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Cardiology Today Jan-Feb 2019.Pdf VOLUME XXIII No. 1 JANUARY-FEBRUARY 2019 PAGES 1-40 Rs. 1700/- ISSN 0971-9172 RNI No. 66903/97 www.cimsasia .com Cardiology MANAGING DIRECTOR & PUBLISHER Dr. Monica Bhatia TODAY EDITOR IN CHIEF OP Yadava SECTION EDITORS SR Mittal (ECG, CPC), David Colquhou n (Reader’s Choice) EDITORIAL NATIONAL EDITORIAL ADVISORY BOARD Circadian Rhythm of the Body - Is it the Holy Arun K Purohit, Arun Malhotra, Ashok Seth, Grail ? 3 Ashwin B Mehta, CN Manjunath, DS Gambhir, OP YADAVA GS Sainani, Harshad R Gandhi, I Sathyamurthy, Jagdish Hiremath, JPS Sawhney, KK Talwar, K Srinath Reddy, KP Misra, ML Bhatia, Mohan Bhargava, MR Girinath, Mukul Misra, Nakul Sinha, PC Manoria, Peeyush Jain, Praveen Jain, Ramesh Arora, Ravi R Kasliwal, S Jalal, S Padmavati, Satyavan Sharma, SS Ramesh, Sunil Kumar Modi, Yatin Mehta, Yogesh Varma, R Aggarwala. INTERNATIONAL EDITORIAL ADVISORY BOARD REVIEW ARTICLE Andrew M Tonkin, Bhagwan Koirala, Carlos A Mestres, Chuen N Lee, David M Colquhoun, Davendra Mehta, Contrast Induced Nephropathy: How to Enas A Enas, Gerald M Pohost, Glen Van Arsdell, Indranill Basu Ray, James B Peter, James F Benenati, Predict and Prevent? 5 Kanu Chatterjee, Noe A Babilonia, Pascal R Vouhe, RAGHAV BANSAL, VIVEKA KUMAR Paul A Levine, Paul Simon, P K Shah, Prakash Deedwania, Salim Yusuf, Samin K Sharma, Sanjeev Saxena, Sanjiv Kaul, Yutaka Imoto. DESK EDITOR Gandhali DESIGNER A run Kharkwal REVIEW ARTICLE OFFICES CIMS Medica India Pvt Ltd How do I Manage My Patients with Heart (Previously known as UBM Medica India Pvt Ltd.) Failure with Preserved Ejection Fraction? 10 Registered Office MOHAMMED SADIQ AZAM, DAYASAGAR RAO V Margosa Building, No. 2, 3rd Floor, 13th Cross, Margosa Road, Malleshwaram, Bengaluru -560 003 Karnataka, India Tel: +91-80-4346 4500 Fax: +91-80-4346 4530 Corporate Office Boomerang (Kanakia Spaces), Wing-B1, 403, 4th Floor, Chandiwali Farm Road, Chadiwali Powai, Mumbai - 400 072 REVIEW ARTICLE Tel.: +91-22-6612 2600 Fax : +91-22-6612 2626 Practical Approach to Constrictive Pericarditis 15 Regional Off ice 709, 7th Floor, MONIK MEHTA Devika Tower, Nehru Place, New Delhi-110 019, India. Tel: +91-11-4285 4300 Fax: +91-11-4285 4310 1 Cardiology Today VOL.XXIII NO. 1 JANUARY-FEBRUARY 2019 FOR MARKETING QUERIES REVIEW ARTICLE Aparna Mayekar: +91-9930937020 +91-22-6612 2612 Transesophageal Echocardiography in [email protected] Children with Congenital Heart Defects 18 SNEHAL KULKARNI FOR EDITORIAL QUERIES Dr Gandhali : +91-22-6612 2657 [email protected] ©2019 CIMS Medica India Pvt Ltd (Previously known as UBM Medica India Pvt Ltd) Copyright in the material contained in this journal (save for advtg. and save as otherwise indicated) is held by CIMS Medica India Pvt Ltd Margosa Building, No. 2, 3rd Floor, 13th Cross, REVIEW ARTICLE Margosa Road, Malleshwaram, Bengal uru-560 003, Karnataka, India. All rights reserved. No part of this When to Refer for CABG in Today’s Era publication may be reproduced, stored in a retrieval of Affordable Stents and PTCA and Wide system or transmitted in any form or by any means, Application of Technologies 24 electronic, photocopying or otherwise, without prior permission of the publisher and copyright owner. C N MANJUNATH, PRABHAVATHI, C RAGHAVENDRA The products and services advertised are those of individual advertisers and are not necessarilty endorsed by or connected with the publisher or with Cardiology Today or CIMS Medica India Pvt Ltd. Cardiology Today does not guarantee, directly or indirectly, the quality or efficacy of any product or services described in the advertisements in this issue, which are purely commercial in nature. The editorial opinions expressed in this publication ECG OF THE MONTH are those of individual authors and not necessarily those of the publisher. Whilst every effort has been Cause of Increase in P Wave Amplitude made to ensure the accuracy of the information in this During Exercise Induced Tachycardia 30 publication, the publisher accepts no responsibility for errors or omissions. SR MITTAL For reprints (minimum order: 500) contact the production Department. Further copies of Cardiology Today are available from CIMS Medica India Pvt Ltd, 709, Devika Tower, Nehru Place, New Delhi-110 019, India. Cardiology Today is Published and Printed by CIMS Medica India Pvt Ltd, Margosa Building, No. 2, 3rd Floor, 13th Cross, Margosa Road, Malleshwaram, PICTORIAL CME Bengaluru - 560 003, India Tel: +91-80-4346 4500 (Board); Isolated Tricuspid Valve Prolapse 31 Fax: +91-80-4346 4530 SR MITTAL Printed at Modest Print Pack (P) Ltd., C-52, DDA Sheds Okhla Industrial Area, Phase-I, New Delhi-110 020. Congenital Fused Cervical Vertebrae 38 MONIKA MAHESHWAR 2 Cardiology Today VOL.XXIII NO. 1 JANUARY-FEBRUARY 2019 EDITORIAL Circadian Rhythm of the Body - Is it the Holy Grail ? Existence of a circadian rhythm for the activities of the brain is a given and a common knowledge, but that there is a similar peripheral clock in gastro-intestinal tract and other organs and tissues is not that well appreciated. It is intuitive that when one defi es nature, some penalties would have to be paid, but it is only now that scientifi c sanctity has been accorded to this rather obvious fact of life. Long duration manipulation and disruption of the circadian rhythm has been associated with metabolic disorders like obesity, diabetes, hypertension etc. But it is not clear, whether this is modulated through the central pacemaker in the brain, or to certain products of metabolism, which too have a circadian rhythm. In a recent study conducted at the Washington State University, two groups - one having a night-shift sleep routine and the other a day-shift pattern were studied1. Melatonin and Cortisol were used as markers of the brain master clock and another 132 metabolites were used to study the peripheral clock of other organs and tissues. It was found that both Melatonin and Cortisol showed only negligible diff erences between the day and night shift patterns, suggesting that the master clock of the brain is resistant to the shift patterns. However, of the 132 other metabolites, nearly half (65) had a signifi cant daily rhythm and only 3 metabolites (Taurine, Serotonin and Sarcosine) mirrored Melatonin and Cortisol, the markers of the brain's master clock. Metabolites that were aff ected by the night-shift sleep pattern were found to be related to the liver, pancreas and the gastrointestinal tract, prompting Van Dongen, the lead author, to comment, 'no one knew that the biological clocks in people's digestive organs are so profoundly and quickly changed by shift-work schedules, even though the brain's master clock barely adapts to such schedules. As a result, some biological signals in shift workers' bodies are saying its day, while other signals are saying its night, which causes disruption of metabolism.'1 These fi ndings assume special importance for countries in Asia, especially India, which have become back offi ce data analysis and storage repositories for North America. As such, we have genetic predisposition for metabolic syndrome, and if to this 'nature', we add another confounder in terms of the 'nurture', and that too in a young work force, then it is going to have disastrous consequences for the country, besides the individuals DR. OP YADAVA and their families. Lack of exercise and frequent unhealthy snacking, that is attendant CEO and Chief Cardiac Surgeon to the night shift workers' profi le, complemented by the unhealthy genes, make matters National Heart Institute, worse. New Delhi 3 Cardiology Today VOL.XXIII NO. 1 JANUARY-FEBRUARY 2019 The Business Process Outsourcing (BPO) model therefore needs to be regulated and norms drawn to protect the health of individuals involved, as they may not be aware of the occult health issues attendant to night shifts. They should be suitably counselled and informed and healthy behaviours inculcated by cajoling and regulations, besides voluntary self discipline in culinary matters. Could this circadian rhythm be applicable to the gut microbiome too? This is indeed another interesting thought and worthy of scientifi c pursuance, as it has not been evaluated till date. In these two facets - the circadian rhythm of the human body and the gut microbiota, and their interaction, may lie the answers to a lot of imponderables on causation of disease. REFERENCE 1. Skene DJ, Skornyakov E, Chowdhury NR, Gajula RP, Middleton B, Satterfield BC, Porter KI, Van Dongen HPA, Gaddameedhi, S. Separation of circadian- and behavior-driven metabolite rhythms in humans provides a window on peripheral oscillators and metabolism. S. Proc Natl Acad Sci U S A. 2018 Jul 10. Epub ahead of print. PMID: 29991600. 4 Cardiology Today VOL.XXIII NO. 1 JANUARY-FEBRUARY 2019 REVIEW ARTICLE Contrast Induced Nephropathy: How to Predict and Prevent? Keywords RAGHAV BANSAL, VIVEKA KUMAR contrast media acute kidney injury renal replacement therapy european society of cardiology rec- ommendation Abstract Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures resulting from the administration of contrast media (CM). CIN is usually transient, with serum creatinine levels peaking at 2–3 days after administration of contrast medium and returning to baseline within 7–10 days after administration. Multiple studies have been conducted using a variety of therapeutic interventions in an attempt to prevent CIN. Of these, careful selection of patients, using newer radiocontrast agents, maintenance of hydration status, and avoiding nephrotoxic agents pre- and post- procedure
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