of Asian Indian origin. Materials and Methods: A total of 682 (302 males and 380 females) participants aged 25-85 years took part in the study. The subjects were categorized into 4 groups, namely, Group I (25-34 years), Group II (35-44 years), Group III (45-54 years), and Group IV (55 years and above). Height, weight, and the circumferences of minimum waist (MWC) and maximum hip were collected using standard techniques. Waist-hip ratio (WHR) was then calculated. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron body fat analyzer. Left arm systolic (SBP) and diastolic (DBP) blood pressure were taken from each participant with the help of an Omron MI digital electronic blood/pulse monitor. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high (HDL), low (LDL), very low-density lipoprotein (VLDL), and fasting blood glucose (FBG) were also measured using an autoanalyzer. Results: One-way analysis of variance revealed significant differences for age, BMI, MWC, WHR, SBP, DBP, TC, TG, LDL, VLDL, and TC:HDL and TG:HDL ratios across the groups. It was observed that there were significant sex-specific group differences (male [χ² (12)] =29.22, P < 0.01 and female [χ² (12)] =56.69, P < 0.001) for obesity, high BP, high TC, high TG, and high FBG. But no significant group-specific sex difference was evident for either of the risk factors, except for Group IV. Conclusion: Age irrespective of sex modulates CVD risk factors and warranted prevention as early as middle age.

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Pulmonary edema, a major manifestation of left ventricular heart failure, renal insufficiency, shock, diffuse alveolar damage and lung hypersensitivity states, is a significant medical problem worldwide and can be life-threatening. The proinflammatory cytokine tumor necrosis factor (TNF) has been shown to contribute to the pathogenesis and development of pulmonary edema. However, some recent studies have demonstrated surprisingly that TNF can also promote alveolar fluid reabsorption in vivo and in vitro. This protective effect of the cytokine is mediated by the lectin-like domain of the cytokine, which is spatially distinct from the TNF receptor binding sites. The TIP peptide, a synthetic mimic of the lectinlike domain of TNF, can significantly increase alveolar fluid clearance and improve lung compliance in pulmonary edema models. In this review, we will discuss the dual role of TNF in pulmonary edema. Abbreviations:-tumor necrosis factor (TNF); acute lung injury (ALI); acute respiratory distress syndrome (ARDS); positive end-expiratory pressure (PEEP);epithelial sodium channel (ENaC);neural precursor cell-expressed developmentally downregulated (gene 4) protein (Nedd4-2);serum and glucocorticoid dependent kinase (Sgk-1);insulin-like growth factor 1 (IGF-1);Protein Kinase C (PKC);reactive oxygen species (ROS);myosin light chain (MLC);pneumolysin (PLY);listeriolysin (LLO);interleukin (IL);bronchoalveolar lavage fluids (BALF);Bacillus Calmette-Guerin (BCG);TNF receptor type 1 (TNFR1); TNF receptor type 2 (TNF-R2);

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Diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. This condition increases the risk of developing coronary, cerebrovascular, and peripheral arterial disease fourfold. Endothelial dysfunction is a major contributor to the pathogenesis of vascular disease in diabetes mellitus patients and has recently received increased attention. In this review article, some recent developments that could improve the knowledge of diabetes-induced endothelial dysfunction are discussed.

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Background:-Sometime, it's difficult to distinguish the electrophysiological mechanism of some tachycardia, and so, influencing the efficacy and safety of ablation operation. Therefore, it's helpful to analysis some tachycardia in particular mechanism, as in this case. Methods and results:-A 49 years old Chinese male patient had a history of paroxysmal palpitation for 25 years, and recurred more frequently in the month before admission. Electrocardiogram (ECG) showed no abnormity under sinus rhythm, and showed no specific sign to distinguish its reentrant mechanism when tachycardia running. Electrophysiological examination and the result of successful ablation showed that the retrograde pathway of its reentry was in slow conduction, and from which the reentry started; moreover, after partially ablating, the reentry started from antegrade slow conduction. Conclusion:-Careful cardiac electrophysiological examination and paying more attention to inducing conditions of tachycardia are critical to accurately determining the tachycardia mechanism.

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Hyperosmolar food causes atherosclerosis. Hyperosmolal food hypothesis encompasses all the factors involved under one heading and, that is, the generation of heat in the body. The involvement of cigarette smoking is obvious. High glycemic index food and diabetes result in high levels of blood glucose, which raises the core body temperature. The ingestion of hyperosmolal salt, glucose, and amino acids singularly or synergistically raise the core body temperature, forcing abdominal aorta to form an insulation wall of fatty material causing atherosclerotic plaques. The osmolarity of food, that is glucose, salt, and amino acids is reduced when water is ingested with food. The incidence of atherosclerosis goes down with increasing intake of water.

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Mortality and morbidity are still high in cardiovascular disease (CVD). Myocardial ischemia reperfusion injury leading to myocardial infarction is one of the most frequent causes of the death in humans. Atherosclerosis and generation of reactive oxygen species through oxidative stress is the major risk factor for CVD. From the literature collection, it has been identified that moderate consumption of red wine helps in preventing CVD through several mechanisms, including increasing the high-density lipoprotein cholesterol plasma levels, decreasing platelet aggregation, by antioxidant effects, and by restoration of endothelial function. The aim of this review is to discuss the accumulating evidence that suggests that red wine possesses a diverse range of biological actions and may be beneficial in the prevention of CVD.

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Chronic stable angina is a clinical expression of myocardial ischemia associated with fixed atherosclerotic coronary stenosis, which prevents the adaptation of coronary circulation resulting in an increased oxygen requirement. We recommend that once the diagnosis of chronic stable angina is made, first every patient should be offered the optimal medical therapy, including ACE inhibitors, beta-blockers, statins, and nitrates. If the patients' symptoms are not controlled in spite of these drugs being used in maximum tolerated dosages, then these patients should be subjected to coronary angiography. If a patient shows a single- or double-vessel disease, then PCI should be offered. On the contrary, if the coronary angiogram shows a triple-vessel disease and left main disease, then one has to look for comorbidities that put the patient at a higher risk of CABG and the patient should be treated with PCI. Other patients with left main and triple-vessel disease having diabetes and left ventricular dysfunction should go directly for surgical revascularization. Overall, health related quality of life ( HRQoL) is similar in both PCI and CABG.

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Background: Brugada syndrome and congenital long-QT syndrome (LQTS) type 3 (LQT3) are 2 inherited conditions of abnormal cardiac excitability characterized clinically by an increased risk of ventricular tachyarrhythmias. SCN5A gene that encodes the cardiac sodium channel α subunit is responsible for the 2 diseases, and more work is needed to improve correlations between SCN5A genotypes and associated clinical syndromes. Methods and Results: Four patients diagnosed as having Brugada syndrome, 9 patients suspected to have Brugada syndrome, and 3 LQTS patients suspected to be LQT3 without mutations in KCNQ1 and HERG participated in the study. DNA samples from these patients were analyzed using direct sequencing. One patient with Brugada syndrome had 2 novel mutations, V95I and A1649V. The former was identified in the N-terminus of SCN5A and the latter was in the DIVS4/S5 linker of SCN5A. One patient suspected to have Brugada syndrome had a mutation, delF1617, in the DIIIS3/S4 linker of SCN5A. A novel mutation in the C-terminus of SCN5A, delD1790, was found in a patient with LQT3. No other mutations of SCN5A were found in the remaining patients. These 4 mutations were not detected in 50 unrelated control subjects. Conclusions: Two novel and a reported SCN5A mutations were found in Chinese patients with Brugada syndrome, and a novel SCN5A mutation was found in a Chinese patient with LQT3.

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Endothelial dysfunction is a key event in the development of vascular disease, and it precedes clinically obvious vascular pathology. Abnormal activation of the RhoA/Rho kinase (ROCK) pathway has been found to elevate vascular tone through unbalancing the production of vasodilating and vasoconstricting substances. Inhibition of the RhoA/ROCK pathway can prevent endothelial dysfunction in a variety of pathological conditions. This review, based on recent molecular, cellular, and animal studies, focuses on the current understanding of the ROCK pathway and its roles in endothelial dysfunction.

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Background:-The Yellow Oleander is an ornamental tree that is common throughout the tropics. Ingestion of its seeds results in a clinical picture similar to digoxin toxicity. Objectives:-The aim of this study was to evaluate cardiac findings in acute Yellow Oleander poisoning. Methods and Materials: -A total of 21 patients with history of Yellow Oleander ingestion were enrolled in this study. Results:-All symptomatic patients had conduction defects affecting the sinus node, theatrio-ventricular node or both. Patients showing cardiac arrhythmias that required specific management had significantly higher serum potassium concentrations. Conclusion: -Most of the symptomatic patients had conduction defects affecting sinus or atrio-ventricular nodes but few had atrial or ventricular arrhythmias typical of digoxin poisoning.

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Objective: To summarize the experience in the diagnosis and treatment of carotid body tumor (CBT). Materials and Methods: CBT in 18 cases was confirmed by digital subtraction angiography (DSA). Resection of the tumor under the carotid adventitial plane was performed in 10 cases, the tumor with the external carotid artery in five cases, and the tumor with the internal and external arteries at the same time in three cases. Results: Neither death nor any major complications occurred in all the 18 cases. Our follow-up of the 18 patients revealed neither recurrence nor metastasis. Conclusion: DSA is the gold standard for the diagnosis of CBT. After confirmation, thorough preoperative examination, sufficient preoperative preparation, and correct surgical approaches can result in satisfactory surgical effects.

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Atherosclerosis is the leading cause of death in developed countries. High density lipoproteins (HDL) cholesterol level correlates inversely with the risk of cardiovascular diseases. Thus, HDL has obtained lots of interest for drug development. In this review, we summarized the mechanisms for the antiatherogenic function of HDL, current HDL-based drugs in clinical use and the future direction for HDL-based therapy development.

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Arrhythmia is a big headache for cardiologist for a long time. A new antiarrythmic drug with good effects and few side effects should be explored. Hydrogen sulfide, a newly found gaseous transmitter, was found to have multi-effects on a variety of ion channels. It may be a promising antiarrythmic drug. This article reviews the different effects of hydrogen sulfide on different ion channels.

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Sleep disorders are the common side effects of beta blockers. Beta blockers have been shown to reduce the production of melatonin via specific inhibition of adrenergic beta1-receptors. Exogenous melatonin, taken in the evening as a supplement, could reduce the central nervous system (CNS) side effects (sleep disorder) associated with beta-adrenergic receptor blockers as well as the potential risk associated with reduction of the melatonin synthesis.

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Background: Healthcare system in most parts of the world functions on a three-tier system, involving primary, secondary, and tertiary care centers. The appropriate and efficient referral system plays crucial role in maximally efficient healthcare delivery. Materials and Methods: In all, 46 referrals made to the medicine department of the hospital over a period of 1 month with chief complaint of chest pain and presumptive diagnosis of myocardial ischemia/infarct by outside physicians were selected randomly. Analysis was done both for extent and clarity of useful information provided. Results: Out of 46 referrals, exact indication for referral was mentioned in 4 (8.7%), time of referral in 2 (4.3%), blood pressure in 38 (17.4%), pulse rate in 29 (63.04%), respiratory rate in 1 (2.17%), electrocardiograph diagnosis was not mentioned in 12 (26.08%), and the contact number/details of referring physician were mentioned in 2 (4.34%). Correct dose of aspirin was given to 27 (58.69%), clopidogrel to 19 (41.30%), statins to 9 (19.45%), angiotensin-converting enzyme inhibitors to 6 (13.04%), beta-blockers to 8 (17.39%), low-molecular weight heparin in 6 (13.04%), and 22 (47.82%) patients warranted thrombolysis, but was given in 12 (54.54%). Conclusions: There is a serious lack of quality and clarity of important information provided while making referrals.

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Background: Several studies hinted about the clustering of risk variables of the metabolic syndrome (MS) and suggested that the underlying genetic polymorphisms could be responsible for the increasing incidence of coronary heart disease (CHD) in people of Indian origin. Therefore, identification of the components of the MS along with the genetic factors could be one of the aspects to make an attempt to prevent the increasing incidence of CHD. Materials and Methods: Principal component factor analysis (PCFA) was undertaken to identify the components or factors of the MS among the adult (≥30 years) Asian Indians living in and around Calcutta, India. The study comprised 350 adult Asian Indians. Anthropometric measurements were taken, and lipid profiles, blood pressure and fasting blood glucose were measured for each participant. Two genetic polymorphisms, namely, angiotensin converting enzyme (ACE) gene polymorphism (insertion/deletion [I/D]) or ACE (I/D) and apolipoproteinE (Hha I) were also studied. Results: PCFA revealed 3 factors that cumulatively explained 65.39% of the observed variance of the MS by measured variables. The 3 factors identified were lipids and lipoprotein (Factor 1), centripetal fat and blood pressure (Factor 2), and ACE (I/D) polymorphism with blood pressure (Factor 3). Moreover, the first 2 factors, that is, lipids, lipoprotein, centripetal fat, and blood pressures cumulatively explained ~46% (45.94%) of the observed variance of MS in this population. Conclusions: Since more than 1 factor was identified for the MS phenotype, more than 1 physiogenetic mechanism could be accounted for MS in the Asian Indian population.

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Purpose: In patients with massive ascites, large volume paracentesis may be associated with complications as circulatory dysfunction. Selection of appropriate patients might reduce such side effects. Patients and Methods: Forty-five patients known to have liver cirrhosis and presenting with massive ascites were included. There were 27 males and 18 females, with age (mean 51.2+10.64). All patients were subjected to full history, clinical examination, complete blood picture, prothrombin time, serum albumin, total plasma protein, serum bilirubin, serum creatinine, serum electrolytes and plasma renin activity measured by radioimmunoassay. Echocardiographic evaluation for cardiac output, pulmonary artery pressure, diastolic and systolic function before and after paracentesis. Large-volume paracentesis (LVP) ranging 8-18 liters with a mean 9.9 L was performed to all patients. Paracentesis induced circulatory dysfunction (PICD) was defined as increase in plasma renin activity (PRA) of more than 50% of pretreatment value to a level greater than 7.5ng /ml/ hour on the 6th day after paracentesis. Results: The incidence of PICD in patients with massive hepatic ascites was 73.3% (87.5% with Dextran and 38.5% with albumin). There were no serious systemic or local side effects one week following LVP. Type of plasma expander and younger ages were the only independent predictors (odd ratio OR with 95% confidence interval CI, 3.01<21.79<157.58 and 0.80<.88<.97 respectively) Gender and other clinical and laboratory parameters had no influence. Neither electrolytes levels nor hematocrite value had an influence. Ascitic patients showed higher heart rate and cardiac output and lower arterial pressure that was accentuated after LVP (P < 0.01). Echocardiographic diastolic function, A wave velocity and deceleration time of the E wave were markedly increased in cirrhotic patients with tense ascites and the E/A ratio was markedly reduced (0.9 ± 0.3) but was not significantly affected by LVP. Ejection fraction had similar values of the normal patients with a tendency to increase after paracentesis. There were no changes in the left ventricular wall thickness. Conclusion: LVP is a safe and effective procedure for treatment of tense/refractory ascites. PICD is a frequently occurring silent complication following LVP. Salt free human albumin should be the plasma expander of choice especially if at least 8 liters are evacuated. Left ventricular diastolic function is altered in cirrhosis with tense ascites. This may represent an early stage of hepatic cardiomyopathy but was not affected by LVP and this was not reflected on the occurrence of PICD.

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Diabetic retinopathy (DR) is one of the most common complications of diabetes and is a leading cause of blindness in people of the working age in Western countries. A major pathology of DR is microvascular complications such as non-perfused vessels, microaneurysms, dot/blot hemorrhages, cotton-wool spots, venous beading, vascular loops, vascular leakage and neovascularization. Multiple mechanisms are involved in these alternations. This review will focus on the role of inflammation in diabetic retinal microvascular complications and discuss the potential therapies by targeting inflammation.

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