S100 Abstracts / Indian Heart Journal 70 (2018) S93eS108
Results: A total of 107 patients with clinical suspicion of PE were enrolled
in the study. On MDCT pulmonary angiography 64 patients (59.8%) were
found to have PE out of which 36(56.2%) were men and 28(43.8%) were
women, respectively. Wells score>4 i.e. PE likely was documented in 59.8%
patients and Revised Geneva score ¼11 i.e., high probability of PE was
documented in 21.9% of patients. The most sensitive parameter for the
diagnosis of PE was Revised Geneva score 11 was the most specific (93%
specificity) parameter followed by the combination of positive D-dimer
test and Well’s score>4. The diagnostic accuracy of Well’s score>4 (64.5%)
was higher compared to Revised Geneva score>11(50.5%).
Conclusion: Clinical probability assessment is an easy and effective way to
decide which patient should undergo further testing. Positive D-dimer has
the best diagnostic accuracy for diagnosis of PE. Well’s score has better
diagnostic accuracy than Revised Geneva score, especially when combined
with positive D-dimer.
CARDIOVASCULAR MANIFESTATIONS OF HYPOTHYROIDISM
Himanshu Arora, Jabir Abdullakutty, Rony Mathew, Jo Joseph, Jimmy
George, Vijin Joseph, Israel Ramanathan, Rufus Demel. Lisie Hospital,
Kochi, India
Background: Hypothyroidism is a syndrome characterized by clinical and
biochemical manifestation of thyroid hormone deficiency in target tissue
of thyroid hormone.Hypothyroidism has a multisystem involvement
among which cardiovascular manifestations are well known-but one of
the less researched upon topics.This study is aimed at detecting and
analyzing the cardiovascular manifestations of hypothyroidsm and their
response to treatment.
Method: 60 newly diagnosed cases of hypothyroidism,diagnosed by clin-
ical evaluation and confirmed by serum TSH,free T4 and free T3 level were
included in the study.Duration of the study was from May 2017 to May
2018.Ecg and Echo findings of all patients were noted at the time of
diagnosis.All the patients were started on levothyroxine tablets-with the
dose ranging from 25-100 microgrmas,depending upon serum TSH lev-
els.S.TSH,FT3,FT4,Ecg and Echo were repeated at the end of 2nd and 6th
month.
Result: Bradycardia was an ecg finding in 45%cases.Other rare findings
were Q-T interval prolongation,Right bundle branch block and Low voltage
complexes.After 6 months of treatment with levothyroxine 63.15% patients
showed improvement in form of a normal ecg.(p value¼<0.001).At the
time of detection of hypothyroidism-45%patients had abnormal parame-
ters of echocardiography.Commonest abnormal findings seen in selected
group of patients was"Raised interventricular septal dimensions" seen in
26.66% patients which showed a improvement in 50% cases after 6 months
of treatment with Levothyroxine.Other cardiovascular manifestations
which showed a positive response to treatment with levothyroxine were
pericardial effusion and diastolic dysfunction.After 6 months of treatment-
73.33% patients had a normal echocardiogram(P value¼<0.002)
Conclusion: This study reflects upon the fact,that early diagnosis and
treatment of hypothyroidism can prevent it''s cardiovascular complica-
tions.However,it needs to be done on a large scale basis with follow up for
a prologed duration.
CLINICAL PROFILE AND OUTCOME OF CRITICAL CARDIAC PATIENTS
TREATED WITH TELEMEDICINE USING WHATSAPP ECG GROUP
Bishav Mohan, Anil O. Mehra, Nitish Naik, Arun Chopra, Gaurav
Mohan, Abhsishek Goyal, T.S. Kler, Anil Sharma, Mridul
Sharma. Dayanand Medical College & Hospital Unit Hero DMC Heart
Institute, Ludhiana, India; USC Division of Cardiovascular Medicines, USA;
AIIMS, New Delhi, India; Fortis Escorts Hospital, Amritsar, India
Introduction: Telemedicine is rapidly creating a fundamental trans-
formation in healthcare. There are some cost effective ways to communi-
cate with treating doctors and experts. There are acute critical cardiac
situations where there is diagnostic and therapeutic dilemma. In this
scenario getting expert advice can change the outcome.
Methods: A WhatsApp ECG group comprising of 208 physicians (MBBS,
MD) dealing with acute cardiac care in semi urban and rural area of Punjab
were included in this retrospective analysis. Nine experts (4 interventional
cardiologist, 2 electro-physiologist, 3 clinical cardiologist) from teaching
hospitals including one from USA were part of giving advice in acute car-
diac crises. The reason for sending ECG and clinical problems were noted.
The time to response time was calculated and the outcome of patients after
expert advice was noted and change in management was further analyzed.
Results: Total duration of the project 3 years till March 2018, 5280 ECG’s
and related clinical problems were submitted in ECG project group. The
majority of the issues were related with acute coronary syndrome fol-
lowed by arrhythmias. The total analysis of above mentioned parameter
will be presented.
Conclusion: WhatsApp ECG group is a cost effective way of telemedicine.
Problem solving within specific time can change the outcome in acute
cardiac care.
HYPERURICAEMIA AND CARDIOMETABOLIC RISK
Ramesh Ratanlal Dargad, Mahesh Ramshabd Munakka Prajapati. Lilavati
Hospital and Research Centre, Mumbai, Stress Test Clinic, Mumbai, India
Hyperuricaemia isn’t a buzz word in cardiology anymore. In recent years,
there has been an increase in the prevalence of hyperuricemia, and the
latter has attracted attention as an adult lifestyle-associated disease.
Elevated levels of SUA have been associated with an increased risk for not
only type 2 diabetes mellitus (T2DM) and hypertension (HTN) but also for
dyslipidemia, metabolic syndrome, hyperinsulinemia, gout, stroke,
atherosclerosis, chronic kidney disease, congestive heart failure, obesity,
coronary artery disease and stroke. More than five decades ago, Gertler et
al had postulated that an increase in uric acid levels is a risk factor for CAD.
As of today, number of clinical studies and meta-analyses have shown that
serum uric acid plays a role in predicting cardiovascular mortality &
morbidity. Studies have demonstrated a significant relationship between
hyperuricaemia and associated conditions. This is confirmed in hyper-
uricaemic patients with and without deposition, and may significantly
contribute to the overall CV risk beyond the role of traditional risk factors.
The mechanisms that link elevated serum uric acid (SUA) levels and
hyperuricaemia with deposition with CV comorbidities seem to be
multifactorial, implicating low-grade systemic inflammation and xanthine
oxidase (XO) activity, as well as the deleterious effects of hyperuricaemia
itself. In a retrospective study published recently (2018) in JAPI by Billa et al
approximately 25.8% (7580/29391) of the overall subjects had hyper-
uricaemia. Grossly 10% of adults are documented to have hyperuricaemia
atleast once in their lifetime, however; a majority of the cases do not need
further workup or treatment unless there is an increased risk of compli-
cations. Elevated serum uric acid levels are a frequent finding in persons
with obesity, hypertension, cardiovascular and kidney disease as well as in
those with the cardiorenal metabolic syndrome (CRS). The increased
consumption of a fructose-rich Western diet has contributed to the
increasing incidence of the CRS, obesity and diabetes especially in indus-
trialized populations. There is also increasing evidence that supports a
causal role of high dietary fructose driving elevations in uric acid in as-
sociation with the CRS.
EXERCISE STRESS TEST AS AN ANTIDOTE FOR ANXIETY NEUROSIS
Geetha Subramanian, Aviraj Chaudhary, Kamaldeep Bansal. IMS BHU,
Varanasi, India
Introduction: Anxiety disorders are characterized by feeling of worry, fear,
chest pain, palpitation or shortness breathlessness. Approximately one
fourth of patients who presents to physicians for treatment of chest pain
have anxiety disorder. Panic attacks may cause chest pain through multiple
mechanisms. Such patients often undergo expensive cardiac as well as
noncardiac workup, nevertheless their chest pain frequently remains
untreated.
Material And Methods: we conducted a prospective, observational,
descriptive, cohort study at Sir Sunderlal Hospital, IMS, and BHU Varanasi.
The study was conducted over a period of one year. Inclusion criteria: all
patients, age >18 years. Exclusion criteria :(1) any history or records sug-
gestive of previous angina, angina equivalent or myocardial infarction or
corpulmonale. (2) Patients with prior cardiac pathology like valvular heart
disease, cardiomyopathy, pericardial diseases or corpulmonale. (3)
 Abstracts / Indian Heart Journal 70 (2018) S93eS108
Patients any metabolic or endocrine disorder. 4) Patients with muscular
chest pain and local tenderness. Detailed history and physical examination
was done. The baseline clinical characteristics analyzed in each group were
the age, gender, hypertension, diabetes mellitus, dyslipidemia, smoking
status, personal and family history of cardiovascular history, duration of
chest pain, and treatment received. Treadmill test was done after ruling
out any structural heart disease by echocardiogram. The Data was studied
and statistically treated.
Observation: We analyzed 100 patients with atypical chest pain and
frequent episode of panic attack. Mean age of the cohort was 37.6year and
male ,female ratio was 0.88.Before test basal heart rate of cohort was
92±13 per minute and after 2-3 days of Treadmill test the basal heart rate
was reduced to 76±7 per minute (P<0.001). After one month of follow up
to 93% patients became asymptomatic without any anxiolytic drug.
Conclusion: Anxiety disorders are common and have profound effects on
quality of life. Treadmill test is work as psychotherapy and it provide
confidence by ruling out any cardiac illness.
CLINICAL AND EPIDEMIOLOGICAL PROFILE OF PULMONARY
HYPERTENSION
Medha Gupta, Matin Parkar, Chandrakant Chavan, Deewan. Bharati
Vidyapeeth Hospital, Pune, India
Introduction: Pulmonary hypertension is a complex disease that presents
with a broad spectrum of morphological and hemodynamic findings of
varying severity, which has a major impact on morbidity and mortality. In
developing country like ours, prevalence will also likely increases as newer
associations with PAH emerge, including dialysis and the metabolic syn-
drome, and as widespread access to echocardiography identifies PAH
earlier and in more individuals. This study had recorded the clinical
characteristics and demographics of PAH cases in a single centre study that
hopefully could be a stepping stone in the development of a national
registry.
Objective: To study clinical and epidemiological profile of pulmonary
hypertension in a tertiary care centre.
Method: All patients admitted to bharati hospital in medicine ward & OPD
who met PAH criteria on echocardiography, between August 2014 to
January 2016. Detailed history taken along with physical examintion was
done in each patient. Exercise capacity is then measured using 6-minute
walk test along with oxygen saturation at rest and immediately after 6-
minute walk. Relevant investigations like blood examination, ecg, chest X-
ray, comprehensive echocardiogram, performed.
Result: During the study period, 100 patients were admitted with pul-
monary hypertension with average male to female ratio was 1.1: 1, with
maximum incidence in patient between 31 to 40 year (range- 18 yr &
above). Dyspnoea 94% was the commonest symptom followed by palpi-
tation 58%, chest pain 57% and easy fatigability 48%. The mean 6 minute
distance walked by patients was 251±110 m. Immediately following 6-
minute walk, SO2 remained unchanged (or decrease by 5% absolute
reduction) in 38.6%. Major etiological factors were primary respiratory
illness (group 3) around 34% followed by primary left heart disease (group
2) around 31%; about 17% of patients of our study fall in group 1.
ROLE OF MULTIMODALITY IMAGING IN EVALUATION LEFT ATRIAL
MASSES: OUR EXPERIENCE & ANALYSIS WITH A CASE SERIES
Satish Kumar Arunachalam, Gnanavelu G, Venkatesan S. Madras Medical
College, Chennai, India
Background: Most common causes of left atrial masses are thrombi, tu-
mor, and vegetation. Differential diagnosis of left atrial masses poses
diagnostic and therapeutic challenges. Multi-modality imaging is useful in
delineating different left atrial masses (LA). We are presenting 10 cases of
rare left atrial masses.
Case discussion: Most of our patients were presented with non-specific
symptoms and left atrial masses were detected incidentally during routine
echocardiographic evaluation. We had 5 cases of left atrial Myxoma. On
transthoracic echocardiography (TTE), they had mobile mass with intera-
trial septal (IAS) attachment by stalk, variable echo density- both hypo and
hyperechoic areas due to calcification and necrosis, irregular surface due to
S101
papillary fronds except 1 case had capsulated smooth surface. On TTE, site
of attachment and echotexture was best delineated. In cardiac magnetic
resonance imaging (cMRI), they had heterogeneous signal intensity on
T2W images and IAS attachment. Surgical excision and histopathological
examination confirmed the diagnosis of myxoma. In another 2 patients,
the pedunculated mass was attached to the free wall of left atrium close to
the mouth of left atrial appendage (LAA). On TEE, the mass was attached to
the ridge between left upper pulmonary vein and LAA. First, it was sus-
pected as thrombus, so we anticoagulated, but not resolved. On doing
Gadolinium contrast cMRI, the mass had contrast enhancement which
favored towards tumor possibly papillary fibro-elastoma. Another 1 pa-
tient was presented with fever and septic embolic manifestation with
negative blood culture. In TTE, the mass was attached to the base of
anterior mitral leaflet which made us think of vegetation. As the patient
had persistent fever despite antibiotic therapy, surgical excision was done
& histopathological examination confirmed vegetation. Another 2 rare
cases of left atrial thrombi, one was ball valve thrombus and fixed cystic
thrombus. Both the patients had predisposing heart disease erheumatic
severe mitral stenosis with atrial fibrillation. Both of them clot was
resolved completely after anticoagulation. Differentiating tumor from
thrombus is difficult when the patient is in sinus rhythm without under-
lying cardiac disease. LAA pulse wave velocity is less than 20 cm/sec, in TEE
and no contrast enhancement on TTE more favors to the thrombus.
Conclusion: Evaluation of LA masses requires high quality imaging mo-
dalities in confirming the diagnosis and plan appropriate management
strategies. In our analysis echocardiography was good enough in many
cases, we found the role of MRI is more than complementary as it could
delineate the morphology better that had an Impact on the final diagnosis
& overall outcome.
CLINICAL, ECHOCARDIOGRAPHIC AND RADIOLOGICAL PROFILE OF
PATIENTS WITH SUSPECTED PULMONARY EMBOLISM
Shivani Rao, Sanjeev Asotra. IGMC Shimla, Shimla, India
Background: Pulmonary embolism (PE) is a life-threatening condition,
being one of the three major cardiovascular killers along with myocardial
infarction and stroke. The diagnosis of PE is a challenge and high index of
suspicion, early recognition and use of various diagnostic modalities are
required for best outcomes.
Methods: Tertiary care based prospective study was done to document the
clinical features, echocardiographic and radiology profile of patients pre-
senting with suspected PE over a 12-month period. Patients were stratified
into clinical probability scales by Wells Dichotomous Clinical decision rule
as well as Revised Geneva score. A crude and stratified analysis was done to
compare the clinical and echocardiographic findings with the gold stan-
dard, multidetector CT angiography. We compared the efficacy of various
clinical parameters and scores in predicting PE.
Results: 107 study participants were divided into PE (n¼64) and Non-PE
(n¼43) groups on basis of MDCT. Mean age (± s.d.) was 53.7 ±15.4 years.
Acute, acute on chronic and chronic PE was documented in 51.4%, 2.8% and
5.6% patients, respectively. Dyspnea (92.2%) was the predominant symp-
tom but, only cough (66.8%), hemoptysis (39.1%), and pain in lower limbs
(20.3%) had a statistically significant association with PE. Tachypnea
(92.2%)was the most common sign in both groups. In these, raised JVP
(56.3%), clinical signs of DVT (23.4%) and pedal edema (70.3%) had statis-
tical significance for PE. Immobilization (54.7%)was the most common risk
factor of PE (p ¼ 0.013). D-dimer had the highest sensitivity (95.3%) but low
specificity (27.9%). Wells score¼4 (PE likely) was documented in 59.8% of
patients (p ¼ 0.001). Revised Geneva score ¼11 (high probability of PE) was
documented in only 21.9% patients but had highest specificity (93%) and
positive predictive value (82.4%). Revised Geneva score ¼4 had highest
negative predictive value (100%). In CXR, pulmonary artery enlargement
(35.9%) and Hampton’s hump (10.9%) were associated with PE. In echo-
cardiography, RA (84.4%) and RV dilatation (82.8%), paradoxical septal
motion (31.3%), pulmonary acceleration time (PAT) and PAH were statis-
tically significant findings. Thrombus was most commonly detected in
subsegmental part of the pulmonary artery (PA) (57%) in MDCT while
thrombus in main PA was found in only 10% patients.
Conclusions: The diagnostic workup for patients with suspected PE is still
a challenge for every physician despite using advanced technology with