Background: The incidence of heart failure in diabetic subjects is high even in the absence of hypertension and coronary artery disease. Aims: The purpose of this study was to study the incidence of diastolic dysfunction in diabetic subjects and its relation to age, duration of diabetes mellitus (DM), Glycosylated hemoglobin (HbA1c) levels, obesity indices and diabetic microangiopathies. Settings and Design: This was a case control prospective study conducted at the teaching hospital during a one year period. Materials and Methods: A total of 127 subjects (case) with type 2 diabetes of more than five years duration were studied. Total 100 healthy subjects were included as the control group. Echocardiography was performed to assess left ventricular diastolic function. Results: Out of the total 127 subjects, 69 (54.33%) from the case group had diastolic dysfunction, and 11% amongst 100 in the control group population showed the diastolic dysfunction (P < 0.001). Patients with a longer duration of DM (of 11 to 15 years) had a higher prevalence of diastolic dysfunction (P < 0.02). Subjects with high waist circumference and high waist to hip ratio had statistically significant diastolic dysfunction with 'P' =0.001 and 'P' = < 0.02 respectively. Subjects with HbA1c > 7.5% had a higher prevalence of diastolic dysfunction than subjects with HbA1c < 7.5% (P < 0.02). Diastolic dysfunction was present in majority of the subjects with autonomic neuropathy and retinopathy. Conclusions: Present study reveals high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the duration of diabetes, HbA1c levels, obesity indices and diabetic microangiopathies. We conclude that early diagnosis and institution of treatment will reduce morbidity and improve the outcomes, and prevent future heart failure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Evidence is emerging that obesity-associated cardiovascular disorders (CVD) show variations across regions and ethnicities. However, it is unclear if there are distinctive patterns of abdominal obesity contributing to an increased CVD risk in South Asians. Also, potential underlying mechanistic pathways of such unique patterns are not comprehensively reported in South Asians. This review sets out to examine both. A comprehensive database search strategy was undertaken, namely, PubMed, Embase and Cochrane Library, applying specific search terms for potentially relevant published literature in English language. Grey literature, including scientific meeting abstracts, expert consultations, text books and government/non-government publications were also retrieved. South Asians have 3-5% higher body fat than whites, at any given body mass index. Additional distinctive features, such as South Asian phenotype, low adipokine production, lower lean body mass, ethno-specific socio-cultural and economic factors, were considered as potential contributors to an early age-onset of obesity-linked CVD risk in South Asians. Proven cost-effective anti-obesity strategies, including the development of ethno-specific clinical risk assessment tools, should be adopted early in the life-course to prevent premature CVD deaths and morbidity in South Asians.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Background: GJA1 gene encodes a gap junction protein known as connexin 43 (Cx43). Cx43 is abundantly expressed in the ventricular myocardium and in cardiac neural crest cells. Cx43 is proposed to play an important role in human congenital heart disease, as GJA1 knock-out mice die neonatally from outflow tract obstruction. In addition, patients with visceroatrial heterotaxia or hypoplastic left heart syndrome were reported to have point mutations in GJA1 at residues that affect protein kinase phosphorylation and gating of the gap junction channel. However, as these clinical findings were not replicated in subsequent studies, the question remains about the contribution of GJA1 mutations in human congenital heart disease (CHD). Materials and Methods: We analyzed the GJA1 coding sequence in 300 patients with CHD from two clinical centers, focusing on outflow tract anomalies. This included 152 with Tetralogy of Fallot from over 200 patients exhibiting outflow tract anomalies, as well as other structural heart defects including atrioventricular septal defects and other valvar anomalies. Our sequencing analysis revealed only two silent nucleotide substitutions in 8 patients. To further assess the possible role of Cx43 in CHD, we also generated two knock-in mouse models with point mutations at serine residues subject to protein kinase C or casein kinase phosphorylation, sites that are known to regulate gating and trafficking of Cx43, respectively. Results: Both heterozygous and homozygous knock-in mice were long term viable and did not exhibit overt CHD. Conclusion: The combined clinical and knock-in mouse mutant studies indicate GJA1 mutation is not likely a major contributor to CHD, especially those involving outflow tract anomalies.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Objectives: It is known that exercise induces cardio-respiratory autonomic modulation. The aim of this study was to assess the cardio-pulmonary fitness by ultra-short heart rate variability. Materials and Methods: Study population was divided into 3 groups: Group-1 (n = 40) consisted of military sports man. Group-2 (n = 40) were healthy age-matched sedentary male subjects with normal body mass index [BMI = 19 - 25 kg/m ² ). Group-3 (n = 40) were healthy age-matched obese male subjects [BMI > 29 kg/m ² ). Standard deviation of normal-to-normal QRS intervals (SDNN) was recorded over 15 minutes. Bruce protocol treadmill test was used; and, maximum oxygen consumption (VO ₂max) was calculated. Results: When the study population was divided into quartiles of SDNN (first quartile: < 60 msec; second quartile: > 60 and < 100 msec; third quartile: > 100 and <140 msec; and fourth quartile: >140 msec), progressive increase was found in VO ₂max; and, SDNN was significantly linked with estimated VO ₂max. Conclusion: In conclusion, the results of this study demonstrate that exercise training improves cardio-respiratory autonomic function (and increases heart rate variability). Improvement in cardio-respiratory autonomic function seems to translate into a lower rate of long term mortality. Ultra-short heart rate variability is a simple cardio-pulmonary fitness test which just requires 15 minutes, and involves no exercise such as in the treadmill or cycle test.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Background : Early diagnosis of hypertension (HT) is an important strategy in its control. Previous studies have documented that hypertension may begin in adolescence, perhaps even in childhood. The purpose of this study was to determine the prevalence of hypertension and risk factors among school going children in Surat city, south Gujarat, India. Materials and Methods : School going children aged between 6 to 18 years, of two schools were selected by purposive sampling method and blood pressure measurements were taken by mercury sphygmomanometer as per recommendation of American heart association. Hypertension is considered when blood pressure is more than 95 ^th percentile according to update on task force report (2004) and children having hypertension in first and second recording repeat measurement was done to confirm hypertension after a week. Results : Total prevalence of hypertension in our study was 6.48%. Hypertension in males was 6.74% (<10 yrs 5.88%, 10-13yrs 6.04%, >13yrs 9.19%) and in females was 6.13% (<10yrs 0.62%, 10-13yrs 8.67%,.13yrs 8.48%). Prevalence of obesity in hypertension was 8.7% against normotensive 1.1% (P <0.05). Prevalence of hypertension in family members of hypertensive was 18.6% and in normotensive 13.1% (P =0.1). Prevalence of diabetes mellitus in family members of hypertensive was 23.4% and 13.7% in normotensive (P<0.05); while prevalence of ischemic heart disease in family members was 12.34% in hypertensive and 8.3% in normotensive (P <0.05). Conclusion : Prevalence of hypertension was 6.48% in the study subjects. We identified obesity, family history of diabetes mellitus, ischemic heart disease was found to be significant association for childhood hypertension.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Context: Yoga is an ancient science, which originated in India. Pranayama has been assigned a very important role in yogic system of exercises. It is known that regular practice of breathing exercises (pranayama) increases parasympathetic tone, decreases sympathetic activity, and improves cardiovascular functions. Different types of breathing exercises alter autonomic balance for good by either decrease in sympathetic or increase in parasympathetic activity. Mukh Bhastrika (yogic bellows), a type of pranayama breathing when practiced alone, has demonstrated increase in sympathetic activity and load on heart, but when practiced along with other types of pranayama has showed improved cardiac performance. Aim: The present study was conducted to evaluate the effect of long term practice of fast pranayama (Mukh Bhastrika) on autonomic balance on individuals with stable cardiac function. Settings and Design: This interventional study was conducted in the department of physiology. Materials and Methods: 50 healthy male subjects of 18 - 25 years age group, fulfilling the inclusion and exclusion criteria underwent Mukh Bhastrika training for 12 weeks. Cardiovascular autonomic reactivity tests were performed before and after the training. Statistical Analysis Used: The parameters were analyzed by Student t test. Results: This study showed an increase in parasympathetic activity i.e., reduced basal heart rate, increase in valsalva ratio and deep breathing difference in heart rate; and reduction in sympathetic activity i.e., reduction in fall of systolic blood pressure on posture variation. Conclusion: It can be concluded that Mukh Bhastrika has beneficial effect on cardiac autonomic reactivity, if practiced for a longer duration.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

A 48-year-old female presented with complete heart block. On evaluation, it was diagnosed as a congenital cyanotic heart disease, namely, L-transposition of great arteries (L-TGA) with Fallot's physiology. She led the normal life of a manual laborer and had three hospital deliveries and yet escaped detection of her cardiac condition.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

The pandemic spread of human immunodeficiency virus (HIV) has been the greatest challenge to public health in modern times. However today, people infected with HIV are living longer due to highly active antiretroviral therapy (HAART). This has resulted in age related complications like cardiovascular diseases, causing increased morbidity and mortality. The relative contributions of HIV infection versus potential adverse effects of HAART to coronary heart disease risk remains unclear. Recent reports implicate both HIV infection per se and HAART therapy to cause metabolic derangements which are pro-atherogenic. Here, we report a case of HIV infected young patient never exposed to HAART, presenting with accelerated atherosclerosis in aorta, coronary and carotid arteries.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Background: There are many studies about the association of nephropathy with congenital heart diseases (CHD), and the risk factors such as cyanosis and pulmonary hypertension have been evaluated. In our study, we have considered the relation of CHD associated nephropathy with other newer factors and the type of the structural heart defect. Materials and Methods: A prospective cross sectional study was carried out. 48 children were selected on the basis of specific inclusion criteria, and reviewed over a period of 9 months. Nine different simple and complex structural heart defects were evaluated and compared after obtaining the imaging, blood and urine test results. Results: Significant proteinuria occurred in 8 patients included in the study. More severe forms of pulmonary hypertension were observed in patients suffering from truncus arteriosus (TA); while the least values were detected in cases of pulmonary stenosis (PS) and tetralogy of fallot (TOF). The highest values of protein excretion were seen in patients of TA; and, the lowest values were observed in patients of PS and aortic stenosis (AS). Renal insufficiency was uncommon in infants and children with CHD. Conclusion: TA is an important cause of proteinuria among the infants and children suffering from CHD, probably because of the associated severe pulmonary hypertension (PH) and cyanosis. Also, proteinuria occurred at an earlier age in patients of TA as compared to other conditions, and was also found to be more severe if the TA was associated with moderate to severe tricuspid regurgitation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]

Acute myocardial infarction (AMI) following a centipede bite has been very rarely reported. Here, we describe a 22 year-old man who had ST-segment elevation AMI after a centipede bite. He presented with typical chest pain, electro and echocardiographic abnormalities, and elevated cardiac enzymes with normal coronary angiography. The probable mechanisms were described. Practitioners treating centipede bites shall not consider it lightly, as centipede envenomation may produce a variety of systemic and local manifestations in susceptible individuals.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]  [PubMed]